Pituitary 1 Flashcards
what 2 things can pituitary tumours be broken into?
microadenoma and macroadenoma
microadenomas are = ?cm
macroadenomas are > ?cm
microadenomas are = 1cm
macroadenomas are > 1cm
a large pituitary adenoma can compress what?
optic chiasma
CN III,IV,VI
name the common visual field defect in pituitary adenomas
bitemporal hemianopia
an anominous hemitopnia from a stroke causes blindness in how many eyes?
1 exam Q
what is under an inhibitory affect from dopamine?
PRL
what causes a raised prolactin?
breast feeding, pregnancy, stress, sleep
Dopamine antagonists eg metoclopramide
Antipsychotics eg phenothiazines
antidepressants eg TCA, SSRIs
other eg estrogens, cocaine
pathological - hypothyroidism, stalk lesions, RTA, prolactinoma
in prolactinomas, there is early/late presentation in females and early/late presentation in males
in prolactinomas, there is EARLY presentation in females and LATE presentation in males
signs and symptoms of prolactinoma
galactorrhea menstrual irregularity ammenorrhoea infertility impotence
Prolactinoma investigations?
serum prolactin concentration
MRI pituitary
name the class of drug given in prolactinoma as medical treatment
dopamine agonist - cabergoline (dostinex) once to twice a week
what is there an excess in acromegaly?
GH
what test is performed to diagnose acromegaly
glucose tolerance test - GTT
GGT results in normal and in acromegaly?
normal -
acromegaly -
normal - GH suppresses
acromegaly - GH unchanged/rise/remains same
IGF1 is important in what condition?
acromegaly
acromegaly treatment?
pituitary surgery
external radiotherapy to pituitary fossa
pituitary surgery cure rates are higher in ____adenoma
pituitary surgery cure rates are higher in MICROadenoma
name the 3 drug classes for treatment of acromegaly
- somatostatin analogues
- dopamine agonists
- GH antagonists
somatostatin analogues (Sandostatin LAR/Lanreotide/(Octreotide)) side effect?
gallstones
how are somatostatin analogues delivered?
IM or SC
name a dopamine agonist
cabergoline
name a GH antagonist
pegvisomant
is pegvisomant first or last line in acromegaly treatment?
last line
why is pegvisomant last line treatment for acromegaly?
cost - £36,000 pa
what type of cancer are those with acromegaly at higher risk of?
colon and tubule-villous adenoma
