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notes to flashcards year 2 - LCRS1 > hyposecretion of anterior pituitary disorders > Flashcards

hyposecretion of anterior pituitary disorders Flashcards

1
Q

what is a primary endocrine disorder?

A

disorder lies in endocrine gland

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2
Q

what is a secondary endocrine disorder?

A

disorder lies in anterior pituitary

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3
Q

what is a tertiary endocrine disorder?

A

disorder lies in hypithalamus

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4
Q

what is panhypopituitarism?

A

dec. production of all adenohypophysial hormones

congenital (rare) or acquired

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5
Q

what are the causes of congenital panhypopituitarism?

A

due to mutations of TF genes needed for normal pituitary development

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6
Q

what is the outcome and signs of this?

A

deficiency of GH and at least 1 other pituitary hormone

get short stature

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7
Q

what are the different types of acquired panhypopituitarism?

A
  • tumours: hypothalamic, pituitary
  • radiation
  • infection
  • TBI
  • infiltrative disease
  • pituitary apoplexy
  • peri-partum infarction (Sheehan’s syndrome)
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8
Q

what are the symptoms of FSH/LH deficiency?

A

secondary hypogonadism

  • reduced libido
  • secondary amenorrhoea
  • erectile dysfunction
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9
Q

what are the symptoms of ACTH deficiency?

A 
secondary hypoadrenalism (cortisol def)
- fatigue
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10
Q

what are the symptoms of TSH deficiency?

A

secondary hypothyroidism

  • fatigue
  • weight gain
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11
Q

what is Sheehan’s syndrome?

A
  • post-partum hypopituitarism secondary to hypotension
  • anterior pituitary often enlarges in pregnancy, hypotension from loss of blood from giving birth can mean the pituitary becomes under perfused and then infarcts
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12
Q

what is the presentation of Sheehan’s syndrome?

A
  • lethargy
  • anorexia
  • weight loss
  • failure of lactation
  • failure to resume menstrual cycles post delivery
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13
Q

what is pituitary apoplexy?

A
  • intra-pituitary haemorrhage/infarction
  • dramatic presentation in patients w/ pre-existing pituitary adenoma
  • precipitates by anti-coagulants
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14
Q

what are the symptoms of pituitary apoplexy?

A
  • severe sudden onset headache
  • bitemporal hemianopia (pressing on optic chiasm)
  • diplopia
  • ptosis
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15
Q

when ACTH is deficient, what is used to replace it? what should you check?

A

hydrocortisone

serum cortisol

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16
Q

when TSH is deficient, what is used to replace it? what should you check?

A

thyroxine

serum free T4

17
Q

when women LH/FSH is deficient, what is used to replace it? what should you check?

A

HRT

symptom improvement, withdrawal bleeds

18
Q

when men LH/FSH is deficient, what is used to replace it? what should you check?

A

testosterone

symptom improvement, serum testosterone

19
Q

when GH is deficient, what is used to replace it? what should you check?

A

GH

IGF1, growth chart (children)

20
Q

what are the different biochemical tests you can do to diagnose hypopituitarism?

A
  • basal plasma conc of target endocrine gland hormone

- stimulated pituitary function tests

21
Q 
describe the basal plasma conc levels of:
cortisol
T4
FSH/LH
GH/ACTH
A
  • cortisol: small volumes, varies throughout day
  • T4: long half life, take a while to fall
  • FSH/LH: cyclical
  • GH/ACTH: pulsatile
22
Q

describe the stimulated pituitary function tests

A
  • ACTH and GH = stress hormones
  • stress = hypoglycaemia
  • insulin induces hypoglycaemia stimulates GH and ACTH release
  • TRH in injection stimulates TSH release
  • GnRH stimulates FSH and LH release
23
Q

how can be radiology be used for diagnosis?

A

pituitary MRI

24
Q

what is the short stature definition in children?

A

<2SDs from mean

25
Q

what are the causes of short stature?

A
  • genetic
  • emotional deprivation
  • systemic disease
  • malnutrition
  • malabsorption
  • endocrine disorders
  • skeletal dysplasia
26
Q

what is dwarfism?

A

achondroplasia

  • mutation in FGF3
  • abnormalities in growth plate chondrocytes that impairs linear growth
  • results in average sized trunk and short arms/legs
27
Q

what causes pituitary dwarfism?

A

childhood GH def

28
Q

what causes Prader Willi syndrome?

A

GH deficiency secondary to hypothalamic dysfunction

29
Q

what causes laron dwarfism?

A

high local incidence

mutation in GH receptor treated with IGF-1 in childhood

30
Q

what are the causes of acquired GH def in adults?

A
  • trauma
  • pituitary tumour/surgery
  • cranial radiotherapy
31
Q

how can you diagnose acquired GH def in adults?

A
  • Provocative challenge (stimulation) test
  • cannot measure GH as it is pulsatile
  • GHRH + arginine (IV), insulin (IV), glucagon (IM), exercise
  • plasma GH measured at specific time points after
  • normally insulin causes peak in GH
32
Q

what is the response to hypoglycaemia in GH deficient people?

A

GH def people have a low GH response

33
Q

what is the metabolism and DoA of GH therapy?

A
  • max conc in plasma in 2-6 hours
  • hepatic/renal metabolism with short half life of 20mins
  • lasts well beyong clearance, peak IGF1 levels at approx 20 hrs
34
Q

what are the symptoms of GH deficiency?

A
  • reduced lean mass
  • reduced muscle strength
  • dec. plasma HDL
  • impaired psychological well-being
  • inc. adiposity
  • reduced exercise performance
  • raised LDL
35
Q

what are the risks of GHRT?

A
  • inc. susceptibilty to cancer

- expensive

notes to flashcards year 2 - LCRS1 (58 decks)

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