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Year2 Endo > Hypopituitarism > Flashcards

Hypopituitarism Flashcards

Lesson 1 endo

1
Q

What are the 5 hormones released by the anterior pituitary

A 
Growth Hormone ( somatotropin) 
Prolactin 
TSH (thyrotrophin) 
LH + FHS
ACTH ( corticotrophin)
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2
Q

What happens in the hypothalamo- pituitary portal system

A

Hypothalamic releasing/ inhibitory factors travel in portal system to anterior pituitary to regulate hormone production

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3
Q

Function of GH

A

Growth

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4
Q

Function of prolactin

A

Milk production

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5
Q

Function of LH and FSH

A

Stimulate oestrogen, progesterone and testosterone production

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6
Q

Function of TSH

A

Produce T3 ( triiodothyronine ) and T4 ( thyroxine)

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7
Q

Function of ACTH

A

Cortisol production

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8
Q

What is primary failure vs secondary failure

A

Primary: Gland itself fails ( usually thyroid. adrenal cortex for cortisol or gonads)
Secondary: No signal from hypothalamus or Anterior pituitary

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9
Q

Causes of primary hypothyroidism, hypoadrenalism , hypogonadism

A

Autoimmune destruction of thyroid gland, adrenal cortex, destruction of testes ( mumps) or ovaries( chemotherapy)

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10
Q

Diagnosis of primary hypothyroidism

A

High TSH , low T3, T4 ( TRH also high but unmeasurable)

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11
Q

Causes of secondary hypothyroidism, hypoadrenalism , hypogonadism

A

Pituitary tumour

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12
Q

Diagnosis of secondary hypothyroidism,

A

Low TSH, Low t3 and t4

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13
Q

Diagnosis of 1st hypoadrenalism

A

Low cortisol, high ACTH ( high CRH unmeasurable)

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14
Q

Diagnosis of 2nd hypoadrenalism

A

low ACTH, low cortisol

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15
Q

Diagnosis of 1st hypogonadism

A

Testosterone / Oestrogen low
LH , FSH high
(GnRH high but unmeasurable)

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16
Q

Diagnosis of secondary hypothroidism

A

Low LH/FSH

Low testosterone / oestrogen

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17
Q

Causes of hypotiuitarism

A

Congenital ( rare)

Aquired

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18
Q

What causes congenital hypopituitarism

A

Mutation of transcription factor genes for normal anterior pituitary development ie PROP1 mutation

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19
Q

Outcome of congenital hypopiuitarism

A

Deficient in GH and >1 more anterior pituitary hormone

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20
Q

Effects of congenital hypopituitarism

A

short stature

hypoplastic ( underdeveloped) anterior pituitary on mri

21
Q

What cases acquired hypopituitarism

A

Tumours ( adenomas, metastases, cysts)
Inflammation ( hypophysitis)
Radiation ( hypothalamic / pituitary damage)
Traumatic brain injury
Pituitary apoplexy –> haemorrhage or infarction ( infarction uncommon)
Peri-Partum infection (Sheehan’s syndrome)

22
Q

what can cause posterior pituitary dynsfunction

A

inflammation ( hypophysitis ) or surgery

23
Q

What is panhypopituitarism

A

loss of a and posterior pituitary

24
Q

why does radiotherapy induce hypopituitarism

A

Pituitary and hypothalamus both sensitive to radiation. direct radiation to pituitary ( due to acromegaly) or indirect ( nasopharyngeal carcinoma) can cause hypopituitarism.
extent depends on dose of radiotherapy

25
Q

what happens to hormones released during radiotherapy

A

GH and gonadotropin most sensitive
Prolactase can increase
Risk persists up to 10y after therapy so annual assessment

26
Q

Symptoms of hypopituitarism

A

FSH,LH –> low libido, secondary amenorrhea , erectile dysfunction
reduced pubic hair

ACTH –> fatigue ( no salt crises as that is part of renin - angiotensin )

TSH –> fatigue

GH–> reduced quality of life , short stature ( children only)

PRL –> inability to breastfeed

27
Q

What is sheehan’s syndrome

A

secondary post partum hypopituitarism due to hypotension from post partum haemorrhage (pph)
–> anterior pit enlarges in pregnancy ( lactotroph hyperplasia)
pph leads to pituitary infacrtion

