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ESA2 > MEH - Pituitary Disorders > Flashcards

MEH - Pituitary Disorders Flashcards

1
Q

What can cause pituitary hypersecretion of hormones? What 3 main conditions can this cause?

A

Pituitary adenoma - secreting

Prolactinaemia
GH excess
ACTH excess

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2
Q

Which is the most common of these?

A

Prolatinaemia

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3
Q

How would you diagnose a pituitary adenoma?

A

Normally by MRI
Assess visual field defects
Assess endocrine function (blood test) to see whether there is hormone excess or deficiency

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4
Q

What is the most common cause of hypopituitism?

A

Mass effect - compression of pituitary - decreased hormone release

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5
Q

What are some symptoms of prolactin excess (5)?

A

Galactorrhea - unexplained milk production in men
Gynecomastia (hard breast tissue)
Hypogonadism (diminished activity of testes or ovaries)
Amenorrhea - cessation of menstrual cycle
Erectile dysfunction

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6
Q

What is the name of a pituitary adenoma that secretes prolactin?

A

Prolactinoma

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7
Q

What is the treatment for prolactin excess? What other treatments are there?

A

Cabergoline
Radiotherapy
Surgery - trans-sphenoidal

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8
Q

How would you test for prolactin excess?

A

Serum prolactin

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9
Q

What is growth hormone excess commonly due to?

A

A hormone secreting pituitary tumour

It is usually large so get symptoms from both mass effect and hormone secretion

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10
Q

What are the symptoms of growth hormone excess?

A

Gigantism
Acromegaly
Mass effects - visual disturbances/headaches

  • Broad nose, coarse facial features, thick lips, prominent supraorbital ridge, enlarged hands and feet, greasy skin, deeper voice
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11
Q

How can you get diabetes with growth hormone excess?

A

As it antagonises insulin (opposite effects).

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12
Q

How do you test for growth hormone excess?

A

GH/IGF-1 glucose tolerance test - GH should be depressed with increased glucose (it isn’t in GH excess).

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13
Q

What is the treatment for a growth hormone secreting adenoma?

A

Octreotide
Surgery
Radiotherapy

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14
Q

What can excess secretion of ACTH cause from a pituitary adenoma? What about from other causes?

A

From pituitary adenoma - Cushing’s disease

From other causes -
Cushing’s syndrome

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15
Q

Which three hormones are the first ones to deplete in hypopituitarism?

A

GH
LH
FSH

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16
Q

What are the symptoms of growth hormone deficiency?

A

Subtle - reduced exercise tolerance, reduced muscle strength, increased body fat, decreased sense of wellbeing

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17
Q

What is the test for growth hormone deficiency?

A

Response to hypoglycaemic stress (insulin stress test) GH should increase but in deficiency it wont

18
Q

What is the treatment for GH deficiency?

A

Recombinant GF

19
Q

What are the symptoms of gonadotropin deficiency (5)?

A 
Lack of libido
Infertility
Oligomennorrhea (infrequent menstruation)
Amenorrhea
Impotence (men)
20
Q

What are the tests for gonadotrpin deficiency?

A

LH and FSH
and then for women - oestrogen
men - testosterone

21
Q

What are the symptoms of TSH deficiency?

A

Hypothyroidism

22
Q

Test?

A

free T4/TSH

23
Q

Treatment?

A

Oral thyroxine

24
Q

What are the symptoms of ACTH deficiency?

A

CAN BE LIFE THREATENING Indistinguishable from glucocorticoid deficiency
General symptoms - weight loss, anorexia, weakness, nausea, vomitting, low BP

25
Q

What is the test for ACTH deficiency?

A

Stimulated adrenals with ACTH (synthetic)

26
Q

What is the treatment for ACTH deficiency?

A

Cortisol replacment

27
Q

What are the symptoms/signs for ADH deficiency?

A

Diabetes insipidus
Excess excretion of dilute urine
Hypernatraemia

28
Q

How do you test for ADH deficiency?

A

ADH in blood

29
Q

Causes of ADH deficiency?

A

Normally hypothalamic tumour (as post pituitary)

30
Q

Which are the two most dangerous pituitary hormone deficiencies?

A

ACTH deficiency - can lead to death

ADH deficiency - diabetes insipidus - can lead to death

31
Q

What is the diagnosis and treatment for ACTH excess?

A

Diagnosis - suppression test - with steroids (dexamethasone)

Remove tumour (Pituitary/Adrenal)
Radiotherapy
Cortisol inhibiting medication
Remove steroids if thats causing Cushings syndrome

32
Q

What are some causes of Cushings SYNDROME?

A

Cushing disease
Adrenal tumour
Steroid medication

33
Q

What is the cause of Cushings DISEASE?

A

Pituitary adenoma - secreting ACTH

34
Q

What is the difference between cranial and nephrogenic diabetes insipidus?

A

Cranial is due to pituitary disease

Nephrogenic is due to vasopressin resistance in kidney disease

35
Q

Why is diabetes insidious rare in pituitary tumours?

A

As they normally just affect anterior pituitary

36
Q

What are some causes of cranial diabetes insipidus (4)?

A

Inflammation
Infiltration
Malignancy
Infection

37
Q

What are the consequences of untreated diabetes insipidus? How do you treat it?

A

Severe dehydration
Hypernatraemia
Coma
Death

Desmopressin - synthetic vasopressin

38
Q

What is haemorrhage or infarction called in the pituitary?

A

Apoplexy (old word for stroke)

39
Q

What are some symptoms of apoplexy (4)?

A

Sudden headache
Double vision
Visual field loss
Cranial nerve palsy

40
Q

In general when do you do suppression and when do you do stimulation tests?

A

Suppression if suspected excess

Stimulation if suspected deficiency

ESA2 (37 decks)

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