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BRS YEAR 2 > Endo - Hypopituitarism > Flashcards

Endo - Hypopituitarism Flashcards

1
Q

What are the 5 APG hormones?

A
  1. Thyroid stimulating hormone (thyrotrophin)
  2. Growth hormone (somatotrophin)
  3. LH/FSH
  4. Prolactin
  5. Adrenocorticotrophic hormone
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2
Q

What are the 5 APG cells?

A 
Thyrotrophs
Somatotrophs
Gonadotrophs
Lactotrophs
Corticotrophs
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3
Q

How are APG hormones primarily regulated?

A

Mainly through hypothalamic inhibitory or leasing factors travelling from the hypothalamus to the APG cells via the portal circulation

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4
Q

Where does GH act?

A

Muscles and bones (and liver to give IGF-1)

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5
Q

Where does TSH act?

A

Thyroid gland

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6
Q

Where does FSH/LH act?

A

Gonads (ovaries F or testes M)

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7
Q

Where does prolactin act?

A

Mammary gland

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8
Q

Where does ACTH act?

A

Adrenal gland

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9
Q

What are the main affected sites in APG failure?

A

3 glands can fail for 2 main reasons:

Thyroid gland, adrenal gland and the gonads

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10
Q

How do we test for primary vs secondary hypothyroidism?

A

If TSH is low and T3/T4 are also low then 2

TSH high and T3/T4 low then 1

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11
Q

How do we test for primary vs secondary hypoadrenalism?

A

Low ACTH, Low cortisol = 2

High ACTh, low cortisol = 1

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12
Q

How do we test for primary vs secondary hypogonadism?

A

Low FSH/LH, Low sex hormone = 2

High FSH/LH, Low sex hormone = 1

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13
Q

What is a common cause for primary hypogonadism in men?

A

Mumps

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14
Q

What is a common cause for primary hypogonadism in women?

A

Chemotherapy

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15
Q

What is usually the cause of congenital hypopituitarism?

A

Ineffective APG development e.g. from the PROP1 mutation

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16
Q

What is the result of congenital hypopituitarism?

A

Deficient in growth hormone and at least one other APG hormone therefore they have a short stature and hypoplastic APG on MRI

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17
Q

What is the more common cause of hypopituitarism?

A

Acquired hypopituitarism

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18
Q

What are some of the causes for acquired hypopituitarism

A 
Tumour (adenoma, metastasis, cysts)
Radiation (hypothalamus or pituitary damaged)
Infection e.g. meningitis 
Pituitary surgery
Traumatic brain injury
Inflammation (hypophysitis)
Pituitary apoplexy (haemorrhage or infarction)
Peri-partum haemorrhage (Sheehan's)
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19
Q

What do we call a total loss of APG and PPG function?

A

Panhypopituitarism

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20
Q

What is the common cause of panhypopituitarism?

A

Hypophysitis

Surgery

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21
Q

Why can radiotherapy cause hypopituitarism?

A

We can be giving radiotherapy for a pituitary reason such as acromegaly, or for a different reason such as a nasopharyngeal carcinoma

22
Q

How can radiotherapy cause hypopituitarism?

A

The pituitary and hypothalamus are both very sensitive to radiotherapy and therefore can be damaged

23
Q

How long does radiotherapy risk last?

A

10 years

24
Q

What hormones are most affected from radiotherapy?

A

Growth hormone and gonadotropins are most commonly lost, whereas prolactin may increase

25
Q

Presentation of FSH/LH deficiency?

A

Libido
2º amenorrhoea
Erectile dysfunction
Loss of pubic hair or decrease in growth rate

26
Q

Presentation of ACTH deficiency

A

Fatigue

27
Q

Presentation of TSH deficiency

A

Fatigue

Weight gain

28
Q

Presentation of GH deficiency

A 
Quality of life decreases 
Short stature (children)
29
Q

Presentation of PRL deficiency

A

Nothing in men

Decrease in post parts lactation (women)

30
Q

What happens in Sheehan’s

A

Post partum haemorrhage leads to hypotension and thus pituitary infarction leading to post party hypopituitarism

31
Q

What are the symptoms of Sheehans

A 
Lethargy
Anorexia
Weight loss
Failure to lactate
Failure of post delivery menses
32
Q

What is pituitary apoplexy

A

Intra pituitary haemorrhage or less commonly an infarction

33
Q

How does pituitary apoplexy present?

A

Dramatic presentation associated with pre-existing adenomas therefore it may be the first presentation of the adenoma.

34
Q

How do we stimulate GH release?

A

Induce stress response

35
Q

How do we stimulate ACTH release?

A

Induce stress e.g. inject insulin to make them hypoglycaemic (glucose <2.2mM), stimulating an adrenergic stress response to cause GH and ACTH release

36
Q

How do we stimulate TSH release?

A

Give TRH

37
Q

How do we stimulate FSH/LH release?

A

Give GnRH

38
Q

How do we diagnose hypopituitarism?

A

Can be diagnosed radiologically with an MRI showing an empty sella

39
Q

How do we treat PRL deficiency?

A

Cannot be treated

40
Q

How to treat Gh deficiency?

A

Make children their target weight with GH injection

With adults - give GH and plasma IGF-1 injections to see if their quality of life improves

41
Q

How to treat TSH deficiency?

A

Levothyroxine once daily - aim for fT4 in the top half of the reference range

42
Q

How to treat ACTH deficiency?

A

Prednisolone -3mg once every morning

Hydrocortisone (10mg, then 5mg, then 5mg again throughout day)

43
Q

How to treat FSH/LH deficiency in men if fertility required

A

FSH/LH injections
Measure T/Sperm intermittently
Sperm production may return to normal in 6-12 months - normal gonad size produces the best response

44
Q

How to treat FSH/LH deficiency in men if no fertility required

A

Topical/ IM testosterone
Measure plasma T
T doesn’t restore sperm production - just restores low libido and loss of pubic hair

45
Q

How to treat FSH/LH deficiency in women if fertility required

A

Carefully timed gonadotrophin injection

46
Q

How to treat FSH/LH deficiency in women if no fertility required

A

Oral/topical oestrogen

Intact uterus requires addition progesterone to prevent endometrial hyperplasia

47
Q

What can cause pituitary apoplexy

A

Can be precipitate by anticoagulants

48
Q

What are the symptoms of pituitary apoplexy

A

Headache (fast and sudden)
Visual field defect (bitemporal hemianopia)
Problems with eye movement - if blood enters cavernous sinus then CN 2, 3, 4, V1, V2, 6 can be affected

49
Q

What is the purpose of sick day rules

A

If someone is on cortisol replacement with Addisons or secondary ACTH deficiency, they’re at risk of an adrenal crisis due to intercurrent illness

50
Q

What can cause an adrenal crisis?

A

UTI or chest infection for example

51
Q

What are the symptoms of a crisis?

A 
Dizziness
Hypotension
Vomiting
Weakness
Collapse and death (potentially)
52
Q

What are the sick day rules?

A
  1. Are you wearing a steroid alert pendant or bracelet?
  2. Double your steroid dose (glucocorticoid not mineralocorticoid), because during illness the body should be making more cortisol
  3. If you can’t take tablets due to vomiting, inject IM or come to A&E

BRS YEAR 2 (37 decks)

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