28
Q

Symptoms of sheehan’s syndrome

A 
Lethargy , anorexia and weight loss
TSH/ACTH/GH deficient 
PRL deficiency if fail to lactate 
Failure to resume meses post delivery 
post pit not usually effected
29
Q

What is pituitary apoplexy

A

intra pituitary haemorrhage or infarction ( infarction uncommon)

–> often dramatic presentation in patients with pre existing adenomas ( pit tumours)

30
Q

Symptoms of pituitary apoplexy

A

Severe sudden headache
Bitemporal hemianopia –> compressed optic chiasm
canervous sinuous involvement may lead to diplopia ( IV,VI) ( two images of same thing aka blurry vision) , ptosis (III) ( droopy eyelid)

31
Q

what can cause pituitary apoplexy

A 
use of anticoagulants
pituitary adenomas ( pit apoplexy is usually an indicator of adenomas)
32
Q

Why is cortisol not used in diagnosis of hypopituitarism

A

fluctuates during time of day

33
Q

why is T4 not used in diagnosis f hypopituitarism

A

Long half life – circulating t1/2 is 6 days

34
Q

Why is FSH/LH not used as a diagnosis of hypopituitarism

A

Cyclical in women

35
Q

Why is GH /ACTH not a perfect diagnosis of hypopituitarism

A

They are Pulsatile

36
Q

What is used to diagnose hypopituitarism

A

Dynamic pituitary function ( series of hormone measurements into a series of time)

1) Measure ACTH and GH –> these are stress hormones. When hypoglycaemia occurs the body responds to it like stress. Therefore can create an insulin induced hypoglycaemia to stimulate GH and ACTH release to measure cortisol levels. In normal : when induced levels of Gh and ACTH should increase
2) Give TRH stimulating TSH release and measure
3) Give GnRH stimulating FSH and LH release and measure

37
Q

what machine and what does the image show to diagnose hypopituitarism using radiology

A

Use pit MRI ( CT not good)

–> empty sella due to thin rim of pituitary tissue

38
Q

what hormones can be treated in hypopituitarism

A

all ( Growth hormone,TSH, LH+FSH, ACTH) except prolactin

39
Q

How to treat GH deficiency and how can we improve the treatment ?

A

1) confirm GH on dynamic pit function test
2) Assess quality of life using questionnaire
3) daily injection of GH

improvements: Better QoL questionnaire, plasma IGF-1

40
Q

How to we treat TSH deficiency

A

Replace with levothyroxine daily
( Remember TSH is low so can’t use this to adjust the dose as you would do in primary hypothyroidism)
–> aim for free T4 above the middle of the reference range

41
Q

How to treat ACTH deficiency

A

Replace cortisol not ACTH ( though will be hard to mimic diurnal variation of cortisol)

2 ways:use synthetic glucocorticoids

1) Prednisolone one daily AM
2) Hydrocortisone 3 times per day

42
Q

Why is it important to have sick day rules for patients with ACTH deficincy

A

Patients with ACTH deficiency or 1ary adrenal failure ( addisons) are at risk of adrenal crisis trigged by illness

43
Q

Features of adrenal crisis

A

dizziness, hypotension,vomiting, weakness –> results in collapsing and death

44
Q

Who must be told sick day rules with ACTH deficiency and what must they do?

A

Ppl who take steroid replacements ( ie prednisolone, hydrocortisone)

rules:

1) Must have steroid alert pendant / bracelet
2) take double steroid dose ( glucocorticoid not mineralocorticoid) if fever / intercurrent illness
3) if unable to take tablets ie vomiting must inject intramuscularly or go to Aand E

45
Q

what is the treatment for FH/LH deficiency in men if no fertility is required?

A

1) Measure plasma testosterone
2) Testosterone replacement –> topical or intramuscular
Note : testosterone replacement doesn’t restore sperm production ( this is dependent on FSH)

46
Q

what is the treatment for FH/LH deficiency in men if fertility is required?

A

1) induce spermatogenesis by gonadotropin injections
( works best if 2ary hypogonadism has developed post puberty )
2) Measure test + semen analysis
( sperm prod may take 6-12 months)

47
Q

what is the treatment for FH/LH deficiency in women if no fertility is required?

A

1) Oestrogen replacement ( oral / topical)

2) Need additional progestogen if uterus is intact to prevent endometrial hyperplasia

48
Q

what is the treatment for FH/LH deficiency in women if fertility is required?

A

induce ovulation using gonadotropin injections ( IVF)

Year2 Endo (13 decks)

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