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eLCRS - 엔도 > ENDO 1: Hyposecretion of anterior pituitary hormones > Flashcards

ENDO 1: Hyposecretion of anterior pituitary hormones Flashcards

1
Q

List some hormones produced by the anterior pituitary gland

A
  • FSH/LH
  • Prolactin
  • GH
  • TSH
  • ACTH
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2
Q

What is meant by hypopituitarism ?

A

Hypopituitarism =
- decreased production of:

a) ALL anterior pituitary hormones (panhypopituitarism)

OR

b) of specific hormones

congenital/acquired

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3
Q

How can congenital panhypopituitarism occur?

A

can be be due tp:

a) congenital defects
b) gene mutations (e.g PROP1 mutation)
c) usually = occurs in adults with progressive loss of pituitary secretion

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4
Q

for panhypopituitarism, loss of secretion happens in what order?

A
  • Gonadotrophin
  • GH
  • Thyrotrophin
  • Corticotrophin
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5
Q

What are the 3 main types of panhypopituitarism?

A
  1. simmond’s disease
  2. sheehan’s syndrome
  3. pituitary apoplexy
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6
Q

Give examples of causes of acquired panhypothyroidism

A

causes:
- infiltrative processes
- pituitary adenomas
- craniopharyngiomas
- cranial injury
- following surgery

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7
Q

symptoms of pan hypothyroidism = mainly due to:
a)
b)
c)

A

symptoms of Simmond’s Disease = mainly due to decreased :

a) thyroidal function
b) adrenal function
c) gonadal function

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8
Q

Give examples of symptoms of Simmond’s Disease

A
  • secondary amenorrhoea/ oligomenorrhoea
  • impotence
  • loss of libido
  • tiredness
  • waxy skin
  • loss of body hair
  • hypotension
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9
Q

What is one key characteristic of panhypothyroidism

A
  • insidious onset

- develops very slowly

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10
Q

What is one key characterisitc of Sheehan’s Syndrome ?

A
  • specific in women

- develops very fast

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11
Q

Describe the onset of Sheehan’s syndrome

A
  • develops acutely –> following post partum hemorrhage
  • results in pituitary infarction
  • blood loss –> causes vasoconstrictor spasm of hypophyseal arteries
  • which leads to ischemia of pituitary
    AND
  • necrosis of the pituitary
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12
Q

What is the difference between pituitary apoplexy and sheehan’s disease ?

A
  • Pituitary apoplexy = not specific to women

- sheehan’s = specific to women

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13
Q

What is the cause of pituitary apoplexy?

A

due to:

- intra-pituitary infraction or hemorrhage

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14
Q

What is a key characteristic of pituitary apoplexy?

A
  • rapid presentation
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15
Q

Describe the presentation of sheehan’s syndrome

A
  • lethargy, anorexia, weightless = TSH/ACTH/GH deficiency
  • failure to lactate = PRL deficiency
  • failure to resume menses –> post delivery
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16
Q

How is hypopituitarism diagnosed? (biochemical diagnosis)

A
  1. Basal plasma conc of pituitary / target endocrine gland hormones
  2. Stimulated pituitary function test
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17
Q

How is hypopituitarism diagnosed? (radiological diagnosis)

A
  1. pituitary MRI

- e.g empty pituitary sella

18
Q

What effect does growth hormone (somatotrophin deficiency) have on

a) children
b) adults

A

What effect does growth hormone (somatotrophin deficiency) have on

a) children –> short stature
b) adults –> less clear effects

19
Q

What are some causes of short stature ?

A
  • genetic (down syndrome, PW syndrome)
  • emotional deprivation
  • systemic disease (CF)
  • malnutrition
  • malabsorption (coeliac disease)
  • endocrine disorders (cushing syndrome, hypothyroidism)
  • skeletal dysplasias (achondroplasia)
20
Q

What is dwarfism?
(achondroplasia)

describe the onset

A
  • mutation in fibroblast growth factor 3 (FGF3)
  • abnormality in growth plate chondrocytes
  • results in impaired linear growth

(average size trunk BUT short arms + legs)

21
Q

What is Laron dwarfism?

