Lecture 8: The Pituitary Gland - Clinical Case and Discussion Flashcards
what are the complication of acromegaly?
- headache
- chiasmal compression
- diabetes mellitus
- hypertension
- cardiomyopathy
- sleep apnoea
- accelerated osteoarthritis (OA)
- colonic polyps and cancer
what are the clinical features of acromegaly?
- ‘spade like’ hands
- wide feet
- coarse facial features
- thick lips and tongue
- carpal tunnel syndrome
- sweating
diagnosis of acromegaly?
Bloods:
- is IGF-1 elevated?
- if raised, you then do a confirmatory test: failure of suppression of growth hormone during an oral glucose tolerance test
- are the rest of the pituitary hormone levels normal?
- assess vision
- perform MRI to detect pituitary tumour
complications of Cushing’s syndrome?
- weakness of skin, muscle and bone
- hypertension and heart failure
- diabetes
Cushing’s syndrome: symptoms and signs
-Proximal myopathy
- Striae and easy bruising
- Osteoporosis and fractures
- Glucose intolerance or diabetes mellitus
- Obesity, particularly truncal or “centripetal” obesity
- Hypertension
- Hypokalaemia
- Facial changes, such as moon face and acne
- Hirsutism in women
- Fat redistribution leading to interscapular and supraclavicular fat pads
- Thin extremities due to muscle wasting
- Thin, fragile skin
- Erectile dysfunction in men
- Psychological issues, such as depression or cognitive dysfunction
- Osteopenia or osteoporosis
what are causes of ACTH-dependent Cushing’s syndrome?
- pituitary tumour (Cushing’s disease)
- ectopic ACTH secretion (e.g. lung carcinoid)
what are causes of ACTH-independent Cushing’s syndrome?
- adrenal tumour (adenoma or carcinoma)
- corticosteroid therapy (e.g. for asthma, IBD)
what are the clinical manifestations of hyperprolactinaemia in women?
- galactorrhoea 30-80%
- menstrual irregularity
- infertility
what are the clinical manifestations of hyperprolactinaemia in men?
- galactorrhoea < 5%
- impotence
- visual field abnormalities
- headache
- extraocular muscle weakness
- anterior pituitary malfunction
list the possible causes of hyperprolactinaemia
physiological,pharmacological and pathological
- physiological: pregnancy, lactation, stress
- pharmacological: DA depleting and DA antagonist drugs
- pathological: primary hypothyroidism, pituitary lesions (prolactinoma or pituitary ‘stalk pressure’)
what drugs may cause hyperprolactinaemia?
- dopamine antagonists: neuroleptics (e.g. chlorpromazine), anti-emetics (e.g. metoclopramide).
- DA-depleting agents
- oestrogens (not in OCP dosage)
- some antidepressants
what are clinical features of hypopituitarism in adults?
- tiredness
- weight gain
- depression
- reduced libido
- impotence
- menstrual problems
- skin pallor
- reduced body hair
what are clinical features of hypopituitarism in children?
- reduced linear growth
- delayed puberty
what is diabetes insipidus?
Diabetes insipidus (DI) is a condition characterized by the reduced production or response to antidiuretic hormone (ADH), resulting in excessive urination and thirst.
list the causes of cranial diabetes insipidus
- head trauma
- inflammatory conditions (e.g. sarcoidosis)
- cranial infection such as meningitis
- vascular conditions such as sickle cell disease
- rare genetic causes
- metastatic carcinoma
- craniopharyngioma
- other brain tumours: e.g. germinoma
