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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
how to investigate pituitary dysfunction
Hormonal tests If hormonal tests abnormal or tumour mass effects perform MRI pituitary
26
local mass effects
1. headaches 2. CSF rhinorrhea 3. visual field defects 4. cranial nerve palsy and temporal lobe epilepsy
27
how do you find a non functioning tumour
No specific test but absence of hormone secretion Test normal pituitary function Trans-sphenoidal surgery if threatening eyesight or progressively increasing in size
28
why is testing pituitary function complex
- Many hormones: GH, LH/FSH, ACTH, TSH and ADH - May have deficiency of one or all and may be borderline - Circadian rhythms and pulsatile
29
what is the guiding principle for testing pituitary function
If the peripheral target organ is working normally the pituitary is working
30
symptoms of GH deficiency
- short stature - abnormal body composition - reduced muscle mass - poor quality of life
31
treatment for growth hormone deficiny
growth hormone
32
symoptoms of LH/FSH defiency
- hypogonadism - reduced sperm count - infertility - menstruation problems
33
treatment for LH/FSH defieicny for males
testosterone
34
treatment for LH/FSH defieincy for females
oestradiol +- progesterone
35
symptoms of TSH deficency
hypo thyrodiism
36
treatment for TSH deficiency
levothyroxine
37
symptoms of ACTH deficiency
adrenal filiure deceased pigment
38
treatment for ACTH deficiency
hydro cortisone
39
symptoms of ADH deficneicy
diabets insipidus due to decreased water absorption in kidney resulting in polyuria and polydipsia
40
treatment for ADH deficneicy
DDAVP
41
how to test for primary hypothyroid
youll find Raised TSH low Ft4
42
how to test for hypopituitary y
youll find Low Ft4 with normal or low TSH
43
how to test for graves disease (toxic)
youll find Suppressed TSH high Ft4
44
how to test for TSHoma (very rare)
youll find High Ft4 with normal or high TS
45
how to test for Hormone resistance
High Ft4 with normal or high TSH
46
what. to measure in pituitary disease for pituitary thyroid axis
Ft4
47
how to test for Primary Hypogonadism in men
youll find Low T raised LH/FSH
48
how to test for Hypopituitary in men
Low T normal or low LH/FSH
49
how to test for anabolic use in men
Low T and suppressed LH
50
what to measure in pituitary disease for male gonadal axis
Measure 0900h fasted T and LH/FSH in pituitary disease
51
testing gonadal axis in women before puberty
Oestradiol very low/undectable with low LH and FSH although FSH slightly higher than LH
52
testing gonadal axis in women in puberty
Pulsatile LH increases and oestradiol increases
53
testing gonalda axis in women post menarche
Monthly menstrual cycle with LH/FSH, mid-cycle surge in LH and FSH and levels of oestradiol increase through cycle
54
testing gonadal axis in women in primary ovarian failiure
(includes menopause) - High LH and FSH with FSH greater than LH and low oestradiol
55
testing gonalda axis in women with hypopoituitary
Oligo or amenorrhoea with low oestradiol and normal or low LH and FSH
56
testing the HPA axis
Circadian Rhythm Measure 0900h cortisol and synacthen
57
what do you find in hypopituitarism in HPA axis
Low cortisol, low or normal ACTH, poor response to synacthen
58
what di you find in Primary AI in HPA axis
Low cortisol, high ACTH, poor response to Synacthen
59
how is GH secreted
GH is secreted in pulses with greatest pulse at night and low or undetectable levels between pulses
60
when are GH levels low
GH levels fall with age and are low in obesity
61
how to measure GH/IGF1 axis
IGF-I and GH stimulation test - Insulin stress test - Glucagon test - Other
62
what hormone is prolactin linked to
it is under negative control of dopamine Prolactin is a stress hormone
63
how to measure prolactin
Measure prolactin or cannulated prolactin (3 samples over an hour to exclude stress of venepuncture
64
what can cause prolactin levels to rise
Stress Drugs: antipsychotics Stalk pressure Prolactinoma
65
when is dynamic testing useful
Dynamic stimulation/suppression testing may be useful in select cases to further evaluate pituitary reserve and/or for pituitary hyperfunction
66
what is the preferrred imaging technique for pituiatry
MRI
67
BENEFITS OF MRI
Better visualization of soft tissues and vascular structures than CT No exposure to ionizing radiation
68
advantages of CT
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
when is CT useful
May be useful when MRI is contraindicated, such as in patients with pacemakers or metallic implants in the brain or eyes
70
disadvnatages of CT
less optimal soft tissue imaging compared to MRI use of intravenous contrast media exposure to radiation
71
dose for thyroxine replacement
Dose 1.6 micrograms/kg/day
72
who needs higher dose thyroixne
Higher doses usually required in patients on oestrogens or in pregnancy
73
what does GH replacement do
mproves lipid profiles, body composition and bone mineral density
74
types of testerone replacement
Different types of formulations: gels, injections, oral
75
what does testosterone replacement do
Improve bone mineral density, libido, sexual function, energy levels and sense of well being, muscle mass and reduc
76
tyopes of oestrogen replacements
Oral oestrogen or combined oestrogen/progestogen formulations (also transdermal, topical gels, intravaginal creams)
77
what does oestogen replacement do
Alleviate flushes and night sweats; improve vaginal atrophy Reduce risk of cardiovascular disease, osteoporosis and mortality
78
what does desmopressin do
monitor sodium levels
79

endocrinology lectures phase 2 (17 decks)

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