Clinical Aspects of Pituitary Disease Flashcards
What are the three categories of pituitary diseases?
- Hypersecretion
- Hyposecretion
- Space occupation
Give examples of conditions caused by hypersecretion of hormones
- GH -> acromegaly (gigantism)
- ACTH -> Cushing’s disease
- Prolactin -> hyperprolactinaemia
Give examples of what hormones are released in excess in hypersecretion
- Anterior -> FSH/LH, GH, ACTH, TSH
* Posterior (vasopressin)
What is another name for vasopressin?
Anti-diuretic hormone
What is the most common cause of hyper secretion and hyposecretion?
Tumours
What is the cause of a decrease in space occupation?
Optic chiasmal compression
What are the two categories of the clinical features of acromegaly?
Soft tissue overgrowth and complications
Describe the effect of soft tissue overgrowth in acromegaly
- ‘Spade like’ hands (rings)
- Wide feet (shoes)
- Coarse facial features
- Thick lips and tongue
- Carpal tunnel syndrome
- Sweating
What is carpal tunnel syndrome?
Condition due to compression of the median nerve as it travels through the wrist at the carpal tunnel.
The main symptoms are pain, numbness and tingling
What are the eight possible complications of acromegaly?
- Headache
- Chiasmal compression
- Diabetes mellitus
- Hypertension
- Cardiomyopathy
- Sleep apnoea
- Accelerated OA
- Colonic polyps + CA
Through investigations, what do you look for to diagnose acromegaly?
- Can GH be suppressed?
- Is IGF-1 elevated?
- Is rest of pit. function normal?
- Is there a pituitary tumour on MRI?
- Is vision normal?
What investigations do you carry out for acromegaly?
- Random GH measurements
- Serum IGF-1
- OGTT (increase in Glc inhibits GH secretion, GH should be very low)
- MRI of pit. fossa
What causes Cushing’s syndrome?
Excess corticosteroids
What is the effects of cortisol?
Cortisol is a catabolic hormone:
• Tissue breakdown - causes weakness of skin, muscle & bone
• Sodium retention - may cause hypertension + heart failure
• Insulin antagonism - may cause diabetes mellitus
What are the high diagnostic value clinical features of Cushing’s syndrome?
- Skin atrophy
- Spontaneous purpura (non-blanching purple spots)
- Proximal myopathy
- Osteoporosis
- Growth arrest in children
What are the intermediate diagnostic value features of Cushing’s syndrome?
- Pink striae
- Facial mooning & hirsutism
- Oedema
What are the non specific clinical features of Cushing’s syndrome?
- Central obesity
* Hypertension
What are the three categories of clinical features of Cushing’s syndrome?
High, intermediate and non-specific value