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endocrinology lectures phase 2 > non-functioning tumours and pituitary hormone testing > Flashcards

non-functioning tumours and pituitary hormone testing Flashcards

1
Q

anatomy of anterior pituitary lobe

A

glandular tissue, accounts for 75% of total weight.

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2
Q

anatomy of posterior pituitary lobe

A

nerve tissue & contains axons that originate in the hypothalamus.

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3
Q

types of pituitary mass lesions

A
  • Non-functioning pituitary adenomas
  • Endocrine active pituitary adenomas
  • Malignant pituitary tumours: functional and non-functional pituitary carcinomas
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4
Q

where do pituitary mass lesions metastasie

A

in the pituitary (breast, lung, stomach, kidney)

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5
Q

example of pituitary cyst

A

Rathke’s cleft cyst

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6
Q

examples of developmental abnormalities

A

Craniopharyngioma (occasionally intrasellar location)

Germinoma

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7
Q

examples of Primary Tumors of the central nervous system

A

Perisellar meningioma

Optic glioma

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8
Q

example of vascular tumour

A

Hemangioblastoma

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9
Q

examples of malignant systemic diseases

A

Hodgkin’s disease

Non-Hodgkin lymphoma

Leukemic infiltration

Histiocytosis X

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10
Q

examples of granulomatous diseases

A

Neurosarcoidosis

Wegner’s granulomatosis

Tuberculosis

Syphilis

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11
Q

what does Craniopharyngioma arise from

A

squamous epithelial remnants of Rathke’s pouch (base of the brain near the pituitary)

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12
Q

what is Rathkes pouch

A

an evagination at the roof of the developing mouth in front of the buccopharyngeal membrane – gives rise to the anterior pituitary.

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13
Q

what happens in craniopharyngioma

A
  • Benign tumour infiltrates surrounding structures
  • Solid, cystic, extends to suprasellar region
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14
Q

symptoms of craniopharyngioma

A
  • Raised ICP
  • visual disturbances
  • growth failure
  • pituitary hormone deficiency
  • weight increase
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15
Q

peak ages of craniopharyngioma

A

5 to 14 years; 50 to 74 years

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16
Q

what is rathke’s cyst derived from

A

remnants of Rathke’s pouch

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17
Q

what is Rathke’s Cyst

A

Single layer of epithelial cells with mucoid, cellular, or serous components in cyst fluid

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18
Q

characteristics of rathke’s cyst

A

Mostly asymptomatic and small

Mostly intrasellar component, may extend into parasellar area

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19
Q

what conditions is rathkes cyst present with

A

Present with headache and amenorrhoea, hypopituitarism and hydrocephalus

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20
Q

what is mengioma

A

Complication of radiotherapy

Commonest tumour after pituitary adenoma

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21
Q

what is mengioma usually present with

A

oss of visual acuity, endocrine dysfunction and visual field defects

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22
Q

how much. of primary intracranial tumours are Non-functioning pituitary adenoma (NFPA)

A

10-15%

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23
Q

impacts of macroadenomas

A

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

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24
Q

characteristics of non functioning pituitary adenomas

A

Signs of aggressiveness
Large size
Cavernous sinus invasion
Lobulated suprasellar margins

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25
Q

how to investigate pituitary dysfunction

A

Hormonal tests

If hormonal tests abnormal or tumour mass effects perform
MRI pituitary

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26
Q

local mass effects

A
  1. headaches
  2. CSF rhinorrhea
  3. visual field defects
  4. cranial nerve palsy and temporal lobe epilepsy
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27
Q

how do you find a non functioning tumour

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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28
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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29
Q

what is the guiding principle for testing pituitary function

A

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

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30
Q

symptoms of GH deficiency

A
  • short stature
  • abnormal body composition
  • reduced muscle mass
  • poor quality of life
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31
Q

treatment for growth hormone deficiny

A

growth hormone

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32
Q

symoptoms of LH/FSH defiency

A
  • hypogonadism
  • reduced sperm count
  • infertility
  • menstruation problems
33
Q

treatment for LH/FSH defieicny for males

A

testosterone

34
Q

treatment for LH/FSH defieincy for females

A

oestradiol +- progesterone

35
Q

symptoms of TSH deficency

A

hypo thyrodiism

36
Q

treatment for TSH deficiency

A

levothyroxine

37
Q

symptoms of ACTH deficiency

A

adrenal filiure

deceased pigment

38
Q

treatment for ACTH deficiency

A

hydro cortisone

39
Q

symptoms of ADH deficneicy

A

diabets insipidus due to decreased water absorption in kidney resulting in polyuria and polydipsia

