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Y2 ENDOCRINOLOGY > Hypopituitarism > Flashcards

Hypopituitarism Flashcards

1
Q

Which hormone from the anterior pituitary is responsible for Growth?

A

GH (growth hormone)

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2
Q

Which hormone released from the anterior pituitary is responsible for milk production?

A

Prolactin

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3
Q

What is the difference between primary and secondary endocrine diseases?

A

Primary disease is where the gland itself fails (e.g thyroid gland) secondary disease is due to malfunctioning of signals from hypothalamus or anterior pituitary

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4
Q

What is primary hypothyroidism and how is it measured?

A

Autoimmune destruction of thyroid gland. T3 and T4 will be low and TSH will be high

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5
Q

What is secondary hypothyroidism and how is it measured?

A

Failure to make TSH e.g. due to tumour damaging thyrotrophs. Low TSH, low T3 + T4

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6
Q

What hormones does ACTH regulate?

A

Cortisol. NOT aldosterone, this is through renin-angiotensin system

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7
Q

What is primary hypoadrenalism and what would be the effects on blood hormone levels?

A

Destruction of adrenal cortex . Low cortisol, increased ACTH

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8
Q

What is secondary hypoadrenalism and how would blood hormone levels be affected?

A

Pituitary tumour damages Corticotrophs so cannot make ACTH. ACTH and cortisol low

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9
Q

What is primary hypogonadism and how would it effect blood hormone levels?

A

Destruction of testes (e.g mumps) or ovaries (e.g. chemotherapy). Testosterone/oestrogen low, increased LH and FSH

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10
Q

What is secondary hypoythyroidism and how would it effect blood hormone levels?

A

Pituitary tumour damaging gonadotrophs so cannot make LH/FSH. Low FSH/LH, low testosterone/oestrogen

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11
Q

Are congenital or acquired causes of hypopituitarism more common

A

Acquired

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12
Q

What often causes congenital hypopituitarism?

A

Mutations of transcription factor genes needed for normal anterior pituitary hormone

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13
Q

What can be seen on the MRI of someone with congenital hypopituitarism?

A

Hypoplastic (underdeveloped) anterior pituitary gland

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14
Q

What is seen in the blood hormone levels of someone with congenital hypopituitarism? What does this cause?

A

Deficiency in GH and at least 1 other anterior pituitary hormone, resulting in a short stature

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15
Q

List some causes of acquired hypopituitarism?

A

tumours, radiation, infection, traumatic brain injury, pituitary surgery, pituitary apoplexy, sheehans syndrome

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16
Q

what is the name given for the total loss of anterior and posterior pituitary function?

A

panhypopituitarism

17
Q

describe the association between radiotherapy dosage and HPA axis damage, what is most sensitive?

A

the higher the radiation dosage the higher the risk of HPA axis damage. GH and gonadotrophins most sensitive

18
Q

Describe the process which leads to hypopituitarism in sheehans syndrome

A

a post partum haemorrhage leads to pituitary infarction, this causes post-partum hypopituitarism.

19
Q

what happens to lactotrophs during pregnancy?

A

undergo hyperplasia resulting in enlargement of the anterior pituitary

20
Q

how does sheehans syndrome present?

A

lethargy, anorexia, weight loss. failure of lactation. failure to resume menses post-delivery.

21
Q

what causes the failure to lactate seen in sheehans syndrome?

A

prolactin deficiency

22
Q

what is the best way to visualize the pituitary gland?

A

through MRI

23
Q

What is pituitary apoplexy?

A

bleeding into the pituitary or loss of blood flow to the pituitary

24
Q

how can a pituitary apoplexy be precipitated?

A

using anti-coagulants

25
Q

when does a pituitary apoplexy have the most dramatic presentaion?

A

in patients with pre-existing pituitary tumours

26
Q

how does a pituitary apoplexy present?

A

severe sudden onset headache, bitemporal hemianopia. cavernous sinus involvement may lead to diplopia (CN 4,6)

27
Q

what cautions need to be taken when interpreting basal plasma hormone concentrations? (cortisol, T4, FSH/LH, GH, ACTH)

A

Cortisol should be measured at 9am.
T4 has a half life of 6 days.
FSH/LH is cyclical in women.
GH/ACTH are pulsatile

28
Q

how do you test for hormone levels to diagnose hypopituitarism?

A

insulin-induced hypoglycaemia stimulates GH and ACTH release, TRH stimulates TSH release and GnRH stimulates FSH/LH release. If the hormone levels dont increase post stimulation this is indiciative of hypopituitarism

29
Q

What can be seen in the radiological diagnosis of hypopituitarism?

A

posterior bright spot and empty sella turcica

30
Q

How is TSH deficiency treated?

A

levothyroxine. Aim for a fT4 above the middle of the reference range

31
Q

How is GH deficiency treated?

A

GH deficiency confirmed on dynamic pituitary function test, asses QoL. Daily injection of Genotrophin

32
Q

How is an ACTH deficiency treated?

A

Replacement of cortisol rather than ACTH using synthetic glucocorticoids.

33
Q

what are the names of the two drugs prescribed in the UK to treat ACTH deficiency?

A

Prednisolone and Hydorcortisone

34
Q

What must patients who take replacement steroids be told about?

A

Sick day rules: must wear a steroid alert pendant/bracelet. must double glucocorticoid dose if ill.

35
Q

How is FSH/LH deficiency treated in men?

A

Replace testosterone. However this does not restore sperm production, this is achieved through induction of spermatogenesis?

36
Q

How can spermatogenesis be induced?

A

gonadotrophin injections

37
Q

How is FSH/LH deficiency treated in women?

A

replace oestrogen with additional progestogen to prevent endometrial hyperplasia.

38
Q

How can ovulation be induced?

A

carefully timed gonadoptrophin injections (IVF)

39
Q

What is the usual cause of a pituitary apoplexy?

A

pre-existing adenoma

Y2 ENDOCRINOLOGY (13 decks)

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