pituitary

Question 1

define panhypopituitarism

Answer 1

decreased production of all anterior pituitary hormones, or of specific hormones

Question 2

2 generic causes of hypopituitarism and prevalence

Answer 2

congenital (rare), acquired (common)

Question 3

usual cause of congenital panhypopituitarism

Answer 3

mutations of transcription factor genes needed for normal anterior pituitary development e.g. PROP1

Question 4

hormone deficient characteristics of congenital panhypopituitarism

Answer 4

deficient in growth hormone and at least 1 or more anterior pituitary hormones

Question 5

clinical presentation of congenital panhypopituitarism

Answer 5

short stature, hypoplastic (incomplete development) anterior pituitary gland on MRI

Question 6

8 causes of acquired panhypopituitarism

Answer 6

tumours (most common), radiation, infection, traumatic brain injury, infiltrative disease, inflammatory (hypophysitis e.g. caused by autoimmune destruction), pituitary apoplexy, peri-partum infarction

Question 7

2 types of tumours causing acquired panhypopituitarism

Answer 7

hypothalamic (craniopharyngiomas), pituitary (adenomas, metastases, cysts)

Question 8

effect of radiation on acquired panhypopituitarism, including relative resistance of GH and TSH

Answer 8

can be caused by radiotherapy for cancer: hypothalamic/pituitary damage, with GH being most vulnerable and TSH being relatively resistant

Question 9

example of infection causing acquired panhypopituitarism

Answer 9

meningitis

Question 10

what does an infiltrative disease causing acquired panhypopituitarism often involve

Answer 10

pituitary stalk e.g. neurosarcoidosis

Question 11

causes of pituitary apoplexy causing acquired panhypopituitarism

Answer 11

intra-pituitary haemorrhage, or less commonly infarction

Question 12

what is the name of peri-partum infarction causing acquired panhypopituitarism

Answer 12

Sheehan’s syndrome

Question 13

what is panhypopituitarism also called

Answer 13

Simmond’s disease

Question 14

what is the name of the condition where there is deficient FSH/LH due to panhypopituitarism

Answer 14

secondary hypogonadism

Question 15

clinical presentation of secondary hypogonadism

Answer 15

reduced libido (sexual desire), secondary amenorrhoea, erectile dysfunction

Question 16

what is the name of the condition where there is deficient ACTH due to panhypopituitarism

Answer 16

secondary hypoadrenalism

Question 17

clinical presentation of secondary hypoadrenalism

Answer 17

fatigue (similar to Addison’s disease which is primary hypoadrenalism)

Question 18

what is the name of the condition where there is deficient TSH due to panhypopituitarism

Answer 18

secondary hypothyroidism

Question 19

clinical presentation of secondary hypothyroidism

Answer 19

fatigue

Question 20

what does Sheehan’s syndrome describe

Answer 20

post-partum hypopituitarism (most common cause is post-partum haemorrhage) secondary to hypotension

Question 21

epidemiology of Sheehan’s syndrome

Answer 21

less common in developed countries

Question 22

characteristic of Sheehan’s syndrome in pregnancy and what post-partum haemorrhage leads to

Answer 22

anterior pituitary naturally enlarges in pregnancy (lactotroph hyperplasia) to produce more lactin, so if large post-partum haemorrhage and large gland, not much blood will flow to it, leading to pituitary infarction

Question 23

3 clinical presentations of Sheehan’s syndrome with reasons

Answer 23

lethargy, anorexia, weight loss (TSH/ACTH/GH deficiency), failure of lactation (prolactin deficiency), failure to resume menses post-delivery (not getting period back); posterior pituitary not usually affected

Question 24

when is pituitary apoplexy often dramatically presented

Answer 24

when patient has pre-existing pituitary tumours (adenomas); may be first presentation of pituitary adenoma

Question 25

what can precipitate pituitary apoplexy

Answer 25

anti-coagulants as bleeding into pituitary gland

Question 26

2 clinical presentations of pituitary apoplexy

Answer 26

severe sudden onset headache (enlargement stretches dura), visual field defect (compressed optic chiasm - bitemporal hemianopia)

Question 27

if cavernous sinus involved in pituitary apoplexy, what may it lead to

Answer 27

have many cranial nerves and internal carotid arteries, so can get diplopia (IV, VI) - double vision, ptosis (III) - drooping of upper eyelid

Question 28

what is the usual cause of panhypopituitarism

Answer 28

pituitary tumour, as tumours compress pituitary cells against bone of sella turcica

Question 29

is panhypopituitarism naturally associated with the aging process

Answer 29

no