Endocrine - Pituitary Disease Flashcards
features of a prolactinoma?
amenorrhoea infertility galactorrhoea decreased libido osteoporosis bitemporal hemianopia
Ix for a prolactinoma?
PRL (raised)
MRI
Tx for prolactinoma?
observe if asymptomatic
dopamine agonist (e.g cabergoline, bromocriptine)
surgery
what can cause hypopituiatrism?
problem with
hypothalamus
pit stalk
pituitary
what causes acromegaly?
increase in growth hormone secretion due to a pituitary adenoma
features of acromegaly?
headache fatigue spade hands big tongue DM HT visual field defects coarse facial features
Ix for acromegaly?
GTT (GH production not switched off)
pituitary MRI
Pituitary hormone profile
what is involved in a pituitary hormone profile?
TSH GH PRL oestradiol/testosterone cortisol
Tx for acromegaly?
somatostatin analogues (e.g ocretide) dopamine agonist (e.g cabergoline) shrink tumour pre surgery
what risk factors need to be monitored in acromegaly?
colon cancer (scope)
CVS risks
sleep apnoea
DM
features of cushing’s?
frontal balding proximal myopathy HT DM osteoporosis immunosuppresion facial plethora striae acne psychosis wt gain (central obesity) buffalo hump hirsutism
what cancers can produce ectopic ACTH?
renal cell carcinoma
small cell lung cancer
what does a craniopharyngioma cause?
inferior visual field loss growth failure (panhypopit)
what happens in pituitary apoplexy?
increase in size due to a bleed
features of pituitary apoplexy?
decreased GCS
meningism (neck stiffness, headache, photophobia)
ophthlamoplegia
Tx for pituitary apoplexy?
IV hydrocortisone
what drugs can cause increased PRL?
MDMA methyldopa antipsychotics metaclopramide oestrogens
what is ACTH dependent cushing’s?
cushing’s disease
what is cushing’s disease?
pituitary adenoma secreting ACTH
causes bilateral adrenal hyperplasia
what are the two causes of ACTH dependent cushing’s?
cushing's disease ectopic production (tumour)
causes of ACTH indepedent cushing’s?
cushing’s syndrome
e.g iatrogenic
adrenal adenoma
adrenal nodular hyperplasia
what is the overnight dex suppression test? results?
low dose cortisol given
if suppresses = cushing’s syndrome
what do plasma ACTH results tell you about the cushing’s cause?
if detectable = ACTH dependent
undetectable = cushing’s syndrome
what results would lead you to do a CT/MRI in cushing’s?
low dose dex = no suppression
undetectable ACTH in plasma
(adrenal hyperplasia/adenoma suspected)
what do results of the high dose dexamethasone suppression test tell you?
suppression = cushing's disease none = ectopic
what other blood tests and results should be done in cushing’s?
high Na low K high BM high lipids metabolic acidosis
what does cortisol do?
increases BP increases BM delays digestion delays ovulation hypothyroid
Tx for cushing’s disease?
transphenoidal removal of tumour
