Pituitary Adenomas Flashcards
Name all malignancies of the pituitary gland?
All types of pituitary adenomas
Hyperpituitarism
Cushing Syndrome
Acromegaly
Prolactinoma
What hormones are released by the anterior and posterior pituitary glands
Anterior pituitary gland:
TSH - Stimulates release of thyroid hormones
FSH - Stimulates gamete synthesis
Prolactin - Promotes milk production
GH - Stimulates release of
ACTH - Stimulates release of cortisol
LH - Stimulates production of sex hormones
Posterior pituitary gland
ADH - Water balance - Vasoconstriction + Water resorption
Oxytocin - Trigger uterine contraction (birth)
Enlargement of Pituitary adenoma can lead to ….
Compression of the optic chiasm leading to visual defect
What is Cushing Disease? Aetiology?
Long term exposure to cortisol (Hypercortisolaemia)
ACTH Dependant - Pituitary adenoma (Cushing’s Disease), Ectopic ACTH production -SCLC
Non-ACTH Dependant - Adrenal Adenoma, Iatrogenic corticosteroid use (HPA Suppression)
How would a patient with cushing’s present?
Excess cortisol:
Signs
Central Obesity
Straie
Buffalow Hump
Moon face
Plethoric complexion
HTN
Thin skin - easy bruising
Symptoms
Bloating
Weight gain
Mood Change
Increased risk of infection
Decreased libdo
Menstrual irregularity
Metabolic Alkalosis
Decsribe cortisol secretion pattern
Diurnal Cycle - Highest in the morning
How do you differentiate between corticotropin associated Cushings and not?
Dexamethasone test differentiates between ACTH dependant
Dexamethasone is a cortisol analogue.
Administration = HPA suppression (Cortisol = Less ACTH=Less cortisol)
1st dose Overnight low dose
Suppression of serum cortisol / Low cortisol ~ - Likely to be ACTH independent
High cortisol ~ ACTH Dependant
2nd dose - High dose of dexamethasone - Localise source
suppression + ~ Pituitary adenoma
No suppression ~ Ectopic SCLC
Pituitary
Cushing’s TX
Medication - Cortisol synthesis inhibitors - Ketoconzaole, Metyrapone
+
Treat source
Pituitary adenoma - Transphenoidal resection 2 line- Radiotherapy
SCLC - Surgical removal
Adrenal Adenoma - Adrenalectomy
Iatrogenic steroid use - Cease use
What are the long term complication of Cushing syndrome
Osteoperosis
HTN
T2DM
What diseases are associated with Exess Growth hormone secretion
In kids (prior fusion of epiphyseal plates) - Gigantism
In adults - Acromegaly
What features are associated with acromegaly?
Signs
Hoarse voice
Box Jaw
Large extremities hands, feet, face
Profusely sweating
Bitemporal hemianopia
Symptoms
Visual disturbances
Erectile dysfunction
Galactorrhoea
Headache
Sleep Apnoea
Bitemporal hemianopia
Does somatostatin and dopamine inhibit growth hormone release? TRUE OR FALSE
TRUE
DX - Acromegaly
2 test:
Serum Igf1
+
GS - OGTT -glucose load ->X GH release.
No suppression after two hours —–> Pituitary MRI
TX Acromegaly
1- Transphenoidal resections
2- Octreotide (Somatostatin analogue)
3- Pegvisomant (GH antagonist)
4- Cabergoline (DA Agonist)
5- Radiotherapy
What is the main complications of acromegaly?
COLORECTAL CANCER %%%%%
T2DM
Erectile dysfunction
