Pituitary Adrenal Disease Flashcards
What are the causes of seller masses?
Benign tumours: -pituitary adenoma -craniopharyngioma -meningioma Malignant tumours: -primary (vanishingly rare) -metastatic tumours (lung, breast) Cysts: Rathke's cleft, arachnoid, dermoid Lymphocytic hypophysitis Carotid aneurysm
What are the local effects of pituitary tumours?
- Headaches
- ->a) stretching of dura by tumour
- ->b) hydrocephalus (rare).
- Visual field defects (nasal retinal fibres compressed)
- Cranial nerve palsies and temporal lobe epilepsy (lateral extension of tumour)
- CSF rhinorrhea (downward extension of tumour)
What are the types of pituitary adenoma?
Prolactinoma - prolactin secreting
Acromegaly - GH secreting
Cushing’s - ACTH secreting
RARE: TSH secreting, Gonadotrophin secreting (FSH and LH).
Non funtioninig - just mass effect features but no hormone disruption.
What are the symptoms of prolactinoma in female?
- Galactorrhoea
- Hypogonadism - infertility + amenorrhoea or oligomenorrhea
What are the symptoms of prolactinoma in males?
- Hypogonadism - decreased libido, infertility, impotence, gynaecomastia.
- Rarely galactorrhoea.
What is the treatment for prolactinoma?
Dopamine agonists usually reduce tumour size and prolactin secretion e.g. bromocriptine, carbergoline.
What are the causes of acromegaly?
> Common: GH secreting pituitary adenoma
Rare:
-GH secreting extra pituitary tumour.
-GHRH hormone secreting tumour.
What are the clinical features of acromegaly?
- Insidious onset
- Enlarged jaw, hands and feet (dental problems, tight rings, increased shoe size).
- Coarsening facial features, enlarged frontal bones and nose.
- Thickened skin
- Enlargement of tongue, deepening of voice.
Investigations in suspected acromegaly?
- GH biochem: Increased
- OGTT: Failure to suppress GH w/ OGTT
- Increased IGF1 / Somatomedin C
- Diabetes or impaired OGTT
- CT/MRI: pit tumour
What is the treatment for acromegaly?
1’: transphenoidal hypophysectomy to remove tumour
Surgical resection unsuccessful:
- radiotherapy
- octreotide: long acting prep every 1/12
- bromocriptine
What is the size cut off for pituitary adenoma macro v micro?
10mm macro
What are the causes of Cushing’s syndrome?
- ACTH dependent Cushing’s syndrome:
- Cushing’s
- ectopic ACTH
- ectopic CRF.
- ACTH-independent Cushing’s syndrome:
- adrenal adenoma
- adrenal carcinoma
- micronodular hyperplasia
- macronodular hyperplasia.
What are the clinical features of Cushingoid appearance??
- Obesity: redistribution of weight centrally, moon face, buffalo hump, wasting of buttocks.
- Skin: atrophy of epidermis; thin skin, plethoric face, easy bruising, striae.
- Hirsutism
What are the major AEx of bromocriptine?
N/V, postural dizziness.
What are the neuropsychiatric clinical features of Cushing’s?
- Depressed mood/ crying
- decreased concentration and memory;
- insomnia
- decreased libido.
What are the MSK alterations of Cushing’s?
- Proximal myopathy
- Osteopaenia: crush fractures of vertebrae.
What are the metabolic features of Cushing’s?
- Diabetes 25%;
- glucose intolerance 75%
What are the investigations and expected results in Cushing’s syndrome?
- FBE: Hb high normal; WCC slightly elevated, decreased neutrophils
- Electroytes: hypokalemia and metabolic alkalosis in ectopic ACTH.
- Hyperglycemia: due to insulin resistance
- Increased Ca2+ absorption and hypercalciuria
How is Cushing’s diagnosed?
- 24h urine free cortisol
- Overnight dexamethasone suppression test.
How is pathological cause of Cushing’s determined?
ACTH:
- if suppressed, likely adrenal cause.
- Normal or elevated: likely pituitary dependent.
- Very high, likely ectopic ACTH.
Describe the 4 major forms of Cushing’s syndrome.
- Pituitary Cushing Syndrome
- Adrenal Cushing syndrome
- Paraneoplastic Cushing Syndrome
- Iatrogenic Cushing syndrome
Pituitary dependent Cushing’s treated?
Transphenoidal hypophysectomy to remove tumour.
How is adrenal adenoma or carcinoma Cushing’s treated?
Adrenal surgery
How is ectopic ACTH or CRF treated?
Treat the tumour associated with the hormone production.
