Pituitary Disease Flashcards
Test for too much + too little of a hormone?
Too much = suppression
Too little = stimulation
What is the main cause of anterior pituitary hyperfunction?
Tumours
Name causes of anterior pituitary hypofunction.
Tumours Radiation Infection Autoimmune disease Ischemia
Name 3 causes of posterior pituitary dysfunction.
Tumours
Diabetes insipidus
SIADH
Are pituitary adenomas functional or non-functional?
Non-functional
What are the 2 types of pituitary adenoma + size?
Microadenoma = < 1cm Macroadenoma = > 1cm
What are pituitary adenomas associated with?
MEN 1
Name 4 ways pituitary adenomas present + if they are functional (rare) then which 2 hormones are most common?
Bitemporal hemianopia Headaches Gland hypofunction Diabetes insipidus Prolactin and GH
Compression and infarction of the pituitary gland may lead to what condition?
Panhypopituitarism/ Sheehan’s syndrome
What is the treatment for pituitary adenomas?
Transsphenoidal surgery
What is the most common benign pituitary tumour + what condition is it linked to?
Prolactinoma
MEN1
Do prolactinomas present early or late in men/women?
Early in women
Late in men
Name 2 ways prolactinomas present in women?
Galactorrhea
Menstrual/fertility issues
Name 3 ways prolactinomas present in men?
Impotence
Headaches
Visual field abnormalities
Name 4 times prolactin is normally raised + name a dopamine antagonist which can increase prolactin.
Pregnancy Breast feeding Stress Sleep Metoclopramide
What is the treatment for prolactinomas + mechanism + side effect?
Carbergoline
Dopamine agonist
N and V
2 treatments for prolactinoma if drugs are ineffective?
Surgery
Sellar radiotherapy
What rare tumour derives from Rathke’s pouch and presents as headaches and growth retardation?
Craniopharyngioma
What causes SIADH and what is the most common cause?
Excess ADH release
Ectopic tumour
Name a condition that releases ectopic ADH?
Small cell lung carcinoma
Is Na and osmolality high or low in blood/urine in SIADH?
Na low in blood/high in urine
Osmolality low in blood/high in urine
Treatment for SIADH?
High salt intake
Restrict fluids
What is acromegaly caused by?
Excess GH due to a pituitary somatotroph adenoma
What over expressed gene is acromegaly linked to + associated condition?
GRP101
MEN 1
Name 5 signs of acromegaly.
Excess bone growth Hypertension Headaches Sleep apnoea Colonic polyps
Which 2 pituitary hormones increase blood glucose?
GH
ACTH
What 2 tests for acromegaly?
IGF-1
OGTT
Surgical treatment for acromegaly?
Transphenoidal surgery
Name 2 drugs for acromegaly?
Somatostatin analogue
GH antagonist
What is the target number for GH and random blood glucose in acromegaly?
GH < 0.4
Random BG < 2
What is the difference between Cushing’s disease vs. Cushing’s syndrome?
Disease = pituitary origin Syndrome = other origin
What is Cushing’s syndrome and what 2 things does it cause a rise in?
Excess cortisol
Mineralocorticoids and androgens
Name 2 causes of ACTH dependent Cushing’s.
Pituitary tumour
Cushing’s disease
Name 2 causes of ACTH independent Cushing’s?
Adrenal tumour
Nodular adrenal hyperplasia
Name 4 facial/head/neck features of Cushing’s.
Frontal balding in women
Moon face
Buffalo hump
Eye disease
Name 3 MSK signs of Cushing’s.
Proximal myopathy
Osteoporosis
AVN of femoral head
What is dexamethasone and what should it normally do to cortisol levels + why?
Glucocorticoid
Reduce cortisol
Inhibits HPA axis
What are 2 screening tests for Cushing’s + normal result?
Overnight 1mg dexamethasone suppression = < 5
24hr urine cortisol = no cortisol
What is the definitive test for Cushing’s + normal result + result for a pituitary cause?
2 day/2 mg dexamethasone suppression test
Normal = < 50
Suppress by 50%
Name 3 treatments for pituitary, adrenal and ectopic Cushing’s + 3 possible drugs?
Pituitary = hypophysectomy + radiation Adrenal + ectopic = adrenalectomy Metyrapone Ketoconazole Pasireotide
Treatment for ectopic cause of Cushing’s with no obvious cause?
Bilateral adrenalectomy
Posterior hypopituitarism can cause what disease + why?
Diabetes insipidus
Lack of ADH
Name 3 types of diabetes insipidus.
Cranial
Nephrogenic
Gestational
What is the 4 signs of familial DI?
DI
DM
Optic atrophy
Deafness
Name 4 symptoms of DI?
Polyuria/dipsia
Nocturia
Weight loss
CNS disease
What is the test for DI + how does it work?
Water deprivation test
No water for 6-8 hours then give desmopressin
What is a cranial + nephrogenic DI result from a water deprivation test?
Cranial = rises significantly after desmopressin Nephrogenic = stays the same before/after
Treatment for DI?
Desmospray or desmopressin