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Year 2 LCRS > Endocrinology 1 - Hyposecretion of Anterior Pituitary Hormones > Flashcards

Endocrinology 1 - Hyposecretion of Anterior Pituitary Hormones Flashcards

1
Q

List the anterior pituitary hormones

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

What results in secondary hypothyroidism?

A
  • Lack of production of the anterior pituitary hormone (TSH)

- Thyroid gland is functional

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3
Q

What results in primary hypothyroidism?

A
  • Disorder in the thyroid gland

- Results in lack of production of T3 and T4

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4
Q

Define hypopituitarism

A
  • Decreased production of all anterior pituitary hormones (panhypopituitarism)
  • Or can be decreased production of specific hormones
  • May be congenital or acquired
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5
Q

Congenital panhypopituitarism

  • Cause
  • Symptoms
A
  • Usually due to mutations of transcription factor genes needed for normal anterior pituitary development (eg PROP1 mutation)
  • Deficient in GH and at least 1 more anterior pituitary hormone
  • Short stature
  • Hypoplastic anterior pituitary gland on MRI
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6
Q

List the causes of acquired panhypopituitarism

A
  • Hypothamic tumours (craniopharyngiomas) or pituitary tumours (adenomas, metastases and cysts)
  • Radiation (hypothamic/pituitary damage, GH most vulnerable and TSH resistant)
  • Infection (eg. meningitis)
  • Traumatic brain injury
  • Infiltrative disease (pituitary stalk - neurosarcoidosis)
  • Inflammatory (hypophystitis)
  • Pituitary apoplexy (haemorrhage)
  • Peri-partum infarction (sheenans syndrome)
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7
Q

Describe the presentation of panhypopituitarism (Simmonds disease)

A

FSH/LH causes

  • Secondary hypogonadism
  • Reduced libido
  • Secondary amenorrhoea
  • Erectile dysfunction

ACTH causes

  • Secondary hypoadrenalism
  • Fatigue

TSH causes:

  • Secondary hypothyroidism
  • Fatigue
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8
Q

What is Sheenans syndrome?

A
  • Post-partum hypopituitarism secondary to hypotension
  • Less common in developed countries
  • Anterior pituitary enlarges in pregnancy (due to lactotroph cell enlargement), and post partum haemorrhage leads to pituitary infarction
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9
Q

Describe the presentation of Sheehans syndrome

A
  • Lethargy anorexia and weight loss (TSH, ACTH and GH deficiency)
  • Failure of lactation (Prolactin deficiency)
  • Failure to resume menses post- delivery
  • Posterior pituitary usually not affected
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10
Q

What is pituitary apoplexy?

A
  • Intra-pituitary haemorrhage or infarction
  • Often dramatic presentation in patients with pre-existing pituitary tumours
  • May be first presentation of adenoma
  • Precipitated by anti-coagulants
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11
Q

What are the symptoms of pituitary apoplexy?

A
  • Severe sudden onset headache
  • Visual field defect (bitemporal hemianopia)
  • Cavernous sinus involvement may lead to diplopia or ptosis
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12
Q

How is biochemical diagnosis of hypopituitarism performed?

A
  • Basal plasma concentrations of pituitary or target endocrine gland hormones (although may not be appropriate as levels are not constant)
  • Stimulated pituitary function tests (ACTH/GH stimulated by hypoglycaemia, so insulin is used. TRH and GnRH can be used for TSH and FSH and LH)
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13
Q

How is radiological diagnosis of hypopituitarism performed?

A

Pituitary MRI (may reveal haemorrhage or adenoma)

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14
Q

List the drugs used in hormone replacement therapy in hypopituitarism

A
  • ACTH needs replacement of hydrocortisone (serum cortisol monitored)
  • TSH thyroxine replacement (serum free T4)
  • LH/FSH HRT in women, testosterone in men (symptom improvement)
  • GH needs GH administration (monitor IGF1 or growth in children)
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15
Q

What are the effects of growth hormone deficiency?

A
  • Short stature in children

- Less clear in adults

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16
Q

List the causes of short stature

A
  • Genetic (Downs, Turners, Prader Willi)
  • Emotional deprivation
  • Systemic disease (CF or arthritis)
  • Malnutrition
  • Malabsorption (coeliac)
  • Endocrine disorders (Cushings, Hypothyroidism, GH deficiency)
  • Skeletal dysplasias (Achondroplasia, osteogenesis imperfecta)
17
Q

List the different causes of short stature in children, relating to the growth axis

A
  • Prader Willi affects hypothalamus
  • Lack of GH results in pituitary dwarfism
  • Laron dwarfism is due to GH receptor defect at the liver
18
Q

What is achondroplasia (cause, characteristics)?

A
  • Mutation in FCF3 (fibroblast growth factor receptor 3)
  • Abnormality in growth plate chondrocytes
  • Average size trunk with short arms and legs
  • Not a pituitary disorder
19
Q

How is short stature diagnosed?

A
  • Using mid parental height

- Predicted adult height based on the mothers and fathers height

20
Q

List the causes of acquired GH deficiency in adults

A
  • Trauma
  • Pituitary tumour
  • Pituitary surgery
  • Cranial
  • Radiotherapy
21
Q

How is GH deficiency diagnosed?

A
  • Random GH is not useful as it is pulsatile

- Stimulation test is used (GHRH and arginine, insulin, glucagon or exercise)

22
Q

Describe the preparation and administration of growth hormone therapy

A
  • Uses human recombinant GH
  • Administered daily by subcutaneous injection
  • Dose adjusted based on IGF1
23
Q

List the signs and symptoms of GH deficiency in adults

A
  • Reduced lean mass, increased adiposity and increased waist to hip ratio
  • Reduced muscle strength and bulk
  • Decreased plasma HDL and increase LDL
  • Impaired psychological wellbeing
24
Q

List the potential benefits of GH therapy in adults

A
  • Improved body composition (decreased waist circumference and visceral fat)
  • Improved muscle strength and exercise capacity
  • Higher HDL and lower LDL
  • Increased bone mineral density
  • Improved psychological well-being and quality of life
25
Q

List the potential risks of GH therapy in adults

A
  • Increased cancer risk (no data to support this)

- Expensive (£42K)

26
Q

Describe the growth axis

A
  • GHRH is released from the hypothalamus which stimulates growth hormone release from the anterior pituitary
  • Somatostatin inhibits growth
  • GH binds to liver cells and releases IGF1 and IGF2

Year 2 LCRS (128 decks)

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