A
  • mutation in the GH receptor
22
Q

How can laron dwarfism be treated?

A
  • IGF-1 treatment

- during childhood can increase height

23
Q

List some causes of acquired GH deficiency in adults ?

A
  • trauma
  • pituitary tumour
  • pituitary surgery
  • cranial
  • radiotherapy
24
Q

to test for pituitary deficiency - what test might you do?

A
  • provocation challenge

stimulation test

25
Q

What do you need for a growth hormone therapy? and

How does growth hormone therapy take place?

A

you need:

  • Human recombinant GH
    (somatotrophin)

administration:
- daily, subcutaneous injection
- monitor clinical response
- and adjust dose to IGF-1

26
Q

What are some signs and symptoms of GH deficiency in adults?

A
  • reduced lean mass
  • increased adiposity
  • increased waist:hip ratio
  • reduced muscle strength + bulk –> leads to reduced exercise performance
  • decreased plasma HDL cholesterol
  • raised LDL cholesterol
  • impaired psychological well being + reduced quality of life
27
Q

What are some potential benefits of GH therapy in adults

A
  • improved body composition
    (decreased waist circumference, less visceral fat)
  • improved muscle strength
    + (exercise capacity)
  • more favorable lipid profile
  • increased bone mineral density
  • improved psychological well being + quality of life
28
Q

What are some potential risks of GH therapy in adults?

A
  • increased susceptibility to cancer

- expensive

29
Q

What is pituitary apoplexy?

A

-intra pituitary haemorrhage or infarction

30
Q

What could pituitary apoplexy be a presentation of?

A
  • pituitary adenoma
31
Q

What is sheehan’s syndrome

A

post partum hypopituitarism secondary to hypotension

32
Q

describe the process of dynamic stimulated pituitary function test.

A
  • make patient hypoglycemic
  • by injecting insulin
  • then cortisol + GH measured
  • and an injection of TRH
  • which causes TSH release
  • TSH is measured
  • sometimes GnRH is also injected
    to measure LH + FSH
33
Q

what kind of radiological diagnosis can be used to diagnose hypothyroidism

A
  • pituitary MRI
  • -> might show pituitary pathologies such as apoplexy/ adenoma

–> or there might be no pituitary at all (empty sella)

34
Q

management through HRT in hypopituitarism

low ACTH

low TSH

low LH/FSH in women

low LH/FSH in men

low GH

A

low ACTH

  • give hydrocortisone
  • check serum cortisol

low TSH

  • give thyroxine
  • check serum free T4

low LH/FSH in women

  • HRT
  • check symptom improvement

low LH/FSH in men

  • testosterone
  • check symptom improvement + serum testosterone

low GH

  • give GH
  • check IGF1 levels
35
Q

where does PWS syndrome affect the growth axis?

A
  • affects hypothalamus

- GH deficiency secondary to hypothalamic dysfunction

36
Q

how would you diagnose short stature?

A

calculate mid parental height

–> predicted adult height base on mother + father’s height

37
Q

What are some GH provocation tests

A
  • GHRH + Arginine (IV)
  • Insulin (IV)
  • glucagon (IM)
  • exercise

–> measure plasma GH at specific time points
(before + after)

38
Q

What suppression test would you use to diagnose hypothalamic GH deficiency

A

Insulin suppression test

39
Q

What are 2 unrelated symptoms of adult GH deficiency?

A
  • Muscle wasting

* Reduction in bone density

40
Q

Give side effects of GH therapy

A
  • Lipoatrophy at injection site
  • Intracranial hypertension
  • increased risk of cancer
41
Q

What is the main tissue mediator involved in GH linked growth?

A

• Liver (hepatocyte)

eLCRS - 엔도 (20 decks)

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