40
Q

treatment for ADH deficneicy

A

DDAVP

41
Q

how to test for primary hypothyroid

A

youll find
Raised TSH low Ft4

42
Q

how to test for hypopituitary y

A

youll find
Low Ft4 with normal or low TSH

43
Q

how to test for graves disease (toxic)

A

youll find
Suppressed TSH high Ft4

44
Q

how to test for TSHoma (very rare)

A

youll find
High Ft4 with normal or high TS

45
Q

how to test for Hormone resistance

A

High Ft4 with normal or high TSH

46
Q

what. to measure in pituitary disease for pituitary thyroid axis

A

Ft4

47
Q

how to test for Primary Hypogonadism in men

A

youll find
Low T raised LH/FSH

48
Q

how to test for Hypopituitary in men

A

Low T normal or low LH/FSH

49
Q

how to test for anabolic use in men

A

Low T and suppressed LH

50
Q

what to measure in pituitary disease for male gonadal axis

A

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

51
Q

testing gonadal axis in women before puberty

A

Oestradiol very low/undectable with low LH and FSH although FSH slightly higher than LH

52
Q

testing gonadal axis in women in puberty

A

Pulsatile LH increases and oestradiol increases

53
Q

testing gonalda axis in women post menarche

A

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

54
Q

testing gonadal axis in women in primary ovarian failiure

A

(includes menopause) - High LH and FSH with FSH greater than LH and low oestradiol

55
Q

testing gonalda axis in women with hypopoituitary

A

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

56
Q

testing the HPA axis

A

Circadian Rhythm
Measure 0900h cortisol and synacthen

57
Q

what do you find in hypopituitarism in HPA axis

A

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

58
Q

what di you find in Primary AI in HPA axis

A

Low cortisol, high ACTH, poor response to Synacthen

59
Q

how is GH secreted

A

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

60
Q

when are GH levels low

A

GH levels fall with age and are low in obesity

61
Q

how to measure GH/IGF1 axis

A

IGF-I and GH stimulation test
- Insulin stress test
- Glucagon test
- Other

62
Q

what hormone is prolactin linked to

A

it is under negative control of dopamine
Prolactin is a stress hormone

63
Q

how to measure prolactin

A

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

64
Q

what can cause prolactin levels to rise

A

Stress
Drugs: antipsychotics
Stalk pressure
Prolactinoma

65
Q

when is dynamic testing useful

A

Dynamic stimulation/suppression testing may be useful in select cases to further evaluate pituitary reserve and/or for pituitary hyperfunction

66
Q

what is the preferrred imaging technique for pituiatry

A

MRI

67
Q

BENEFITS OF MRI

A

Better visualization of soft tissues and vascular structures than CT

No exposure to ionizing radiation

68
Q

advantages of CT

A

Better at visualizing bony structures and calcifications within soft tissues

Better at determining diagnosis of tumors with calcification, such as germinomas, craniopharyngiomas, and meningiomas

69
Q

when is CT useful

A

May be useful when MRI is contraindicated, such as in patients with pacemakers or metallic implants in the brain or eyes

70
Q

disadvnatages of CT

A

less optimal soft tissue imaging compared to MRI
use of intravenous contrast media
exposure to radiation

71
Q

dose for thyroxine replacement

A

Dose 1.6 micrograms/kg/day

72
Q

who needs higher dose thyroixne

A

Higher doses usually required in patients on oestrogens or in pregnancy

73
Q

what does GH replacement do

A

mproves lipid profiles, body composition and bone mineral density

74
Q

types of testerone replacement

A

Different types of formulations: gels, injections, oral

75
Q

what does testosterone replacement do

A

Improve bone mineral density, libido, sexual function, energy levels and sense of well being, muscle mass and reduc

76
Q

tyopes of oestrogen replacements

A

Oral oestrogen or combined oestrogen/progestogen formulations (also transdermal, topical gels, intravaginal creams)

77
Q

what does oestogen replacement do

A

Alleviate flushes and night sweats; improve vaginal atrophy

Reduce risk of cardiovascular disease, osteoporosis and mortality

78
Q

what does desmopressin do

A

monitor sodium levels

79
Q
A

endocrinology lectures phase 2 (17 decks)

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