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Pituitary Flashcards

1
Q

How can the causes of Cushing’s syndrome be divided?

A

ACTH and non-ACTH dependent Cushings

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2
Q

What is the the pathological cause of the symptoms in Cushings?

A

Excess cortisol production by adrenal cortex, also excess mineralocorticoid and excess androgen

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3
Q

What are some symptoms of Cushings syndrome?

A
  • Weight increase
  • Mood change
  • Proximal weakness
  • Gonadal dysfunction
  • Acne
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4
Q

What are some signs of Cushings syndrome?

A
  • Central obesity
  • Plethora
  • Moon face
  • Buffalo neck hump
  • Thin skin
  • Bruising
  • Pigmentation
  • Hypertension
  • Abdominal striae
  • Osteoporosis
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5
Q

What are the key clinical features of Cushing’s syndrome?

A

Pigmentation (only ACTH-dependent)
Cushingoid appearance (excess alcohol consumption-pseudo-Cushings)
Impaired glucose tolerance (especially ectopic ACTH syndrome)
Hypokalaemia (common with ectopic ACTH secretion), HT
Thin skin
Proximal myopathy
Frontal balding in women
Conjunctival oedema
Osteoporosis

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6
Q

How is Cushings diagnosed?

A

Diagnosis

Tests-Many to choose from
Dexamethasone overnight suppression test is 1st line, followed by 48hr test.
Failure to suppress=Cushing’s syndrome,

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7
Q

What are the causes of cushings?

A

Pituitary, adenoma of adrenal, ectopic-thymus, lung, pancreas, pseudo-alcohol and depression, steroid medication

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8
Q

How can you differentiate between a pituitary, adrenal or ectopic cause of Cushings?

A

ACTH test- pituitary less than 300, ectopic more than 300, adrenal less than 1. In high dose dexam suppression pituitary will be suppressed by 50%, not seen in adrenal/ectopic

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9
Q

What is the treatment for Cushings?

A

Pituitary-hypophysectomy and radiotherapy, adrenal-adrenalectomy, ectopic-remove source or bilateral adrenalectomy. Also Metyrapone, ketoconazole and fluconazole to decrease cortisol pre-op

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10
Q

What toxicity can occur from keotconazole?

A

Hepatoxicity

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11
Q

What are the hormonal effects of pan hypopituitarism?

A

Anterior pituitary-GH:growth failure, TSH-hypothyroidism, LH/FSH-hypogonadism, ACTH-hypoadrenal, Prolactin-none known

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12
Q

What are some causes of hypopituitarism?

A

Pituitary tumours, secondary metastatic lesions (lung, breast), local brain tumours-(astrocytoma, meningioma, glioma), granulomatous disease, vascular disease, trauma, hypothalamic diseases (syphiilis, meningitis), iatrogenic-surgery, AI-Sheenan:post pregnancy, infection

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13
Q

What are some features of hypopituitarism?

A 
Menstrual irregularities
Infertility
Impotence
Gynaecomastia
Abdominal obesity
Loss facial hair, loss axillary &pubic hair (M&F)
Dry skin and hair
Hypothyroid faces
Growth retardation
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14
Q

How are the adrenal glands stress response tested?

A

Synacthen test-ACTH stimulation

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15
Q

What is the treatment for hypopituitarism?

A

Hormone replacement therapy- thyroxine, hydrocortisone, ADH, GH, sex steroids

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16
Q

What are the effects of giving GH to adults?

A

Improves well being and QOL, decreased abdo fat, increases muscle mass, strength, exercise capacity and stamina, improves cardiac function, decreased cholesterol and increases LDL, increases bone density, given by daily SC injection

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17
Q

What are the risks of testosterone replacement?

A

Prostate enlargement, polycythaemia, hepatitis (Only oral tabs)

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18
Q

What are some causes of cranial Diabetes Insipidus?

A

Familial -isolated in most cases, can be part of DIDMOAD(DI, DM, optic atrophy, deaf). Acquired-idiopathic 50%, trauma-road accidents etc. Rare -tumour, sarcoid, irradiation, meningitis

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19
Q

How do you diagnosis DI?

A

Water deprivation test

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20
Q

How do you treat DI?

A

Desmopressin-spray, oral, sublingual, injection

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21
Q

What is the peripheral hormone of ACTH?

A

Cortisol

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22
Q

What is the peripheral hormone of TSH?

A

Thyroxine

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23
Q

What is the peripheral hormone of LH/FSH?

A

Testosterone or Estradiol

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24
Q

What is the peripheral hormone of GH?

A

IGF-1

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25
Q

What is the peripheral hormone of Prolactin?

A

No peripheral hormone

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26
Q

How are pituitary tumours sized?

A

More than or equal to 1cm: Macroadenoma. Less than 1cm: Microadenoma

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27
Q

What can a Non-functioning pituitary adenoma cause compression on?

A

Optic chiasma, as well as other structures e.g. CN 3,4,6

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28
Q

What can a Non-functioning pituitary adenoma cause?

A

Hypoadrenalism, hypothyroidism, hypogonadism, DI, GH deficiency

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29
Q

What are some of the physiological causes of raised prolactin?

A

Breast feeding, pregnancy, stress, sleep

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30
Q

What are some drug causes of raised prolactin?

A

Dopamine antagonists e.g. metoclopramide, antipsychotics e.g. phenothiazines, antidepressants e.g. TCA, SSRIs, others-estrogens, cocaine

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31
Q

What are some pathological causes of raised prolactin?

A

Hypothyroidism, Stalk lesions-iatrogenic,- road accident, prolactinoma

32
Q

What are some clinical signs and symptoms of prolactinoma in females?

