Pituitary Flashcards
6 anterior pituitary hormones?
GH
prolactin
TSH
LH
FSH
ACTH
2 posterior pituitary hormones?
Oxytocin
vassopressin
Testing for Pituitary Failure: Patients may present with ?
galactorrhoea or amenorrhoea
define macroadenoma?
> 1cm
macroadenoma causes which visual changes?
it may compress the optic chiasm resulting in a bitemporal hemianopia
30 year old patient comes in with galactorrhoea and prolactin of 6000.
what to do next?
prolactinoma so;
Pituitary function testing
to see whether it can still respond adequately to a metabolic stress:
LHRH + TRH + applying a metabolic stress (e.g. hypoglycaemia)
what is involved in the CPFT (Combined Rapid Anterior Pituitary Evaluation Panel) - Triple Test.
and why?
§ Insulin (0.15 units per kg)
§ TRH 200 µg
§ LHRH 100 µg
they lead to secretion of all 6 anterior pituitary hormones
what happens as you induce hypoglycaemia as part of the CPFT?
activate the sympathetic nervous system (leading to sweating, tachycardia etc.)
What should you do if SEVERE HYPOGLYCAEMIA occurs (and the patient is unconscious) ?
they should be rescued with 50 mL 20% dextrose
who can’t have the CPFT test?
cardiac risk factors,
angina
abnormal ECG
history of epilepsy
what is considered a normal response in CPFT?
○ Cortisol rise > 550 nM
○ GH rise > 10 IU/L (starts around 0)
glucose falls <2.2 and raises without help
if all pituitary hormones are reduced, you must do what?
URGENTLY replace HYDROCORTISONE
others in order
T4replacement
Oestrogen replacement
GH replacement
Treatment for prolactinoma?
dopamine agonist : bromocriptine or cabergoline
a tumour causing compression of the pituitary stalk can prevent dopamine from reaching the pituitary causing?
Hyperprolactinaemia:
Disconnection Hyperprolactinaemia from a
Non-functioning pituitary adenoma
how to treat Disconnection Hyperprolactinaemia?
need surgery because
will NOT respond to dopamine agonists
