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Endocrinology Y2 > Hypersecretion of Anterior Pituitary Hormones > Flashcards

Hypersecretion of Anterior Pituitary Hormones Flashcards

1
Q

Most common reason for hyperpituitarism?

A

Usually due to isolated tumours in the pituitary.

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2
Q

If not due to a pituitary tumour, what is the other common reason for hyperpituitarism, give an example?

A

Ectopic production of hormones from tumours, vasopressin producing lung tumours

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3
Q

What defect is hyper pituitarism from pituitary tumour associated with and why

A

Visual field defects and the tumour can grow up and squash the optic chiasm

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4
Q

What Visual field defect can a pituitary tumour cause

A

Bilateral hemianopia

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5
Q

How does a ptuitary tumour cause Bilateral hemianopia

A

At the optic chiasm, the fibres from the inner (nasal) part of both retinae (corresponding to the outer visual field) cross.
Light from the left visual field will hit the right part of the retina and vice versa
Because of the crossing over, all the light from the left visual field is detected by the right side of the brain.

A pituitary tumour could protrude out of the sella turcica and disrupt the fibres coming from the nasal parts of the retinae by compressing the optic chiasm where the optic nerves cross.
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6
Q

What is bilateral hemianopia

A

loss of the temporal/outer part of the visual field.

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7
Q

loss of the temporal/outer part of the visual field is known as….

A

bilateral hemianopia

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8
Q

What disease is excess corticotrophin by a pituitary tumour known as …

A

Cushings disease

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9
Q

Cushings disease is caused by …

A

excess corticotrophin (ACTH) by a pituitary adenoma

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10
Q

What disease is excess ACTH by a pituitary tumour known as …

A

Cushings disease

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11
Q

What is excess ACTH known as …

A

Cushings syndrome

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12
Q

What is Cushings syndrome

A

Excess ACTH in the blood

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13
Q

What does excess thyrotrophin result in …

A

thyroxicosis

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14
Q

What does excess gonadotrophins result in … (2)

A

Precocious puberty in children and a large ovary in women

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15
Q

Precocious puberty in children is caused by …

A

Gonadotrophins

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16
Q

What does excess prolactin result in …

A

Hyperprolactinaemia

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17
Q

What does excess somatotrophins result in … (2)

A

Gigantism in children, acromegaly in adults

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18
Q

Gigantism is caused by ….

A

Excess somatotrophin

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19
Q

Acromegaly is caused by…

A

Excess somatotrophin

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20
Q

a large ovary in women is caused by ….

A

excess oestrogen through excess gonadotrophins

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21
Q

Hyperprolactinaemia is defined as… (think about physiological hyperprolactinaemia)

A

Excess circulating prolactin when not due to a physiological cause such as pregnancy or breast-feeding

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22
Q

How serious is hypoprolactinaemia

A

HYPOprolactinaemia isn’t really a problem because the absence of prolactin doesn’t really have any serious physiological consequences

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23
Q

Most common type of prolactinoma?

A

Microadenoma, (a prolactinoma)

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24
Q

Symptoms of hyperprolactinaemia due to Prolactinoma in women? (4)

A

Galactorrhoea
Secondary amenorrhoea (or oligomenorrhoea)
Loss of libido
Infertility

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25
Q

Symptoms of hyperprolactinaemia due to Prolactinoma in men? (4)

A

Galactorrhoea uncommon
Importence
Loss of libido
Infertility

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26
Q

What effect does High levels of prolactin have on the reproductive axis

A

High prolactin suppresses GnRH pulsatility from the hypothalamus.
and so It decreases LH and FSH

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27
Q

How does High levels of prolactin cause secondary amenorrhoea

A

High prolactin suppresses GnRH pulsatility from the hypothalamus.
and so It decreases LH and FSH leading to secondary amenorrhea

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28
Q

why is Galactorrhoea in men very uncommon

A

Uncommon as you need oestrogen to prime the breast but men don’t have much oestrogen circulating in their bodies.

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29
Q

How does hyperprolactinaemia cause loss of libido, impotence and infertility

A

High prolactin suppresses GnRH pulsatility from the hypothalamus.
and so It decreases LH and FSH leading to loss of libido, impotence and infertility

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30
Q

What receptor is on lactotrophs

A

D2

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31
Q

What hormone regulates prolactin secretion

A

Dopamine

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32
Q

How does dopamine regulate prolactin secretion

A

Dopamine binds to D2 receptors on lactotrophs and inhibits prolactin secretion, and a lower level of dopamine means that the inhibition is lifted allowing the secretion of prolactin

33
Q

What is different for first line treatment of hyperprolactinaemia compared to other tumours

A

MEDICAL TREATMENT IS FIRST LINE. ALL OTHER TUMOURS ARE USUALLY TREATED SURGICALLY FIRST.

34
Q

What is used to treat hyperprolactinaemia

A

Dopamine receptor (D2) agonists are used. This decreases prolactin secretion and reduces tumour size.

