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endocrine > Pituitary Disorders > Flashcards

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
Q

What is hypophysitis

A

Inflammation of the pituitary gland

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26
Q

Clinical features of hypophysitis

A

Headache, hypopituitarism, mass effect, diabetes insipidus

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27
Q

Investigations for hypophysitis

A

MRI
pit function
Biopsy ?

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28
Q

MRI in hypophysitis

A

Pituitary stalk thickening, homogenous pituitary enlargement

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29
Q

Management of hypophysitis

A

Treat underlying cause
Replace hormones that are deficient

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30
Q

What is pituitary apoplexy

A

Sudden bleeding or impaired blood flow to the pituitary gland

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31
Q

Name some predisposing factors for pituitary apoplexy

A

Major surgery, medications, anticoagulation, hypertension, diabetes

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32
Q

Name a medication that can cause pituitary apoplexy

A

GnRH analogues

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33
Q

Pathophysiology of pituitary apoplexy

A

Results from the rapid expansion of a pituitary tumour due to either haemorrhage or infarction

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34
Q

Clinical features of pituitary apoplexy

A

Severe headache
N+V
Visual acuity and field defects
Ocular palsy due to cranial nerve compression
Reduced GCS

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35
Q

Investigations for pituitary apoplexy

A

Assess pituitary function
MRI
formal ophthalmic assessment

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36
Q

Management of pituitary apoplexy

A

Treat hormone defects with emergency steroid dosing

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37
Q

What is hyperprolactinaemia

A

Abnormally high levels of prolactin in the blood

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38
Q

Physiological causes of hyperprolactinaemia

A

Breastfeeding, pregnancy, stress or lack of sleep

39
Q

How do drugs cause hyperprolactinaemia

A

Any drugs which reduce dopamine will reduce inhibition of prolactin so increase levels of

40
Q

Give some examples of drugs that cause hyperprolactinaemia

A

Metoclopramide
Antipsychotics
Antidepressants (less commonly)

41
Q

Pathological causes of hyperprolactinaemia

A

Hypothyroidism
Stalk compression due to masses
Damage to stalk
Prolactinoma

42
Q

When stage of disease do people usually present with hyperprolactinaemia

A

Females- early
Males- late

43
Q

How do females present with hyperprolactinaemia

A

Galactorrhea
Menstrual irregularity
Decreased libido
Amenorrhoea
Infertility

44
Q

How do males present with hyperprolactinaemia

A

Impotence
Visual field defects
headaches
Anterior pit malfunction

45
Q

Management of prolactinoma

A

Dopamine agonist - cabergoline
If it doesn’t shrink the tumour then consider surgery

46
Q

what is acromegaly

A

disorder that occurs when the pituitary gland produces excess growth hormone after the growth plates have closed during adulthood

47
Q

what is acromegaly usually caused by

A

GH-secreting pituitary adenomas

48
Q

clinical presentation of acromegaly

A

enlargements of hands and feet, thickened soft tissues (e.g. skin, large jaw), snoring/speel apnoea, DM, headaches

49
Q

gold standard investigation for acromegaly

A

GTT suppression test
indicated if GH is unchanged - no suppression or paradoxical rise

50
Q

hormone that is usually raised in acromegaly

A

IGF1

51
Q

surgical management of acromegaly

A

transsphenoidal pituitary surgery

52
Q

pharmacological management of acromegaly

A

somatostatin analogues used to reduce GH before surgery to relieve symptoms

53
Q

give an example of a somatostatin analogue

A

sandostatin

54
Q

complications of acromegaly

A

formation of colon polyps and cancer
increased risk of hypertension and cardiac failure

55
Q

what is diabetes insipidus

A

a rare condition in which the body cannot control water balance

56
Q

what part of the pituitary is affected in diabetes insipidus

A

posterior

57
Q

name the 2 main types of diabetes insipidus

A

central and nephrogenic

58
Q

when does central DI occur

A

there is insufficient levels of circulating ADH

59
Q

what are the 2 types of central DI

A

familial or acquired

60
Q

cause of familial DI

A

DIDMOAD

61
Q

mutation associated with DIDMOAD

A

WFS1 gene

62
Q

name some causes of acquired central DI

A

trauma, tumours, infiltrations (e.g. sarcoid), infections

63
Q

name some tumours that may cause central DI

A

craniopharyngioma, hypothalamic tumour, metastases

64
Q

name some infections that may cause central DI

A

TB, meningitis, inflammatory disorders of the hypothalamus or pituitary

65
Q

what characterises nephrogenic DI

A

renal tubular resistance to ADH

66
Q

name 3 causes of nephrogenic DI

A

idiopathic
AVPR2 receptor mutations
renal disease

67
Q

clinical presentation of DI

A

polydipsia and polyuria with dilute urine

68
Q

what is polydipsia

A

excessive thirst

69
Q

what is polyuria

A

excessive urine output

70
Q

investigations for diabetes insipidus

A

water deprivation test

71
Q

positive result for DI water deprivation test

A

Ur/serum osmol ratio <2

72
Q

how to differentiate between central and nephrogenic DI using water deprivation test

A

good response to desmopressin (increased urine conc and decreased output) is suggestive of central DI

73
Q

imaging in central Di

A

CT or MRI of the head to rule out brain tumours

74
Q

management of central DI

A

desmospray nasally or desmopressin oral tablets
IM injection in emergency

75
Q

management of nephrogenic DI

A

no current management

76
Q

what is the main cause of hypopituitarism in adults

A

non-functioning macroadenomas

77
Q

name some other causes of hypopituitarism

A

non-pituitary brain tumours
brain injury
surgery, radiation
TB, sarcoid, haemochromatosis
medications (MABs)
infection

78
Q

when does hypopituitarism become symptomatic

A

when more than 80% of pituitary cells are damaged

79
Q

consequences of anterior pituitary hypofunction

A

growth failure, secondary hypothyroidism, hypogonadism

80
Q

consequence of posterior pituitary hypofunction

A

diabetes insipidus

81
Q

what is panhypopituitarism

A

deficiency of all anterior pituitary hormones

82
Q

most common causes of panhypopituitarism

A

pituitary tumours, surgery or radiotherapy

83
Q

clinical presentation of longstanding panhypopituitarism

A

alabaster skin

84
Q

what is alabaster skin

A

pallor and hairlessness

85
Q

basal tests of the anterior pituitary

A

LH, FSH, oestradiol/testosterone
IGF-1
prolactin
free T4, T3, TSH
ACTH, cortisol

86
Q

basal test of the posterior pituitary

A

plasma/urine osmolarity

87
Q

dynamic tests of the anterior pituitary

A

insulin tolerance test, glucagon test, ACTH stimulation test

88
Q

dynamic test of the posterior pituitary

A

water deprivation test

89
Q

management of TSH deficiency

A

levothyroxine

90
Q

what is the most important pituitary hormone to replace

A

cortisol

91
Q

management of ATCH deficiency

A

hydrocortisone

92
Q

testosterone replacement for males

A

sustanon IM every 3-4 weeks
or skin gel or nebido (prolonged IM injection)

93
Q

sex steroid replacement in women

A

HRT, oestrogen/progesterone pill

endocrine (15 decks)

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