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BRS2 Endocrinology > Hypopituitarism > Flashcards

Hypopituitarism Flashcards

1
Q

Name the anterior pituitary hormones

A
  1. GH
  2. Prolactin
  3. ACTH
  4. TSH
  5. LH
  6. FSH
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2
Q

What are the cells producing GH called?

A

Somatotrophs

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3
Q

What are the cells producing prolactin called?

A

Lactotrophs

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4
Q

What are the cells producing TSH called?

A

Thyrotrophs

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5
Q

What are the cells producing ACTH called?

A

Corticotrophs

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6
Q

What are the cells producing LH and FSH called?

A

Gonadotrophs

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7
Q

Which circulatory system do hypothalamic releasing or inhibitory factors travel in to regulate anterior pituitary hormone production?

A

Hypothalamo-hypophysial portal system

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8
Q

Production of which hormones could be compromised due to the gland itself failing (primary) or a regulatory organ failing (secondary)?

A

Thyroid - T3, T4
Adrenal Cortex - Cortisol
Gonads - LH, FSH

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9
Q

Production of which hormones could be compromised due to the gland itself failing (primary) or a regulatory organ failing (secondary)?

A

Thyroid - T3, T4
Adrenal Cortex - Cortisol
Gonads - LH, FSH

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10
Q

Cause of primary hypothyroidism

A

Hashimoto’s disease (autoimmune condition)

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11
Q

Most common cause of secondary hypothyroidism

A

Pituitary tumour (affecting tyrotrophs)

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12
Q

Which adrenal hormone is regulated by ACTH?

A

Cortisol

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13
Q

How are the T3, T4 and TSH levels affected in primary hypothyroidism?

A

T3, T4 fall
TSH increases

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14
Q

How are the T3, T4 and TSH levels affected in secondary hypothyroidism?

A

TSH falls
T3, T4 fall

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15
Q

How are the Cortisol and ACTH levels affected in primary hypoadrenalism?

A

Cortisol falls
ACTH increases

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16
Q

How are the Cortisol and ACTH levels affected in secondary hypoadrenalism?

A

ACTH falls
Cortisol falls

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17
Q

How are the testosterone (males), oestrogen (females), LH and FSH levels affected in primary hypogonadism?

A

Testosterone or Oestrogen fall
LH and FSH increase

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18
Q

How are the testosterone (males), oestrogen (females), LH and FSH levels affected in secondary hypogonadism?

A

LH and FSH fall
Testosterone or Oestrogen fall

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19
Q

What are the 2 types of hypopituitarism?

A

Congenital and Acquired

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20
Q

Which type of hypopituitarism is more common?

A

Acquired

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21
Q

Which type of hypopituitarism is characterised by GH deficiency and at least 1 more pituitary hormone?

A

Congenital

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22
Q

Short stature and hypoplastic anterior pituitary gland on MRI are related with which type of hypopituitarism?

A

Congenital

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23
Q

Pituitary adenomas, radiation damage to the pituitary, meningitis cause which type of hypopituitarism?

A

Acquired

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24
Q

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

A

Panhypopituitarism

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25
Q

Which anterior pituitary hormones are most sensitive to radiotherapy?

A

GH and gonadotrophins

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26
Q

How long after radiotherapy does the risk of pituitary damage persist?

A

Up to 10 years after

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27
Q

What are the symptoms presented by reduced levels of FSH and LH?

A
  • Reduced libido
  • Secondary amenorrhoea
  • Erectile dysfunction
  • Less pubic hair
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28
Q

What is the symptom presented by reduced levels of TSH?

A

Fatigue

29
Q

What is the symptom presented by reduced levels of ACTH?

A

Fatigue

30
Q

What are the symptoms presented by reduced levels of GH?

A
  • Reduced quality of life
  • Short stature in children
31
Q

What is the symptom presented by reduced levels of prolactin?

A

Inability to breastfeed

32
Q

What is the condition causing post-partum hypopituitarism secondary to hypotension called?

A

Sheehan’s Syndrome

33
Q

Why is Sheehan’s Syndrome secondary to hypotension?

A
  1. Hypotension caused by post-partum haemorrhage
  2. PPH leads to pituitary infarction
34
Q

Why does the anterior pituitary enlarge during pregnancy?

A

Lactotroph hyperplasia

35
Q

What are the symptoms presented with Sheehan’s Syndorme?

