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Endocrine Disorders > Hypopituitarism > Flashcards

Hypopituitarism Flashcards

1
Q

Distinguish between primary and secondary disease

A

Primary is where the gland itself is affected
Secondary is where there is an issue with signalling from the hypothalamus or pituitary gland

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2
Q

What is primary hypothyroidism?

A

Autoimmune destruction of thyroid gland - Hashimoto’s
T4/3 low, TSH high

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3
Q

What is secondary hypothyroidism?

A

Pituitary tumour affecting thyrotrophs so no TSH
TSH, T4/3 all low

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4
Q

What is primary hypoadrenalism?

A

Autoimmune destruction of adrenal glands
Low cortisol, high ACTH

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5
Q

What do CRH levels look like in primary hypoadrenalism?

A

They would be high but it’s difficult to measure

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6
Q

What is secondary hypoadrenalism?

A

Pituitary tumour affecting corticotrophs so low ACTH & cortisol

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7
Q

What is primary hyopogonadism?

A

Destruction of the testes by mumps or ovaries by chemotherapy. Results in low oestrogen/testosterone and high LH/FSH

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8
Q

What is secondary hypogonadism?

A

Pituitary tumour affecting gonadotrophs. Results in low oestrogen, testosterone, LH & FSH

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9
Q

Explain the congenital causes of hypopituitarism

A

It’s rare and caused by a mutation in the TFs that are involved in anterior pituitary development.
Deficiency in growth hormone and one other AP hormone

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10
Q

Signs of hypopituitarism

A

short stature and hypoplastic pituitary gland on MRI (underdeveloped)

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11
Q

Causes of acquired hypopituitarism

A

Tumours
Infection
Surgery
Radiation
Pituitary surgery
Hypophysitis (inflammation)
Pituitary apoplexy - haemorrhage or infraction
Peri-partum infarction (Sheehan’s syndrome)

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12
Q

Name of total loss of pituitary function

A

Panhypopituitarism

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13
Q

Presentations of low FSH/LH

A

Secondary amenorrhoea
Reduced libido
Reduced pubic hair
Erectile dysfunction

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14
Q

Presentation of low PRL

A

Inability to breastfeed

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15
Q

Presentation of low ACTH

A

Fatigue
NOT a salt losing crisis because aldosterone is under control by renin-angiotensin

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16
Q

Presentation of low TSH

A

Fatigue

17
Q

Presentation of low GH

A

Short stature IN CHILDREN
Reduced QoL

18
Q

What happens to the anterior pituitary during pregancy?

A

It enlarges aka lactotroph hyperplasia

19
Q

What is Sheehan’s Syndrome?

A

Post-partum haemorrhage leads to infarction, often secondary to hypotension
Most common in developing countries

20
Q

Signs/Symptoms of Sheehan’s

A

Inability to resume menses
Lethargy, weight loss, anorexia
Issues with lactation

21
Q

What is pituitary apoplexy?

A

Haemorrhage or infarction to pituitary gland often inidcates a pituitary adenoma

22
Q

Medical term for double vision

A

Diplopia

23
Q

What kind of medication precipitates pituitary apoplexy?

A

Anti-coagulants (blood thinners)

24
Q

Presentation of pit. apoplexy

A

Severe headache
Bitemoporal hemianopia
Diplopia
Ptosis (drooping of upper eyelid)

25
Q

What is a dynamic pituitary function test?

A

Where hypoglycaemic stress is induced by administering insulin.
GH/ACTH are released in response to stress and are measures
TRH and GnRH cause TSH & LH/FSH release respectively

26
Q

Treatment of GH deficiency

A

Daily injection of GH
Measure QoL and see if there is improvement
Plasma IGF-1 measured

27
Q

Treatment of TSH deficiency

A

Replace with levothyroxine
in secondary hypothyroidism aim for a T4 above the middle of the reference range

28
Q

Treatment of ACTH deficiency

A

Replace cortisol rather than ACTH
Give synthetic glucocorticoids like hydrocortisone (3x daily) or prednisolone (once daily)

29
Q

Features of adrenal crisis

A

Vomiting, dizziness, hypotension, may even collapse and die

30
Q

Sick day rules for ACTH deficiency

A

Wear steroid bracelet
Double dose of glucocorticoids
Inject intramuscularly (vomiting means they can’t take it orally)

31
Q

Treatment of FSH/LH deficiency (men - no fertility)

A

Topical or intramuscular injections of testosterone
Testosterone will not cause spermatogenesis

32
Q

Treatment of FSH/LH deficiency (men - fertility)

A

Induce spermatogenesis by gonadotropin injections
Best response if secondary hypogonadism occurs AFTER puberty

33
Q

Treatment of FSH/LH deficiency (women - no fertility)

A

Administer oestrogen orally or topically
Progesterone also needed

34
Q

Why is progesterone needed alongside oestrogen?

A

To prevent endometrial hyperplasia if the womb is intact

35
Q

Treatment of FSH/LH deficiency (women - fertility)

A

Gonadotropin injections needed to induce ovulation - IVF

Endocrine Disorders (3 decks)

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