hypopituitarism

Question 1

what are the 5 hormones stored by anterior pituitary gland

Answer 1

growth hormone, prolactin, lh and fsh, tsh, acth

Question 2

what are some differences between the anterior and posterior pituitary glands?

Answer 2

anterior pituitary is glandular as opposed to posterior which has neural origin.
posterior is continous with hypothalamus
anterior is regulated by inhibitory/ releasing factors via hypothalamic pituitary portal system

Question 3

what is prolactin responsible for

Answer 3

milk production

Question 4

what is fsh and lh responsible for

Answer 4

oestrogen and progesterone and testosterone production

Question 5

what is tsh responsible for

Answer 5

production of t3 and t4 in thyroid glands

Question 6

what is acth responsible for

Answer 6

cortisol in adrenal cortex

Question 7

difference between primary and secondary pituitary disease

Answer 7

primary disease - gland itself fails

secondary disease - no signals from hypothalamus or anterior pituitary

Question 8

what is primary hypothyroidism?

Answer 8

autoimmune destruction of thyroid gland, Hashimoto’s thyroiditis or iodine deficiency
t3 and t4 fall,
tsh increases because no negative feedback

Question 9

what is secondary hypothyroidism

Answer 9

cant make tsh, tsh falls
t3 and t4 fall
e.g pituitary tumour damaging thyrotrophs

Question 10

what one rare cause of hypopituitarism?

Answer 10

congenital( rare) - pituitary gland hasnt developed properly in utero - mutation in transcription factors e.g, prop1 mutation
tend to be deficient in gh and at least 1 other anterior hormone
typical features - short stature
hypoplastic anterior pituitary on mri

Question 11

another cause of hypopituitarism

Answer 11

acquired (much more common)
tumours
radiation
infection e.g meningitis
traumatic brain injury
pituitary surgery
imflammatory - hypophytitis
pituitary apoplexy - haemorrhage/ infarction
shhehans syndrome - peri partum infarction

Question 12

what is panhypopituitarism

Answer 12

total loss of anterior and posteror pituitary function

Question 13

how does radiotherapy cause hypopituitarism

Answer 13

pituitary and hypothalamus sensitive to radiation
gh and gonadotrophins are most sensitive
prl can also increasedue to loss of hypothalamic dopamine

Question 14

after how many years of radiotherapy can effects last for

Answer 14

persists upto 10 yrs after

Question 15

what will loss of fsh/lh cause

Answer 15

reduced libido
secondary amenorrhoea
erectile dysfunction
reduced pubic hair

Question 16

loss of acth causes..

Answer 16

fatigue

Question 17

loss of tsh causes…

Answer 17

fatigue

some weight gain

Question 18

loss of gh causes..

Answer 18

reduced quality of life

short stature in children

Question 19

loss of prl causes…

Answer 19

Inabililty to breastfeed

Question 20

what is sheehans syndrome

Answer 20

Hyperplasia of lactotrophs during pregnancy
And post partum haemorrhage - 
hypotension - leads to blood loss
leading to pituitary infarction - 
post partum hypopituitarism 
affects anterior pituitary
more common in developing countries

Question 21

what are some of the symptoms of sheehans syndrome

Answer 21

lethargy, anorexia
weightloss
failure of lactaction
failure to resume menses

Question 22

what is pituitary apoplexy

Answer 22

pituitary haemorrhage
dramatic presentation
usually bleed into existing pituitary tumour

Question 23

how can pituitary apoplexy be exacerbated

Answer 23

precipitated by anticoagulants e.g warfarin

Question 24

symptoms of apoplexy

Answer 24

severe sudden onset of headache
visual field defects - bitemporal hemianopia
cavernous sinus involvement can lead to diplopia or ptosis

Question 25

how can you diagnose hypopituitarism

Answer 25

dynamic pituitary function test 
acth and gh are stress hormones
therefore induce stress by making hypoglycaemic to test for levels
give insulin injection 
make glucose <2.2mm
look for usual increase in cortisol and gh
measure at diff time points
can also give trh and gnrh

Question 26

scan for diagnosis of hypopit..

Answer 26

pituitary mri
may reveal other pathology
empty sella?

Question 27

treatment of gh def

Answer 27

assess quality of life using questionnaire - then give daily injection
measure response via improvement in qol and plasma igf1
give gh to kids

Question 28

treatment of tsh deficiency

Answer 28

daily levothyroxine

aim for ft4 above middle of reference range

Question 29

treatment of acth def

Answer 29

replace cortisol with prednisolone once daily 3mg

hydrocortisone 3 times 10mg 5mg 5mg

Question 30

sick day rules for those with acth def

Answer 30

patients with addisons have risk of adrenal crisis when triggered with intercurrent illness
patients with steroid replacement must have
steroid alert pendant/bracelet
double glucocorticoid steroid dose if fever/ill
if unable to take tablets - inject im or come straight to and e.

Question 31

treatment for fsh/lh def in men

Answer 31

if no fertility required - replace testosterone topically or intramuscular - does not restore sperm production
measure plasma testosterone
if fertility req - lh fsh injections

Question 32

treatment for fsh/lh def in women

Answer 32

no fertility - oestrogen oral or topical
additional progesterone if intact uterus
if fertilty req - carefully times lh fsh injections
ivf