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ESA 2 SEMESTER 2 TK > MEH - Pituitary Disorders > Flashcards

MEH - Pituitary Disorders Flashcards

1
Q

What is the clinical presentation of pituitary tumours?

A

Mass effect of tumour on local structures leads to visual loss and headache, and there will be an abnormality in pituitary function (hyper- or hyposecretion)

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2
Q

What will happen to a patient if a pituitary tumour grows superiorly?

A

Visual field loss due to pressure on optic chiasm

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3
Q

What symptoms will occur if a pituitary tumour grows laterally?

A

Pain and double vision

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4
Q

What is the first hormone to be affected by a tumour of the pituitary?

A

GH

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5
Q

Which hormones are affected by a medium-sized tumour of the pituitary?

A

GH, and there is a gonadotropin deficiency so there will be no LH or FSH either. This leads to loss of secondary sexual characteristics in adults and amenorrhoea

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6
Q

What are the symptoms of TSH deficiency?

A

Low thyroid hormones, cold, weight gain, tiredness, slow pulse

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7
Q

What are the symptoms of ACTH deficiency?

A

Low cortisol, tired, dizzy, low BP, low sodium - this can be life threatening

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8
Q

What does a TSH and ACTH deficiency indicate about the size of a pituitary tumour?

A

It is extremely large (late stage)

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9
Q

How is disease on the thyroid, gonadal and prolactin axis tested?

A

Basal blood test

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10
Q

How is a hormone deficiency tested for?

A

‘Stimulation test’ to see if hormone levels will respond

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11
Q

How is a suspected hormone excess tested for?

A

Suppression test

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12
Q

What visual field characteristic is highly suggestive of a pituitary tumour?

A

Bitemporal hemi-anopia

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13
Q

What is a prolactinoma?

A

Prolactin-secreting pituitary tumour

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14
Q

What is the difference between a micro- and a macroadenoma?

A

Macroadenoma is over 1cm, micro is under 1cm

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15
Q

How are prolactinomas treated?

A

The tumour will shrink if the patient takes a dopamine agonist regularly

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16
Q

What are the symptoms of hyperprolactinaemia in women?

A

Menstrual disturbance, fertility problems, galactorrhoea

17
Q

Why do men often present later than women with hyperprolactinaemia?

A

They do not have the symptoms of amenorrhoea to alert them

18
Q

If the prolactin level is <5000, is it likely to be due to prolactinoma?

A

It may be due to disinhibition (stalk effect)

19
Q

What are the long term complications of untreated acromegaly?

A
  • premature cardiovascular death
  • increased risk of colonic tumours
  • increased risk of thyroid cancer
  • disfiguring body changes
  • hypertension and diabetes
20
Q

How can acromegaly be treated?

A 
Surgical:
- remove tumour in trans-sphenoidal hypophysectomy 
Medical:
- reduce GH secretion
- block GH receptor 
- radiotherapy
21
Q

What is Cushing’s disease?

A

ACTH-secreting pituitary tumour

22
Q

What is the classical change in appearance seen in Cushing’s disease?

A
  • round, pink face with round abdomen
  • skinny, weak arms and legs
  • thin skin and easy bruising
  • red stretch marks on abdomen
  • high BP and diabetes
  • osteoporosis
  • fat pad on back
23
Q

What is the difference between Cushing’s disease and Cushing’s syndrome?

A

Cushing’s disease is due to a pituitary tumour, while Cushing’s syndrome can be caused by other pathologies

24
Q

What are the symptoms of diabetes insipidus?

A

Large quantities of pale (insipid) urine are passed, extreme thirst due to fluid loss

25
Q

What causes diabetes insipidus?

A

Insufficient ADH hormone secretion means that water is not re-absorbed at the kidneys, so there is high urine secretion

26
Q

What is the difference between cranial and nephrogenic diabetes insipidus?

A

Cranial DI is due to pituitary disease, while nephrogenic DI is due to kidney disease

27
Q

What are the consequences of untreated diabetes insipidus?

A

Severe dehydration, hypernatraemia, reduced consciousness/coma, death

28
Q

How is cranial DI treated?

A

Synthetic vasopressin - can use a desmopressin nasal spray, tablets or injection

29
Q

What is pituitary apoplexy?

A

A sudden stroke due to bleeding within tumour, or the tumour cutting off blood supply to part of the brain

30
Q

What is the clinical presentation of pituitary apoplexy?

A
  • sudden onset headache
  • double vision
  • visual field loss
  • cranial nerve palsy
  • hypopituitarism

ESA 2 SEMESTER 2 TK (87 decks)

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