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Endocrinology > Hyposecretion Of Anterior Pituitary Hormones > Flashcards

Hyposecretion Of Anterior Pituitary Hormones Flashcards

1
Q

What are the anterior pituitary hormones

A

1) gonadotrophins - FSH/LH
2) prolactin
3) growth hormone
4) TSH - thyroid stimulating hormone
5) ACTH - adrenocorticotropic hormone

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2
Q

What is the chain of command in the hypothalamo-adrenohypophysial axis?

A

Hypothalamus -> releasing/inhibiting hormones -> anterior pituitary -> anterior pituitary hormone -> gland -> glandular hormone

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3
Q

What is primary endocrine disease?

A

Problem is with the end gland itself.

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4
Q

What is secondary endocrine disease?

A

Problem is in the anterior pituitary

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5
Q

What is hypopituitarism?

A

Decreased production of ALL anterior pituitary hormones (panhypopituitarism)
OR of specific hormones

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6
Q

What are the two types of panhypopituitarism?

A

Congenital (rare) or acquired

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7
Q

What is congenital panhypopituitarism usually caused by?

A

Mutations of the transcription factor genes needed for normal anterior pituitary development - eg: PROP1 mutation

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8
Q

What hormone/s are people with congenital panhypopituitarism usually deficient in?

A

Growth hormone and at least one more anterior pituitary hormone

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9
Q

What do people with congenital panhypopituitarism present with?

A

Short stature

Because of lack of growth hormone

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10
Q

What shows up on the MRI of someone with congenital panhypopituitarism?

A

Hypoplastic anterior pituitary gland

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11
Q

What are the possible causes of acquired panhypopituitarism

A 
Tumours
Radiation
Infection
Traumatic brain injury
Infiltrative disease
Inflammatory
Pituitary apoplexy
Peri-partum infarction
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12
Q

What are the two types of tumours that can cause acquired panhypopituitarism

A

Hypothalamic - craniopharyngiomas (squash the pituitary, prevent releasing hormones from happening)
Pituitary - adenomas (benign tumours), metastases (from other cancers), cysts (that can squash the anterior pituitary)

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13
Q

Which pituitary hormone is most and least resistant to radiotherapy.

A

GH is most vulnerable. TSH relatively resistant

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14
Q

What is the autoimmune inflammation of the pituitary called?

A

Hypophysitis

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15
Q

What is the presentation of panhypopituitarism

A

Symptoms rely on deficient hormones

  • Secondary hypogonadism
  • reduced libido
  • secondary amenorrhoea
  • erectile dysfunction
  • (cortisol deficiency - secondary hypoadrenalism)
  • fatigue
  • Secondary hypothyroidism
  • fatigue
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16
Q

What happens in Sheehan’s syndrome

A
  • specific to post partum hypopituitarism secondary to hypotension
  • most common cause is post partum haemorrhage
  • in pregnancy, pituitary gland gets bigger, because of lactotroph hyperplasia to make more prolactin.
  • haemorrhage causes loss of blood supply - pituitary infarction
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17
Q

What is the presenartion of Sheehan’s syndrome

A
  • lethargy, anorexia, weight loss - TSH, ACTH, GH deficiency
  • failure of lactation - PRL deficiency
  • failure to resume menses post delivery

(Post pituitary not affected)

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19
Q

What can pituitary apoplexy be precipitated by?

A

Anti-coagulants

22
Q

What is pituitary apoplexy

A

Bleeding into or impaired blood supply of the pituitary gland - haemorrhage/infarction

23
Q

What is the symptoms of pituitary apoplexy

A

Severe Sudden onset headache
Visual field defect - bitemporal hemianopia
Cavernous sinus - squash cranial nerves - Diplopia (double vision - IV, VI), ptosis (drooping of upper eyelid - III)

24
Q

How do diagnose hypopituitarism biochemically?

A

1) BASAL plasma conc of pituitary or target endocrine gland hormones

25
Q

Why could the interpretation be limited for blood analysis of hormones when testing for hypopituitarism?

