Hyposecretion of anterior pit Flashcards
What are the 5 anterior pituary hormones?
FSH/LH, TSH, GH, Prolactin, ACTH
In endocrine terms, explain the terms primary and secondary diseases?
The chain of command is Hypothallamus->Pit->Endocine gland
Problems with the gland-primary
Problems with the Pit-secondary
Problems with Hypothalamus-tertiary
What is Panhypopituarism?
Lose all pituary hormones
Rare to be born without a Ant Pit
What are the signs and causes of congenitale panhypoputuarism?
Usually genetic-caused by lack of GH and others in development
short stature and small pit gland on imagine
What are the causes of acquired panhypopituarism?
Tumours-hypothalamus/pituary Radiations-damage (GH most vulnerable, TSH resistant)-can be caused by radiotherapy Infections (eg:meningitis) Traumatic brain injury Infiltrative disease with stalk Inflammatory-hypophytitis-AID Piturary apoplexy (heamorrhage/infartion) sheerans syndroms
What are the signs and presentations of panhypopituarism?
Occasionally Simmons disease-
Relevant to deficiency. If lack:
FSH/LH: Secondary Hypogonadism (low libido, erectile dysf, amenhorroa)
ACTH-Secondary hypoadrenalism (no cortisol)-fatigue, death
TSH-secondary hypothyroidism-tired and others
Sheehan’s syndroms
What is Sheehans syndrome?
Specifically describes post-partum hypopituitary damage secondary to hypotension after post partum haemorrhage
Pregnant women have bigger AntPit (need more blood) (for prolactin)-so if heamorrhage, not enough blood comes to the AntPit, and it dies off (infarction)
PostPit is usually fine
Causes: Lethargy, anorexia, weight loss, (TSH/ACTH/GH), failure of lactation, failure to resume periods
What is pituary apoplexy? Causes and signs?
Intrapituitary haemorrhage or infarction
Often patients have pre-existing Pit tumours
Can be 1st presentations of adenomas
Can be precipitated by Anti-coagulants
Excruciating Headache, visual field defect (compress optic chiasm->Bitemproal Hemianopia (lose exterior vision)
Can also squash cranial nerves
What are the biochemical and radiological diagnosis methods of Hypopituiarsim?
1) Basal plasma conc of pit/target endocrine gland hormones-but very limited because these vary during the day (like cortisol), or T4 has a long half live, FSH/LH are cyclical, etc
So prefer:
2) Stimulated pituary function tests
ACTH and GH-in response to stress (Like hypoglyceamia (<2.2 mM)-makes large amounts
TRH/GnRH also can be given to make TSH. FSH/LH
3) radio-Pituatary MRI-reveals pit pathology (hemorrrhage, adenoma, empty sella (long term hypopit)
What replacement hormones can you give for therapy of hypopit?
ACTH-Hydrocortisone (check serum cortisol)
TSH-Thyroxine-serum free T4
Women LH/FSH -HRT (E2 and progesteran)-symptoms
Men LH/FSH -Testosterone-symptom improvements
GH-GH-check IGF1 and growth (in children)
One issue is that drugs cant mimic the timing/modulations of these hormones-cant quite give them same QOL as before)
Describe causes and symptoms Somatotrophin deficiency
In children-pathologically short (2SD lower than the charts/or drastic stop of growth)
in adults, effects unclear
-> present with lean mass, increased adiposity, increase Waist/Hip ratio, reduced strength?, Cholesterol profile wrong Feel bad => should resolve with treatment
WHat are some causes of Short stature?
Causes: Genetic (down syndrome, turners, PW-affects hypothylamus/GHRH)
Emotional deprivation, Systemic disease (CF, arthiritis), Malnutrition, Malabsorption (coeliac), Endocinre-cushing, Hypothry, GH, dwarfism (different ones-can be bones, can be LARON-shit GH receptors)
All in all-impact the growth pathway (GHRH, GH, GHR)
In adults usually caused by trauma
Do provocative challenge (stimulated test (Insulin, or GHRH+Arg, Glucagon, Exercise) -Cut off is not reaching 3mcg/L
