Lecture 22: pituitary disorders Flashcards
Which diseases can result from a malfunction in the hypothalamic pituitary axis?
Malfunctions include pituitary or hypothalamic tumour.
- Gigantism
- Acromegaly
- Cushing’s syndrome
Describe the clinical effect a non-functioning pituitary tumour would have.
They can result in inadequate production of 1+ ant. pituitary hormones due to the mass’ physical pressure on the gland.
Can also result in headaches, visual problems, nausea, vomiting due to the mass pressing on surrounding structures.
Describe the clinical effect a functioning pituitary tumour would have.
They would cause hyperpituitarism as the tumour itself is also secreting pituitary hormones.
- prolactin excess
- GH excess
- Adrenocorticotropic hormone (ACTH) excess
How would you investigate a patient’s pituitary tumour?
Give a description of its size, anatomy and topographical location via MRI.
Assess the patient’s visual field.
Assess whether the tumour is (non) functioning to confirm if excess/deficient in hormones.
You are a junior doctor and want to confirm whether or not your patient has hyperpituitarism hypopituitarism. What endocrine tests would you do?
Measure the pituitary hormone levels in their blood
Retrieve a part of the tumour via biopsy then stain it using the hormones’ relative antibodies eg: GH antibodies.
Define hypopituitarism and which hormones are usually affected first.
Insufficient pituitary hormone production resulting from a pituitary adenoma.
Usually GH, FSH/LH are affected first in APG.
What is the term given when there is a deficiency of all the APG hormones?
Panhypopituitarism
Would a pituitary tumour affect the secretion of OT and ADH?
Only if the tumour affects the hypothalamic function
OR
An inflammatory process is involved.
Which hormones are deficient in hypopituitarism?
GH
Gonadotropin
TSH&ACTH
ADH
Describe what can happen is GH deficiency.
- low exercise tolerance
- decrease muscle strength
- more body fat
- reduce sense of well being
- short stature
- children poor growth
- severe prenatal deficiency = hypoglycaemia + jaundice
Adults cause: pituitary adenoma
Children cause: unknown (mutations + autoimmune?)
How can we treat patients with GH deficiency?
Manufactured GH is given as treatment.
What happens in Gonadotropin deficiency (hypogonadism)?
Women…
- lack libido
- infertility
- oligomenorrhea
- amenorrhea
Men..
- decrease libido
- impotence
What are some causes of ADH deficiency?
- Hypothalamic tumour
- Pituitary tumour
- Cranial radiotherapy
- Pituitary surgery autoimmune infiltration
- infections (meningitis)
How can a pituitary and hypothalamic tumour cause ADH deficiency?
ADH produced in the hypothalamus so tumour would affect production.
Pituitary tumour could extend into the hypothalamus and affect the production.
What symptoms would you experience if you had ADH deficiency?
- polyuria
- polydipsia (more thirsty)
- more dehydration
- more frequently urinating
- getting up at night to urinate