pituitary disease Flashcards
give causes of a high prolactin
Prolactinomas
Physiological - Lactation / pregnancy
Drugs (that block dopamine) - Tricyclics / antiemetics / antipsychotics
“stalk” effect - Due to loss of inhibitory dopamine
give causes of hypopituitarism
tumour, radiotherapy, infarction/haemorrhage, infiltration (e.g.sarcoid), trauma, lymphocytic hypophysitis
what is the stalk effect
where there is disruption to the portal system along which dopamine travels to the anterior pituitary from the hypothalamus. This reduces inhibition resulting in a small increase in prolactin.
what are the clinical features of a prolactinoma
– Galactorrhoea – Headaches – Mass effect – Visual field defect – Amenorrhoea / erectile dysfunction
describe the symptoms of acromegaly
Sweats, headache, tiredness, increase in ring or shoe size are very telling, joint pains
describe the signs of acromegaly
o Coarse facial appearance - Increased frontal bossing, brow protrudes, enlargement of the base of the nose, thickening of the nasolabial sulcus, thickening of the lips, parotid hypertrophy, loss of oval facial features
o Enlarged hands and feet
o Visual field loss
what are the complications of acromegaly
hypertension, diabetes/impaired glucose tolerance, increase risk of bowel cancer/heart failure
how would you diagnose acromegaly
GTT - giving a glucose load will fail to suppress the GH level (would normally reduce)
IGF-1 level
pituitary MRI
how would you treat acromegaly
surgery is first line
Can give somatostatin analogues.Other drugs as well
Radiotherapy can be used but carries a risk of long-term complications
what are the clinical features of diabetes insipidus
polydipsia, polyuria, nocturia
what will a patient with DI have in terms of osmolality of their urine and plasma
urine -low osmolality, plasma - high osmolality
what are the two types of DI
cranial (central) - problem with the posterior pituitary; not producing enough ADH.
nephrogenic - resistance to ADH.
how would you determine the type of DI a person had
water deprivation test.
how do you treat cranial DI
desmopressin
