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Year 2 > Non-Functioning Tumours and Pituitary hormone testing > Flashcards

Non-Functioning Tumours and Pituitary hormone testing Flashcards

1
Q

Name two structures in the parasellar area of the pituitary gland

A
  1. Optic chiasm

2. Hypothalamus

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2
Q

Describe the development of the pituitary gland (embryology)

A
  1. infundibulum becomes hypothalamus and infundibulum
  2. Rathe’s pouch stalk degenerates and the body of the pouch becomes the intermediate and anterior lobe of the pituitary glands
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3
Q

Where do craniopharyngiomas arise from

A
  1. Squamous epithelial remnants of Rathe’s such
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4
Q

Name the two types of craniopharyngiomas

A
  1. Adamantinous: cyst formation and calcification
  2. Squamous papillary: well circumscribed

These extend into suprasellar region

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5
Q

Age prevalence of craniopharyngiomas

A
  1. 5 to 14

2. 50 to 74

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6
Q

Clinical presentation of crnaiopharyngiomas

A
  1. Headaches (obstructive hydrocephalus)
  2. Polydipsia
  3. Polyuria
  4. Bitemporal hemianopia (presses against optic chiasm)
  5. Vomiting
  6. Raised ICP
  7. Weight increase
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7
Q

What would be seen in a CT for crnaiopharyngiomas

A

CYSTIC MASS

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8
Q

Diagnosis of craniopharyngiomas

A
  1. MRI

2. CT

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9
Q

What is Rathke’s cysts

A
  1. Single layer of epithelial cells with mucoid and cellular components in cyst fluid
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10
Q

Difference between Rathke’s cyst and craniopharyngiomas

A
  1. Intrasellar component (don’t usually extend to parasellar)
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11
Q

Clinical presentation of Rathke cyst

A

ASYMPTOMATIC:

  1. Headache
  2. Ammorheoa
  3. Hypopituitarism
  4. Hydrocephalus
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12
Q

When are meningiomas common

A

After radiotherapy

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13
Q

Clinical presentation of meningioma

A
  1. Visual acuity loss and visual field defects
  2. Endocrine dysfunction
  3. Focal seizures
  4. ICP raised
  5. Diplopia if third and 6th cranial palsy occurs
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14
Q

How is meningioma diagnosed

A

MRI with contrast

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15
Q

Why is an MRI done with contrast for meningioma

A

Because meningiomas can hypo intense to pituitary

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16
Q

What is lymphocytic hypophysitis

A
  1. Inflammation of pituitary gland due to an autoimmune reaction
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17
Q

Name three types of lymphocytic hypophysitis

A
  1. Lymphocytic adenohypophysitis
  2. Lymphocytic infindibuloneurohypophysitis
  3. Lymphocytic panhypophysitis
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18
Q

In what gender is LAH common in

A

Women

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19
Q

Age of presentation of LAH

A
  1. 35 - women
  2. 45 - men

Usually occurs postpartum

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20
Q

What is seen in a CT for LAH

A
  1. Stalk enlargement

2. Pituitary enlargement

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21
Q

What is non-functioning pituitary adenoma

A
  1. A type of intracranial tumours
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22
Q

Peak incidence for NFPA

A

20 and 60

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23
Q

Clinical presentation of non-functioning pituitary adenoma

A
  1. Large cerebral size
  2. Cavernous sinus invasion
  3. Lobulated suprasellar margins
  4. Visual disturbances
  5. Headaches
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24
Q

How are pituitary adenomas classified

A
  1. Microadenomas without sella expansion
  2. Macroadenomas which extend above sella
  3. Macroadenomas with enlargement and invasion of floor or suprasellar extension
  4. Destruction of the sella
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25
Q

Diagnostics of non-functioning pituitary adenomas

A
  1. Test for absence of hormone secretion

2. Test normal pituitary function

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26
Q

What surgical procedure is done to remove NFPA

A
  1. Trans-sphenoidal surgery
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27
Q

How do we test for pituitary function

A
  1. If peripheral target organ is working normally then that hormone is being secreted fine

A LOT OF HORMONES ARE SECRETED BY THE PITUITARY GLAND

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28
Q

How do test the pituitary-thyroid axis for Primary hypothyroidism

A

Raised TSH low T4 (WE LOOK AT Ft4 in pituitary diseases)

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29
Q

Result of axis test in hypopituitary

A

Low T4 normal or low TSH

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30
Q

Test for Grave disease via axis

A

Suppressed TSH

High T4

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31
Q

Test for TSHoma via axis

A

High TF

High TSH

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32
Q

Test for hormone reisstance via the axis

A

High T4

High TSH

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33
Q

Gonadal axis for men in primary hypogonadism

A
  1. Low Testosterone, raised LH/FSH
34
Q

Gonaldal axis for men with hypopituitary

A

Low Testosterone

Low LH and FSH

35
Q

Testing the gonadal axis for men who have used anabolic

A

Low Testosterone and Low LH

36
Q

When do we measure the gonadal axis

A

0900h fasted T and LH/FSH

37
Q

Gonadal axis for females before puberty

A

Estradiol low

LH and FSH is low (FSH slightly greater)

38
Q

Role of estradiol

A

Responsible for secondary sexual characteristics such as breast, widening of the hips

