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Endocrine > Pit pathology > Flashcards

Pit pathology Flashcards

1
Q

What are the three broad categories of pathology of the pit gland?

A

Too little hormone
Too much hormone
Too big

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2
Q

How do you test for too much/little hormone?

A

Blood tests

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3
Q

How do you test for a pit gland that is too big?

A

Imaging- MRI or US

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4
Q

In a dynamic endocrine test for too much hormone what do you do?

A

See if you can suppress the hormone

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5
Q

In a dynamic endocrine test for too little hormone what do you do?

A

See if you can stim hormone

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6
Q

Give examples of a dynamic endocrine test for too little hormone?

A

Insulin stress test
Water deprivation test
Synacthen test

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7
Q

How does the insulin stress test work?

A

Drop blood glucose to <2.2 using insulin to stim cortisol and GH release

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8
Q

What is a safer alternative to the insulin stress test?

A

Prolonged glucagon test

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9
Q

What should cortisol rise to in the insulin stress test for it to be normal?

A

> 500

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10
Q

What should GH rise to in the insulin stress test for it to be normal?

A

> 7 micrograms/l

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11
Q

How does the water deprivation test work?

A

Deprive of liquid for 8h and check is Ur/Serum osmol ratio is >2.

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12
Q

What does a Ur/Serum osmol ratio of <2 suggest?

A

Diabetes insipidus

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13
Q

When do you not need to do a water deprivation test?

A

If the baseline reading is >2

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14
Q

What is the second part of the water deprivation test?

A

Give desmopressin. If it improves after DDAVP then problem with pit/hypo if not problem with kidneys.

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15
Q

What are two causes of too little pit hormone?

A

Panhypopituitarism

Tumour in one cell type squeezing out others

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16
Q

What is the main cause of too little pit hormone?

A

Panhypopituitarism

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17
Q

What causes panhypopituitarism?

A 
Pit tumour
Pit apoplexia
Lung/breast met
Infection- TB/sarcoidosis
Vascular disease 
Trauma/ iatrogenic
Hypothalamus disease- TB/meningitis
Autoimmune 
Sheehan's syndrome
Congenital
Drugs
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18
Q

What is Sheehan’s syndrome?

A

Necrosis of pit due to blood loss during birth

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19
Q

How can panhypopituitarism present?

A 
Menstrual irregularities 
Infertility/impotence
Gynaecomastia
Abdo obesity
Dry skin/ pale
Hypothyroid face
Growth retardation
Lack of sexual charcteristics
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20
Q

How can you test for panhypopituitarism?

A 
Blood tests for:
TSH/fT4
LH/FSH (naturally increased post menopause)
Prolactin
IGF-1
Test/oestrogen
Random cortisol
Synacthen/ITT for cortisol
Symptoms of DI
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21
Q

How do you treat panhypopituitarism?

A 
Hormone replacement: 
Thyroxine
Hydrocortisone- Give first
ADH
GH
Testosterone- in males
Oestrogen/progesterone- in females
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22
Q

How important is GH in adults?

A

Not needed but good for quality of life.

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23
Q

How is testosterone normally given?

A

IM injection or daily topical

24
Q

What are some side effects of testosterone?

A

Enlarged prostate- Does not cause cancer
Hepatitis from tablets.
Blood count issues
Fusion of growth plates

25
Q

What two sizes of pit tumours are there?

A

Microadenoma <1cm

Macroadenoma >1cm

26
Q

What to categories of pit tumours are there?

A

Functioning

Non-functioning

27
Q

What pathology can non-functioning pit tumours cause?

A

Too big

Too little hormone

28
Q

What pathologies can a ‘Too big’ tumour cause?

A

Compression of optic chiasm
Compression of CN 3, 4, 6
Compression of carotid artery

29
Q

What pathologies can a ‘Too little hormone’ cause?

A 
Hypoadrenalism
Hypothyroidism
Hypogonadism
GH defects
DI- rare as anterior tumours rarely impact on post
30
Q

What pathologies can a functioning pit tumour cause?

A 
Too much hormone:
Prolactin
GH
ACTH
TSH
31
Q

What is the most common functional pit adenoma?

A

Prolactinoma

32
Q

Are TSH secreting tumours common or rare?

A

Rare

33
Q

What is a craniopharyngioma?

A

Tumour derived from the remnants of Rathke’s pouch

34
Q

How do craniopharyngiomas present?

A

Cystic
5-15 and 60-70
Headaches + visual disturbances

35
Q

What can cause increased prolactin production?

A

Prolactinoma
Physio- Breastfeeding, pregnancy, sleep
Pharma- DA antagonists: antipsychotics/depressants
Patho- Hypothyroidism (TRH can stim prolactin release)
Stalk lesion (prevent DA reaching pit)

36
Q

How does increased prolactin production present in females?

A

Early presentation
Galactorrhoea
Menstrual irregularities
Infertility

37
Q

How does increased prolactin production present in males?

A 
Late presentation
Impotence
Visual field abnormalities
Headaches
Ant pit function
38
Q

How do you test for increased prolactin production?

A

Serum prolactin conc
MRI
Visual fields
Pit function tests

39
Q

How do you treat increased prolactin production?

A

DA agonists- will shrink but not cure:

Cabergoline- best option

40
Q

What complications can too little prolactin production cause?

A

None known

41
Q

What can excessive GH production produce?

A

Acromegaly

42
Q

How can acromegaly present?

A 
Giant if occurs before epiphyseal fusion
Thickened soft tissue
Hypertension -> LVH -> CF
Headaches- due to vascular complications
DM due to increased blood glucose
Colon cancer and polyps
43
Q

How do you test for acromegaly?

A 
Blood IGF-1 and GH levels- not diagnostic
GTT
Insulin suppression test
Visual fields
MRI/CT
pit function test
44
Q

How do you perform a GTT for acromegaly?

A

Give 75g oral glucose.
Check GH levels at: 0, 30, 60, 120
If <0.4 then normal

45
Q

How do you treat acromegaly?

A

Pit surgery- transsphenoidal common
Radiotherapy
Somatostatin analogues (suppress GH)- Can cause gall stones
GH antagonists- Block GHR but can increase tumour size- last resort.

46
Q

What complications can a lack of growth hormone cause?

A

Growth retardation in children

Increased abdo fat and decreased muscle in adults

47
Q

Is GH essential in adults?

A

No but needed for a good quality of life

48
Q

What can lack of LH and FSH cause?

A

Genital atrophy

49
Q

What is pituitary apoplexy?

A

Hemorrhage into pit leading it be compressed and die

50
Q

What happens after a pit apoplexy?

A

When it drains get an open cavern and no pit

51
Q

What kind of prolactin levels can prolactinomas cause?

A

Big- 15000mU/l due to prolactin production

Small- ~1500mU/l due to pressing on stalk

52
Q

What physiological things can cause increase prolactin levels?

A

Just about anything:
Exercise
Stress

53
Q

What is the main chemical treatment for acromegaly?

A

Somatostatin analogues

54
Q

In panhypopituitary which treatment should you give first and how long for?

A

Cortisol replacement for 72hrs

Then thyroxine

55
Q

Can you give thyroxine to someone who is steroid deplete?

A

No!!!

56
Q

Which type of pit tumour (micro or macro) tends to be the most hormonally active?

A

Micro

57
Q

How does a macroadenoma cause issues?

A

Non-functioning but produces problems due to mass effect

Endocrine (23 decks)

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