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Year 3 - Met3b > Pituitary Disease > Flashcards

Pituitary Disease Flashcards

1
Q

what is the hypothalamus

A

Coordinating centre of the endocrine system

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2
Q

what signals does the hypothalamus get

A
  • signals from upper cortical inputs
  • autonomic function
  • environmental cues
  • peripheral endocrine feedback
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3
Q

Where does the hypothalamus deliver signals to

A

Delivers signals to pituitary, via the pituitary stalk to release hormones that influence the endocrine system of the target organ

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4
Q

what does the portal system ensure

A

Portal system, ensuring high levels of hormones reaching the pituitary only

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5
Q

What two parts is the pituitary made out of

A

 Anterior

 Posterior

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6
Q

How is the anterior pituitary connected to the hypothalamus

A

via a portal system

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7
Q

How is the posterior pituitary connected to the hypothalamus

A

via the infundibulum

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8
Q

it the pituitary inside or outside the dura

A
  • Lies outside the dura
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9
Q

where is the pituitary gland

A

 Rests in the sella turcica,

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10
Q

Is the pituitary below or above the optic chiasm

A

below the optic chiasm

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11
Q

How can you access the pituitary

A

Pituitary lies behind the eyes and can be accessed through the sphenoid bones

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12
Q

Describe the blood supply to the anterior pituitary

A

Blood supply – bathed in a capillary plexus where high concentrations of releasing hormones are present

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13
Q

What are the 6 hormones released from the anterior pituitary gland

A 
 ACTH
 TSH
 GH
 LH, FSH 
 PRL
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14
Q

Describe the blood supply for the inferior pituitary gland

A

Blood supply – inferior hypophyseal artery and drains into the inferior hypophyseal veins – going directly into the systemic circulation

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15
Q

What two hormones are released from the inferior pituitary gland

A
  • vasopressin (ADH)

- Oxytocin

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16
Q

How does the inferior pituitary gland release hormones

A
  • releases hormones directly from the neurones in the hypothalamus
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17
Q 
What does excess 
- GH 
- PRL 
- FSH/LH 
- ACTH 
- TSH 
- ADH 
produce
A
  • GH = acromegaly
  • PRL = hypogonadism
  • FSH/LH = rarely clinical
  • ACTH = Cushings disease
  • TSH = hyperthyroidism
  • ADH = SIADH
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18
Q 
What does deficient 
- GH 
- PRL 
- FSH/LH 
- ACTH 
- TSH 
- ADH 
produce
A
  • GH = GH deficiency
  • PRL = failed lactation
  • FSH/LH = hypogonadism
  • ACTH = adrenal insufficiency
  • TSH = hypothyroidism
  • ADH = diabetes insipidus
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19
Q

What happens if the pituitary gland presses on the cavernous sinus

A

Cranial nerve palsies

stroke

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20
Q

What happens if the pituitary gland presses on the optic chiasma

A

Bitemperal hemianopia

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21
Q

How does hormone hypersecretion present

A

 Prolactinoma - amenorrhoea / galactorrhoea
 Acromegaly
 Cushing’s Disease
 (Thyrotoxicosis – secondary

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22
Q

What is the commonest FUNCTIONING type of pituitary tumour

A

 Prolactinoma - amenorrhoea / galactorrhoea

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23
Q

What are the symptoms from mass effect (pituiary pressing on structures)

A

 Headaches
 Vision loss
 Pituitary gland hyposecretion (hypopituitarism)
 Pituitary apoplexy - occurs acutely

