Lecture 17- Pituitary Disorders Flashcards
How can pituitary tumours present?
Abnormality of functioning or effect of the mass on surrounding structures eg nerve compression and visual compromisation
Name of vision disturbance associated with pituitary tumour?
Hi-temporal hemi anopia
Growth hormone deficiency detection?
Short stature in children. Harder to detect in adults but can lead to depression
Gonadotropin releasing hormone deficiency?
Loss of secondary sexual characteristics as no LH or FSH
Loss of periods in women
Why is ACTH deficiency so serious?
Leads to lack of cortisol which results in low BP, low sodium, tiredness, dizziness etc
Can die of hypo adrenal crisis
What is the difference between a stimulation and suppression test?
If hormone level suspected to be low use a stimulation test and vice versa
Adrenal axis deficiency test?
Induce a hypoglycaemic state which triggers stress and will test ACTH reserve
How can you assess the pituitary radiologically?
Use of MRI and PET scan
What is prolactinoma?
Prolactin secreting pituitary tumour
How do you treat prolactinoma?
Give tablets eg dopamine agonist which inhibits prolactin
Macro-prolactinoma treatment?
If large tumour with low prolactin surgery probably required to remove as it’s a non functioning tumour
Why does hyperprolactinaemia disrupt periods?
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
How would you see a hyperprolactinaemia in men?
Symptoms are harder to detect. Usually mass symptoms present first like visual disturbances
Effect of ant psychotics on prolactin?
Block dopamine and so prolactin not inhibited. Periods effected etc
How to treat prolactinoma?
Give dopamine agonsista and look at anti psychotic of anti sickness drugs
What is acromegaly?
Excess GH in adults over time.
Can cause diabetes, premature cardiovascular death, disfiguring body changes, hypertension etc
How do you treat acromegaly?
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
What is cushings disease?
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
Cushing’s disease vs Cushing’s syndrome?
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
What is diabetes insipidous?
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
Cranial diabetes insipidous vs nephrite IV DI?
Cranial results from a pituitary disease and ADH deficiency while nephrogenic results from the kidney becoming resistant to ADH
Consequences of untreated DI?
Severe dehydration, high sodium levels, reduced consciousness and coma
How to treat diabetes insipidous?
Synthetic ADH works very well
What is pituitary apoplexy?
Haemorrhage of pituitary tumour resulting in headache, double vision, cortisol deficiency which is very dangerous
