Lecture 19 Clinical Aspects of Pituitary Disease Flashcards
Hypersecretion of GH leads to
Acromegaly
Gigantism
Hypersecretion of ACTH
Cushing’s
Hypersecretion of Prolactin leads to
Hyperprolactinaemia
Clinical Features of Acromegaly
Spade like’ hands (rings) • Wide feet (shoes) • Coarse facial features • Thick lips & tongue • Carpal tunnel syndrome • Sweating
Complications of Acromegaly
- Headache
- Chiasmal compression
- Diabetes mellitus
- Hypertension
- Cardiomyopathy
- Sleep apnoea
- Accelerated OA
- Colonic polyps & CA
How is acromegaly diagnosed
Glucose is administered
If GH isn’t suppressed it is acromegaly
Elevated IGF-1
Whats the effect of excess cortisol in Cushing’s Syndrome
• Tissue breakdown
– Causes weakness of skin, muscle & bone
• Sodium retention
– May cause hypertension & heart failure
• Insulin antagonism
– May cause diabetes mellitus
What are the signs and symptoms of Cushing’s syndrome
• Skin atrophy • Spontaneous purpura- blood spots or skin haemorrhages • Proximal myopathy • Osteoporosis • Growth arrest in children • Pink striae • Facial mooning • Oedema • Hirsutism • Cushingoid appearance • Raised 24 hour urine cortisol • Rapid weight gain • Increased hunger Central obesity Hypertension
Whats a differential diagnosis for Cushing’s Sydrome
PCOS
Name ACTH dependent diseases
Pituitary tumour- Cushing’s disease
Ectopic ACTH secretion - lung carcinoid
Name ACTH independent diseases
Adrenal tumour Corticosteroid therapy (Asthma, IBD)
What are the causes of Hyperprolactinaemia
Pregnancy Lactation Stress Dopamine depleting drug/antagonist Hypothyroidism Pituitary lesion
Name drugs that may cause hyperprolactinaemi
Neuroleptics
Anti-emetics
oestrogen
Some anti-depressants
Clinical features of pituitary hypofunction in adults
- Tiredness, weight gain, depression, reduced libido, impotence, menstrual problems
- Skin pallor
- Reduced body hair
Clinical features of pituitary hypo function in children
- Reduced linear growth
* Delayed puberty
