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Pituitary Disorders Flashcards

1
Q

Is pituitary adenoma benign or malignant

A

Benign

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2
Q

What is pituitary adenoma derived from

A

Cells of the anterior pituitary

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3
Q

What are the 2 main causes of pituitary adenoma

A

Sporadic OR associated with MEN1

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4
Q

How do we classify pituitary adenoma

A

Micro and macro adenoma
> or < 1cm

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5
Q

Which are worse: micro or macroadenomas

A

Macro

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6
Q

Consequences of a macro adenoma (3)

A

Compression of the optic chiasma
Cause pressure atrophy of surrounding tissue
Infarction can lead to panhypopituitarism

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7
Q

Why do non-functioning pituitary adenomas usually present

A

Due to mass effects

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8
Q

Clinical presentation of non-functioning pituitary adenomas

A

Hypopituitarism
Visual field defect
Headache, cranial nerve deficit

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9
Q

What is the most common functional pituitary adenoma

A

Prolactinoma

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10
Q

Who usually gets prolactinoma

A

Women

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11
Q

Clinical presentation of prolactinoma

A

Amenorrhoea, infertility, loss of libido, galactorrhea

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12
Q

Presentation of a somatotroph adenoma in children

A

Gigantism

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13
Q

Presentation of somatotroph adenoma in adults

A

Acromegaly

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14
Q

Investigations for prolactinoma

A

Serum prolactin raised
MRI pituitary
Test visual fields

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15
Q

Visual field defect seen in pituitary adenoma

A

Bitemporal hemianopia

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16
Q

Management of pituitary adenoma

A

transphenoidal surgery
Hormone replacement

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17
Q

Is a craniopharyngioma benign or malignant

A

Benign

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18
Q

Where do craniopharyngioma arise

A

In the sellar / suprasellar region

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19
Q

What is craniopharyngioma derived from

A

Remnant of rathkes pouch

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20
Q

When does craniopharyngioma usually present

A

5-15 years and then 60-70

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21
Q

Investigations for craniopharyngioma

A

CT/MRI head

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22
Q

Management of craniopharyngioma

A

Resection and radiotherapy

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23
Q

Complication following radiation for craniopharyngioma

A

SSC may develop

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24
Q

Clinical presentation of craniopharyngioma

A

Headaches, visual disturbances, pituitary hypofunction

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25
What is hypophysitis
Inflammation of the pituitary gland
26
Clinical features of hypophysitis
Headache, hypopituitarism, mass effect, diabetes insipidus
27
Investigations for hypophysitis
MRI pit function Biopsy ?
28
MRI in hypophysitis
Pituitary stalk thickening, homogenous pituitary enlargement
29
Management of hypophysitis
Treat underlying cause Replace hormones that are deficient
30
What is pituitary apoplexy
Sudden bleeding or impaired blood flow to the pituitary gland
31
Name some predisposing factors for pituitary apoplexy
Major surgery, medications, anticoagulation, hypertension, diabetes
32
Name a medication that can cause pituitary apoplexy
GnRH analogues
33
Pathophysiology of pituitary apoplexy
Results from the rapid expansion of a pituitary tumour due to either haemorrhage or infarction
34
Clinical features of pituitary apoplexy
Severe headache N+V Visual acuity and field defects Ocular palsy due to cranial nerve compression Reduced GCS
35
Investigations for pituitary apoplexy
Assess pituitary function MRI formal ophthalmic assessment
36
Management of pituitary apoplexy
Treat hormone defects with emergency steroid dosing
37
What is hyperprolactinaemia
Abnormally high levels of prolactin in the blood
38
Physiological causes of hyperprolactinaemia
Breastfeeding, pregnancy, stress or lack of sleep
39
How do drugs cause hyperprolactinaemia
Any drugs which reduce dopamine will reduce inhibition of prolactin so increase levels of
40