A

> hormone profile for a lot of hormones varies throughout the days/weeks/years
(Eg - cortisol changes over a day, T4 - circulating half life of 6 days so if pt comes to A&E with apoplexy immediately T4 could still be high, FSH/LH - cyclical , GH/ACTH - pulsatile)

26
Q

What is a stimulated (dynamic) pituitary function test?

A

ACTH and GH - Stress induced in the body by inducing hypoglycaemia (<2.2mM) by giving insulin. ACTH and GH (stress hormones) should increase in the blood to increase blood glucose.

TRH - stimulates TSH release

GnRH - stimulates FSH and LH release

TLDR: insulin, TRH, GnRH given to induce production of pituitary hormones

27
Q

What is the HRT for ACTH and what do you monitor in the blood

A

Hydrocortisone given diurnally

Serum cortisol

28
Q

What is the HRT for TSH and what do you monitor in the blood?

A

Thyroxine

Serum free T4

29
Q

What is the HRT for LH/FSH replacement in women and what do you monitor in the blood?

A

Oestrogen + progestagen

Symptom improvement, withdrawal bleeds

30
Q

What is the HRT for LH/FSH in men, and what do you monitor in the blood

A

Testosterone

Symptom improvement, serum testosterone

31
Q

What is the HRT for GH and what do you monitor in the blood

A

Growth hormone injections

IGF1 - produced by the liver in response to growth hormone
Growth (in children)

32
Q

What are the effects of growth hormone deficiency in children?

A

short stature (=2 SDs less than mean height for children of that age and sex)

33
Q

What are some causes of short stature

A 
Genetic
Emotional Deprivation
Systemic disease
Malnutrition
Malabsorption
Endocrine Disorders
Skeletal dysplasias
34
Q

What are some genetic causes of short stature

A

Down’s syndrome, Turner’s syndrome, Prader Willi syndrome

35
Q

Draw the growth axis

A

[insert growth axis here]

36
Q

What causes short stature in Prader Willi syndrome?

A

GH deficiency due to hypothalamic dysfunction (can be made better with GH treatment)

37
Q

What causes short stature in pituitary dwarfism?

A

Decrease in hormones produced by the anterior pituitary

38
Q

What causes short stature in Laron dwarfism?

A

Mutation of GH receptors which causes lack of production of IGF-1. (Giving IGF-1 treatment in childhood can increase height)

39
Q

What is MID PARENTAL HEIGHT

A

A predicted adult height –

based on father’s & mother’s height

40
Q

Why is random GH tests of little use?

A

GH is pulsatile

41
Q

How do you diagnose GH deficiency?

A

Through a stimulation test

42
Q

What are some GH provocation tests

A

GHRH + ARGININE (i.v.) (in combination more effective than each alone)
INSULIN (i.v.) – via hypoglycaemia
GLUCAGON (i.m.)
EXERCISE (e.g. 10 min step climbing; when appropriate)

43
Q

GH DEFICIENCY IN ADULTS:

SIGNS AND SYMPTOMS

A
  • Reduced lean mass, increased adiposity, increased waist:hip ratio
  • Reduced muscle strength & bulk  reduced exercise performance
  • Decreased plasma HDL-cholesterol & raised LDL-cholesterol
  • Impaired ‘psychological well being’ and reduced quality of life
44
Q

Growth hormone therapy

A 
GROWTH HORMONE THERAPY
•Preparation:
–Human recombinant GH
• (approved name: SOMATOTROPIN)
•Administration:
–Daily, subcutaneous injection
–Monitor clinical response &amp;
 adjust dose to IGF-1
45
Q

POTENTIAL BENEFITS OF GH THERAPY IN ADULTS

A
  • Improved body composition – decreased waist circumference, less visceral fat
  • Improved muscle strength and exercise capacity
  • More favourable lipid profile - higher HDL-cholesterol, lower LDL-cholesterol
  • Increased bone mineral density
  • Improved psychological well being and quality of life
46
Q

POTENTIAL RISKS OF GH THERAPY IN ADULTS

A

Increased susceptibility to cancer
– no data to support this currently

Expensive – NICE estimated cost of lifelong GH treatment in adult = £42K

Endocrinology (4 decks)

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