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Year 2 Endocrinology > Hypersecretion of anterior pituitary hormones > Flashcards

Hypersecretion of anterior pituitary hormones Flashcards

1
Q

What normally causes hyperpituitarism?

A

Isolated pituitary tumours or can be ectopic

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2
Q

What defect is hyperpituitarism usually associated with?

A

Visual field defects eg bitemporal hemianopia due to the descussation of the nerves being at the optic chiasm where the pituitary is

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3
Q

What does an excess of ACTH cause?

A

Cushing’s disease

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4
Q

What does an excess of TSH cause?

A

Thyrotoxicosis

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5
Q

What does an excess of LH/FSH cause?

A

Precocious puberty in children

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6
Q

What does an excess of prolactin cause?

A

Hyperprolactinaemia

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7
Q

What does an excess of GH cause?

A

Gigantism, acromegaly

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8
Q

What are physiological causes of hyperprolactinaemia?

A

Pregnancy and breastfeeding

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9
Q

What are pathological causes of hyperprolactinaemia?

A

Prolactinoma - a microadenoma of <10mm and the most common functioning pituitary tumour.

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10
Q

What does high prolactin supress

A

GnRH pulsality

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11
Q

What are signs of hyperprolactinaemia in women

A

Galactorrhoea, secondary amenorrhoea/oligomenorrhoea, loss of libido, infertility

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12
Q

What are signs of hyperprolactinaemia in men?

A

Galactorrhoea, erectile dysfunction, loss of libido, infertility

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13
Q

What is the pathophysiology of the treatment for hyperprolactinaemia?

A

Dopamine from dopaminergic neurones bind to D2 receptors on the lactotrophs and switches off prolactin secretion

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14
Q

What is the treatment for hyperprolactinaemia?

A

D2 receptor agonists that deliberately inhibit prolactin release - 1st line treatment

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15
Q

What do D2 receptor agonists do to hyperprolactinaemia?

A

Decrease prolactin secretion and reduce the tumour size

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16
Q

What are examples of D2 receptor agonists?

A

Bromocriptine, cabergoline

17
Q

What is the difference between giganistim and acromegaly

A

Gigantism is in children and acromegaly is in adulthood

18
Q

What are acromegaly and gigantism usually due to

A

Benign GH secreting pituitary adenomes

19
Q

What are possible general complication risks of acromegaly and what are the chances of getting them?

A

CVS - 60%
Resp complications - 25%
Cancer - 15%

20
Q

What are clinical features of acromegaly?

A

excessive sweating (hyperhidrosis), headache, supraorbital ridge enlargement, big nose, big hands and feet, thickened lips, macroglossia, prognathism (protrusion of lower jaw), carpal tunnel syndrome, barrel chest and kyphosis.

21
Q

What grows in acromegaly?

A

Periosteal bone, cartilage, fibrous tissue, connective tissue, internal organs ie hepatomegaly

22
Q

What are complications of acromegaly?

A

OSA - increased soft tissue growth in throat
Hypertension - effect of GH and/or IGF-1 on vascular tree, GH mediated Na reabsorption
Cardiomyopathy - hypertension, DM, toxic effects of GH on myocardium
Cancer - colonic polyps

23
Q

What other hormone is often high in acromegaly apart from GH

A

Prolactin - reflects tumour secreting both GH and prolactin, and the hyperprolactinaemia will cause secondary hypogonadism

24
Q

How can diabetes mellitus develop in someone with acromegaly?

A

Excess GH inhibits insulin, increases insulin resistance. This impaires glucose tolerance and causes diabetes mellitus

25
Q

How is acromegaly diagnosed?

A

GH is pulsatile and so random measurements are unhelpful however after an oral glucose load, GH should drop in a healthy person as the insulin rises but in acromegaly there is a paradoxical rise of GH
There will also be elevated level of serum IGF-1

26
Q

What is the first line treatment for acromegaly?

A

Surgery - trans-sphenoidal entry and remove tumour

27
Q

What are the two types of drugs that can be used to treat acromegaly?

A

Somatostatin analogues - Octreotide or dopamine antagnoists - Cabergoline

28
Q

What are somatostatin analogues also called and how are they administered?

A

Endocrine cyanide that is injected or administered in a monthly depot injection

29
Q

What are side effects of somatostatin analogues

A

GI side effects are common eg nausea, diarrhoea and gallstones

30
Q

Why are somatostatin analogues used as a pre-treatment before surgery

A

They can ‘shrink’ the tumour therefore reduce the vasculature to it therefore making it easier to remove

31
Q

What, other than surgery and with drugs, can you do to treat acromegaly?

A

Radiotherapy

Year 2 Endocrinology (21 decks)

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