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Pituitary Disease Flashcards

1
Q

What are the hormones produced by the anterior pituitary?

A

FLATPiG: FSHLHACTHTSHProlactinignoreGrowth Hormone

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2
Q

What are the hormones produced by the anterior pituitary?

A

FLATPiG: FSHLHACTHTSHProlactinignoreGrowth Hormone

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3
Q

What are the hormones produced by the posterior pituitary?

A

ADHOxytocin

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4
Q

List the causes of sellar massess

A
  1. Benign tumours:- Pituitary adenoma- Craniopharyngioma- Meningioma2. Malignant tumours- Primary (rare)- Metastatic tumours (especially from lung and breast - but rare)3. Cysts- Rathke’s cleft- Arachnoid - Dermoid4. Lymphocytic hypophysitis (autoimmune)5. Carotid aneurysm
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5
Q

Local effects of pituitary tumours

A
  • Headaches- Bitemporal hemianopia (nasal retinal fibers compressed by tumour)- Cranial nerve palsies and temporal lobe epilepsy (lateral extension of the tumour)- Cerebrospinal fluid rhinorrhea (downward extension of tumour)
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6
Q

What are the types of pituitary adenomas?

A

a. Common three:- Prolactinoma- Acromegaly- Cushing’sb. Very rare:- TSH secreting- Gonadotrophin secreting (FSH and LH) c. Non functioning tumour (no hormone changes, just the mass effect - headache, visual changes)

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7
Q

Prolacting secreting pituitary tumours

A

TRIAD: 1. Galactorrhea (w/ breast enlargement, breast pain)2. Amennorrhea 3. Infertility or subfertility

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8
Q

What are the clinical features of hyperprolactinaemia?

A

TRIAD: 1. Galactorrhea (w/ breast enlargement, breast pain)2. Amennorrhea 3. Infertility or subfertility

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9
Q

Causes of hyperprolactinaemia?

A
  • Prolactin secreting tumour- Lack of dopamine - Blood supply cut off at pituitary stalk- Drugs inducing prolactin excess: e.g. maxolon, antipsychotics, antiepileptics
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10
Q

Results of pituitary hormone levels will be abnormal in..?

A

F taking OCP or with hormone associated IUDs

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11
Q

Results of pituitary hormone levels will be abnormal in..?

A

F taking OCP or with hormone associated IUDs

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12
Q

What is the difference between a macroadenoma and microadenoma?

A

10mm = macroadenoma

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13
Q

Ix if suspected pituitary adenoma?

A
  • MRI- Pituitary hormone panel- Visual fields
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14
Q

Rx of prolactinaemia

A

Dopamine agonist - consider pyschological effects OCP - consider risk of breast cancer in pt

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15
Q

What are the two main dopamine agonists used in prolactinaemia?

A

a. old - bromocriptine (biochemical resolution, Sx improvement and tumour reduction) b. young - carbegoline

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16
Q

Rx of prolactinaemia

A

1st line: Dopamine agonist - consider pyschological effects

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17
Q

What are the two main dopamine agonists used in prolactinaemia?

A

a. old - bromocriptine (biochemical resolution, Sx improvement and tumour reduction) AFx: postural dizziness, nausea, vomitingb. young - carbegolineInitial high dose, then wean down to lower baseline to control Sx

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18
Q

What is the difference between gigantism and acromegaly?

A

Gigantism: increase GH before epiphyseal closure Acromegaly: increase GH after epiphyseal closure

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19
Q

What are the clinical features of prolactinaemia in women?

A

TRIAD: 1. Galactorrhea (w/ breast enlargement, breast pain)2. Amennorrhea 3. Infertility or subfertility

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20
Q

Rx of prolactinaemia

A

1st line: Dopamine agonist - consider pyschological effectsEffect: reduction in tumour size and prolactin secretion

21
Q

What is the difference between gigantism and acromegaly?

A

Gigantism: increase GH before epiphyseal closure Acromegaly: increase GH after epiphyseal closure

22
Q

What are the clinical features of acromegaly

A

Somatic effects - growth of many tissues- skin- connective tissue- cartilage- bone- viscera- epithelial tissuesTherefore: a. enlarged jaw, hands and feet leading to dental problems, tight rings, increased shoe sizeb. coarsening of facial features, enlarged frontal bones (bossing of skull) and nosec. thickened skind. enlargement of tongue, deepening of voice

23
Q

What are the clinical features of prolactinaemia in males?

A

Hypogonadism - decreased libido, infertility, impotence, gynaecomastia, rarely galactorrhea

24
Q

What are the causes of acromegaly?

