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MBChB IV Endocrinology > Hypopituitarism > Flashcards

Hypopituitarism Flashcards

1
Q

How big is the pituitary gland and how much does it weight?

A

Pea sized

0.5g

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2
Q

Which hormones are secreted by the anterior pituitary gland?

A 
Prolactin
FSH
LH
TSH
ACTH
GH
MSH
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3
Q

Which hormones are secreted by the posterior pituitary gland?

A

Oxytocin

ADH

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4
Q

Which hormones are secreted by the hypothalamus?

A 
CRH
GHRH
GnRH
TRH
Somatostatin
Dopamine
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5
Q

What is a hormone?

A

A substance, usually a peptide or steroid, produced by one tissue and conveyed by the bloodstream to another to effect physiological activity eg growth, metabolism

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6
Q

How do you investigate for a hormone deficiency?

A

Stimulatory test

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7
Q

How do you investigate for hormone excess?

A

Suppression test

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8
Q

When should cortisol be tested for suspected adrenal insufficiency?

A

8am when it should be highest

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9
Q

When should cortisol be tested for suspected Cushing’s?

A

12am when it should be lowest

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10
Q

Name common causes of hypopituitarism

A 
Surgical hypophysectomy
Compression by tumour
Pituitary radiotherapy
Sheehan syndrome
Empty sella syndrome
Metastatic tumours/granulomas
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11
Q

What are the 9Is of hypopituitarism?

A 
Invasive
Infarction
Infiltrative
Injury
Immunological
Iatrogenic
Infectious
Isolated
Idiopathic
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12
Q

Give examples of invasive causes of hypopituitarism?

A

Pituitary adenoma

Craniopharyngioma

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13
Q

Give examples of infarction causes of hypopituitarism?

A

Pituitary apoplexy

Sheehan syndrome

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14
Q

Give examples of infiltrative causes of hypopituitarism?

A

Sarcoidosis

Haemochromatosis

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15
Q

Give examples of immunological causes of hypopituitarism?

A

Autoimmune

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16
Q

Give examples of iatrogenic causes of hypopituitarism?

A

Pituitary surgery

Radiation therapy

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17
Q

Give examples of infectious causes of hypopituitarism?

A

TB

18
Q

Give examples of isolated causes of hypopituitarism?

A

E.g gonadotrophin deficiency
Kallman’s syndrome
Anorexia nervosa

19
Q

Give examples of injury causes of hypopituitarism?

A

Trauma

20
Q

What are the most common causes of hypopituitarism?

A

Macroadenomas

Followed by vascular

21
Q

What is the classical fallout pattern of hypopituitarism?

A

Gonadal
GH
Thyroid
ACTH

22
Q

Hypofunction of the pituitary gland results in?

A 
2° hypogonadotrophic hypogonadism 
GH deficiency
2° hypothyroidism
2° hypoadrenalism
Incr/decr prolactin
23
Q

What is hypogonadotrophic hypogonadism and how do these patients present?

A

Low LH, FSH, oestradiol, testosterone
Amenorrhoea in females
ED and decreased libido in males

24
Q

What is GH deficiency and how do these patients present?

A

Low GH
Growth retardation
Dwarfism

25
Q

What is hypothyroidism and how do these patients present?

A

Low/normal TSH
Low T3
Low T4
Secondary hypothyroidism

26
Q

What is hypoadrenalism and how do these patients present?

A

Low ACTH, cortisol

Secondary hypoadrenalism

27
Q

Name signs of pituitary failure

A 
Fine scalp hair
Ocular palsies
Wrinkling of skin
Evidence of prev acromegaly/Cushing's
Loss of body hair
Pale, dry, fine skin
Testicular atrophy
Loss of mm bulk
Plump w/ female distribution of fat
Hypotension
Galactorrhoea
Niiple pallor
Optic atrophy
Temporal field defect
Scar from prev pituitary surgery
28
Q

What tests do you perform to test for anterior hypopituitarism?

A

ACTH deficiency
- 8h00 cortisol / ACTH stimulation test / insulin
tolerance test
LH/FSH deficiency
- serum LH/FSH/testosterone/oestradiol
TSH deficiency
- random serum T4, TSH (but TSH can be ↑/↓/N)
Growth hormone deficiency
- only investigate if GH replacement is considered
- exercise / other stimulatory tests (eg glucagon)

29
Q

What is empty sella syndrome?

A

Subarachnoid space extends into sella turcica -> filled with CSF -> remodelling
Pituitary function normal but must be checked

30
Q

What are causes of empty sella syndrome?

A 
Congenital 
2° to Sheehan syndrome
Pituitary radiation
Pituitary surgery
Post pituitary adenoma infarction
31
Q

What is pituitary apoplexy?

A

Rare
Frightening syndrome of violent headache, visual and VN disturbances, mental confusion/coma/death from haemorrhage or infarction of pituitary gland
Diagnosed on MRI findings

32
Q

Causes of pituitary apoplexy?

A

Usually pituitary tumour
DM
Head trauma
Anticoagulation therapy

33
Q

How do you treat pituitary apoplexy?

A

High dose dexamethasone
Trans-sphenoidal pituitary decompression
Evaluate for deficiencies afterwards

34
Q

What is Sheehan’s syndrome?

A

Postpartum pituitary necrosis preceded by obstetric haemorrhage leadin to circulatory collapse
Severe hypotension -> pituitary ischaemia

35
Q

Which part of the pituitary gland does Sheehan’s syndrome usually spare?

A

Posterior pituitary gland

36
Q

How do patients with Sheehan’s syndrome present?

A

Failure to lactate
Loss of axillary + pubic hair
Hypothyroidism
Hypocortisolism

37
Q

What is important in the treatment of hypopituitarism?

A

Always replace cortisol before T4

38
Q

ACTH hormone replacement

A

Hydrocortisone 10mg am, 5mg noon 5mg evening
Cortisone acetate 25mg am 12.5mg pm
Prednisone 5mg am 2.5mg pm

39
Q

TSH hormone replacement

A

L-thyroxine 0.075-0.15mg daily

40
Q

FSH/LH hormone replacement

A

Males

  • testosterone enanthate 200mg IM every 2 weeks
  • testosterone skin patch 5mg/d

Females

  • conjugated oestrogen 0.65-1.25mg qd for 25days
  • progesterone 5-10mg qd on days 16-25
  • oestradiol skin patch 0.5mg every other day
  • menopausal gonadotropins
  • HCG
41
Q

GH hormone replacement

A

Adults
- somatotropin 0.3-1.0mg SC qd
Children
- somatotropin 0.02-0.05 mg/kg/day

MBChB IV Endocrinology (8 decks)

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