MEH - Pituitary Disorders

Question 1

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

Answer 1

Pituitary adenoma - secreting

Prolactinaemia
GH excess
ACTH excess

Question 2

Which is the most common of these?

Answer 2

Prolatinaemia

Question 3

How would you diagnose a pituitary adenoma?

Answer 3

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

Question 4

What is the most common cause of hypopituitism?

Answer 4

Mass effect - compression of pituitary - decreased hormone release

Question 5

What are some symptoms of prolactin excess (5)?

Answer 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

Question 6

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

Answer 6

Prolactinoma

Question 7

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

Answer 7

Cabergoline
Radiotherapy
Surgery - trans-sphenoidal

Question 8

How would you test for prolactin excess?

Answer 8

Serum prolactin

Question 9

What is growth hormone excess commonly due to?

Answer 9

A hormone secreting pituitary tumour

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

Question 10

What are the symptoms of growth hormone excess?

Answer 10

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

Question 11

How can you get diabetes with growth hormone excess?

Answer 11

As it antagonises insulin (opposite effects).

Question 12

How do you test for growth hormone excess?

Answer 12

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

Question 13

What is the treatment for a growth hormone secreting adenoma?

Answer 13

Octreotide
Surgery
Radiotherapy

Question 14

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

Answer 14

From pituitary adenoma - Cushing’s disease

From other causes -
Cushing’s syndrome

Question 15

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

Answer 15

GH
LH
FSH

Question 16

What are the symptoms of growth hormone deficiency?

Answer 16

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

Question 17

What is the test for growth hormone deficiency?

Answer 17

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

Question 18

What is the treatment for GH deficiency?

Answer 18

Recombinant GF

Question 19

What are the symptoms of gonadotropin deficiency (5)?

Answer 19

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

Question 20

What are the tests for gonadotrpin deficiency?

Answer 20

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

Question 21

What are the symptoms of TSH deficiency?

Answer 21

Hypothyroidism

Question 22

Test?

Answer 22

free T4/TSH

Question 23

Treatment?

Answer 23

Oral thyroxine

Question 24

What are the symptoms of ACTH deficiency?

Answer 24

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

Question 25

What is the test for ACTH deficiency?

Answer 25

Stimulated adrenals with ACTH (synthetic)

Question 26

What is the treatment for ACTH deficiency?

Answer 26

Cortisol replacment

Question 27

What are the symptoms/signs for ADH deficiency?

Answer 27

Diabetes insipidus Excess excretion of dilute urine Hypernatraemia

Question 28

How do you test for ADH deficiency?

Answer 28

ADH in blood

Question 29

Causes of ADH deficiency?

Answer 29

Normally hypothalamic tumour (as post pituitary)

Question 30

Which are the two most dangerous pituitary hormone deficiencies?

Answer 30

ACTH deficiency - can lead to death | ADH deficiency - diabetes insipidus - can lead to death

Question 31

What is the diagnosis and treatment for ACTH excess?

Answer 31

Diagnosis - suppression test - with steroids (dexamethasone) Remove tumour (Pituitary/Adrenal) Radiotherapy Cortisol inhibiting medication Remove steroids if thats causing Cushings syndrome

Question 32

What are some causes of Cushings SYNDROME?

Answer 32

Cushing disease Adrenal tumour Steroid medication

Question 33

What is the cause of Cushings DISEASE?

Answer 33

Pituitary adenoma - secreting ACTH

Question 34

What is the difference between cranial and nephrogenic diabetes insipidus?

Answer 34

Cranial is due to pituitary disease | Nephrogenic is due to vasopressin resistance in kidney disease

Question 35

Why is diabetes insidious rare in pituitary tumours?

Answer 35

As they normally just affect anterior pituitary

Question 36

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

Answer 36

Inflammation Infiltration Malignancy Infection

Question 37

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

Answer 37

Severe dehydration Hypernatraemia Coma Death Desmopressin - synthetic vasopressin

Question 38

What is haemorrhage or infarction called in the pituitary?

Answer 38

Apoplexy (old word for stroke)

Question 39

What are some symptoms of apoplexy (4)?

Answer 39

Sudden headache Double vision Visual field loss Cranial nerve palsy

Question 40

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

Answer 40

Suppression if suspected excess | Stimulation if suspected deficiency