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24
Q

Name the sizes of microadenoma and macroadenoma

A
  • Microadenoma - <1cm

- Macroadenoma - >1cm

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25
define amenorrhoea
Amenorrhoea means the absence of a menstrual period in females
26
define galactorrhoea
excessive or inappropriate production of milk
27
what are the two types of pituitary tumour
- Macroadenoma - dont cure completely | - Microadenoma - only tend to cure these
28
How often do prolactinomas occur
- they occur in 30-40% of pituitary tumours
29
What are the symptoms of prolactinomas
- Amemorrhoea, - galactorrhoea - erectile dysfunction - If very large can lead to sight loss – chiasmal compression
30
What are the signs of prolactinomas
- Galactorrhoea, - hypogonadism, - bitemporal hemianopia
31
What investigations should you use in prolactinomas
- Prolactin - TFT - hypothyroidism can cause a raised prolactin - LH - FSH - Testostorone - MRI pituitary
32
What is the management of prolactinomas
- treated with dopamine agonists (dopamine causes tonic inhibition of prl release) – bromocriptine / cabergoline - useful oral agents
33
What causes the inhibition of prolactin release
dopamine
34
Apart from a prolactinoma what can cause high prolactin
 Lactation/Pregnancy  Drugs: - Antacids (ranitidine) - H2 blockers - Anti-psychotics (chlorpromazine) - dopamine agonist - Anti-emetics (prochlorperazine) - dopamine agonist  Stress  Seizures  Stalk compression - tumour compresses this this blocks the dopamine pathway and as a result prolactin levels rise  Macroprolactin - some people produce a larger prolactin molecule which can show a higher prolactin but in reality the prolactin is normal
35
What happens if you have GH excess before puberty
Gigantism | - This happens before the closure of growth plates
36
What happens if you have GH excess after puberty
Acromegaly | - happens after the growth plates have closed
37
What are the symptoms of acromegaly
- Headaches, - arthralgia - sweating - increased ring/shoe size - weakness - diabetes (secondary cause) - carpal tunnel - atherosclerosis - increase risk of cancer - particularly colon cancer due to excess IGF-1
38
What are the typical 3 symptoms of someone with acromegaly
- Headaches - arthralgia - sweating
39
What are the signs of acromegaly
- Prognathism - Spade hands - prominent supraorb ridge - bi-temporal hemianopia - hypertension
40
What investigations should you carry out to test for acromegaly
OGTT (oral glucose tolerance test)- - make them fast - check glucose and GH - give 75g of glucose - if you dont have growth hormone excess then GH goes to 0 - if you do than growth hormone doesnt decrease and fails to suppress = acromegaly - IGF-1 - not a diagnostic test - MRI pituitary
41
What is the treatment of acromegaly
- Octreotide - somatostatin analogue = can lower GH levels - Pegvisomont – GH receptor antagonist = expensive but useful in people who are not responsive to octreotide - Surgery (Trans-sphenoidal)
42
What are the two types of cushing syndrome
- ACTH -dependent = 70-75% | - ACTH-Independent = 25-30%
43
Describe what can cause ACTH-dependent Cushing syndrome
* Corticotroph Adenoma (Cushing’s Disease) | * Ectopic Cushing’s (ACTH/CRH tumours)
44
Describe what can cause ACTH-independent Cushing syndrome
* Adrenal Carcinoma * Adrenal Adenomas * Exogenous steroids (Cushingoid appearance)
45
What are the problems you get in cushings disease
- changes in CHO, protein and fat metabolism - Changes in sex hormones - Salt and water retention - impaired immunity - Neurocognitive changes - steroid psychosis
46
What symptoms in cushings do you get with changes in CHO, protein and fat metabolism
```  Peripheral Wasting of Fat/Muscle  Central obesity, Moon facies, fat pads  Osteoporosis  Diabetes  Hypertriglyceridemia ```
47
What symptoms in cushings do you get with changes sex hormones
 Amenorrhoea/Infertility  Excess hair growth (♀)  Impotence
48
What symptoms in cushings do you get with changes in salt and water retention
 HTN and Oedema
49
What are the screening tests for cushings
Disrupted Circadian Rhythm - Midnight Salivary or Serum Cortisol - Cortisol day curve  Increased Filtered Cortisol Load - 24 hr Urine Free Cortisol  Attenuated Negative Feedback- tend to do this test now - Low Dose (1 mg) Dexamethasone Suppression test - Measuring cortisol and ACTH - failure of suppression of cortisol is a sign of cushings
50
What is the management of Cushing's syndrome
 Trans-sphenoidal surgery  Adrenolytics - Ketoconazole - an anti-fungal agent and blocks the steroid adrengenic pathway and reduce steroid levels in people with cushings disease - Metyrapone - prevents excess cortisol
51
What are the physical signs of cushings syndrome
- central obesity - purple striae over the abdomen - moon face - easy bruising
52
What is hypopituitarism
- Loss of all or some of pituitary hormones | - usually the anterior pituitary hormones
53
What are the causes of hypopituitarism
- Adenoma - Irradiation - Infarction (Sheehans) - pituitary infarction - happens after childbirth - Infiltration (Sarcoid, TB)
54
What are the symptoms of hypopituitarism
- Loss of libido - weakness - amenorrhoea - impotence - depression, - hypothyroidism
55
What are the signs of hypopituitarism
- Pallor - Hypothyroid, - Absent pubic/axillary hair - Testicular atrophy - Visual field defect, - Postural hypotension
56
What are the investigations for hypopituitarism
- Check hormones - Insulin Stress Test - lower levels of glucose you start producing GH and stuff, in hypoituitsim tend to not produce these hormones - Low T4, Test, - Oestradiol with low FSH, LH, TSH, ACTH - MRI pituitary
57
What is the treatment for hypopituitarism
Hormone replacement – Hydrocortisone first line treatment, if you give then thyorxine first then you can induce an adrenal crisis, then give T4, testostorone, HRT, - Ovulation induction for women with fertility issues
58
What is pituitary apoplexy
Abrupt acute hemorrhagic infarction | of a pituitary adenoma
59
What is the presentation of pituitary apoplexy
``` ▪ acute headache, ▪ meningism, ▪ visual impairment, ▪ ophthalmoplegia, ▪ Low GCS ```
60
How do you treat pituitary apoplexy
Glucocorticoid replacement is the most important first step due to adrenal insufficiency ▪ Followed by urgent surgical decompression

Year 3 - Met3b (26 decks)

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