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*Medicine: Endocrinology > Pituitary Disease > Flashcards

Pituitary Disease Flashcards

1
Q

What two hormones does the posterior pituitary release?

A
  • ADH
  • Oxytocin
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2
Q

GGTAP

Hypopituitarism entails reduced secretion of anterior pituitary hormones.

What are the anterior pituitary hormones (and in which order are they affected)?

A
  • Growth Hormone (GH)
  • Gonadotropins: FSH + LH
  • Thyroid stimulating hormone (TSH)
  • ACTH
  • Prolactin
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3
Q

What 3 levels can hypopituitarism impact at?

A
  • Hypothalamus → Kallman’s / inflammation / infection / ischaemia
  • Pituitary stalk → trauma / surg / mass lesion / meningioma
  • Pituitary gland → tumour / irradiation / inflammation / autoimmune / ischaemia
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4
Q

What are the clinical features of hypopituitarism?

A
  • GH → central obesity / dry winkly skin / weakness / osteoporosis / hypoglycaemia
  • FSH/LH → oligomenorrhoea / amenorrhoea / red. libido / hypogonadism
  • TSH → hypothyroidism
  • ACTH → adrenal insufficiency
  • PRL → rare
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5
Q

Which investigations for hypopituitarism?

A
  • Basal tests → LH + FSH / testosterone or oestradiol / TSH / Insulin-like GF
  • Dynamic → short synacthen test / insulin intolerance test
  • Investigate cause → MRI scan to look for hypothalamic or pituitary lesion
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6
Q

What is the management of hypopituitarism?

A
  • Refer to endo
  • Hydrocortisone for 2o adrenal failure before other hormones given
  • Thyroxine if hypothyroid
  • Treat hypogonadism (for symptoms + to prevent osteoporosis)
    • Men → testosterone enanthate 250mg IM every 3 wks
    • Women → transdermal oestradiol patches or COCP
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7
Q

What is Kallmann’s syndrome?

A
  • Recognised cause of delayed puberty 2o to hypogonadotrophic hypogonadism
  • Inherited as an X-linked recessive trait
  • Clue given is lack of smell in a boy with delayed puberty
  • Clinical features → delayed puberty / hypogonadism / anosmia / low sex hormones / pts typically normal/above avg height
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8
Q

Pituitary tumours (almost always benign adenomas) account for 10% of intracranial tumours. May be divided by size: microadenoma (< 1cm) or macroadenoma (>1cm).

There are 3 histological types, what are they?

A
  • Chromophobe (70%) → many non-secretory, some cause hypopituitarism; half produce prolactin; few produce ACTH or GH; local pressure effect in 30%
  • Acidophil (15%) → secrete GH or prolactin; local pressure effect in 10%
  • Basophil (15%) → secrete ACTH; local pressure effect rare
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9
Q

Clinical features are caused by pressure, hormones or hypopituitarism.

Wha tare features of local pressure?

A
  • Headache
  • Bilateral temporal hemianopia
  • Palsy: CN III, IV, VI (pressure or invasion of cavernous sinus)
  • Diabetes insipidus
  • Disturbance of hypothalamic centres of temp, sleep + appetite
  • Erosion through floor of sella → CSF rhinorrhoea
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10
Q

Which investigations for pituitary tumours?

A
  • Pituitary blood profile → GH / prolactin / ACTH / FSH / LH / TFTs
  • Formal visual field testing
  • MRI brain w/ contrast
  • Water deprivation test if diabetes insipidus suspected
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11
Q

What is the management for pituitary tumours?

A
  • Start hormone therapy as needed - ensure steroids are given before levothyroxine, as thyroxine may precipitate an adrenal crisis
  • In a prolactinoma → 1st line treatment is dopamine agonist
  • Surgery → transsphenoidal
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12
Q

What is pituitary apoplexy?

A
  • Rapid pituitary enalrgement
  • From bleed into a tumour
  • May cause mass effects, CV collapse due to acute hypopituitarism, and death
  • Sx → acute onset headache / meningism / red. GCS / visual field defect
  • Rx → urgent steroids - hydrocortisone 100mg IV + meticulous fluid balance
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13
Q

What is hyperprolactinaemia?

A
  • Prolactin secreted by ant pit
  • Release inhibted by dopamine (prod in hypothalamus)
  • Commonest hormonal disturbance of pituitary
  • Presents earlier in women (menstrual disturbance), but later in men
  • Prolactin simtulates lactation
  • Raised levels lead to hypogonadism, infertility + osteoporosis by inhibitng secretion of GNRH hormones
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14
Q

What are causes of hyperprolactinaemia (PRL > 390 mu/L)?

A
  • XS production from pituitary → prolactinoma (usually causes >5K)
  • Disinhibition → by compression of pit stalk, reducing local dopamine
  • Use of dopamine antagonist → metocloperamide / haloperidol / methyldopa / anti-psychotics
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15
Q

What are clinical features of hyperprolactinaemia?

A
  • Women → amenorrhoea / infertility / galactorrhoea / red. libido / dry vagina
  • Men → erectile dysfunction / reduced facial hair / galactorrhoea
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16
Q

Which investigations for hyperprolactinaemia?

A
  • Basal prolactin → non-stressful venepuncture between 9:00-16:00
  • Pregnancy test, TFTs, U+Es, MRI pituitary
17
Q

What is the management of hyperprolactinaemia?

A
  • Dopamine agonists (eg. Cabergoline, Bromocriptine)
  • Majority of cases treated medically
  • Surgery for those who cannot tolerate, or fail to respond, to med therapy
18
Q

What is acromegaly?

A
  • This is due to increased secretion of GH from a pituitary tumour (99%) or hyperplasia eg. via ectopic GH-releasing hormone from a carcinoid tumour
  • Incidence 3 million/yr
  • 5% associated w/ MEN-1
  • GH stimulates bone and soft tissue growth through increased secretion of IGF-1
19
Q

What are clinical features of acromegaly?

A
  • Coarse facial appearance, spade-like hands, increase in shoe size
  • Large tongue, prognathism, interdental spaces
  • Excessive sweating + oily skin → caused by sweat gland hypertrophy
  • Pit tumour sx → hypopituitarism, headaches, bitemp hemianopia
  • Acanthosis nigiricans
  • OSA
  • Carpal tunnel signs (50%)
  • Goitre (thyroid vascularity inc)
20
Q

What are complications of acromegaly?

A
  • Impaired glucose tolerance (40%)
  • Diabetes mellitus (15%)
  • Hypertension / LVH / Cardiomyopathy / Arrhythmias
  • Colon cancer risk inc
21
Q

Which investigations for acromegaly?

A
  • Serum IGF-1 levels
  • OGTT → recommended to confirm diagnosis if IGF-1 levels raised
22
Q

What is the management of acromegaly?

A
  • Transsphenoidal surgery (1st line)
  • If surgery fails to correct GH / IGF-1 hypersecretion → try somatostatin analogues (eg. Octreotide)
    • SEs → pain at injection site / abdo cramps / loose stools / gallstones
  • Pegvisomant (GH antagonist) used if resistant or intolerant to ocreotide; it suppresses IGF-1 to normal in 90%, but GH levels may rise

*Medicine: Endocrinology (10 decks)

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