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Y2 BRS Endocrinology > Hypopituitarism > Flashcards

Hypopituitarism Flashcards

1
Q

What hormones are made by the anterior pituitary?

A
  1. Growth hormone
    - Somatotrophin
  2. Prolactin
  3. Thyroid stimulating hormone (TSH)
    - Thyrotrophin
  4. Luteinising hormone (LH)
  5. Follicle stimulating hormone (FSH)
  6. Adrenocorticotrophic hormone
    - ACTH, corticotrophin
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2
Q

How is anterior pituitary hormone production regulated?

A

Hypothalamic releasing or inhibitory facotrs

Travel in portal circulation

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3
Q

What is the function of growth hormone?

A

Growth

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4
Q

What is the function of prolactin?

A

Milk production

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5
Q

What does LH and FSH produce?

A

Oestrogen and Progesterone

Testosterone

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6
Q

What does TSH produce?

A
  1. T3 - Triiodothyronine

2. T4 - Thyroxine

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7
Q

What does ACTH produce?

A

Cortisol

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8
Q

What is a primary disease?

A

The gland (thyroid, adrenal cortex, gonad) itself fails

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9
Q

What is a secondary disease?

A

No signals from hypothalamus or anterior pituitary

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10
Q

Describe T3 and T4 levels in primary hypothyroidism.

A

Fall

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11
Q

Describe TSH (and TRH) levels in primary hypothyroidism.

A

Increases

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12
Q

What is a cause of primary hypothyroidism?

A

Autoimmune destruction of thyroid gland

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13
Q

What is a cause of secondary hypothyroidism?

A

Pituitary tumour damaging thyrotrophs

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14
Q

Describe T3 and T4 levels in secondary hypothyroidism.

A

Fall

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15
Q

Describe TSH levels in secondary hypothyroidism.

A

Falls (Can’t make TSH)

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16
Q

What is cortisol regulated by?

A

ACTH

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17
Q

What does ACTH regulate?

A

Cortisol

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18
Q

What is aldosterone regulated by?

A

Renin-angiotensin

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19
Q

What does renin-angiotensin regulate?

A

Aldosterone

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20
Q

What is a cause of primary hypoadrenalism?

A

Destruction of adrenal cortex (e.g. autoimmune)

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21
Q

Describe cortisol levels in primary hypoadrenalism.

A

Falls

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22
Q

Describe ACTH (and CRH) levels in primary hypoadrenalism.

A

Increases

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23
Q

What is a cause of secondary hypoadrenalism?

A

Pituitary tumour damaging corticotrophs

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24
Q

Describe cortisol levels in secondary hypoadrenalism.

A

Falls

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25
Q

Describe ACTH levels in secondary hypoadrenalism.

A

Falls (Can’t make ACTH)

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26
Q

What is a cause of primary hypogonadism?

A

Destruction of testes or ovaries

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27
Q

What is a common cause of destruction of testes?

28
Q

What is a common cause of destruction of ovaries?

A

Chemotherapy

29
Q

Describe sex steroid levels in primary hypogonadism.

30
Q

Describe LH and FSH (and GnRH) levels in primary hypogonadism.

31
Q

What is a cause of secondary hypogonadism?

A

Pituitary tumour damaging gonadotrophs

32
Q

Describe sex steroid levels in secondary hypogonadism.

33
Q

Describe LH and FSH levels in secondary hypogonadism.

A

Fall (as can’t make)

34
Q

What can we divide causes into?

A

Congenital and acquired

35
Q

Which of congenital and acquired causes are more common?

36
Q

What examples of acquired causes are there?

A
  1. Tumours eg adenomas, metastases, cysts
  2. Radiation (hypothalamic/pituitary damage)
  3. Infection eg meningitis
  4. Traumatic brain injury
  5. Pituitary surgery
  6. Inflammatory
  7. Pituitary apoplexy - haemorrhage (or less
    commonly infarction)
  8. Peri-partum infarction (Sheehan’s syndrome)
37
Q

What is inflammation of the pituitary gland called?

A

Hypophysitis

38
Q

What is hypophysitis?

