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Endocrine > Pituitary Conditions > Flashcards

Pituitary Conditions Flashcards

1
Q

What is the difference between functional and non-functional pituitary disease?

A

Functional - secretes excess hormone

Non-functional - results in decrease in hormone secretion

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2
Q

Despite pituitary adenomas being benign they can cause a wide range of symptoms.
At what point does a microadenoma become a macroadenoma?

A

Microadenoma = 1cm

Macroadenoma >/= 1cm

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3
Q

What 2 nearby structures can be compressed by a too large pituitary adenoma?
What does this lead to?

A

Optic chiasm
- Bitemporal haeminopia

Compress nerves found in cavernous sinus
- visual defects/ palsy of eye

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4
Q

What is the most common functional pituitary adenoma?

A

Prolactinoma

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5
Q

Aside from prolactinoma give 4 other reasons for a raised prolactin level?

A
  • Physiological
    • Pregnancy
    • Breastfeeding
  • Drugs (any drug that interferes with dopamine levels)
    • metoclopramide
    • antipsychotics (older styles)
  • Lesions to pituitary stalk (prevent dopamine from being able to inhibit prolactin levels)
  • Hypothyroidism
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6
Q

How is the pituitary gland imaged?

A

MRI

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7
Q

What drug is used to treat increased prolactin levels?
How does it work?
What effect does it have on the tumour?

A

Cabergoline (dopamine agonist)

Causes tumour to shrink

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8
Q

Why are women more likely to present early with prolactinoma compared to men?

A

Women have symptoms more quickly relating to increased prolactin levels

  • amenorrhea (prolactin inhibits ovulation)
  • galactorrhoea (spontaneous milk production)

Men

  • impotence
  • other hormone insufficencies
  • visual defects
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9
Q

Why can a functional pituitary tumour cause a defect in other pituitary hormones?

A

It can become so large that it compresses on other areas of the pituitary gland and inhibits their secretion

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10
Q

Excess growth hormone can cause two types of condition depending on if it occurs in adults or children. What is the name of each?

A

Children - gigantism

Adults - acromegaly

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11
Q

What cancer is associated with acromegaly?

A

Colon cancer from polyp formation

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12
Q

Acromegaly can often cause headaches what is the most likely cause of these?

A

Vascular

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13
Q

How is acromegaly tested for?

A

Oral glucose tolerance test - GH should be suppressed

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14
Q

What is the typical characteristics of acromegaly?

A

Continued growth

  • large hands
  • large feet
  • large lower jaw
  • protrusion of forehead

Soft tissue swelling

  • hands
  • feet
  • face
  • tongue -> obstructive sleep aponea

Carpal tunnel syndrome

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15
Q

How is acromegaly managed?

A
  1. Transsphenoidal surgery

2. Somatostatin analogues e..g sandostatin

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16
Q

What is the most common cause of acromegaly?

A

Pituitary adenoma

17
Q

Middle aged male patient presents with pallor, gynaecomastia, loss of facial and body hair and puffy face.

What investigations would you do and based on the most likely cause what would the treatment be?

A

Panhypopituritism

Test for all pituitary hormones

  • cortisol @9AM
  • testosterone @9AM
  • LH + FSH (note these are v high in post-menopausal women)
  • TSH + free T3+T4
  • GH + IGF-1 = oral glucose test
Cortisol - hydrocortisone
Testosterone - IM testoterone injections
LH + FSH - oral contraceptive
TSH + f/T3+T4 - levothyroxine
GH + IGF-1 - GH SC injection nightly 
ADH - desmospression
18
Q

What is the autoimmune condition that can occur post pregnancy that causes panhypopituitarism?

A

Sheenan

19
Q

What is diabetes inspipidus?

What is commonly seen in the history?

A

Osmotic symptoms either caused by low production of ADH or kidneys poorly responding to ADH

Previous brain trauma

20
Q

A patient is on ward who will drink anything and everything in sight, blood sugar levels are normal.
What test should now be done?

A

8hr water deprivation test

Patients drink loads and have very diluted urine

If then given desmopression and urine becomes more concentrated -> cranial DI (DI caused by low ADH production)

21
Q

What are the side effects of synthetic testoterone treatment?

A

Polycythaemia (high conc. of RBC)

Prostate enlargement (not cancerous - but still has to be checked)

22
Q

What cranial nerve is most commonly affected by pituitary adenoma?

How would this present?

A

III

Eye palsy - dilated pupil and down and out eyeball

23
Q

Would a raised prolactin <1000 be suggestive of a prolactinoma?

A

No - needs to be raised significantly more than that - into the many thousands

24
Q

What drug should be started first in panhypopituitrsim?

A

Hydrocortisone - avoid adrenal crisis

25
Q

Which of the following is suggestive of DI:

  • low plasma osmolality
  • low urine osmolality
  • low serum osmolality
A

Low urine osmolality

= dilute urine - not enough ADH to concentrate the urine

26
Q

What effect does high prolactin have on other pituitary hormones?

A

Inhibits GnRH -> reduced FSH and LH

27
Q

What condition is associated with the destruction of supraoptic nuclei in the hypothalamus?

A

Central DI

28
Q

Define pituitary apoplexy

A

Bleed or obstruction of blood to the pituitary gland

Can arise from large tumour

29
Q

Can men get galactorrhoea from increased prolactin?

A

Yes - although rare

More commonly present with gynaecomastia

30
Q

What anti-nausea drug can cause raised prolactin levels?

A

Metoclopramide

Endocrine (23 decks)

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