39
Q

Gonadal axis for females during puberty

A

Pulsatile LH increase

Oestradiol increase

40
Q

Gonadal axis for females post menarche

A

Mid-cycle surge in LH and FSH

Levels of estradiol increases through cycle

41
Q

Gonadal axis for females with primary ovarian failure

A
  1. High LH and FSH
  2. Low estradiol
  3. FSH > LH
42
Q

Gonadal axis for females with hypopituitary

A
  1. Ammenorrheoa
  2. Low estradiol
  3. Low FH and FSH
43
Q

How do we test the HPA axis

A
  1. Measure cortisol and syncathen test at 0900h
44
Q

How do we diagnose hypopituitarism

A

Poor response to synacthen

Low cortisol
Low ACTH

45
Q

How do we diagnose Primary Adrenal Insufficiency

A

Low cortisol
High ACTH
Poor response to synacthen

46
Q

When is pulsatory GH secretion greatest

47
Q

What happens to GH levels with age

48
Q

What the reactor causes decrease in GH

49
Q

What two ways can we test the GH/IGF1 axis

A
  1. Insulin stress test (GOLD STANDARD for assessing HPA axis)
  2. Glucagon test
50
Q

What is the insulin stress test

A
  1. Insulin is injected into a patient’s vein after which glucose levels are measured at regular interval
51
Q

What response would we see in a norma functioning HPA axis for the insulin stress test

A

Gh réponse exceeds 20mU/L

52
Q

What inhibits the action of prolactin

53
Q

How do we monitor if prolactin is being produced properly by the pituitary

A
  1. Measure prolactin or cannulated prolactin (3 samples over an hour to exclude stress of venipuncture)
54
Q

What may raise prolactin levels

A
  1. Stress
  2. Antipsychotics
  3. Stalk pressure
  4. Prolactinoma
55
Q

What is suppression testing

A

Where one substance is measured before and after the administration of a drug to determine is levels are stimulated or suppressed by the pituitary axis

56
Q

How is Cushing’s syndrome diagnosed

A

DEXAMETHASONE suppression testing

57
Q

What is the dexamethasone suppression test

A
  1. 1-2 mg dexamethasone is given which should suppress cortisol production in individuals who have a normal HPA axis
  2. 8mg Dexamethasone is given which exerts a negative feedback mechanism
58
Q

What is a positive dexamethasone suppression test for Cushing’s syndrome

A
  1. If cortisol level is not suppressed by low doses and ACTH is low then hypercortisolism is not being driven by ACTH - cushion’s syndrome
59
Q

What is a positive dexamethasone suppression test for cushion’s disease

A
  1. Cortisol is suppressed in high doses but not in low doses
  2. ACTH is elevated

Cushing’s disease because pituitary has some feedback control

60
Q

What suppression test is done for acromegaly

A

Oral glucose Gh suppression test

61
Q

Stimulation tests for Chushing’s

A

CRH stimulation

62
Q

Stimulation test for TSHoma

A

TRH stimulation

63
Q

Stimulating test for gonadotrophin deficiency

A

GnRH stimulation

64
Q

Stimulation test for GH deficiency

A

Glucagon test

65
Q

List two types of MRIs we do to look at the pituitary gland

A

T1 and T2

T1 - High-signal intensity images of fat (fatty marrow and orbital show up as bright images)

T2 - Shows high water content structures like cerebrospinal fluid and cystic lesions

66
Q

Pros of MRI

A
  1. No ionising radiation

2. Good at soft tissue and vascular structures

67
Q

Pros of CT

A
  1. Visualising bony structures and calcifications within soft tissues
  2. Can be used when MRi is contraindicated
68
Q

What are CTs used for

A

Tumour staging and diagnosis

69
Q

Disadvantage of CT

A
  1. Bad at soft tissue imaging
  2. Use of intravenous contrast media
  3. Exposure to radiation
70
Q

Clinical presentation of GH deficiency

A
  1. Short stature
  2. Abnormal body composition
  3. Reduced muscle mass
71
Q

Clinical presentation of LH/FSH

A
  1. Hypogonadism
  2. Reduced sperm count
  3. Infertility
  4. Menstruation problems

Testosterone deficiency in males, oestradiol and progesterone in females

72
Q

How is primary adrenal insufficiency treated

A
  1. Hydrocortisone replacement therapy

2. Modified-Release HC

73
Q

Describe thyroxine replacement therapy

A
  1. 1.6 Micrograms/Kg/day

2. LEVOTHYROXINE

74
Q

When is a dose higher than 1.6 needed for LEVOTHYROXINE

A
  1. patients on oestrogen and pregnancy
75
Q

Describe growth replacement therapy

A
  1. <60 (0.2-0.4 mg/day)

2. >60 (0.1-0.2 mg/day)

76
Q

When do we measure IGF1 levels following GH replacement

A

6 weeks after dose is started

77
Q

What improvements do we see with people on GH replacement

A

Improves lipid profiles
Body composition
BMD

78
Q

How is hypogonadism in males be treated

A

Testosterone replacement

79
Q

Effects of testosterone replacement

A
  1. Improves BMD
  2. Libido
  3. Muscle mass
  4. Fat loss
80
Q

In what forms can we get oestrogen replacement

A
  1. Orally
  2. Combined with progesterone
  3. Tensdermal
  4. Topical gels
  5. Intravaginal creams
81
Q

benefits of oestrogen replacement

A

Stops flushes, night sweats and improves vaginal atrophy

Reduces CVD, osteoporosis and mortality

82
Q

How is desmopressin given

A
  1. SC
  2. Orally
  3. Nasally
  4. Sub-lingually

Year 2 (155 decks)

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