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Year 3 Endocrinology > Pituitary disorders > Flashcards

Pituitary disorders Flashcards

1
Q

Multiple Endocrine Neoplasia

A

Functioning hormone tumours in multiple organs

All autosomal dominant

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2
Q

MEN 1

A

Pituitary adenoma: prolactin or GH
Parathyroid adenoma/ hyperplasia
Pancreatic tumours: gastrinoma or insulinoma

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3
Q

MEN 2

A

Thyroid medullary carcinoma
Adrenal phaeochromocytoma
A) Hyperthyroidism
B) Marfanoid habitus

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4
Q

Hypopituitarism causes

A

Hypothalamic:
Kallmann’s syndrome
Tumour
Inflam, infection, ischaemia

Pituitary Stalk:

  • Trauma
  • Surgery
  • Tumour (e.g. craniopharyngioma)

Pituitary:

  • Irradiation
  • Tumour
  • Ischaemia: apoplexy, Sheehan’s
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5
Q

Kallmann’s syndrome

A

anosmia + GnRH deficiency)

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6
Q

Features of hypopituitarism

A

Hormone Deficiency:
GH: (linked with insulin like GF) - central obesity, atherosclerosis, ↓CO,

LH/FSH:
M: ↓libido, ED, ↓hair
F: ↓libido, amenorrhoea, breast atrophy

TSH: hypothyroidism
ACTH: Secondary adrenal failure

Prolactin excess

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7
Q

Ix for hypopituitarism

A 
Basal hormone tests
Dynamic pituitary function test
- Insulin → ↑ cortisol + ↑ GH
- GnRH → ↑ LH/FSH
- TRH → ↑T4 + ↑ PRL

MRI brain

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8
Q

Tx of hypopituitarism

A

Hormone replacement

Treat underlying cause

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9
Q

Pituitary tumours

A

Microadenoma: <1cm
Macroadenoma: >1cm

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10
Q

Pathology of pituitary tumours

A

Pathology
Many are non-secretory
~50% produce PRL
Others produce GH or ACTH

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11
Q

Mass effects of pituitary tumours

A

Headache
Visual field defect: bitemporal hemianopia
CN palsies: 3, 4, 5, 6 (pressure on cavernous sinus)
Diabetes insipidus
CSF rhinorrhoea

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12
Q

Hormone effects of pituitary tumours

A

PRL → galactorrhoea, ↓libido, amenorrhoea, ED

PRL → ↓GnRH → ↓LH/FSH

GH → acromegaly

ACTH → Cushing’s Disease

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13
Q

Ix for pituitary tumours

A

MRI
Visual field tests
Hormones: PRL, IGF, ACTH, cortisol, TFTs, LF/FSH
Suppression tests

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14
Q

Mx of pituitary tumours

A

Medical:

  • Replace hormones
  • Treat hormone excess
  • Increased prolactin treated with dopamine

Surgical: Trans-sphenoidal excision
- Pre-op hydrocortisone
- Post-op dynamic pituitary tests
Radiotherapy: sterotactic

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15
Q

Craniopharyngeoma

A

Originates from Rathke’s pouch

causes growth failure in children

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16
Q

Causes of hyperprolactinaemia

A

Excess pituitary production:

  • Pregnancy, breastfeeding
  • Prolactinoma (PRL >5000)
  • Hypothyroidism (↑TRH)
  • Disinhibition by compression of pituitary stalk
  • Pituitary adenoma
  • Craniopharyngioma
  • Dopamine antagonsists: Antiemetics: metoclopramide
    Antipsychotics
17
Q

Symptoms of hyperprolactinaemia

A 
Amenorrhoea
Infertility
Galactorrhoea
↓ libido
Erectile dysfuction
Mass effects from prolactinoma
18
Q

Ix of hyperprolactinaemia

A

Basal PRL: >5000 = prolactinoma
Pregnancy test, TFTs
MRI

19
Q

Mx of hyperprolactinaemia

A

1st line: Dopamine agonist- Cabergoline or bromocroptine
- inhibits PRL secretion and ↓ tumour size

2nd line: Trans-sphenoidal excision

  • If visual or pressure symptoms don’t response to medical Rx
20
Q

Acromegaly

A

Excess growth hormone:

Pituitary adenoma in 99%

  • Hyperplasia from GHRH secreting carcinoid tumour
  • GH stimulates bone and soft tissue growth through ↑IGF1
21
Q

Presentation of acromgealy

A
  • Amenorrhoea, ↓libido
  • Headache
  • Snoring
  • Sweating
  • Arthralgia, back ache
  • Carpal tunnel (50%)
Signs;
Huge hands
Face: 
- Prominent supraorbital ridges
- Wide nose and big ears
- Macroglossia
- Widely-spaced teeth

Other

  • Puffy, oily, darkened skin skin
  • Proximal weakness + arthropathy
  • Pituitary mass effects: bitemporal hemianopia
22
Q

Ix and Rx for acromegaly

A

Ix:

  • ↑IGF1
  • ↑ glucose, ↑Ca, ↑PO4
  • Visual fields and acuity
  • MRI brain

Rx

  • 1st line: trans-sphenoidal excision
  • 2nd line: somatostatin analogues
  • 3rd line: GH antagonist
  • 4th line: radiotherapy
23
Q

Diabetes Insipidus presentation

A

Severe polyuria + polydipsia

Hypernatraemia: lethargy, thirst, confusion, coma

24
Q

Cranial diabetes inspidus causes

A 
Idiopathic: 50%
Tumours
Trauma
Vascular: haemorrhage (Sheehan’s syn.)
 Infection: meningoencephalitis
Infiltration: sarcoidosis

Insult causes decreased ADH release

25
Q

Nephrogenic diabetes insipidus

A

Receptors are not sensitive to ADH therefore less aquaporins are expressed and less water is absorbed

26
Q

Ix for diabetes insipidus

A

Bloods: U+E, glucose
Urine and plasma osmolality
Exclude DI if U:P osmolality >2
Find cause: MRI brain

27
Q

Mx of diabetes insipidus

A

Desmopressin - ADH analogue

Nephrogenic - treat cause

Year 3 Endocrinology (14 decks)

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