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Endocrine > Pituitary Disorders > Flashcards

Pituitary Disorders Flashcards

1
Q

What are the hormones secreted by the pituitary?

A 
Anterior
- ACTH
- GH
- TSH
- FSH and LH
- Prolactin 
Posterior
- Oxytocin
- ADH
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2
Q

What tests do you do if there is too much of a hormone?

A

You try and suppress it

-e.g. oral glucose tolerance test for GH excess

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3
Q

What tests do you do if there is not enough of a hormone?

A

Try to stimulate it

- e.g. synACTHen test for steroid deficiency

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4
Q

What is hypopituitarism?

A

Failure of anterior pituitary function
- can affect a single hormonal axis or all the hormones (panhypopituitarism)
Leads to secondary gonadal/thyroid/adrenal failure
Need multiple hormone replacement

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5
Q

Name some possible causes of hypopituitarism.

A 
Tumours
Radiotherapy 
Infarction/haemorrhage (apoplexy)
- associated headache/visual disturbance 
- associated PPH
Infiltration (e.g. sarcoid)
Trauma
Lymphocytic hypophysitis
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6
Q

Describe the deficiency replacement needed for hypopituitarism.

A 
ACTH - hydrocortisone
TSH - thyroxine (not given first as it speeds up the metabolic rate)
FSH/LH - testosterone or oestrogen 
GH - growth hormone
Prolactin - no replacement
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7
Q

Name some causes of high prolactin.

A 
Prolactinomas
Physiological 
- lactation/pregnancy
Drugs (block dopamine)
- tricyclics/antiemetics/carbidopa 
Stalk effect
- due to loss of inhibitory dopamine
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8
Q

What important questions must you ask yourself about pituitary tumours?

A

How big is the tumour?
- <1cm - micro
- >2cm - macro
Is it functional?
It is inhibiting the function of the rest of the pituitary?
If it compressing any surrounding structures?

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9
Q

What are the three main types of pituitary tumour?

A 
Non-functioning (majority)
Functioning 
- prolatinoma
- GH
- ACTH
- TSH
Others
- craniopharyngioma
- pituitary cancer
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10
Q

What are the issues associated with non-functioning pituitary tumours?

A

Visual field defects
Headache
Stops function of other pituitary hormones
Eye movement problems

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11
Q

How are non-functioning pituitary tumours investigated?

A

Imaging
Visual field assessment
Prolactin
Other pituitary hormones

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12
Q

How are non-functioning pituitary tumours treated?

A

If aysymptomatic - it doesn’t require treatment
Symptomatic
- surgery
- radiotherapy

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13
Q

What are the clinical features of a prolactinoma?

A 
Galactorrhoea
Headaches
Mass effect
Visual field defect
Amenorrhoea or erectile dysfunction
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14
Q

What is the most common reason for a woman presenting with amenorrhoea (outside of pregnancy)?

A

Prolactinoma

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15
Q

How are prolactinoma’s diagnosed?

A 
Serum prolactin
- over 6000
MRI pituitary 
Test remaining pituitary function
- gonadal function and thyroid hormones affected most
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16
Q

How are prolactinoma’s treated?

A 
Medical
- dopamine agonist (e.g. cabergoline/bromocriptine/quinagolide) 
Surgery
- visual field compromise
- failure of medical therapy
17
Q

What are the effects of acromeagly before puberty?

A

Don’t stop growing

Gigantism

18
Q

What are the features of acromegaly?

A 
Sweats and headache 
Alteration of facial features 
Increased hand and feet size
Visual impairment 
Cardiomyopathy
Increased inter-dental space
19
Q

How is acromeagly diagnosed?

A 
Glucose tolerance test
- normally glucose suppresses GH
- if it doesn't get suppressed, GH is out of control
Measure IGF-1
- end product of GH product
MRI
20
Q

How is acromeagly treated?

A 
Surgery (first)
- tumours often can't be fully removed
Drugs
- somatostain analogue (inhibits GH)
- dopamine agonist (prevents GH release)
- GH receptor agonist 
Radiotherapy 
- residual tumour/ongoing symptoms
21
Q

What is Cushing’s disease?

A

Pituitary tumour releasing ACTH

- a cause of Cushing’s syndrome

22
Q

How is Cushing’s disease diagnosed?

A

Dexamethasone (steriods) suppression test

- causes ACTH to decrease in normal patients

23
Q

What are the symptoms of Cushing’s syndrome?

A 
Euphoria
Moon face
Red (plethoric) cheeks 
Increased abdominal fat
Easy bruising 
Poor wound healing
Muscle wasting in the arms and legs 
Thinning of the skin
Hypertension
Buffalo hump
24
Q

How is Cushing’s disease treated?

A 
Surgery (first line)
- remove the pituitary tumour
Bilateral adrenalectomy 
Medical therapy
- ketoconazole or metyrapone
Radiotherapy
25
Q

What is a TSHoma?

A

Pituitary tumour releasing TSH
- rare
Causes high TSH and high fT4

26
Q

What is diabetes insipidus?

A 
ADH deficency (cranial)
- causes massive water loss through the urine as none can be reabsorbed
27
Q

What are the clinical features of diabetes insipidus?

A

Polydipsia
- chronic excessive thirst accompanised by excessive fluid intake
Polyuria
- urine output over 3 litres a day

28
Q

What are the differential diagnoses for cranial diabetes insipidus?

A

Nephrogenic diabetes insipidus

Psychogenic polydipsia

29
Q

Name some causes of central diabetes insipidus?

A 
Idiopathic
Trauma
Pituitary tumour
Pituitary surgery 
Pregnancy 
Familial
30
Q

How is diabetes insipidus diagnosed?

A

Try to stimulate the release of ADH
- water deprivation test
Assess the ability to concentrate the urine

31
Q

How is diabetes insipidus treated?

A

Treat the underlying cause
DDAVP
- ADH analogue
- spray, tablets or injection

32
Q

What are the components of Whipple’s triad (clinical appearance of pancreatic insulinomas).

A

Symptoms consistent with hypoglycemia
Relief of those symptoms when glucose is raised
Low plasma glucose (not BM)

33
Q

Name some causes of hypoglycemia in people without diabetes.

A 
Postprandial syndrome
- dumping post-gastric bypass
Endocrine
- addison's disease
Factitious hypoglycemia 
Alcohol 
Tumours
Insuinomas
34
Q

What is an insulinoma?

A

A rare tumour of the islet cells

95% benign

35
Q

What are the symptoms of an insulinoma?

A

Sweats
Weakness
Confusion
Seizures

36
Q

What initial investigations would you do for someone with an insulinoma?

A 
Urine sulphonylurea screen
Overnight fast
- glucose (<2.7 with elevtaed insulin)
- insulin (high)
- c-peptide (a marker of endogenous insulin)
CT abdomen
Endoscopic USS
37
Q

What is the treatment for an insulinoma?

A

Surgery

- mostly benign so no other treatment needed

Endocrine (9 decks)

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