Pituitary Flashcards
Where are vasopressin and OXT stored?
posterior pituitary
When is a pituitary tumour a microadenoma and when is it a macroadenoma?
1cm = macroadenoma
non functioning pituitary adenoma may cause Compression of which cranial nerves?
3,4,6
What are physiological causes of raised prolactin.
breast feeding, preg, sleep, stress
What drugs cause raised prolactin?
dopamine antagonists eg metroclopramide antipsychotics eg phenothiazines antidepressants eg TCA, SSRIs cocaine estrogens
Give 3 pathological causes of raised prolactin.
hypothyroidism
prolactinoma
stalk lesions
In whom, men or women, is the presentation of high prolactin late?
men
What are some female symptoms of high prolactin?
galactorrhoea
menstrual irregularity
ammenorrhoea
infertility
What are some male symptoms of raised prolactin?
galactorrhoea visual field abnormal headache impotence ant pit malfunction
What investigations should be done for prolactinoma?
Pregnancy test, basal PRL levels, MRI pituitary to look for micro/macro, stalk, optic chiasma
Visual fields - bitemporal hemianopia
Most common cause of raised prolactin?
drugs
Why does hypothyroidism cause increased prolactin?
increased TRH
Treatment if high prolactin?
refer to clinic
dopamine agonists are 1st line
In which, macro or micro may there be problems with visual acuity?
macro (near optic chiasm)
Name 3 dopamine agonists.
bromocriptine, quinagolide, cabergoline
What causes acromegaly?
GH excess
What happens to blood pressure in acromegaly?
hypertension
What are some other symptoms of acromegaly?
thickened soft tissues eg skin, large jaw, sweaty large hands snoring diabetes visual fields hypopituitarism
How is acromegaly diagnosed?
IGF1
GTT
also check visual fields,scan pituitary (CT/MRI)
pit function tests
Treatment for acromegaly?
remove lesion (transphenoidal surgery)
if surgery fails, somatostatin analogues eg octreotide/ radiotherapy
GH antagonist called pegvisomant
When does a acromegaly cause gigantism?
if occurs before bony epiphyses fuse (rare)
What is Cushing’s?
excess cortisol/mineralocorticoid/androgen
If excess androgen, what symptoms may occur?
virilism, hirsutism, acne, oligo/amenorrhoea
If excess mineralocorticoid, what symptoms may occur?
hypertension, oedema
If excess cortisol , what symptoms may occur?
protein loss - myopathy, osteoporosis, thinning of skin, bruising
altered carbohydrate/lipid metabolism, diabetes, obesity
Altered psyche eg depression
What characterizes Cushing’s?
- thin skin
- proximal myopathy
- frontal balding in women
- conjunctival oedema (chemosis)
- osteoporosis
How should pituitary Cushing’s be treated?
hypophysectomy
external radiotherapy
How should adrenal Cushings be treated?
adrenalectomy
How should ectopic Cushings be treated?
remove source or bilateral adrenalectomy
Drug treatment of CUshings?
Metyrapone
Ketoconazole
Pasireotide (Somatostatin analogue)
Pan hypopituitarism in the posterior pituitary?
diabetes insipidus
Pan hypopituitarism in anterior pituitary?
GH - growth failure
TSH - hypothyroidism
LH/FSH - hypogonadism
ACTH - hypoadrenal
What infection may cause hypopituitarism.
meningitis, TB
