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Endocrine > Non-functioning adenomas, prolactinomas and acromegaly > Flashcards

Non-functioning adenomas, prolactinomas and acromegaly Flashcards

1
Q

What are the definitions of microadenoma and macroadenoma?

A

Microadenoma: <1cm
Macroadenoma: >1cm

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2
Q

What can a large non functioning pituitary adenoma cause?

A

Compression on optic chiasm

Compression of cranial nerves 3,4 and 6 - commonly abducens which controls lateral eye movement causing an inward squint

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3
Q

What can an atrophic non-functioning pituitary tumour cause?

A 
Hypoadrenalism
Hypothyroidism
Hypogonadism - amenorrhoea, ED
DI 
GH deficiency
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4
Q

What will a pituitary adenoma do to the visual field?

A

Bitemporal hemaniopa - peripheral vision

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5
Q

What will a lack of dopamine do to the levels of prolacin?

A

Increased

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6
Q

What are the physiological causes of raised prolactin?

A

Breast feeding
Pregnancy
Stress
Sleep

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7
Q

What are the pharmacological causes of a raised prolactin?

A 
Dopamine antagonists - metoclopramide
Antipsychotics - phenothiazines
Antidepressants - TCA, SSRIs
Oestreogen 
Coccaine
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8
Q

What are pathological causes of raised prolactin?

A

Hypothyroidism
Stalk lesion - iatrogenic, trauma
Prolactinoma

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9
Q

Over what level of serum prolacin would you suspect a prolactinoma?

A

5000

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10
Q

What are the clinical signs and symptoms of a prolactinoma in females?

A

Galactorrhoea
Menstrual irregularity
Ammenorrhoea
Infertility

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11
Q

What are the clinical signs and symptoms of a prolactinoma in males?

A

Impotence
Visual field abnormal
Headache
Ant pit malfunction

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12
Q

What are the investigations for a prolactinoma?

A 
Serum prolactin conc too high 
MRI pituitary (microprolactinoma, macroprolactinoma, pituitary stalk, optic chiasm) 
Visual fields (bitemporal hemianopia not homonymous hemianopia) 
Pit function tests
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13
Q

What are the treatments for a prolactinoma?

A

Dopamine agonists:
Cabergoline
Quinagolide

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14
Q

What are the S/E for dopamine agonists?

A

N+V
Low mood
Possible fibrosis

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15
Q

What clinical manifestations can result from acromegaly?

A 
Giant (if before epiphyseal fusion) 
Thickened soft tissues (skin, large jaw, sweaty, large hands and nose) 
Sleep apnoea
Hypertension and cardiac failure
Headaches 
DM 
Pituitary - visual fields, hypopituitarism) 
Early CV death
Colonic polyps
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16
Q

What type of headache with acromegaly cause?

A

Vascular effects due to increased dynamic blood flow through vessels

17
Q

How is acromegaly diagnosed?

A

Too much IGF-1
GTT suppression test, in acromegaly GH will stay unchanged or will undergo a paradoxical rise
Visual field
CT/MRI pituitary scan

18
Q

What surgical route is commonly utilised for a GH tumour?

A

Transsphenoidal - through nose into sphenoid sinus and through sphenoid bone

19
Q

What is the treatment for acromegaly?

A

Pituitary surgery
External radiation to pituitary fossa
Retest GTT

20
Q

What will a GTT GH of above 1 warrant after surgery has been performed?

A

Drugs
Radiotherapy
Repeat surgery

21
Q

What is the commonest drug used for acromegaly?

A

Somatostatin analogues - sandostatin LAR

22
Q

What are the effects of sandostatin?

A

Reduces GH in most patients
Tumour shrinkage
Usage pre-op to relieve headache

23
Q

What are the S/E to somatostatin analogues?

A 
Local stinging
Flatulence
Diarrhoea
Abdominal pains
Gallstones
24
Q

Why can dopamine agonists (cabergoline) be used in acromegaly?

A

Some pituitary tumours co-secrete GH and prolactin

25
Q

What is the GH antagonist used in acromegaly?

A

Pegvisomant - binds to GH receptor

26
Q

What is the follow up for acromegaly?

A

Achieve clinically safe levels (GH <0.4ug/l post GGT)
IG1 normal
Check thyroid
Cancer surveillance (colon and tubulovillous adenoma)
CV risk (BP, lipids, glucose)
Sleep apnoea

Endocrine (35 decks)

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