Pituitary and adrenal disease

Question 1

Hyperprolactinaemia

Answer 1

Causes
- Pregnancy
- Adenomas
- Hypothalamic and pituitary stalk lesions
- Empty sella SND
- Hypothyroidism
- CKD
- Seizures
- Drugs eg metoclopramide

Features
- Head symptoms
- Visual field changes
- Inferitlity
- Galactorrhoea
- Amenorrhoea
- DI

Diagnosis
- Neurological exam
- Other pituitary function testing
- MRI/CT

Pregnancy effect: enlarges or remission postpartum
Effect on pregnancy: Nil generally once pregnant

Treatment
- Generally discontinue dopamine receptor agonists once pregnant
- Or continue if high riks
- Review and exam once a trimester
- MRI if concerns

Question 2

Diabetes insipidus

Answer 2

Failure to concentrate urine
Cranial or central: not enough ADH
Nephrogenic: ADH resistance
Transient: eg as in PET/HELLP syndrome or acute fatty liver
Psychogenic: compulsive water drinking

In pregnancy water deprivation test not recommended. Instead review serum, urine osmolality and Na

Pregnancy can worsen it
Can cause maternal seizures and oligo

Mg: review for PET and AFLP, use dDAVP
Nephrogenic: carbamazepine as chlorpropamide can cause fetal hypoglycaemia

Question 3

Acromegaly

Hypopituitarism

Answer 3

Acromegaly
Pts often infertile due to co-secretion of prolactin

Hypopituitarism:
- Surgery, radiotherapy, trauma, tumours, Sheehan’s, lymphocytic hypophysitis
- May need IVF but after conception the feto-placental unit makes the hormones needed for pregnancy
- If untreated can cause misc, PTB, SB, hypotension and hypoglycaemia
- Acute mg: IV glucose, fluids and steroids
- Long term: steroids and thyroxine

Question 4

Cushings: rare in pregnancy (caused by pituitary adenomas mostly or adrenal adenomas/carcinomas)

Question 5

Adrenal disease
Conn’s syndrome: hyperaldosteronism

Phaeochromocytomas

Addisons disease

CAH

Answer 5

Conn’s SND
- HTN and hypokalaemia
- Caused by adrenal adenoma/carcinoma/hyperplasia
- Tested with renin, aldosterone levels, K
- Tx: with anti HTN, K+ and amiloride, surgery pp

Phaeochromocytomas
- HTNc crisis, headahce, sweating, palpitations, anxiety
- Test 24 urinary catecholamines
- MRI or USS
- High risk in pregnancy of maternal and fetal mortality
- Give alpha and beta blockade

Addisions
- Hypotension, low K, Na, bsl
- Check 9am serum cortisol and no response to synacten test.
- Pregnancy doesn’t effect it but can cause issues to pregnancy if not diagnosed

CAH
- AR
- Issues: masculinisation of female fetus, salt losing crisis in male infant due to mineralocorticoid deficiency, precocious puberty in males
- Female adults often infertile, having issues with androgen excess, amenorrhea is common
- Pregnancy is rare, risks of PET, FGR, misc, GDM
- Treatment with steroids and mineralocorticoids need to be continued
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