A

Early presentation, galactorrhoa (30-80%), menstrual irregularity, amenorrhoea, infertility

33
Q

What are some clinical signs and symptoms of prolactinoma in males?

A

Late presentation, impotence, visual field abnormal, headache, anterior pituitary malfunction

34
Q

What investigations should you undertake in suspected prolactinoma?

A

Prolactin concentration, MRI pituitary, visual fields, pituitary function tests (other hormones affected?)

35
Q

What are you looking for in a pituitary MRI?

A

Micro/macroprolactinoma (1cm), pituitary stalk, optic chiasma

36
Q

What are you looking for in a visual fields investigation in suspected prolactinoma?

A

Bitemporal hemianopia, not homonymous hemianopia

37
Q

What is the treatment for prolactinoma?

A

Dopamine agonists-bromocriptine, quinagolide (norprolac), cabergoline (dostinex): usual choice, least S/Es

38
Q

What is acromegaly an excess of?

39
Q

What are some signs and symptoms of acromegaly?

A

Giant (before epiphyseal fusion), thickened soft tissues-skin, large jaw, sweaty, large hands, headaches (vascular), snoring/sleep apnoea, local pituitary affects-visual fields, hypopituitarism

40
Q

What are some associated conditions of acromegaly?

A

HT, cardiac failure, sleep apnoea, DM, early CV death, colonic polyps and colon cancer

41
Q

How is acromegaly diagnosed?

A

IGF1-sex/age matched, GTT-suppresion test: normal result-GH suppresses to 1ug/l after glucose

42
Q

What tests apart from IGF1 and GTT can be used in acromegaly diagnosis?

A

Visual field, CT/MRI pituitary scan, Pituitary function tests

43
Q

What is the treatment for acromegaly?

A

Pituitary surgery, external radiotherapy to pit fossa, retest GTT, if normal fine, if >1ug/l drug therapy:SSA- octreotide. Dopamine agonist e.g. cabergoline. GH receptor antagonist: pegvisomant

44
Q

What is the efficacy of somatostatin analogues in acromegaly?

A

Reduces GH in most patients

45
Q

What tumour shrinkage occurs due to somatostatin analogues in acromegaly?

A

30-50% decrease in size, takes 6-12/12, re expansion 6 weeks after stopping

46
Q

What do somatostatin analogues provide pre-operatively?

A

Relieves headaches in 1hr, improved outcome

47
Q

What are some S/Es of somatostatin analogues?

A

Local stinging, short term-flatulence, diarrhoea, abdominal pains, long term-gastritis, gallstones

48
Q

What is the efficacy of dopamine agonists in acromegaly?

A

Can work well in moderately elevated GH

49
Q

What is the last line in acromegaly therapy?

A

GH antagonist- pegvisomant

50
Q

What do GH antagonists do to tumour size, IGF1 and serum GH concentrations?

A

Size does not decrease, occasional increase. IGF1 decreases but serum GH may increase

51
Q

What follow up is needed in acromegaly?

A

Achieve clinically safe levels of GH and IGF1, check other pituitary hormones, cancer surveillance-colon and tubulo-villous adenoma, CV risk factors-bp, lipids, glucose, check for sleep apnoea

52
Q

What is the anterior pituitary derived from?

A

Rathke’s pouch

53
Q

What is the anterior pituitary made up of histologically?

A

Islands-cords of cells, acidophils, basophils, chromophobe

54
Q

What do somatrophs produce?

55
Q

What do mammotrophs produce?

56
Q

What do corticotrophs produce?

57
Q

What do thyrotrophs produce?

58
Q

What do gonadotrophs produce?

59
Q

What cells are acidophils?

A

Somatotrophs, mammotrophs

60
Q

What cells are basophils?

A

Cortico/thyro/gonadotrophs

61
Q

What is the posterior pituitary made up of?

A

Non-myelinated axons of neurosecretory neurons

62
Q

What can cause ant pit hyperfunction?

A

Adenoma, carcinoma

63
Q

What can cause ant pit hypofunction?

A

Surgery, radiation, sudden haemorrhage into gland, ischaemic necrosis, tumour extending into sella, inflammatory conditions

64
Q

In pituitary adenomas what can infarction lead too?

A

Panhypopituitarism

65
Q

What are some functional pituitary adenomas?

A

Prolactinoma, GH secreting, ACTH secreting

66
Q

What is the most common functional tumour?

A

Prolactinoma (30%)

67
Q

What are some signs of prolactinoma?

A

Infertility, lack of libido, amenorrhea (25%)

68
Q

What can a GH secreting adenoma cause an increase in?

A

Insulin like growth factors (IGF)

69
Q

What does a GH Secreting adenoma stimulate?

A

Growth of bone, cartilage and connective tissue

70
Q

What disease can be caused by an ACTH secreting adenoma?

71
Q

What kind of adenoma is a ACTH secreting tumour usually?

A

Microadenoma

72
Q

What are some causes of pituitary hypofunction?

A

Primary/metastatic causes, trauma, subarachnoid haemorrhage, surgery or radiation, granulomatous inflammation, infarction/haemorrhage, hypothalamic lesions

73
Q

What is a craniopharyngioma derived from?

A

Remnants of Rathke’s pouch

74
Q

Where does craniopharyngioma arise from?

A

Mostly suprasellar, some sella

75
Q

What type of incidence does a craniopharyngioma have?

A

Bimodal-5-15yo, 6th to 7th decades

76
Q

What symptoms and signs may a craniopharyngioma cause?

A

Headaches, visual disturbances, children may have growth retardation

77
Q

What is the prognosis for craniopharyngioma?

A

Good, especially if tumour can be completely removed by surgery/radiation

Endocrine (14 decks)

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