Hypopituitarism

Question 1

What type of hypothyroidism is more common?

Answer 1

Primary

Question 2

Describe T3, T4 and TSH levels in primary hypothyroidism

Answer 2

T3 and T4 fall

TSH increases

Question 3

Describe T3, T4 and TSH levels in secondary hypothyroidism

Answer 3

T3, T4 and TSH fall

Question 4

What is primary hypothyroidism?

Answer 4

Autoimmune destruction of the thyroid

Question 5

Describe cortisol and ACTH levels in primary hypoadrenalism

Answer 5

Cortisol falls

ACTH increases

Question 6

Describe cortisol and ACTH levels in secondary hypoadrenalism

Answer 6

ACTH and cortisol falls

Question 7

Out of cortisol and aldosterone what is regulated by ACTH?

Answer 7

Only cortisol, aldosterone is regulated by renin angiotensin

Question 8

Describe LH/FSH, testosterone/oestrogen levels in secondary hypogonadism

Answer 8

All fall

Question 9

Describe LH/FSH, testosterone/oestrogen levels in primary hypogonadism

Answer 9

LH/FSH increase

Test/oest fall

Question 10

What are the main causes of hypopituitarism?

Answer 10

Acquired eg tumor, radiation, infection, surgery, inflammation, brain injury

Question 11

What is loss of anterior and posterior pituitary function called?

Answer 11

Panhypopituitarism

Question 12

Which pituitary hormones are most sensitive to radiation?

Answer 12

GH and gonadotrophins

Question 13

How does hypopituitarism present- go through all the hormones?

Answer 13

FSH/LH= Reduced libido, Secondary amenorrhoea, Erectile dysfunction, Reduced pubic hair

ACTH= fatigue

TSH= fatigue

GH= reduced quality of life

Prolactin= inability to breastfeed

Question 14

What is Sheehan’s syndrome?

Answer 14

Post-partum hypopituitarism secondary to hypotension (post partum haemorrhage - PPH)- the enlarged pituitary gland doesnt get enough blood and infarcts

Question 15

What happens to the anterior pituitary during pregnancy?

Answer 15

Enlarges

Question 16

How does Sheehan’s syndrome present?

Answer 16

Lethargy, anorexia, weight loss – TSH/ACTH/(GH) deficiency
Failure of lactation – prolactin deficiency
Failure to resume menses post-delivery
Posterior pituitary usually not affected

Question 17

How do you view the pituitary gland?

Answer 17

Pituitary MRI

Question 18

What is pituitary apoplexy?

Answer 18

Intra-pituitary haemorrhage or infarction

Question 19

How does pituitary apoplexy present?

Answer 19

Severe sudden headache
Bitemporal hemianopia
Diplopia or ptosis (droopy eyelid)

Question 20

How is hypopituitarism diagnosed?

Answer 20

Induce hypoglycaemia (via insulin injection) so they release stress hormones (GH and ACTH) and measure cortisol

Inject TRH to stimulate TSH release and measure

Inject GnRH to stimulate FSH and LH release

Question 21

How is hypopituitarism treated- go through all the hormones?

Answer 21

GH= GH replacements- then do a questionnaire to measure quality of life and measure plasma IGF-1

TSH= levothyroxine

ACTH= replace cortisol using prednisolone or hydrocortisone

FSH/LH= for men if no fertility needed replace testosterone, if needed gonadotropin injections. foe women if no fertility needed replace oestrogen if needed induce ovulation via gonadotropin injections (IVF)

Question 22

What is the daily dose of prednisolone?

Answer 22

3mg once a day

Question 23

What is the daily dose of hydrocortisone?

Answer 23

3 times a day 10/5mg

Question 24

What are sick day rules for ACTH?

Answer 24

At risk of adrenal crisis if they miss a day of their meds so they:
should wear a steroid alert
double their steroid dose if fever
if unable to take meds eg vomitting go to A&E straight away

Question 25

What happens to FSH/LH in menopause?

Answer 25

Levels rise