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1. Endocrine > Pituitary Adenomas > Flashcards

Pituitary Adenomas Flashcards

1
Q

Where are pituitary adenomas derived from?

A

cells of the anterior pituitary

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2
Q

What is the genetic defect that can predispose to pituitary adenomas?

A

MEN-1 - Werner Syndrome

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3
Q

What is the most common pituitary adenoma?

A

prolactinoma

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4
Q

What can large adenomas cause?

A

visual field defects
infarction
pressure atrophy

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5
Q

What are the 3 types of pituitary adenomas?

A

Prolactinoma
Growth hormone secreting –> Acromegaly
ACTH secreting –> cushings

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6
Q

What is the most common pituitary adenoma?

A

prolactinoma

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7
Q

How does a prolactinoma present in females?

A 
galactorrhea - increased milk production
early presentation
menstrual abnormalities
ammenorrhoea
infertility
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8
Q

How does a prolactinoma present in males?

A 
impotence - erectile dysfunction
visual field abnormailites
late presentation
headache
anterior posterior malfunction
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9
Q

What drugs can also cause an increased prolactin?

A

dopamine antagonists - metoclopramide
antipsychotics - phenothiazine
antidepressants

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10
Q

What are the investigations done for a prolactinoma?

A

serum prolactin concentration - raised
MRI of brain
test visual fields
pituitary function tests

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11
Q

What is the visual deformity that can occur due to a prolactinoma?

A

bitemporal hemianopia - tunnel vision

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12
Q

What are the treatment for prolactinomas?

A

DOPAMINE AGONISTS e.g.

  1. Cabergoline - 1 or 2 daily
  2. Bromocriptine - 3 daily
  3. Quinagolide - 1 daily
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13
Q

Why are dopamine agonists used to treat prolactinomas?

A

dopamine inhibits PRL

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14
Q

What does a growth hormone producing tumour result in?

A

Acromegaly

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15
Q

What are the presenting features of acromegaly?

A 
enlarged forehead, hands, feet and jawline
prominent brow
thickened soft tissue
hypertension
cardiac failure 
snoring and sleep apopnea
headaches - stop as soon as treated
colonic polyps
pituitary affects - visual disturbances
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16
Q

What is the first diagnostic test for acromegaly?

A

IGF-1

17
Q

What is the second but gold standard diagnostic test for acromegaly?

A

GGT suppression test - (glucose tolerance test)

GH <0.4 = fine GH >1 = needs treatment

18
Q

What are other additional tests for acromegaly?

A

MRI pituitary
pituitary function tests
visual fields

19
Q

How is acromegaly pharmacologically treated?

A
  1. Somatostatin analogues
    - Sandostatin, lanreotide, pasireotide
    suppress GH production, can be used post op to releive headaches
  2. Dopamine agonists
    - Cabergoline
    - only works in 15% of patients
  3. GH antagonists
    - Pegvisomant: binds to the GH receptor, blocking GH activity
    - doesnt decrease tumour size
20
Q

What are the side effects of somatostatin analogues?

A

inhibit gut hormones

stops bladder contracting causing gallstones

21
Q

What are the non pharmacological treatments of acromegaly?

A

pituitary surgery - 90% cure if micro, 50% if macro

external radiation to the pituitary fossa - 25% sucess

22
Q

What is the difference between cushings disease and syndrome?

A 
disease = caused by ACTH over secretion
syndrome = the signs and symptoms that are caused by excess cortisol in the body
23
Q

What is the general presentation of cushings?

A

muscle wasting - myopathy
osteoporosis - leaking of protein out of bones
thin skin
striae
moon face
central obesity
hypertension and oedema -> mineralocorticoid
acne, hirtism, amenorrhea -> excess androgens
conjunctival oedema -> chemosis
depression
buffalo fat pad

24
Q

How is cushings screened?

A

overnight dexamethasone suppression test

cortisol > 100 = abnormal

25
Q

What is the definitive cushings test?

A

2 day 2mg Dexamethasone suppression test (low dose)

26
Q

What results of the low dose dexamethasone test would indicate cushings?

A

cortisol >130 mol/L after 6 hours of last dose

27
Q

What is dexamethasone?

A

oral high dose steroid

28
Q

Why do people with cushings have a high mortality?

A

steroids are immunosuppressive

29
Q

What is the non pharmacological treatment for cushings if it is a pituitary cause?

A

pituitary surgery = hypophysectomy and external radiotherapy if it reoccurs

30
Q

What is the non pharmacological treatment for cushings if it is a adrenal cause?

A

adrenalectomy

31
Q

What is the non pharmacological treatment for cushings if it is a ectopic cause?

A

remove source

32
Q

What is the pharmacological treatment for cushings?

A

Metyapone - if other treatments fail
Ketocanazole - hepatotoxic
Pasireotide - somatostatin analogue

33
Q

What are the non pituitary causes of cushings syndrome?

A

adenoma/carcinoma of the adrenal glands
ectopic ACTH from lung cancers, thymus etc
pseudocushings - steroid meds, alcohol, depression
prolonged high dose steroid therapy >2 weeks

34
Q

What are the 3 causes of pituitary hypofunction?

A

sarcoidosis - granulomatous inflammation
sheehans syndrome - infarction
primary or metastatic tumours

35
Q

What is a craniopharyngioma dervied from?

A

remnant of Rathkes pouch

36
Q

How does a craniopharyngioma present?

A

headaches

visual disturbances

37
Q

How is a craniopharyngioma treated?

A

radiation

1. Endocrine (32 decks)

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