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eLCRS - 엔도 > Endo 2: Hypersecretion of anterior pituitary hormones > Flashcards

Endo 2: Hypersecretion of anterior pituitary hormones Flashcards

1
Q

Define hyperpituitarism

A
  • symptoms associated with excess production of adenohypophysial hormones
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2
Q

What is hyperpituitrism usually due to?

A
  • usually due to isolated pituitary tumors

- but also can be ectopic

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3
Q

What kind of hyperpituitarism often associated with ?

A
  • often associated with visual field

- and endocrine related symptoms

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4
Q

Describe what is bitemporal (heteronymous) hemianopia

A

BASICALLY: loss of peripheral vision with optic chiasm compression

  • at optic chasm –> fibers from nasal part of both retina cross
  • light from left visual field –> hits right part of retina
    (and vice versa)
  • due to crossing over, all light from left visual field = detected by right side of brain
  • pituitary tumor can protrude out of sella turcica –> and disrupt the fibres coming from nasal parts of the retina
  • meaning you can lose temporal part of the visual field
  • -> can see in nasal field
  • -> can’t see in temporal fields
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5
Q

Excess release of ACTH =

A

cushing’s disease

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6
Q

Excess release of TSH =

A

thyrotoxicosis

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7
Q

Excess release of LH + FSH =

A

precocious puberty in children

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8
Q

Excess release of Prolactin =

A

hyperprolactinaemia

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9
Q

Excess release of GH =

A

gigantism, acromegaly

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10
Q

What is hyperprolactinaemia ?

What is it associated with?

A
  • excess circulating prolactin
  • not due to physiological cause such as pregnancy / breast-feeding

associated with:
- pituitary tumors (prolactinoma)

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11
Q

What are effects of hyperprolactinaemia (due to pituitary adenoma) in women?

A

women:
effects:
- galactorrhea
- secondary amenorrhoea
- loss of libido
- infertility

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12
Q

What are effects of hyperprolactinaemia (due to pituitary adenoma) in men?

A

men:
- galactorrhea = uncommon
- loss of libido
- erectile dysfunction
- infertility

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13
Q

What is the effect of high levels of prolactin on the reproductive axis?

A
  • decreases LH + FSH levels
  • leads to secondary amenorrhoea
  • loss of libido
  • infertility
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14
Q

Give methods of treatment of hyperprolactinaemia

A

dopamine receptor (D2) agonists:

  • decreases prolactin secretion
  • reduces tumor size

e.g bromocriptine, cabergoline

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15
Q

What are some side effects of dopamine receptor agonists

A
  • nausea + vomiting
  • postural hypotension
  • dyskinesias
  • depression
  • pathological gambling
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16
Q

Describe patterns of acromegaly

  • describe its onset
A
  • has an insidious onset

- signs/symptoms progress gradually

17
Q

What happens if acromegaly = untreated?

A
  • untreated excess GH
  • leads to increased morbidity + mortality
  • increased CVD/ Resp complication/ cancer
18
Q

What grows in acromegaly?

A
  • periosteal bone
  • cartilage
  • fibrous tissue
  • connective tissue
19
Q

List clinical features of acromegaly

A
  • excessive sweating
  • headache
  • enlargement of supraorbital ridges/noes/hands/feet
  • macroglassia
  • mandible grows –> prognathism
  • carpal tunnel syndrome
  • barrel chest
20
Q

describe the metabolic effects of acromegaly

and how it takes place.

A
  • excess growth hormone
  • insidious onset
  • causes increase in endogenous glucose production +
    decreased muscle glucose uptake
  • which causes increase in insulin production
  • insulin resistance occurs
  • leads to DIABETES MELLITUS
21
Q

What are complications associated with acromegaly?

A
  • obstructive sleep apnoea
  • hypertension
  • cardiomyopathy
  • increased risk of cancer
22
Q

explain the relationship between acromegaly + prolactin

A
  • in acromegaly
  • prolactin level = high
  • reflects tumor secreting GH + prolactin
  • hyperprolactinaemia
23
Q

what are 3 methods for diagnosis acromegaly?

A
  1. GH pulsatile
  2. elevated serum IGF-1
  3. Oral glucose tolerance test (Failed suppression of GH following oral glucose load )
24
Q

Describe graph of glucose induced suppression of GH secretion in acromegaly

A

-

25
Q

Give methods of treating acromegaly

A
  • surgery (1st line)
  • somatostatin analogues
    (e. g octreotide)
  • dopamine agonists
    (e. g cabergoline)
  • radiotherapy
26
Q

What is the effect of somatostatin analogues ?

A
  • Reduces GH secretion + tumor size
27
Q

How is somatostatin analogue administered?

A
  • injection
28
Q

What are possible GI side effects of somatostatin analogues?

A
  • nausea
  • diarrhea
  • gallstones
29
Q

how is high levels of prolactin linked with secondary gonadism?

A

high levels of prolactin –> causes suppression of GnRH pulsatility
- which can cause secondary hypogonadism

30
Q

regulation of prolactin

A
  • prolactin = always inhibited
  • less inhibition –> prolactin release
  • less dopamine binding to D2 receptor
  • -> more prolactin secretion
  • you can mimic dopamine
31
Q

how can you mimic dopamine?

A
  • D2 receptor agonists

act similarly to dopamine

32
Q

How would you diagnose acromegaly?

A
  • elevated serum IGF 1
  • gold standard = oral glucose tolerance test
  • ->
33
Q

What test is used to diagnose acromegaly and how are the results interpreted?

A
  • Oral glucose suppression test

eLCRS - 엔도 (20 decks)

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