Pan hypopituitariasm

Question 1

what is meant by pan hypopituitarism

Answer 1

when the whole pituitary is underactive, ie secreting less/none of hormones it is meant to be

Question 2

what effects are caused by pan hypopituitarism of the anterior pituitary

Answer 2

decreased; GH(growth failure), TSH(hypothyroidism), LH/FSH(hypogonadism), ACTH(hypogonadism), prolactin(no known effect)

Question 3

what effects are caused by pan hypopituitarism of the posterior pituitary

Answer 3

diabetes inspidus

Question 4

what are the 3 commonest causes of hypopituitarism

Answer 4

pituitary tumours, other local brain tumours(astrocytoma, meningioma, glioma) or iatrogenic during pituitary surgery

Question 5

what symptoms/signs are associated with anterior hypopituitarism

Answer 5

menstrual irregularities, infertility/impotence, gynaecomastia, obesity, loss facial, axillary and pubic hair, dry skin/hair, hypothyroid face, growth retardation(children)

Question 6

what tests should be done to check for anterior hypopituitarism

Answer 6

baseline pituitary hormone tests, particularly prolactin, GH, thyroid and sex hormones and their paired hormones

Question 7

how does post-menopause affect the normal pituitary hormone tests

Answer 7

should have elevated LH/FSH

Question 8

what treatment is used for anterior hypopituitarism

Answer 8

hormone replacement therapy

Question 9

what is given for hormone replacement therapy for anterior hypopituitarism

Answer 9

thyroxine, hydrocortisone, ADH, GH, sex steroids(HRT/Oes/Prog pill for female and test for male)

Question 10

describe the different ways of testosterone replacement

Answer 10

IM injection every 3-4 weeks, skin gel, prolong IM injection 10-14 weeks, oral tablets

Question 11

what are the risks of testosterone replacement

Answer 11

polycythaemia(causes risk of stroke/MI), prostate enlargement(not cancer), hepatitis(only from oral tablets)

Question 12

what are some of the effects seen when giving GH to adults with anterior hypopituitarism
(obvs given to children for growth)

Answer 12

improves well being + QOL, decrease abdo fat, increase muscle mass, strength, exercise, improve cardiac function

Question 13

what are the causes of diabetes insipidus(DI)

Answer 13

familial(very rare), example = DIDMOAD

acquired, 50% idiopathic, trauma, tumour

Question 14

describe how the water deprivation test is carried out

Answer 14

no fluids for 8 hours, checking urine and osmolalities for these 8 hours, and then 4hr after giving IM DDAVP

Question 15

what does DDAVP mean

Answer 15

desmopressin; a synthetic analogue of vasopressin

Question 16

what is the normal and diagnostic result for Urine/Serum Osmol ratio

Answer 16

if > 2 normal, if lower then Diabetes Insipidus(DI)

Question 17

what does it mean if Urine/Serum Osmol ration is low and then improves with DDAVP

Answer 17

means pathology is due to ‘Cranial diabetes insipidus’, ie deficiency of DDAVP
(and not nephrogenic DI)

Question 18

what are the different treatment for DI

Answer 18

nasal desmospray, desmopressin oral tablets(most commonly used), or some cases desmopressin injections(emergencies)