Clinical Aspects of Pituitary Disease

Question 1

What tends to cause hypersecretion in pituitary disease?

Answer 1

Tumours

Question 2

What tends to cause hyposecretion in pituitary disease?

Answer 2

Tumours

Question 3

What structure do pituitary tumours often compress?

Answer 3

Optic chiasm

Question 4

Hypersecretion of GH leads to what?

Answer 4

Acromegaly

Question 5

Hypersecretion of ACTH leads to what?

Answer 5

Cushing’s disease

Question 6

Hypersecretion of prolactin leads to what?

Answer 6

Hyperprolactinaemia

Question 7

What is the main issue in acromegaly?

Answer 7

Soft tissue overgrowth

Question 8

What are the features of acromegaly?

Answer 8

Spade like hands
Wide feet 
Coarse facial features
Thick lips and tongue
Carpal tunnel syndrome
Sweating + oily skin (caused by hypertrophy of sweat glands)
May notice ring size going up

Question 9

What are the complications of acromegaly?

Answer 9

Headache
Chiasmal compression 
DM 
HTN
Cardiomegaly
Sleep apnoea
Accelerated OA
Colonic polyps and cancer

Question 10

What are >95% of cases of acromegaly caused by?

Answer 10

Pituitary adenoma secreting xs GH

Question 11

What does chiasmal compression cause?

Answer 11

Bitemporal hemianopia

Question 12

Are GH levels diagnostic of acromegaly?

Answer 12

No - as they naturally fluctuate during the day

Question 13

How do you diagnose acromegaly?

Answer 13

Measure IGF-1

If elevated/equivocal do OGTT to confirm diagnosis

Question 14

How does the OGTT work to diagnose acromegaly?

Answer 14

Normally GH is supressed to <2mu/l with hyperglycaemia, but in acromegaly there is no suppression of GH

Question 15

Apart from IGF-1, and OGTT what other investigation may be useful in acromegaly?

Answer 15

MRI to demonstrate pituitary adenoma

Question 16

What is the first line treatment for acromegaly?

Answer 16

Transphenoidal surgery

Question 17

What medications can be used to manage acromegaly?

Answer 17

Somatostatin analogues
Dopamine agonists
Pegvisomant

Question 18

How do somatostatin analogues work?

Answer 18

Directly inhibits release of GH

Question 19

Give an example of a somatostatin analogue

Answer 19

Octreotide

Question 20

Give an example of a dopamine agonist

Answer 20

Bromocriptine

Question 21

How does pegvisomant work?

Answer 21

GH receptor antagonist - prevents dimerization of GH receptor

Question 22

What may be a last resort treatment in those who fail to respond to medical/surgical Mx/ or are older?

Answer 22

External irradiation

Question 23

Cortisol is an anabolic/catabolic hormone.

Answer 23

Catabolic

Question 24

What is cushing’s syndrome?

Answer 24

XS corticosteroids

Question 25

What are the features of cushing's syndrome?

Answer 25

Tissue breakdown - muscle, skin, bone weakness Sodium retention - HTN, HF Insulin antagonism - DM

Question 26

What are the high value cushing's syndromes signs and symptoms?

Answer 26

``` Skin atrophy Spontaneous purpura Proximal myopathy Osteoporosis Growth arrest in children ```

Question 27

What are the intermediate value Cushing's syndrome signs and symptoms?

Answer 27

Pink striae Facial mooning and hirsutism Oedema Central obesity HTN

Question 28

What is Cushing's disease?

Answer 28

When the symptoms are the result of a pituitary tumour

Question 29

What are the two types of Cushing's syndrome?

Answer 29

ACTH dependent | ACTH independent