Give some examples of drugs that cause hyperprolactinaemia
Metoclopramide Antipsychotics Antidepressants (less commonly)
41
Pathological causes of hyperprolactinaemia
Hypothyroidism Stalk compression due to masses Damage to stalk Prolactinoma
42
When stage of disease do people usually present with hyperprolactinaemia
Females- early Males- late
43
How do females present with hyperprolactinaemia
Galactorrhea Menstrual irregularity Decreased libido Amenorrhoea Infertility
44
How do males present with hyperprolactinaemia
Impotence Visual field defects headaches Anterior pit malfunction
45
Management of prolactinoma
Dopamine agonist - cabergoline If it doesn’t shrink the tumour then consider surgery
46
what is acromegaly
disorder that occurs when the pituitary gland produces excess growth hormone after the growth plates have closed during adulthood
47
what is acromegaly usually caused by
GH-secreting pituitary adenomas
48
clinical presentation of acromegaly
enlargements of hands and feet, thickened soft tissues (e.g. skin, large jaw), snoring/speel apnoea, DM, headaches
49
gold standard investigation for acromegaly
GTT suppression test indicated if GH is unchanged - no suppression or paradoxical rise
50
hormone that is usually raised in acromegaly
IGF1
51
surgical management of acromegaly
transsphenoidal pituitary surgery
52
pharmacological management of acromegaly
somatostatin analogues used to reduce GH before surgery to relieve symptoms
53
give an example of a somatostatin analogue
sandostatin
54
complications of acromegaly
formation of colon polyps and cancer increased risk of hypertension and cardiac failure
55
what is diabetes insipidus
a rare condition in which the body cannot control water balance
56
what part of the pituitary is affected in diabetes insipidus
posterior
57
name the 2 main types of diabetes insipidus
central and nephrogenic
58
when does central DI occur
there is insufficient levels of circulating ADH
59
what are the 2 types of central DI
familial or acquired
60
cause of familial DI
DIDMOAD
61
mutation associated with DIDMOAD
WFS1 gene
62
name some causes of acquired central DI
trauma, tumours, infiltrations (e.g. sarcoid), infections
63
name some tumours that may cause central DI
craniopharyngioma, hypothalamic tumour, metastases
64
name some infections that may cause central DI
TB, meningitis, inflammatory disorders of the hypothalamus or pituitary
65
what characterises nephrogenic DI
renal tubular resistance to ADH
66
name 3 causes of nephrogenic DI
idiopathic AVPR2 receptor mutations renal disease
67
clinical presentation of DI
polydipsia and polyuria with dilute urine
68
what is polydipsia
excessive thirst
69
what is polyuria
excessive urine output
70
investigations for diabetes insipidus
water deprivation test
71
positive result for DI water deprivation test
Ur/serum osmol ratio <2
72
how to differentiate between central and nephrogenic DI using water deprivation test
good response to desmopressin (increased urine conc and decreased output) is suggestive of central DI
73
imaging in central Di
CT or MRI of the head to rule out brain tumours
74
management of central DI
desmospray nasally or desmopressin oral tablets IM injection in emergency
75
management of nephrogenic DI
no current management
76
what is the main cause of hypopituitarism in adults
non-functioning macroadenomas
77
name some other causes of hypopituitarism
non-pituitary brain tumours brain injury surgery, radiation TB, sarcoid, haemochromatosis medications (MABs) infection
78
when does hypopituitarism become symptomatic
when more than 80% of pituitary cells are damaged
79
consequences of anterior pituitary hypofunction
growth failure, secondary hypothyroidism, hypogonadism
80
consequence of posterior pituitary hypofunction
diabetes insipidus
81
what is panhypopituitarism
deficiency of all anterior pituitary hormones
82
most common causes of panhypopituitarism
pituitary tumours, surgery or radiotherapy
83
clinical presentation of longstanding panhypopituitarism
alabaster skin
84
what is alabaster skin
pallor and hairlessness
85
basal tests of the anterior pituitary
LH, FSH, oestradiol/testosterone IGF-1 prolactin free T4, T3, TSH ACTH, cortisol
86
basal test of the posterior pituitary
plasma/urine osmolarity
87
dynamic tests of the anterior pituitary
insulin tolerance test, glucagon test, ACTH stimulation test
88
dynamic test of the posterior pituitary
water deprivation test
89
management of TSH deficiency
levothyroxine
90
what is the most important pituitary hormone to replace
cortisol
91
management of ATCH deficiency
hydrocortisone
92
testosterone replacement for males
sustanon IM every 3-4 weeks or skin gel or nebido (prolonged IM injection)
93
sex steroid replacement in women
HRT, oestrogen/progesterone pill

endocrine (15 decks)

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