A

Inflammation of the pituitary gland

39
Q

What is total loss of anterior and posterior pituitary function called?

A

Panhypopituiarism

40
Q

What is panhypopituitarism?

A

Total loss of anterior and posterior pituitary function

41
Q

What is the presentation of hypopituitarism regarding FSH/LH?

A
  1. Reduced libido
  2. Secondary amenorrhoea
  3. Erectile dysfunction
  4. Reduced pubic hair
42
Q

What is the presentation of hypopituitarism regarding ACTH?

43
Q

What is the presentation of hypopituitarism regarding TSH?

44
Q

What is the presentation of hypopituitarism regarding growth hormone?

A
  1. Reduced quality of life

2. Short stature only in children

45
Q

What is the presentation of hypopituitarism regarding prolactin?

A

Inability to breastfeed

46
Q

Why is hypopituitarism regarding ACTH not a salt losing crisis?

A

The renin-angiotensin system still creates aldosterone

47
Q

What is Sheehan’s Syndrome?

A

Post-partum hypopituitarism secondary to
hypotension (post partum haemorrhage -
PPH)

48
Q

What does PPH lead to?

A

Pituitary infarction

49
Q

Why does the anterior pituitary enlarges in pregnancy?

A

Lactotroph hyperplasia

50
Q

Which hormone in the treatment of hypopituitarism will not get replaced?

51
Q

How do you measure response to GH treatment?

A
  1. Improvement of QoL

2. Plasma IGF-1

52
Q

What causes a pituitary apopplexy?

A

Intra-pituitary haemorrhage or (less commonly) infarction

53
Q

What can a pituitary apoplexy be precipitated by?

A

Anti-coagulants

54
Q

How would you replace cortisol?

A
  1. Prednisolone

2. Hydrocortisone

55
Q

What are the congenital causes of hypopiturtarism?

A

(Rare)
Usually due to mutations of transcription factor genes needed for normal anterior pituitary development
-eg PROP1 mutation

56
Q

What will someone will congenital hypopituitarism present with?

A

-Deficient in GH and at least 1 more anterior pituitary hormone

  • Short stature
  • Hypoplastic (underdeveloped) anterior pituitary gland on MRI
57
Q

What are the sick day rules for patients with ACTH deficiency?

A
  • Steroid alert pendant/bracelet
  • Double steroid dose (glucocorticoid not mineralocorticoid) if fever/intercurrent illness
  • Unable to take tablets (eg vomiting), inject IM or come straight to A & E
58
Q

What are the features of an adrenal crisis?

A

Dizziness, hypotension, vomiting, weakness, can result in collapse and death

59
Q

What Addison’s patients must be told sick day rules?

A

Patients who take replacement steroid eg prednisolone, hydrocortisone

60
Q

Who is at risk of an adrenal crisis?

A

Patients with ACTH deficiency (or Addison’s – primary adrenal failure) are at risk of ‘adrenal crisis’ triggered by intercurrent illness

61
Q

What is the treatment of FSH/LH deficiency in men who do not require fertility?

A
  • Replace testosterone – topical or intramuscular most popular
  • Measure plasma testosterone
  • Replacing testosterone does not restore sperm production (this is dependent on FSH)
62
Q

What is the treatment of FSH/LH deficiency in men who do require fertility?

A
  • Induction of spermatogenesis by gonadotropin injections
  • Best response if secondary hypogonadism has developed after puberty
  • Measure testosterone and semen analysis
  • Sperm production may take 6-12 months
63
Q

What is the treatment of FSH/LH deficiency in women who do not require fertility?

A

-Replace oestrogen
-Oral or topical
-Will need additional progestogen if intact
uterus to prevent endometrial hyperplasia

64
Q

What is the treatment of FSH/LH deficiency in women who do not require fertility?

A

Can induce ovulation by carefully timed gonadotropin injections (IVF)

65
Q

In FSH/LH deficiency in women not requiring fertility, when and why will additional progestogen be given?

A

If intact uterus to prevent endometrial hyperplasia

Y2 BRS Endocrinology (9 decks)

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