A
  • Lethargy, anorexia, weight loss - TSH/ACTH/GH deficiency
  • Failure of lactation - PRL deficiency
  • Failure to resume menses post-delivery
36
Q

What causes pituitary apoplexy?

A

Bleeding (haemorrgae) into the pituitary

37
Q

What may be the first presentation of pituitary adenoma?

A

Pituitary apoplexy

38
Q

How would we treat pituitary apoplexy?

A

Anti-coagulants (blood thinners)

39
Q

What are the main symptoms of pituitary apoplexy?

A

Severe sudden onset headache
Visual field defect

40
Q

What does cavernous sinus involvement in pituitary apoplexy lead to?

A

Diplopia (IV, VI) or Ptosis (III)

41
Q

What causes the visual field defect in pituitary apoplexy or pituitary adenoma?

A

Compressed optic chiasm

42
Q

What is the term given for the visual defect in pituitary apoplexy or adenoma?

A

Bitemporal hemianopia

43
Q

Which conditions present with bitemporal hemianopia?

A

Pituitary apoplexy and pituitary adenoma

44
Q

What are the stress hormones released by anterior pituitary?

A

GH and ACTH

45
Q

What are the stress hormones released by anterior pituitary?

A

GH and ACTH

46
Q

What does the “stress” in stress hormones indicate?

A

Insulin induced hypoglycaemia (<2.2mM)

47
Q

How is hypopituitarism diagnosed?

A

Dynamic pituitary function test (Biochemical)
Pituitary MRI (Radiological)

48
Q

Which hormone stimulates TSH release?

A

TRH (Tyrotroph Releasing Hormone)

49
Q

Which hormone stimulates LH/FSH release?

A

GnRH (Gonadotrophin Releasing Hormone)

50
Q

When should cortisol level be checked and why?

A

Early in the morning as cortisol has a diurnal rhythm

51
Q

Which anterior pituitary hormone axis does not need hormone replacement?

A

Prolactin

52
Q

How is GH deficiency treated?

A

Daily injections (not oral)

53
Q

How is response to GH replacement measured?

A

QoL Assesment
Plasma IGF-1

54
Q

How is TSH deficiency treated?

A

Levothyroxine - once a day

55
Q

How is response to TSH deficiency treatment measured?

A

fT4 above the middle of reference range
(TSH levels won’t indicate anything)

56
Q

How is ACTH deficiency treated?

A

Either:
Prednisolone - once a day AM (e.g 3mg)
or
Hydrocortisone - 3 times a day (10/5/5mg)

57
Q

What is the difference between prednisone and prednisolone?

A
  • Prednisone is a prodrug, which is converted into prednisolone in the liver.
  • Prednisolone is the active drug and particularly prescribed to patients with liver dysfunction.
58
Q

Who is at risk of adrenal crisis?

A

Primary or secondary hypoadrenalism patients

59
Q

What is adrenal crisis triggered by?

A

Triggered by an intercurrent illness (in patients with hypoadrenalism)

60
Q

What are the symptoms of adrenal crisis?

A
  • Dizziness
  • Hypotension
  • Vomiting
  • Weakness
  • Potential collapse and death
61
Q

What is the purpose of sick day rules for patients with adrenal insufficiency?

A

To prevent collapse and death during adrenal crisis

62
Q

What are the sick day rules for patients with adrenal insufficiency?

A
  • Steroid alert bracelet
  • Double the glucocortocoid dose if fever/ illness
  • Inject IM or come to A&E if unable to take oral tablets due to vomiting
63
Q

How is FSH/LH deficiency treated in men with no fertility required?

A

Topical or IM testosterone

64
Q

How is FSH/LH deficiency treated in men with fertility required?

A

Gonadotropin injections

65
Q

Why does testosterone replacement not provide fertility?

A

Sperm production is dependent on LH and FSH

66
Q

How is response to gonadotropin replacement in men measured?

A

Testosterone levels measured
Semen analysis

67
Q

How is FSH/LH deficiency treated in women with no fertility required?

A

Oral or topical oestrogen
Additional progesterone if uterus is intact

68
Q

Why is the additional progesterone needed in oestrogen replacement therapy if uterus is intact?

A

To prevent endometrial hyperplasia

69
Q

How is FSH/LH deficiency treated in women with fertility required?

A
  • Ovulation can be induced by carefully timed gonadotropin injections
  • Possibly IVF

BRS2 Endocrinology (3 decks)

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