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BRS YR2 > Hypopituitarism > Flashcards

Hypopituitarism Flashcards

1
Q

What are the 6 hormones released by the anterior pituitary gland?

A
  • Prolactin
  • Growth hormone (somatotrophin)
  • Thyroid Stimulating Hormone (TSH)
  • Luteinising Hormone (LH)
  • Follicle Stimulating Hormone (FSH)
  • Adrenocorticotrophic Hormone (ACTH)
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2
Q

What does prolactin stimulate?

A

Milk production

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3
Q

What does LH and FSH stimulate?

A
  • Oestrogen

- Progesterone

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4
Q

What does TSH stimulate?

A

Triiodothyronine (T3) - active

Thyroxine (T4)

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5
Q

What does ACTH stimulate?

A

Cortisol release

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6
Q

What is the difference between primary and secondary pituitary gland failure?

A

Primary: failure of the gland itself
Secondary: no signals from the hypothalamus or the anterior pituitary

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7
Q

What is characteristic of primary hypothyroidism?

A

thyroid destruction

  • T3 and T4 fall
  • TSH increases (unmeasured but TRH would also be high)
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8
Q

What is characteristic of secondary hypothyroidism?

A

damaged thyrotrophs

  • TSH falls
  • T3 and T4 fall without TSH
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9
Q

What is characteristic of primary hypoadrenalism?

A

adrenal cortex destruction

  • cortisol falls
  • ACTH increases (CRH would be high)
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10
Q

What is a characteristic of secondary hypoadrenalism?

A

corticotroph damage

  • ACTH falls
  • Cortisol falls
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11
Q

What is characteristic of primary hypogonadism?

A

Destruction of testes (mumps) or ovaries (chemo)

  • Testosterone / estrogen fall
  • LH and FSH increase
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12
Q

What is characteristic of secondary hypogonadism?

A

damaged gonadotrophs

  • LH and FSH fall (can’t be produced)
  • Testosterone / estrogen fall
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13
Q

Causes of Hypopituitarism?

A
  • Congenital (rare)

- Acquired

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14
Q

What are the congenital cause of hypopituitarism?

A
  • Due to mutations of transcription factor genes needed for normal development (eg: PROP1 mutation)
  • Deficient in GH and at least one more anterior pituitary hormone
  • Short stature
  • Hypoplastic anterior pituitary gland (MRI)
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15
Q

What are the acquired causes of hypopituitarism?

A
  • tumours
  • radiation
  • infection
  • traumatic brain injury
  • pituitary brain surgery
  • inflammation
  • pituitary apoplexy (haemorrhage or infarction)
  • peri-partum infection (Sheehan’s syndrome)
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16
Q

What can cause anterior and posterior pituitary gland dysfunction?

A
  • inflammation (hypophysitis)

- surgery

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17
Q

What is the term for the total loss of anterior and posterior pituitary function?

A

Panhypopituitarism

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18
Q

Impact of radiotherapy on hypopituitarism?

A
  • extent depends on the total dose of radiotherapy delivered to the hypothalamo-pituitary axis
  • GH and gonadotrophins are most sensitive, and prolactin can increase after radiotherapy (loss of hypothalamic dopamine)
  • risk persists up to 10years after radiotherapy (annual assessment necessary)
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19
Q

How does secondary hypopituitarism present?

A
  • reduced libido
  • secondary amenorrhoea
  • erectile dysfunction
  • reduced pubic hair
20
Q

How does hypopituitarism with reduced ACTH present?

A
  • fatigue

not a salt losing crisis (renin-angiotensin)

21
Q

How does reduced TSH due to hypopituitarism present?

A

fatigue

22
Q

How does reduced GH (hypopituitarism) present?

A
  • reduced quality of life
    ONLY IN CHILDREN
  • short stature
23
Q

How does reduced prolactin present?

A

inability to breastfeed

24
Q

What is Sheehan’s syndrome?

A

Post-partum hypopituitarism secondary to hypotension (post-partum haemorrhage, which can lead to a pituitary infarction)

25
Q

What changes to the anterior pituitary occur during pregnancy?

A

Lactrotroph hyperplasia (It enlarges)

26
Q

What are common symptoms of Sheehan’s syndrome?

A

TSH/ACTH/GH deficiency
- lethargy
- weight loss (anorexia possible)
PRL deficiency
- lactation failure
- failure to resume normal menses post-delivery
(posterior pituitary not normally affected)

27
Q

What is pituitary apoplexy?

A

Intra-pituitary haemorrhage (rare: infarction)

28
Q

What can cause pituitary apoplexy?

A
  • can be caused by anti-coagulants
  • can be first presentation of a pituitary adenoma
  • can have a dramatic presentation with a current adenoma
29
Q

What are the symptoms of a pituitary apoplexy?

A
  • severe, sudden onset headache
  • visual field defect (possible bitemporal hemianopia)
  • Cavernous sinus involvement may lead to diplopia (IV, VI) and ptosis (III)
30
Q

What is the nature of FSH/LH?

A

cyclical in women

31
Q

What is the nature of GH/ACTH?

A

pulsatile

32
Q

What is the nature of T4?

A

circulating t1/2 of 6 days

33
Q

What can stimulate the release of GH and ACTH?

A

Insulin-induced hypoglycaemia

done in a dynamic pituitary function test

34
Q

How to radiologically diagnose hypopituitarism?

A 
Pituitary MRI (CT has poor differentiation)
may reveal the pathology
35
Q

How to treat a GH deficiency?

A
  • confirm GH deficiency using a dynamic pituitary function test
  • assess QoL
  • Daily injection (Genotropin)
36
Q

How to manage GH deficiency?

A
  • Improvement in QoL

- Plasma IGF-1

37
Q

How to treat a TSH deficiency?

A
  • HRT using a once daily levothyroxine

- aim: fT4 above the middle of the reference range

38
Q

How to treat a ACTH deficiency?

A
  • replace cortisol NOT ACTH
  • difficult to mimic the diurnal variation of cortisol
  • use synthetic glucocorticoids:
  • prednisolone (1 x daily)
  • hydrocortisone (3 x daily)
39
Q

What are people with an ACTH deficiency at risk of?

A

Adrenal crisis

40
Q

How does an adrenal crisis present?

A
  • dizziness
  • hypotension
  • vomiting
  • weakness
  • collapse
  • death
41
Q

What are sick day rules?

A
  • steroid alert pendant/bracelet
  • double steroid dose if fever/intercurrent illness
  • if unable to take tablets, inject IM or straight to A&E
42
Q

When are sick day rules necessary?

A

For patients that take replacement steroids

prednisolone or hydrocortisone

43
Q

How to treat an LH/FSH deficiency in men (no fertility required)?

A
  • testosterone replacement (topical or IM)
  • plasma testosterone monitoring
    (does not restore sperm production)
44
Q

How to treat an LH/FSH deficiency in men (fertility required)

A
  • induction of spermatogenesis by gonadotrophin injections
    (may take 6-12 months)
  • best if secondary hypogonadism is developed post puberty
  • testosterone measurements and semen analysis
45
Q

How to treat an LH/FSH deficiency in women (no fertility required)?

A
  • HRT (Oestrogen) by oral or topical means

- If intact uterus, progestogen to prevent endometrial hyperplasia

46
Q

How to treat an LH/FSH deficiency in women (fertility required)?

A

induce ovulation using timed gonadotrophin injections (IVF)

47
Q

Impact of ACTH deficiency on aldosterone?

A

No affect

BRS YR2 (70 decks)

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