Pituitary Adenoma 2 - Hyperprolactinemia + Acromegaly

Question 1

Hyperprolactinaemia.
Prolactin stimulates ? production in the breast, and also inhibits ? and ? production.
Clinical Features;
o ?: in females, spontaneous / expressible.
o Oligo / ?.
o Decreased ?.
o Subfertility in ?.
o Arrested ? in younger patients

Answer 1

milk
GnRH
Gonadotropin
Galactorrhoea
amenorrhoea
libido
males
puberty

Question 2

Hyperprolactinaemia
In the long term, ? may develop due to androgen / oestrogen deficiency.
Other causes of hyperprolactinaemia;
o ? stimulation / stress (transient).
o ?-induced.
o Idiopathic.
Diagnosis is with ? ? following a raised serum ?.

Answer 2

osteoporosis
breast
drug
pituitary MRI
prolactin

Question 3

Treatment of a prolactinoma.

? ? are first line: ? inhibits prolactin release.
–o Lifelong ? / ?.
–o Side effects include nausea and vomiting, ?, ?.
–o Associated with pulmonary, cardiac and retroperitoneal ?.
—• Monitor for with ? and ?.
These usually ? tumours down, reducing ? effects without the ? risks.
Symptoms usually ? on stopping the drugs.

Answer 3

dopamine agonists
dopamine
bromocriptine/ropinarole
dizziness
syncope
fibrosis
CXR
Echo
shrink
mass
surgical
recur

Question 4

Acromegaly.
GH stimulates ? and soft-tissue growth.
Excess GH causes ? in children.
o If prior to ? ? closure.
In adults it causes acromegaly.
o Acromegaly is almost exclusively due to a ? tumour.
o Rarer causes may be ? release of GH / GH related proteins from non-pituitary tumours.

Answer 4

skeletal
gigantism
epiphyseal plate
pituitary
paraneoplastic

Question 5

Acromegaly Diagnosis;
o Raised ? level.
• Used as level correlates with GH levels over the past ? hours.
• GH itself is too ?.
• Mainly used for monitoring ? rather than ?.

Answer 5

IGF-1
24
variable
treatment
diagnosis

Question 6

Acromegaly diagnosis
o ? ? test.
• Normally will ? GH secretion.
• In acromegaly, concentrations are >?mcg/ml at ? hours.

Answer 6

glucose tolerance
suppress
2
2

Question 7

Symptoms;

Change in ?.
Increased ?/? size.
Tiredness.
Excessive ?.
Decreased ?.
Symptoms of ?.
Headaches.
? deterioration
Symptoms of ?.

Answer 7

appearance
hand/foot
sweating
libido
diabetes
visual
hypopituitarism

Question 8

Signs;

Protruding ?.
Prominent ? ridge.
? separation.
Large ?.
?-like hands / feet.
Tight ?.
? ? defects.
Hypertension

Answer 8

mandible
supraorbital
intradental
tongues
spade
rings
visual field

Question 9

Management;

? analogues may be used to shrink the tumour.
o ? term prior to ?.
o ? term if ? ? not possible.
Surgical management is via a ? approach.
o Look for a scar beneath the ? lip.

Answer 9

somatostatin
short
surgery
long
surgical removal
transphenoidal
upper