MEH - Pituitary Disorders Flashcards
What can cause pituitary hypersecretion of hormones? What 3 main conditions can this cause?
Pituitary adenoma - secreting
Prolactinaemia
GH excess
ACTH excess
Which is the most common of these?
Prolatinaemia
How would you diagnose a pituitary adenoma?
Normally by MRI
Assess visual field defects
Assess endocrine function (blood test) to see whether there is hormone excess or deficiency
What is the most common cause of hypopituitism?
Mass effect - compression of pituitary - decreased hormone release
What are some symptoms of prolactin excess (5)?
Galactorrhea - unexplained milk production in men
Gynecomastia (hard breast tissue)
Hypogonadism (diminished activity of testes or ovaries)
Amenorrhea - cessation of menstrual cycle
Erectile dysfunction
What is the name of a pituitary adenoma that secretes prolactin?
Prolactinoma
What is the treatment for prolactin excess? What other treatments are there?
Cabergoline
Radiotherapy
Surgery - trans-sphenoidal
How would you test for prolactin excess?
Serum prolactin
What is growth hormone excess commonly due to?
A hormone secreting pituitary tumour
It is usually large so get symptoms from both mass effect and hormone secretion
What are the symptoms of growth hormone excess?
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
How can you get diabetes with growth hormone excess?
As it antagonises insulin (opposite effects).
How do you test for growth hormone excess?
GH/IGF-1 glucose tolerance test - GH should be depressed with increased glucose (it isn’t in GH excess).
What is the treatment for a growth hormone secreting adenoma?
Octreotide
Surgery
Radiotherapy
What can excess secretion of ACTH cause from a pituitary adenoma? What about from other causes?
From pituitary adenoma - Cushing’s disease
From other causes -
Cushing’s syndrome
Which three hormones are the first ones to deplete in hypopituitarism?
GH
LH
FSH
What are the symptoms of growth hormone deficiency?
Subtle - reduced exercise tolerance, reduced muscle strength, increased body fat, decreased sense of wellbeing
What is the test for growth hormone deficiency?
Response to hypoglycaemic stress (insulin stress test) GH should increase but in deficiency it wont
What is the treatment for GH deficiency?
Recombinant GF
What are the symptoms of gonadotropin deficiency (5)?
Lack of libido Infertility Oligomennorrhea (infrequent menstruation) Amenorrhea Impotence (men)
What are the tests for gonadotrpin deficiency?
LH and FSH
and then for women - oestrogen
men - testosterone
What are the symptoms of TSH deficiency?
Hypothyroidism
Test?
free T4/TSH
Treatment?
Oral thyroxine
What are the symptoms of ACTH deficiency?
CAN BE LIFE THREATENING Indistinguishable from glucocorticoid deficiency
General symptoms - weight loss, anorexia, weakness, nausea, vomitting, low BP
What is the test for ACTH deficiency?
Stimulated adrenals with ACTH (synthetic)
What is the treatment for ACTH deficiency?
Cortisol replacment
What are the symptoms/signs for ADH deficiency?
Diabetes insipidus
Excess excretion of dilute urine
Hypernatraemia
How do you test for ADH deficiency?
ADH in blood
Causes of ADH deficiency?
Normally hypothalamic tumour (as post pituitary)
Which are the two most dangerous pituitary hormone deficiencies?
ACTH deficiency - can lead to death
ADH deficiency - diabetes insipidus - can lead to death
What is the diagnosis and treatment for ACTH excess?
Diagnosis - suppression test - with steroids (dexamethasone)
Remove tumour (Pituitary/Adrenal)
Radiotherapy
Cortisol inhibiting medication
Remove steroids if thats causing Cushings syndrome
What are some causes of Cushings SYNDROME?
Cushing disease
Adrenal tumour
Steroid medication
What is the cause of Cushings DISEASE?
Pituitary adenoma - secreting ACTH
What is the difference between cranial and nephrogenic diabetes insipidus?
Cranial is due to pituitary disease
Nephrogenic is due to vasopressin resistance in kidney disease
Why is diabetes insidious rare in pituitary tumours?
As they normally just affect anterior pituitary
What are some causes of cranial diabetes insipidus (4)?
Inflammation
Infiltration
Malignancy
Infection
What are the consequences of untreated diabetes insipidus? How do you treat it?
Severe dehydration
Hypernatraemia
Coma
Death
Desmopressin - synthetic vasopressin
What is haemorrhage or infarction called in the pituitary?
Apoplexy (old word for stroke)
What are some symptoms of apoplexy (4)?
Sudden headache
Double vision
Visual field loss
Cranial nerve palsy
In general when do you do suppression and when do you do stimulation tests?
Suppression if suspected excess
Stimulation if suspected deficiency
