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Phase 1b - Endocrinology > Hypopituitarism > Flashcards

Hypopituitarism Flashcards

-> Function of endocrine glands: Summarise the function of the key endocrine glands, including the synthesis, regulation and physiological effects of their hormones. -> Endocrine disorders: Describe the clinical features and treatment options of endocrine disorders.

1
Q

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

A
  • Growth hormone
  • Prolactin
  • Thyroid stimulating hormone (TSH)
  • Luteinising hormone (LH) & Follicle stimulating hormone (FSH)
  • Adrencorticotrophic hormone (ACTH)
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2
Q

Which glands can fail resulting in endocrine hormone deficiencies (4)? Differentiate between primary (1) and secondary (3) pituitary failure.

A
  • Primary pituitary failure:
  • Pituitary gland
  • Secondary pituitary failure:
  • Thyroid gland
  • Adrenal cortex
  • Gonads
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3
Q

Define panhypopituitarism.

A

Total loss of anterior & posterior pituitary function

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4
Q

What are the hormone levels in primary hypothyroidisim (destruction of thyroid gland)?

A
  • T3 & T4 deficiency
  • TSH increase
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5
Q

What are the hormone levels in secondary hypothyroidism (destruction of thyrotrophs)?

A
  • TSH deficiency
  • T3 & T4 deficiency
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6
Q

What are the hormone levels in primary hypoadrenalism (destruction of adrenal cortex)?

A
  • Cortisol deficiency
  • ACTH increase
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7
Q

What are the hormone levels in secondary hypoadrenalism (destruction of corticotrophs)?

A
  • Cortisol deficiency
  • ACTH deficiency
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8
Q

What are the hormone levels in primary hypogonadism (destruction of testes or ovaries)?

A
  • Testosterone deficiency
  • LH & FSH increase
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9
Q

What are the hormone levels in secondary hypogonadism (destruction of gonadotrophs)?

A
  • Testosterone deficiency
  • LH & FSH deficiency
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10
Q

What are the causes of hypopituitarism divided into?

A
  • Congenital
  • Acquired
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11
Q

Which mutation is concerned with congenital hypopituitarism?

A
  • PROP1 mutation (transcription factor required for anterior pituitary development)
  • IGF1 mutation (GH reception mutation)
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12
Q

What are the causes of acquired hypopituitarism (1 / Infection 3 / Trauma 3 / Vascular 2)?

A
  • Tumour: any brain tumour can squashe the pituitary (i.e. adenoma, metastases, cysts)
  • Infection and inflammation: Meningitis / Encephalitis / Autoimmune
  • Trauma: Radiotherapy (Hypothalamic/pituitary damage) / Traumatic brain injury / Pituitary surgery
  • Vascular: Pituitary apoplexy (infarcted pituitary tumour) / Sheehan’s syndrome (Post-partum haemorrhage -> infarction of pituitary gland)
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13
Q

What is the relation between radiotherapy and the risk of HPA axis damage?

A
  • Higher total radiotherapy dose (Gy), higher risk of HPA axis damage
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14
Q

What are the symptoms of congenital hypopituitarism?

A
  • GH deficiency→ Short stature
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15
Q

What are the symptoms of acquired hypopituitarism (4 FSH/LH / 1 ACTH & TSH / 1 GH / 1 PRL)?

A
  • FSH/LH : Reduced libido / Secondary amenorrhoea / Erectile dysfunction / Reduced pubic hair
  • ACTH & TSH: Fatigue
  • GH: Reduced quality of life
  • PRL: Inability to breastfeed
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16
Q

What is the non dynamic investigation used to diagnose hypopituitarism?

A
  • Serum hormone level
17
Q

What are the dynamic tests used to diagnose hypopituitarism (3)?

A
  • Insulin induced hypoglycaemia to stimulate stress → GH & ACTH release
  • TRH to stimulate TSH release
  • GnRH stimulates FSH & LH release
18
Q

Which hormones are released by the anterior pituitary gland in response to hypoglycaemia (<2.2mM) (2)?

A
  • GH
  • ACThH
19
Q

What are the radiological tests used to diagnose hypopituitarism?

A
  • Congenital: Hypoplastic (underdeveloped) anterior pituitary gland on MRI
  • Acquired: Empty sella on MRI thin rim of pituitary tissue
20
Q

What is the treatment of primary hypopituitarism?

A
  • Replace missing hormones
21
Q

What is the treatment of GH deficiency in hypopituitarism? How is the response measured (2)?

A
  • Daily injections of GH
  • Response measure: improvement in QoL / Plasma IGF-1
22
Q

What is the treatment of TSH deficiency in hypopituitarism? How is the response measured?

A
  • Daily tablet of levothyroxine
  • Response measure: Aim for a fT4 above the middle of the reference range
23
Q

What are the treatments of ACTH deficiency in hypopituitarism (2)?

A
  • Prednisolone once daily AM eg 3mg
  • Hydrocortisone three times per day eg 10mg/5mg/5mg
24
Q

What is the treatment of FSH/LH deficiency in hypopituitarism (men with no fertility required)? How is the response measured?

A
  • Topical or intramuscular testosterone
  • Response measure: Measure plasma testosterone
25
Q

What is the treatment of FSH/LH deficiency in hypopituitarism (men with fertility required)? How is the response measured?

A
  • Gonadotropin injections (Best response if secondary hypogonadism has developed after puberty)
  • Response measure: Measure testosterone / Semen analysis (Sperm production may take 6-12 months)
26
Q

What is the treatment of FSH/LH deficiency in hypopituitarism (female with no fertility required) (2)?

A
  • Oral / Topical oestrogen
  • Additional progestogen (if intact uterus) to prevent endometrial hyperplasia
27
Q

What is the treatment of FSH/LH deficiency in hypopituitarism (female with fertility required)?

A
  • Induce ovulation by carefully timed gonadotropin injections (IVF)
28
Q

What are the sick day rules for patients with ACTH deficiency (2)?

A
  • Steroid alert pendant/bracelet
  • Double steroid dose (glucocorticoid not mineralocorticoid) if fever/intercurrent illness
29
Q

What causes post-partum hypopituitarism (Sheehan’s Syndrome)?

A
  • Anterior pituitary enlarges in pregnancy (lactotroph hyperplasia)
  • Post-partum haemorrhage leads to hypotension
  • Pituitary infarction (obstruction to blood supply to pituitary tissue)
30
Q

What are the symptoms of Sheehan’s syndrome (TSH, ACTH, GH 3 / PRL 1 / LH,FSH 1)?

A
  • TSH / ACTH / GH deficiency: Lethargy / Anorexia / Weight loss
  • Prolactin deficiency: Failure of lactation
  • LH/FSH deficiency: Failure to resume menses post delivery
31
Q

What causes pituitary apoplexy?

A
  • Bleeding (haemorrhage) into the pituitary or loss of blood flow (infarction) to the pituitary, usually due to pre-existing adenoma
32
Q

What are the symptoms of a pituitary apoplexy (3)?

A
  • Sudden severe onset headache
  • Visual field defect (compressed optic chiasm / bitemporal hemianopia)
  • May have diplopia (CNIV / CNVI compression and/or ptosis (CNIII compression))

Phase 1b - Endocrinology (19 decks)

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