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Endocrine Pathology > Clinical Aspects of Pituitary Disease > Flashcards

Clinical Aspects of Pituitary Disease Flashcards

1
Q

What does primary refer to?

A

The gland

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2
Q

What does secondary refer to?

A

The pituitary gland

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3
Q

What does tertiary refer to?

A

Releasing hormones from the hypothalamic region acting on the pituitary

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4
Q

Function of parathyroid glands

A

Help to regulate the calcium levels in the blood

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5
Q

What to the adrenal glands help to trigger?

A

The fight or flight response

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6
Q

If there is a lack of hormone at a primary level, the feedback will make the hormone produce LESS or MORE hormones?

A

More

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7
Q

Hypersecretion of GH leads to….

A

Acromegaly

Gigantism

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8
Q

Hypersecretion of ACTH leads to…

A

Cushing’s disease

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9
Q

Hypersecretion of prolactin leads to….

A

Hyperprolactinaemia

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10
Q

What causes hypersecretion of hormones?

A

Tumours

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11
Q

Space occupation of the pituitary gland can lead to what?

A

Optic chiasmal compression

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12
Q

Presentation of acromegaly

A 
Spade like hands
Wide feet / increased shoe size 
Coarse facial features
Thick and large lips and tongue 
Prognathism 
Interdental spaces
Carpal tunnel syndrome
Sweating and oily skin 
Headache 
Chiasmal compression 
DM
HTN
Cardiomyopathy 
Sleep apnoea
Accelerated OA
Colonic polyps and cancer
Features of pituitary tumour
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13
Q

What happens in acromegaly due to the excess GH?

A

Soft tissue overgrowth

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14
Q

Questions to ask yourself if you think it is acromegaly

A 
Can GH be suppressed?
Is IGF-1 elevated?
Is the rest of pituitary function normal?
Is there a pituitary tumour on MRI?
Is vision normal?
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15
Q

Presentation of Cushing’s syndrome

A 
Weakness of skin, muscle and bone
HTN
Heart failure
DM
Skin atrophy 
Spontaneous purpura 
Proximal myopathy 
Osteoporosis 
Growth arrest in children
Pink striae
Facial mooning
hirsutism 
Oedema (non-specific)
Central obesity
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16
Q

Why does cushing’s syndrome cause a lot of weakness?

A

As cortisol is a catabolic hormone

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17
Q

Causes of cushing’s syndrome

A

ACTH dependent
- pituitary tumour (cushings disease)
- Ectopic ACTH secretion (e.g. lung carcinoid)
ACTH independent
- Adrenal tumour (adenoma or carcinoma)
- Corticosteriod therapy (e.g. for asthma, IBD)

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18
Q

Presentation of hyperprolactinaemia in women

A

Galactorrhoea 30-80%
Menstrual irregularity
Infertility

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19
Q

Presentation of hyperprolactinaemia in men

A 
Galactorrhoea < 5%
Impotence
Visual field abnormalities
Headache
Extraocular muscle weakness
Anterior pituitary malfunction
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20
Q

Physiological causes of hyperprolactinaemia

A

Pregnancy
Lactation
Stress

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21
Q

What drugs can cause hyperprolactinaemia?

A

DA depleting and DA antagonistic drugs

  • anti-emetics
  • neuroepileptics
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22
Q

Causes of hyperprolactinaemia

A 
Pregnancy 
Stress
Lactation 
DA depleting/antagonistic drugs 
Primary hypothyroidism 
Pituitary lesions (prolactinoma or pituitary stalk pressure)
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23
Q

Presentation of pituitary hypofunction in adults

A 
Tiredness
Weight gain 
Depression 
Reduced libido 
Impotence
Menstrual problems
Skin pallor
Reduced body hair
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24
Q

