Clinical Aspects of Pituitary Disease Flashcards
What are the endocrine orgons?
Hypothalamus
Pituitary gland
Thyroid gland
Parathyroid gland
Ovaries
Pancreas
Adrenal glands
Testis
What are the different classifications of pituitary disease?
Hypersecretion (tumours)
Hyposecretion (mostly tumours, other causes)
Space occupation
What are examples of diseases caused by hypersecretion of the pituitary gland?
Acromegaly (GH)
Cushing’s disease (ACTH)
Hyperprolactinaemia (prolactin)
What is hypersecretion of the pituitary gland usually caused by?
Tumours
What is hyposecretion of the pituitary gland usually caused by?
Mostly tumours, other causes
What is an example of a space occupation complication of the pituitary gland?
Optic chiasmal compression
What are some clinical features of acromegaly?
Spade like hands
Wide feet
Coarse facial features
Thick lips and tongue
Carpal tunnel syndrome
Sweating
What are some complications of acromegaly?
Headache
Chiasmal compression
Diabetes mellitus
Hypertension
Cardiomyopathy
Sleep apnoea
What disease is this?
acromegaly
- wide feet
- spaced teeth
- coarse features
- enlarged jaw
What investigations are used to diagnose acromegaly?
OGTT (give carbohydrates and see if GH and IGF-1 is suppressed like it should be)
MRI (look for pituitary tumour)
What is Cushing’s syndrome caused by?
Excess corticosteroids
Is cortisol a catabolic or anabolic hormone?
Catabolic
What effects does cortisol have that leads to Cushing’s syndrome?
Tissue breakdown (causing weakness of skin, muscle and bone)
Sodium retention (cause hypertension and heart failure)
Insulin antagonism (may cause diabetes)
What is the clinical presentation of Cushing’s syndrome?
Is cushing’s syndrome due to hyper or hyposecretion of the pituitary gland?
Hypersecretion
Is acromegaly due to hyper or hyposecretion of the pituitary gland?
Hypersecretion
What are some examples of ACTH dependent causes of Cushing’s syndrome?
Pituitary tumour (Cushing’s disease)
Ectopic ACTH secretion (such as lung carinoid)
What are some ACTH independent causes of Cushing’s syndrome?
Adrenal tumour (adenoma or carcinoma)
Corticosteroid therapy (such as for asthma or IBD)
What disease is this?
Cushing’s syndrome
What is the clinical manifestation of hyperprolactinaemia?
Is hyperprolactinaemia due to hyper or hyposecretion of the pituitary gland?
Hypersecretion
What is the aetiology of hyperlacticaemia?
- Physiological
- Pregnancy, lactation, stress
- Pharmacological
- DA depleting and DA antagonist drugs
- Pathological
- Primary hypothyroidism
- Pituitary lesions (prolactinoma or pituitary stalk pressure)
What are some examples of drugs that may cause hyperprolactinaemia?
- Dopamine antagonists
- Neuroleptics
- Anti-emetics
- DA depleting agents
- Oestrogens
- Some antidepressents
What are some clinical features of pituitary hypofunction?
- Adults
- Tiredness, weight gain, depression, reduced libido, impotence, menstrual problems
- Skin pallor
- Reduced body hair
- Children
- Reduced linear growth
- Delayed puberty
What is an example of a condition that is caused by pituitary hypofunction?
Cranial diabetes insipidus
What causes cranial diabetes insipidus?
Hypothalamus does not produce enough vasopressin hormone
What investigation is done for cranial diabetes insipidus?
Fluid deprivation test assess ability of kidneys to concentrate urine under the influence of ADH
What is the differential diagnosis for cranial diabetes insipidus?
- Idiopathic
- Post-trauma
- Metastatic carcinoma
- Craniopharyngioma
- Other brain tumours such as germinoma
- Rare causes like sarcoidosis
What investigation is used to see if there is space occupation due to the pituitary gland?
MRI
What visual field defect is caused by a pituitary tumour?
Bitemporal hemianopia
What is the management of prolactinoma?
Dopamine agonist
What is the management of acromegaly due to pituitary tumour?
Somatostatin analogues
GH receptor antagonist
What is the management of hyposecretion due to pituitary tumour?
Cortisol, T4, sex steroids, GH
Desmopressin
What is the treatment of pituitary tumours?
Surgery (mostly transphenoidal)
Radiotherapy
What approach is used for surgery for pituitary tumours?
Transsphenoidal
What are some of the beneficial effects of somatostatin analogues in acromegaly?
- Improve soft tissue overgrowth, sweating, headache, sleep apnoea in most patients
- Normalise GH and IGF-1 levels in over 50% of patients
- Induce tumour shrinkage in majority
- Reduce morbidity and mortality from acromegaly
What monthly injections can be given for the management of acromegaly?
Slow release octreotide and lanreotide
What are some adverse effects of somatostatin analogues?
- Nausea, cramps, diarrhoea, flatulence
- Cholesterol gallstones
- Slow release preparations required monthly injections
- High cost
What is prolactinoma treated with?
Dopamine agonist
