Lecture 17- Pituitary Disorders

Question 1

How can pituitary tumours present?

Answer 1

Abnormality of functioning or effect of the mass on surrounding structures eg nerve compression and visual compromisation

Question 2

Name of vision disturbance associated with pituitary tumour?

Answer 2

Hi-temporal hemi anopia

Question 3

Growth hormone deficiency detection?

Answer 3

Short stature in children. Harder to detect in adults but can lead to depression

Question 4

Gonadotropin releasing hormone deficiency?

Answer 4

Loss of secondary sexual characteristics as no LH or FSH

Loss of periods in women

Question 5

Why is ACTH deficiency so serious?

Answer 5

Leads to lack of cortisol which results in low BP, low sodium, tiredness, dizziness etc

Can die of hypo adrenal crisis

Question 6

What is the difference between a stimulation and suppression test?

Answer 6

If hormone level suspected to be low use a stimulation test and vice versa

Question 7

Adrenal axis deficiency test?

Answer 7

Induce a hypoglycaemic state which triggers stress and will test ACTH reserve

Question 8

How can you assess the pituitary radiologically?

Answer 8

Use of MRI and PET scan

Question 9

What is prolactinoma?

Answer 9

Prolactin secreting pituitary tumour

Question 10

How do you treat prolactinoma?

Answer 10

Give tablets eg dopamine agonist which inhibits prolactin

Question 11

Macro-prolactinoma treatment?

Answer 11

If large tumour with low prolactin surgery probably required to remove as it’s a non functioning tumour

Question 12

Why does hyperprolactinaemia disrupt periods?

Answer 12

Prolactin inhibits LH secretion and so will lower oestrogen and testosterone. Effects seen earlier in females through oestrogen lowering

Can also lead to galactorrhoea which is milk discharge from breast

Question 13

How would you see a hyperprolactinaemia in men?

Answer 13

Symptoms are harder to detect. Usually mass symptoms present first like visual disturbances

Question 14

Effect of ant psychotics on prolactin?

Answer 14

Block dopamine and so prolactin not inhibited. Periods effected etc

Question 15

How to treat prolactinoma?

Answer 15

Give dopamine agonsista and look at anti psychotic of anti sickness drugs

Question 16

What is acromegaly?

Answer 16

Excess GH in adults over time.

Can cause diabetes, premature cardiovascular death, disfiguring body changes, hypertension etc

Question 17

How do you treat acromegaly?

Answer 17

Can perform a trans sphenoid hypophysectomy

Can reduce GH secretion through a dopamine agonist or a somatostatin analogue

Can block the GH receptor

Can use radiotherapy

Question 18

What is cushings disease?

Answer 18

ACTH secreting pituitary tumour resulting in excess cortisol

Causes reduced wound healing, skin striations, red cheeks, buffalo hump, thin skin with easy brushing, high BP and diabetes, osteoporosis

Question 19

Cushing’s disease vs Cushing’s syndrome?

Answer 19

The disease is caused by a tumour in the pituitary while the syndrome is caused by other pathology such as a tumour in the adrenal gland that makes cortisol

Question 20

What is diabetes insipidous?

Answer 20

Deficient ADH production from posterior pituitary results in inadequate water reabsorption leading to clear coloured urine of which lots is produced. Also leads to excessive thirst

Question 21

Cranial diabetes insipidous vs nephrite IV DI?

Answer 21

Cranial results from a pituitary disease and ADH deficiency while nephrogenic results from the kidney becoming resistant to ADH

Question 22

Consequences of untreated DI?

Answer 22

Severe dehydration, high sodium levels, reduced consciousness and coma

Question 23

How to treat diabetes insipidous?

Answer 23

Synthetic ADH works very well

Question 24

What is pituitary apoplexy?

Answer 24

Haemorrhage of pituitary tumour resulting in headache, double vision, cortisol deficiency which is very dangerous