Pituitary disease Flashcards
Structure of pituitary
pituitary gland attatched to hypothalamus via stalk and sits in pituitary fossa just below optic chiasm.
Divided into the anterior (endocrine productive) and posterior (neuro-endocrine-storage) pituitary
Hormones produced by pituitary gland
Growth Hormone Thyroid Stimulating Hormone LH & FSH Prolactin ACTH
Pituitary tumour symptoms
bi-temporal hemianopia
CN 3, 4 and 6
Headache
Hypothalamic control (weight gain/anorexia, thirst, hypersomulence/ alertness)
Symptoms of hormonal excess (GH, Prolactin, ACTH or combination)
Hypopituitarism. (GH/ TSH)
Hypopituitarism of “other” aetiology
Vascular: Carotid aneurysm
Infective: Basal meningitis / enchepalitis / neurosyphilis
Traumatic: skull fracture
Autoimmune: various
Inflammatory: sarcoid, Haemachromatosis, Giant Cell Arteritis
Neoplastic: 1 pituitary tumour, meningioma, craniopharyngioma, glioma, lymphoma
Congenital: Kallman’s + various
Damage: radiation, fibroisis, chemo
Functional: anorexia, starvation, emotional neglect
GH deficiency
Short stature in children, varied effects in adults,
GOLD STANDARD TEST: Insulin tolerance test.
GH hypersecrection
Gigantism in children
Acromegaly in adults
Almost always due to pituitary tumour
Gigantism
Excess GH before fusion of epiphyseal plates
Acromegaly symptoms
CHANGE IN APPEARANCE -increased size of hands, feet, ears and nose, forehead -greasy thick skin -weight gain -large tongue -hirsuitism -interdental seperation -prognathism (jaw protrusion) SYSTEMIC -tiredness -sweating -polyuria / polydypsia -weakness and joint pain -headaches -ammenorrhoea -impotence + poor libido -galactorrhoea -breathless NERVE COMPRESSION -visual field defects -carpal tunnel syndrome - deep voice -deafness
Complications of acromegaly
Heart Failure
HTN
ACS
Bowel Tumours
Management of acromegaly
TARGET: GH <2.5
Transphenoidal surgery
Radiotherapy
Somatostatin receptor/ dopamine agonists or GH antagonists
Hyperprolactinaemia causes
Prolactinoma Compression of pituitary stalk PCOS Hypothyroidism Idiopathic Organ failure Drugs: anti-emetics, oestrogen therapy and opiates
Symptoms of hyperprolactinaemia
Galactorrhoea Oligo/Amennorrhoea Decreased libido / Erectile dysfunction Subfertility Oestrogen and androgen deficiency Osteoporosis Delayed / arrested puberty Gynaecomastia (headaches, visual field defects, symptoms from mass lesion/ other causes)
Investigations hyperprolactinaemia
Serum Prolactin
+anterior pituitary screen
(TFT /LH+ FSH / Insulin tolerance test /short ATCH stimulation)
MRI
Management hyperprolactinaemia
Dopamine agonists : Bromocriptine / Cabergiline / Quinagolide
Surgery if pituitary cause and small size
Radiotherapy
Pregnancy counselling (risk of growth, dopamine agonists can be used during gestation)
what is Cushing’s Syndrome
Increased free circulating glucocorticoid
Causes of Cushings SYNDROME
Cushing’s Disease (pituitary overproduction of ACTH)
Iatrogenic ACTH administration
ACTH producing tumours- ectopic
Adrenal adenomas / carcinomas
Iatrogenic Gluccocorticoid administration
Pseudo-cushings from alcohol
Causes Cushing’s Disease
80% of CD caused by Pituitary Adenomas
Other causes: hyperthalamic overproduction of CRH
Cushingoid appearance
APPEARANCE
- moon face
- central obesity
- thin skin with easy bruising
- hirsuitism
- acne
- frontal balding
- pigmnetation
- kyphosis and buffalo hump
- facial plethora
- Striae
Non-visual presentation of Cushings
Depression Insomnia Menstrual disturbance Poor libido Muscle Weakness Poor growth in children Back pain Psychosis Poor wound healing & infections HTN Osteoporosis and pathological fractures Odema Myopathy & muscle wasting Diabetes, polyuria and polydipsia Hypokalaemia
Diagnosing Cushing’s
48hr Dexamethasone supression test
24hr free urinary cortisol
Circadian rythym serum cortisol / midnight salivary cortisol.
Identifying cause of Cushing’s
Hx
Plasma ATCH
CT /MRI adrenals
MRI pituitary
Management of Cushings
- Treat the cause
- Give Metyrapone / Ketoconazole to control secretion until definitive treatment.
- transphenoidal Tumour resection
- radiotherapy
- bilateral adrenalectomy (S.E +++)
Complications of Cushings
High mortality
MI, HTN, Sepsis, Heart Failure
