Pituitary

Question 1

Causes of hypopituitarism

Answer 1

Hypothalamus - Kallman’s syndrome - lack of GnRH tumour, inflammation, infection, ischaemia
Pituitary stalk - trauma, surgery, mass lesion, meningioma, carotid artery aneurysm
Pituitary - tumour, irradiation, inflammation, autoimmunity, infiltration - haemachromatosis, amyloid and mets, ischaemia - pit apoplexy,DIC)

Question 2

Features of hypopituitarism

Answer 2

Due to
Hormone lack - GH, FSH and LH and thyroid
Causes - tumour - mass effect, hormone secretionwuth dec secretion of other hormones

Question 3

Tests hypopituitarism

Answer 3

Basal tests

Dynamic tests: short synacthen, ITT, Arginine + GH releasing hormones test, glucagon stimulation test.

Question 4

Tx hypopituitarism

Answer 4

Hormone replacement

Question 5

Pit tumour and types of

Answer 5

Almost always benign 
Size - micro and macro adenoma
1) chromophobe - 70% many are non secretory, some cause hypopituitarism , Alf produce PRL, few produce ACTH or GH, local pressure effect in 30%
2) acidophil - 15% secrete GH or PRL
3) Basophils - secrete ACTH

Question 6

Features of pit tumour

Answer 6

Local pressure effects
Hypopituitarism
Secretion of hormone

Question 7

Local pressure effect symptom pit tumour

Answer 7

Headache
Visual field defects
Palsy CN 3,4 ,6
Temperature , sleep, appetite dysregulation and disturbance
Erosion through the sella Turcica leading to CSF rhinoohea

Question 8

Test pit tumour

Answer 8

MRI visual field, screening hormones

Question 9

Tx pit tumour

Answer 9

Start hormone replacement
Surgery
Radiotherapy

Question 10

wHat is pit apoplexy

Answer 10

Rapid pit enlargement from a bleed into a tumour may cause mass effects, Cvcollapse due to acute hypogonadism, and death
Suspect if acute headache menigism dec GCS

Question 11

What is a craniophryngoma

Answer 11

Originates frorathetkes pouch between the 3rdventricle floor and pituitary

Question 12

What is hyperprolactinoma

Answer 12

Commonest hormonal disturbance of the pit
Women- amenorrhoae
Men presents later - erectile dysfunction and mass effects
PRL - lactation
Raised levels of PRL leads to hypogonadism infertility osteoporosis, inhib secretion of GnRH c LH and FSH —> dec testosterone and oestrogen

Question 13

What causes a raised PRL

Answer 13

Excess production
Disinhibition compress pit stalk, reduce local dopamine levels
Use of dopamine agonist
Pshyiologcial- pregnant, breast feeding
Drugs - metocloperamide, haloperidol, methyldopa, antipsychotics
Diseases - prolactinoma,

Question 14

Symptoms of hyperprolactonaemia

Answer 14

Amenorrhoea
Oligomenorrhoea
Infertility ‘galactorrhea

Question 15

What test should be done in females high PRL symptoms

Answer 15

Pregnancy test

Question 16

Treatment for prolactinoma

Answer 16

1st line -bromocriptine

Dopamine agonist which inhibits the release of prolactin from the pituitary