35
Q

Dopamine receptor (D2) agonists are used to treat what hyperpituitary condition

A

hyperprolactinaemia

and

Acromegaly

36
Q

What hyperpituitary condition is bromocriptine used for

A

hyperprolactinaemia

37
Q

What hyperpituitary condition is cabergoline used for

A

hyperprolactinaemia
and
Acromegaly

38
Q

What drugs are used to treat hyperprolactinaemia (name)

A

bromocriptine and cabergoline

39
Q

Which drug is first line for hyperprolactinaemia

A

Cabergoline

40
Q

Side effects of D2 receptor agonists? (6)

A

nausea and vomiting, postural hypotension, dyskinesias and depression and pathological gambling

41
Q

What weird ting do D2 receptor agonists cause

A

pathological gambling

42
Q

In what case does hyperprolactinaemia call for a surgery

A

If there is a large prolactinoma, e.g. one compressing the optic chiasm, then a neurosurgeon is involved straightaway

43
Q

Excess Somatotrophin In CHILDREN causes …

A

GIGANTISM

44
Q

Excess Somatotrophin In adults causes …

A

Acromegaly

45
Q

Acromegaly is caused by …

A

Excess Somatotrophin In adults

46
Q

Gigantism is caused by …

A

Excess Somatotrophin In CHILDREN

47
Q

Onset of acromegaly is described as …

A

Insidious - signs and symptoms progress very gradually over many years meaning it can go undiagnosed for a while.

48
Q

If untreated, acromegaly (and gigantism) are associated with what morbidities (3)

A

increased morbidity and mortality due to cardiovascular (60%), respiratory (25%) and cancerous (15%) complications

49
Q

What grows in acromegaly (5)

A 
Periosteal bone
	Cartilage
	Fibrous tissue
	Connective tissue
	Internal organs (cardiomegaly, splenomegaly, hepatomegaly etc.)
50
Q

What causes the increased demand in the CVS system

A

increase in organ size

This means that there is increased demand for oxygen and the blood supply must keep up with this extra demand

51
Q

What are the manifestations of acromegaly? (MANY)

A

Enlargement of supraorbital ridges
Enlargement of nose, hands and feet
Thickening of lips
General coarseness of features
Hyperhydrosis
Headache
Mandible grows leading to protrusion of the lower jaw (prognathism)
Enlarged tongue – macroglossia.
Carpal Tunnel Syndrome (median nerve compression)
increased cartilaginous growth increasing the pressure on nerves
Spade shaped hands.
Joint pain
Barrel chest, kyphosis
Galactorrhoea (often in women and occasionally in men) -­‐ at very high levels, GH has some prolactin like effects
Menstrual abnormalities, decreased libido and impotence
Hypertension -­‐ there is a massive strain on the CVS and this is associated with an increase in blood pressure as the body tries to supply blood to the extra tissues
Abnormal glucose tolerance; symptoms of diabetes mellitus
Prognathism

52
Q

What disease does acromegaly predispose

A

Diabetes

53
Q

How does acromegaly predispose to diabetes

A

excess GH stimulates an increase in blood glucose (through increased endogenous glucose production and decrease muscle glucose uptake). This increase stimulates insulin production which then leads to tissue resistance to insulin

54
Q

What effect does GH have on blood glucose and how

A

increase in blood glucose (through increased endogenous glucose production and decrease muscle glucose uptake).

55
Q

Complications of Acromegaly? (4)

A

Obstructive sleep apnoea
Hypertension
Cardiomyopathy
Increased cancer risk

56
Q

How does acromegaly cause Obstructive sleep apnoea

A

bone and soft-tissue changes surrounding the upper airway lead to narrowing and subsequent collapse during sleep

57
Q

How does acromegaly cause Hypertension (2)

A

probs due to GH/IGF-1 effects on vascular tree and GH mediated renal sodium consumption.

58
Q

How does acromegaly cause Cardiomyopathy (3)

A

hypertension, diabetes mellitus, direct toxic effects of excess GH on the myocardium

59
Q

GH is often cosecreted with what

A

Prolactin

60
Q

Hyperprolactinaemia will cause what other pituitary associated condition

A

Hypogonadism

61
Q

Why is random measurement of GH unhelpful

A

GH release is pulasatile

62
Q

What is used to diagnose high GH levels

A

oral glucose tolerance test

63
Q

what is the oral glucose tolerance test results in acromegaly

A

Paradoxical rise in GH levels

64
Q

what is the oral glucose tolerance test results in a normal person

A

you should inhibit growth hormone release and growth hormone levels will decrease and then you get an overswing at the end

65
Q

GH affects on glucose

A

Increase serum glucose

66
Q

What is the oral glucose tolerance test used to test

A

Acromegaly and growth hormone

67
Q

the main treatment of acromegaly?

A

Surgery

68
Q

What surgery is performed for GH

A

Trans-sphenoidal hypophysectomy

69
Q

What medicine types are used to treat acromegaly (2)

A

Somatostatin analogues

Dopamine Agonists

70
Q

How does dopamine agonists help with acromegaly?

A

GH secreting pituitary tumours often express D2 receptors

71
Q

Examples of somatostatin analogues?

A

Octeotride

72
Q

Octeotride is a…

A

somatostatin analogue

73
Q

Octeotride is used to treat what pituitary condition

A

Acromegaly

74
Q

Somatostatins are renowned as being …

A

endocrine cyanide

75
Q

Somatostatins effect on GH secretion

A

Inhibitory

76
Q

Serum levels of IGF in excess GH secretion?

A

high

77
Q

3 treatment options for acromegaly?

A

Surgery - transphernoidal hypophysectomy
Medicine - somatostatin analogues/D2 agonists
Radiotherapy

78
Q

Side effects of somatostatin analogues?

A

‘Endocrine cyanide’ – can interfere with gut functions to e.g. gall stones because CCK is switched off, nausea and diarrhoea.

79
Q

Neoadjuvant/adjuvant for transphernoidal hypophysectomy?

A

Somatostatin analogues

Endocrinology Y2 (18 decks)

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