pituitary diseases Flashcards
causes of raised prolactin
- breast feeding
- pregnancy
- stress
- sleep
- dopamine antagonists
- antipsychotics
- antidepressants
- hypothyroidism
- stalk lesions
- prolactinoma
what are the symptoms and signs in women for a prolactinoma
- early presentation
- galactorrhoea
- menstrual irregularity
- ammenorrhoea
- infertility
signs and symptoms in males of prolactinoma
- late presentation
- impotence
- visual field abnormal
- ant pit malfunction
investigations for prolactinoma
- serum prolactin concentration
- MRI pituitary
- visual fields check
- pituitary function tests
prolactinoma treatment
dopamine agonists
-cabergoline once to twice per week oral
side effects of dopamine agonists
- nausea
- vomiting
- low mood
what do dopamine agonists do
- prolactin normalised
- menstruation regained
- pregnancy
- tumour shrinkage
what is acromegaly
too much GH secreted
symptoms of acromegaly
- giant
- thickened soft tissues
- large hands
- snoring
- sleep apnoea
- hypertension
- cardiac failure
- headaches
- diabetes mellitus
- vision problems
- hypopituitarism
- colonic polyps
diagnosis of acromegaly
- measure IGF1
- GTT suppression test (normal - GH suppresses to <0.4, if acromegaly then GH unchanged)
- check visual fields
- CT or MRI pituitary
treatments for acromegaly
- pituitary surgery
- radiotherapy
DRUGS
somatostatin analogues
-sandostatin LAR
-Lanreotide
GH antagonist (most effective)
- pegvisomant
- SC injection 10-30mg per day
side effects of somatostatin analogues
- local stinging
- short term - flatulence, diarrhoea, abdo pains
- long term - gallstones
could you also use dopamine agonists for acromegaly
yes in some patients
what is cushing’s syndrome
excess cortisol
symptoms of cushing’s syndrome
- muscle wasting
- osteoporosis
- fractures
- thin skin
- striae
- bruising
- frontal balding in women
- conjunctival oedema
- psychosis
- depression
- hypertension
- acne
- excess hair
what is in excess in cushing’s syndrome
- cortisol
- mineralocorticoid
- androgen
tests to diagnose cushing’s
- overnight 1mg dexamethasone suppression test (cortisol <50 normal, >130 abnormal)
- urine free cortisol (<250 normal)
- diurnal cortisol variation (loss of diurnal variation is suspicious of cushing’s)
- 2 day 2mg/day dexamethasone suppression test (cortisol >130mmol/l = cushings)
causes of cushing’s
- mainly pituitary
- adenoma of adrenal
- ectopic ACTH production
- alcohol and depression
- steroid medication
non-drug treatment for cushing’s
pituitary
- hypophysectomy and external radiotherapy if recurs
- bilateral adrenalectomy
adrenal
-adrenalectomy
ectopic
- remove source
- or bilateral adrenalectomy
drug treatment for cushing’s
metyrapone
-if other treatment fails
ketoconazole
pasireotide LAR
what is pan hypopituitarism
a condition in which the production and secretion of all hormones by the pituitary gland is reduced.
pan hypopituitarism effects on anterior pituitary
- growth hormone: growth failure
- TSH: hypothyroidism
- LH/FSH: hypogonadism
- ACTH: hypoadrenal
pan hypopituitarism effects on posterior pituitary
diabetes insipidus
causes of hypopituitarism
- pituitary tumours
- other local brain tumours
- surgery
- granulomatous disease
- vascular diseases
- trauma
- secondary metastatic lesions
- hypothalamic disease
- autoimmune
- infection
symptoms and signs of anterior hypopituitarism
- Menstrual irregularities (F)
- Infertility, impotence
- Gynaecomastia (M)
- Abdominal obesity
- Loss of facial hair (M)
- Loss of axillary and pubic hair (M&F)
- Dry skin and hair
- Hypothyroid faces
- growth retardation (children)
what is replacement therapy for hypopituitarism
- thyroxine 100-150mcg/day
- hydrocortisone 10-25mg/day
- ADH - desmospray or desmopressin tablets
- GH nightly
- HRT/oest/prog pill for females
- testosterone for males
how does testosterone replacement work
- IM injection every 3-4 weeks (sustanon)
- Skin gel (testogel, tostran)
- Prolonged IM injection 10-14 wks (nebido)
- (Oral tablets (restandol))
risks of testosterone replacement
- risk of stroke/MI
- prostate enlargement
- hepatitis only for oral tablets
effects of giving growth hormone in adults
- Improves well being and Quality of life
- Decreases abdominal fat
- Increases muscle mass, strength, exercise capacity and stamina
- Improves cardiac function
- Decreases cholesterol and increases LDL
- Increases bone density
- Given by daily SC injection
causes of cranial diabetes insipidus
- familial
- idiopathic
- trauma
- tumour
- sarcoid
- meningitis
- ext irradiation
what is diabetes insipidus
an uncommon disorder that causes an imbalance of fluids in the body. This imbalance leads you to produce large amounts of urine. It also makes you very thirsty even if you have something to drink
what is the water deprivation test
- Check serum and urine osmolalities for 8h, and then 4h after giving IM DDAVP.
- If Ur/Serum Osmol ratio >2 then it is normal, otherwise DI
treatment of diabetes insipidus
desmospray -nasally 10-60 mcg/day desmopressin oral tablets -100-1000 mcg per day desmopressin injection -1-2 mcg IM per day