A

Common: GH secreting pituitary adenomaRare: a. GH secreting extra pituitary tumourb. GH releasing hormone secreting tumour

25
What are the clinical features of acromegaly
Somatic effects - growth of many tissues- skin- connective tissue- cartilage- bone- viscera- epithelial tissuesTherefore: a. enlarged jaw, hands and feet leading to dental problems, tight rings, increased shoe sizeb. coarsening of facial features, enlarged frontal bones (bossing of skull) and nosec. thickened skin and skin tags on neckd. enlargement of tongue (can see imprints of teeth on tongue) e. deepening of voicef. organ enlargement: hepatomegaly, cardiomegalySxa. arthritis and bone pain
26
What are the causes of acromegaly?
Common: GH secreting pituitary adenomaRare: a. GH secreting extra pituitary tumourb. GH releasing hormone secreting tumour
27
Ix if suspected acromegaly?
Biochemistry:- increased GH,- Failure to suppress GH levels with oGTT (normal: hyperglycaemia leads to suppression of GH) - increased IGF1 (somatomedin C)- Diabetes or impaired glucose toleranceImaging: - CT or MRI to show large pituitary tumour
28
What is the 1st line Rx of acromegaly?
1st line: transphenoidal hypophysectomy to remove tumour NB: GH secreting pituitary adenoma is usually macroadenoma
29
If acromegaly is not cured by surgery what are other options of Rx?
If not cured surgically possible Rx:- Radiotherapy- Octreotide - long acting preparation given once/month- Bromocriptine
30
What is the 1st line Rx of acromegaly?
1st line: transphenoidal hypophysectomy to remove tumour NB: GH secreting pituitary adenoma is usually macroadenoma
31
If acromegaly is not cured by surgery what are other options of Rx?
If not cured surgically possible Rx:- Radiotherapy- Octreotide - long acting preparation given once/month- Bromocriptine
32
What is Cushing's disease?
ACTH secreting pituitary tumour
33
What type of cancer is increased in acromegaly?
Polyps in the GIT present and stimulated by the GH leading to bowel cancerTherefore must refer and routine scopes
34
What are the long term complications of acromegaly?Consider management plan.
Two structures with long term concerns:1. Polyps in the GIT present and stimulated by the GH leading to bowel cancerTherefore must refer gastroenterologist and routine scopes2. Cardiomegaly due to hypertrophy of the heart, leading to eventual failureRefer to cardiologist
35
What are the clinical features of Cushing's syndrome?
a. Obesity: Moon face, Buffalo hump, wasting of buttocksb. Skin: atrophy of epidermis, thin skin, plethoric face, easy bruising, striae (pink/purple)c. Neurpsychiatric: depressed mood and crying, decreased concentration, insomnia, decreased libidod. Proximal myopathye. Osteopaniea - crush fractures of vertebraef. Diabetes 25%, glucose intolerance 75%g. Hirsutism, HTN, menstrual diorders
36
What are the clinical features of Cushing's syndrome?
a. Obesity: Moon face, Buffalo hump, wasting of buttocksb. Skin: atrophy of epidermis, thin skin, plethoric face, easy bruising, striae (pink/purple), skin discolouration (due to b'down of ACTH)c. Neurpsychiatric: depressed mood and crying, decreased concentration, insomnia, decreased libidod. Proximal myopathye. Osteopaniea - crush fractures of vertebraef. Diabetes 25%, glucose intolerance 75%g. Hirsutism, HTN, menstrual diorders
37
What are the causes of ACTH dependent Cushing's syndrome?
Cushing's diseaseEctopic ACTHEctopic CRF
38
What are the causes of ACTH independent Cushing's syndrome?
Adrenal adenomaAdrenal carcinomaMicronodular hyperplasiaMacronodular hyperplasiaIatrogenic
39
Ix for Cushing's syndrome?
1. FBE: - Hb is in the high normal range- WCC is slightly elevated, decreased neutrophilsElectrolytes:- Hypokalaemia and metabolic alkalosis in ectopic ACTHHyperglycaemia due to insulin resistanceIncreased Ca absorption and hypercalcuria2. Overnight dexamethasone Suppression Test3. 24 hour urine free cortisol4. Imaging: pituitary if adenoma, likely Cushing's disease; adrenal tumours5. ACTH levels
40
What is the dexamethasone suppression test?
test serum cortisol at 8am after 1mg dexamethasone at midnight, should be suppressed
41
What is inferior petrosal sinus sampling?
Sample veins from cavernous sinus - must test that ACTH levels are elevated to ensure that it is pituitary tumour rather than adrenal tumour
42
How does the level of ACTH determine the pathological cause?
If suppressed: likely adrenal causeNormal or slightly elevated: likely pituitary dependentVery high: likely ectopic ACTH
43
What two Ix can establish the pathological cause?
ACTH levels and imaging
44
What two Ix can establish the pathological cause?
ACTH levels and imaging
45
Rx of Cushing's
If pituitary dependent Cushing's: transphenoidal hypophysectomy to remove tumourIf adrenal adenoma or carcinoma: adrenal surgeryIf ectopic ACTH or CRF: treat the tumour associated with the hormone production
46
Rx of Cushing's
If pituitary dependent Cushing's: transphenoidal hypophysectomy to remove tumourIf adrenal adenoma or carcinoma: adrenal surgeryIf ectopic ACTH or CRF: treat the tumour associated with the hormone production
47
What are the clinical features of Addison's disease?
Pigmentation (darkening of scars, buccal mucosa)Unintentional weight lossFatigue
48
What are the clinical features of Addison's disease?
Pigmentation (darkening of scars, buccal mucosa)Unintentional weight lossFatigue

Endocrinology (9 decks)

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