Presentation of pituitary hypofunction in children

A

Reduced linear growth

Delayed puberty

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25
What can lack of vasopressin lead to?
Diabetes insipidus
26
What test is done to detect diabetes insipidus?
Water deprivation test
27
Differential diagnosis for cranial diabetes insipidus?
``` Idiopathic Post trauma (including pituitary surgery) Metastatic carcinoma Craniopharyngioma Other brain tumours e.g. germinoma Rare causes e.g. sarcoidosis ```
28
What nerves lie in close anatomical relation to the pituitary gland?
``` Oculomotor Trochlear Opthalmic Abducens Maxillary ```
29
Medical Treatment of a prolactinoma
Dopamine agonist
30
Medical treatment for acromegaly
Somatostatin analogues | GH receptor antagonist
31
What does pituitary radiotherapy cause?
Hypopituitarism
32
Benefits of somatostatin analogues in acromegaly
Improves soft tissue overgrowth, sweating, headache and sleep apnoea in most patients Normalise GH and IGF-1 levels in over 50% of patients Induce tumour shrinkage in the majority Reduce morbidity and mortality
33
What somatostain analogue drugs are used to treat acromegaly and how often are they given?
Octreotide and Lanreotide | Monthly injections of slow release
34
Side effects of somatostatin analogues
``` Nausea Cramps Diarrhoea Flatulence Cholesterol gallstones in 20-30% (mostly asymptomatic) ```
35
To be classed as a microprolactinoma, what size must it be?
< 10mm
36
What is a microprolactinoma treated with?
Dopamine agonist
37
To be classed as a macroprolactinoma, what size must it be?
> 10mm
38
What is the dopamine agonist used to treat micro-macro prolactinoma?
Cabergoline
39
Drugs that affect dopamine
Anti-emetics | Anti-psychotics
40
What puts your prolactin up?
``` Prolactinoma Stress Seizures Drugs Pregnancy ```
41
What visual problem is commonly seen in pituitary problems?
Bitemporal hemaniopia
42
What can TRH also interfere with?
Prolactin
43
Who commonly gets hyperparathyroidism?
Middle aged women
44
What do the levels of FSH/LH do post menopause? Why?
They go UP | As less oestrogen for negative feedback
45
What is characteristic about the levels of cortisol?
It has a circadian rhythm
46
When is the nadir of cortisol?
Midnight
47
When is the peak level of cortisol and what would this be expected to be?
> 300
48
What does the synacthen test stimulate?
The adrenal gland
49
What can compression of the pituitary stalk lead to?
Hyperprolactinaemia
50
What is GH used for in adults?
Bone health Muscle health Repair
51
What does transsphenoidal mean?
Up through the nose
52
What would be measured if suspect acromegaly?
IGF-1 (more stable to measure than GH) | Glucose tolerance test
53
Which hormones reduce your sugar?
Cortisol | GH
54
What is there an increased risk of with increased GH and therefore what is offered?
Bowel cancer | Colonoscopy screening offered
55
If you have more fat, what does this do to your testosterone levels?
Lowers them
56
Definition of polycythaemia
An abnormally increased concentration of haemoglobin in the blood, either through the reduction of plasma volume or an increase in cell numbers
57
Levels of sex hormones / gonadotrophins in Klinefelters XXY
Increased testosterone | Decreased FSH/LH
58
What is the test for Klinfelters?
Karyotype for XXY
59
What is testicular feminisation?
Rare disorder where born genetically male but genitals may appear between male and female due to the androgen receptors not responding properly
60
What is testicular feminisation also known as?
Androgen insensitivity syndrome
61
What is a main side effect when taking testosterone?
It thickens the blood
62
What has to be taken into account when taking testosterone in respect to the prostate?
Testosterone can make prostate cancer grow | So when older monitor prostate levels
63
What is the haematocrit?
The ratio of the volume of red blood cells to the total volume of blood
64
What could be used to treat very "thickened" blood?
Blood letting/venesection
65
What is vitamin D's relationship to calcium?
Vitamin D helps to absorb calcium
66
Why do you get excessive sweating and oily skin in acromegaly?
Sweat gland hypertrophy
67
What is raised in acromegaly in 1/3rd of cases and therefore presents as what?
Prolactin | Galactorrhoea
68
Complications of acromegaly
HTN DM (>10%) Cardiomyopathy CRC
69
Investigations of acromegaly
1. Serum IGF-1 levels 2. Confirmation by lack of suppression of GH following documented hyperglycaemia during an oral glucose load Can do an OGTT - normal patients = suppressed with hyperglycaemia - may demonstrate impaired glucose tolerance which is associated with acromegaly Pituitary MRI may show tumour
70
Why can GH not be used as an investigation for acromegaly?
GH levels vary during the day
71
1st line management for acromegaly in the majority of patients
Transsphenoidal surgery
72
Management of acromegaly
Transsphenoidal surgery Somatostatin analogues Pegvisomant (GH receptor antagonist) Dopamine agonists
73
Who can external irridation be used in in acromegaly?
Older patient following patients or following failed medical /surgical treatment
74
Treatment for galactorrhoea
Bromocriptine

Endocrine Pathology (11 decks)

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