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phase 2a > Non-Functioning Tumours and Pituitary Hormone Testing > Flashcards

Non-Functioning Tumours and Pituitary Hormone Testing Flashcards

1
Q

where does Craniopharyngioma come from?

A

Arises from squamous epithelial remnants of Rathke’s pouch (base of the brain near the pituitary).
benign tumours

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2
Q

what could pituitary mass lesions be?

A

-Non-Functioning Pituitary Adenomas (silent)
-Endocrine active pituitary adenomas
-Malignant pituitary tumors: Functional and non-functional pituitary carcinoma
-Metastases in the pituitary (breast, lung, stomach, kidney)
-Pituitary cysts: Rathke’s cleft cyst, Mucocoeles, Others

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3
Q

what is rathke’s cyst derived from?

A

remnants of rathke’s pouch

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4
Q

what is rathkes pouch?

A

an evagination at the roof of the developing mouth in front of the buccopharyngeal membrane

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5
Q

what does rathkes pouch give rise to?

A

gives rise to the anterior pituitary.

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6
Q

describe the structure of rathkes pouch

A

Benign tumour infiltrates surrounding structures
Solid, cystic, extends to suprasellar region

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7
Q

what symptoms does rathkes pouch cause?

A

Visual disturbances, growth failure, pituitary hormone deficiency

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8
Q

what symptoms does rathke’s cyst cause?

A

Mostly asymptomatic and small
Present with headache and amenorrhoea (missed menstruation), hypopituitarism and hydrocephalus (build-up of fluid on the brain)

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9
Q

what is a meningioma ?

A

the commonest tumour of region after pituitary adenoma

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10
Q

what is a meningioma a complication of?

A

radiotherapy

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11
Q

what symptoms is meningioma associated with?

A

Visual disturbance and endocrine dysfunction
- Usually present with loss of visual acuity, endocrine dysfunction and visual field defects

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12
Q

what percentage do pituitary adenomas account for of primary inter cranial tumours?

A

14-28%

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13
Q

what percentage do non functioning pituitary adenomas account for of clinically relevant pituitary adenomas?

A

<10-15%

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14
Q

what is the percentage of macroadenomas that get headaches and visual disturbances?

A

50% of macroadenomas have visual disturbances and 50% have headaches

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15
Q

what are the signs of aggressiveness?

A

Large size
Cavernous sinus invasion
Lobulated suprasellar margins

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16
Q

what are the three types of pituitary dysfunction?

A

-tumour mass effects
-hormone excess
-hormone deficiency

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17
Q

what tests do you do to test for Non-functioning tumours?

A

No specific test but absence of hormone secretion
Test normal pituitary function
Trans-sphenoidal surgery if threatening eyesight or progressively increasing in size

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18
Q

what are the local mass effects?

A

Headaches
Cranial Nerve Palsy and Temporal Lobe Epilepsy
CSF rhinorrhoea
Visual Field Defects

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19
Q

why is testing pituitary function complex?

A

-Many hormones: GH, LH/FSH, ACTH, TSH and ADH
-May have deficiency of one or all and may be borderline
-Circadian rhythms and pulsatile

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20
Q

what is the guiding principle of testing pituitary function?

A

If the peripheral target organ is working normally the pituitary is working

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21
Q

when testing for primary thyroid, what should you find?

A

Raised TSH low Ft4

22
Q

when testing for hypopituitary, what should you find?

A

Low Ft4 with normal or low TSH

23
Q

when testing for graves disease ( toxic), what should you find?

A

Suppressed TSH high Ft4

24
Q

when testing for TSHoma ( very rare) , what should you find?

A

High Ft4 with normal or high TSH

25
Q

when testing for hormone resistance , what should you find?

A

High Ft4 with normal or high TSH

26
Q

when testing for pituitary disease, what do you measure?( thyroid axis)

A

Ft4

27
Q

when testing for primary hypogonadism , what should you find?

A

Low T raised LH/FSH

28
Q

when testing for hypopituitary , what should you find?

A

Low T normal or low LH/FSH

29
Q

when testing for metabolic use , what should you find?

A

Low T and suppressed LH

30
Q

when testing for pituitary disease, what do you measure? ( goanadal axis men)

A

Measure 0900h fasted T and LH/FSH in pituitary disease

31
Q

when testing gonadal women, what should you find before puberty?

A

Measure 0900h fasted T and LH/FSH in pituitary disease

32
Q

when testing gonadal women, what should you find during puberty?

A

Pulsatile LH increases and oestradiol increases

33
Q

when testing gonadal women, what should you find post menarche ?

A

Monthly menstrual cycle with LH/FSH, mid-cycle surge in LH and FSH and levels of oestradiol increase through cycle

34
Q

when testing gonadal women, what should you find in primary ovarian failure ?

A
  • High LH and FSH with FSH greater than LH and low oestradiol
35
Q

when testing gonadal women, what should you find in hypopituitary ?

A

Oligo or amenorrhoea with low oestradiol and normal or low LH and FSH

36
Q

when testing the HPA axis, what do you measure?

A

0900h cortisol and synacthen

37
Q

when testing the HPA axis, what should you find with primary AI?

A

Low cortisol, high ACTH, poor response to Synacthen

38
Q

when testing the HPA axis, what should you find with hypopituitarism ?

A

Low cortisol, low or normal ACTH, poor response to synacthen

39
Q

How is GH secreted?

A

GH is secreted in pulses with greatest pulse at night and low or undetectable levels between pulses

40
Q

when do GH levels fall?

A

GH levels fall with age and are low in obesity

41
Q

when testing the GH/IGF1 axis, what do you measure?

A

IGF-I and GH stimulation test

42
Q

when testing the GH/IGF1 axis, how do you measure?

A

Insulin stress test
Glucagon test
Other

43
Q

what is prolactin?

A

a stress hormone

44
Q

why do you measure prolactin?

A

Measure prolactin or cannulated prolactin (3 samples over an hour to exclude stress of venepuncture

45
Q

why might prolactin be raised?

A

Stress
Drugs: antipsychotics
Stalk pressure
Prolactinoma

46
Q

when might dynamic stimulation testing be useful?

A

in select cases to further evaluate pituitary reserve and/or for pituitary hyperfunction

47
Q

what does a deficiency in GH cause?

A

Short stature
Abnormal body composition
Reduced Muscle Mass
Poor Quality of Life

Rx: Growth Hormone

48
Q

what does a deficiency in LH/FSH cause?

A

Hypogonadism
Reduced Sperm
Count
Infertility
Menstruation
Problems

49
Q

what does a deficiency in TSH cause?

A

Hypo
Thyroidism

Rx: Levothyroxine

50
Q

what does a deficiency in ACTH cause?

A

Adrenal Failure
Decreased
Pigment

   Rx: 
 Hydro   cortisone
51
Q

what does a deficiency in ADH cause?

A

Diabetes
Insipidus
(ADH deficiency - Decreased water absorption in kidney resulting in polyuria & polydipsia)

Rx:       DDAVP

phase 2a (67 decks)

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