Hypopituitarism & Anterior Pituitary dysfunction

Question 1

what are the anterior pituitary hormones

Answer 1

Growth Hormone
Prolactin
Thyroid stimulating hormone
Lutenising hormone/Follicle stimulating hormone
Adrenocorticotrophic hormone

Question 2

where does the pituitary sit

Answer 2

sella turcica of sphenoid bone

Question 3

what does the anterior pituitary rely on?

Answer 3

the hypothalamus (to regulate function by releasing or inhibiting factors)

Question 4

what factors are released by the hypothalamus for the AP

Answer 4

growth hormone releasing hormone
somatostatin
thyrotrophin releasing hormone
dopamine
gonadotrophin releasing hormone
corticotrophin releasing hormone

Question 5

what is a primary endocrine disease

Answer 5

disease where the pathology originates in the gland itself e.g ovaries

Question 6

what is a secondary endocrine disease

Answer 6

disease where the pathology originates in the signals from the hypothalamus/anterior pituitary

Question 7

what is primary hypothyroidism

Answer 7

thyroid doesn’t produce thyroxine
Hashimotos
T3&4 fall TSH high

Question 8

what is secondary hypothyroidism

Answer 8

thyroid functioning, no releasing signals

TSH falls, T3/4 fall

Question 9

what is primary hypoadrenalism

Answer 9

Addisons disease
adrenal cortex damaged/destroyed by autoimmune
ACTH high, cortisol low

Question 10

what is secondary hypoadrenalism

Answer 10

adrenal cortex functioning,
but can’t make ACTH
ACTH falls, cortisol low

Question 11

what is primary hypogonadism

Answer 11

gonads not functional

LH and FSH high, test/oest low

Question 12

what is secondary hypogonadism

Answer 12

gonadotrophs (pituitary) damaged/hypothalamus damage

LH/FSH fall, test/oest fall

Question 13

congenital causes of hypopituitarism

Answer 13

mutations for anterior pituitary transcription e.g PROP1

Question 14

what are the signs of congenital hypopituitarism

Answer 14

deficient in GH & at least one more hormone since birth

hypoplastic (underdeveloped) anterior pituitary

Question 15

acquired causes of hypopituitarism

Answer 15

Tumours
radiation
infection
traumatic brain injury
pituitary surgery
inflammation/autoimmunity
pituitary apoplexy

Question 16

what is hypophysitis

Answer 16

inflammation of the pituitary or infundibulum

Question 17

what is pituitary apoplexy

Answer 17

bleeding into a pituitary adenoma (causing sudden enlargement and damaging the pituitary)

Question 18

what is the name for complete loss of pituitary function (post. and ant.)

Answer 18

panhypopituitarism

Question 19

what are the causes of pituitary apoplexy

Answer 19

haemorrhage

less commonly infarction

Question 20

what procedures may cause radiotherapy-induced hypopituitarism

Answer 20

acromegaly treatment (radio right to pit.)
nasopharyngeal carcinoma treatment (indirect)

Question 21

what hormones are most sensitive to radioactivity

Answer 21

Growth hormone and gonadotrophins

Prolactin

Question 22

how long does the risk of radiotherapy persist for?

Answer 22

up to 10yrs

requires annual assessment

Question 23

how does hypopituitarism affecting LH/FSH present?

Answer 23

reduced libido
secondary amenorrhoea
erectile dysfunction
reduced pubic hair

Question 24

how does hypopituitarism affecting ACTH present?

Answer 24

fatigue

no salt balance issues

Question 25

how does hypopituitarism affecting TSH present?

Answer 25

fatigue, weight gain

Question 26

how does hypopituitarism affecting GH present?

Answer 26

reduced quality of life, short stature in children

Question 27

how does hypopituitarism affecting Prolactin present?

Answer 27

inability to breastfeed

Question 28

what is sheehan's syndrome?

Answer 28

post-partum hypopituitarism secondary to hypotension/post-partum haemorrhage

Question 29

how does sheehans syndrome happen?

Answer 29

anterior pituitary damaged following hypotension during delivery, causing pituitary infarction

Question 30

what are the signs of sheehans syndrome

Answer 30

lethargy, anorexia, weight loss, failure of lactation, failure to resume menses

Question 31

what happens to the pituitary during pregnancy

Answer 31

enlargement (lactotroph hyperplasia)

Question 32

what is the onset of pituitary apoplexy?

Answer 32

dramatic and sudden | often precipitated by anti-coagulants

Question 33

what are the signs of pituitary apoplexy

Answer 33

severe sudden onset headache visual field defect - bitemporal hemianopia possible diplopia and ptosis

Question 34

what methods can be used to diagnose hypopituitarism

Answer 34

blood tests, dynamic pituitary function tests (stress test), pituitary MRI

Question 35

what hormone dysfunction cannot be treated

Answer 35

prolactin

Question 36

what is the guidance for treating hypopituitarism affecting GH?

Answer 36

daily injection of GH | measure response by improvement in quality of life and plasma IGF-1

Question 37

how to confirm GH treatment is working

Answer 37

assess quality of life and measure response to this | measure plasma IGF-1

Question 38

what is the guidance for treating hypopituitarism affecting TSH

Answer 38

once daily levothyroxine | aim for fT4 above middle of reference range

Question 39

what is the guidance for treating hypopituitarism affecting ACTH?

Answer 39

prednisolone once daily AM or hydrocortisone 3x daily

Question 40

what is an adrenal crisis

Answer 40

dizziness, hypotension, vomiting, weakness triggered by intercurrent illness can collapse and die

Question 41

what should patients taking replacement steroids be advised to do?

Answer 41

keep steroid alert pendant double steroid dose if fever/intercurrent illness if unable to take tablets, inject IM or come to A&E

Question 42

what are the guidelines for hypopituitarism affecting LH/FSH in men?

Answer 42

replace testosterone topically or IM | if fertility required - gonadotrophin injections, sperm production should resume 6-12 months after

Question 43

when is fertility in men best conserved?

Answer 43

if secondary hypogonadism developed after puberty (gonads are right size/development)

Question 44

what are the guidelines for hypopituitarism affecting LH/FSH in women?

Answer 44

oral or topical oestrogen addition of progesterone if uterus is intact to prevent endometrial hyperplasia if fertility is required, carefully timed IVF and gonadotrophin injections can induce ovulation

Question 45

signs/presentation of pituitary apoplexy

Answer 45

sudden onset - blood/haemorrhage in cavernous sinus | cranial III defect as blood compresses this - ptosis