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Pituitary disorders Flashcards

1
Q

Pituitary tumours tend to be…?

A

Adenomas - benign tumour of glandular epithelial tissue

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2
Q

What is a macro-adenoma?

A

Tumour bigger than 1cm

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3
Q

What is a micro-adenoma?

A

Tumour smaller than 1cm

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4
Q

What causes a pituitary tumour to present?

A

Mass effect of tumour, pressure on local structures

Abnormality in pituitary function

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5
Q

Which structures can be compressed by a pituitary tumour?

A

Optic chiasm

Cranial nerves 3+4

Cranial nerve 5

Cranial nerve 6

Internal carotid artery

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6
Q

What will be compressed by a pituitary tumour growing superiorly?

A

The optic chiasm

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7
Q

What are the consequences of a compressed optic chiasm?

A

Bitemporal hemi-anopia - visual field loss

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8
Q

Which structures can be compressed by a pituitary tumour growing laterally?

A

Cranial nerves 3+4

Cranial nerves 5

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9
Q

What are the consequences of compressed cranial nerves 3+4?

A

Double vision

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10
Q

What are the consequences of compressed cranial nerves 5?

A

Pain

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11
Q

What is a non-functioning pituitary tumour?

A

Tumour cells do not produce any biologically active hormones

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12
Q

What is a functional pituitary tumour?

A

Tumour cells produce biologically active hormones

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13
Q

If a non-functioning pituitary tumour secretes hormones, they will be…?

A

Inactive, not biologically active!

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14
Q

What causes abnormality of pituitary function in a non-functioning pituitary tumour?

A

Tumour prevents tropic hormones from hypothalamus
reaching anterior pituitary gland

Or due to pressure of tumour on glandular tissue in anterior pituitary

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15
Q

What does abnormality of pituitary function lead to?

A

Hypo- or hyper-secretion or hormones

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16
Q

What is hypopituitarism?

A

Insufficient anterior pitutiary hormone production

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17
Q

What is panhypopituitarism?

A

Deficiency of all anterior pituitary hormones

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18
Q

In a non-functional pituitary tumour where hypothalamic tropic hormones can’t reach the anterior pituitary gland, which hormones are hypo-secreted? Why?

A 
TSH
GH
ACTH
FSH
LH

Loss of stimulating hormones from hypothalamus

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19
Q

In a non-functional pituitary tumour where the hypothalamic tropic hormones can’t reach the anterior pituitary gland, which hormone is hyper-secreted? Why?

A

Prolactin

Loss of inhibitory hormone PRIH/dopamine from hypothalamus

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20
Q

What is the order by which the hormones become deficient?

A

Growth hormone

FSH, LH

TSH, ACTH

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21
Q

What are the consequences of growth hormone deficiency in children?

A

Pituitary dwarfism - proportionate type of dwarfism

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22
Q

What are the consequences of growth hormone deficiency in teens?

A

Delayed or no sexual development

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23
Q

What are the consequences of growth hormone deficiency in adults?

A

Muscle weakness

Increased body fat

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24
Q

Why is growth hormone deficiency difficult to detect?

A

Because growth hormone is secreted in a pulsatile manner throughout the day

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25
How is growth hormone deficiency treated?
Giving recombinant growth hormone
26
What are the consequences of FSH, LH deficiency in teenagers?
Delayed puberty
27
What are the consequences of FSH, LH deficiency in adults?
Females - oligomenhorrea, amenhorrea Males - impotence Both sexes - loss of sexual characteristics e.g. pubic hair, axillary hair, loss of libido, infertility
28
What are the consequences of TSH deficiency?
Hypothyroidism symptoms
29
What is particular about hypothyroidism caused by a pituitary adenoma?
TSH will be low as well as thyroid hormones | Because even though there's less negative feedback of the anterior pituitary, it can't produce TSH
30
What is hyperpituitarism?
Excessive secretion of hormones from anterior pituitary gland
31
Which hormones are commonly over-secreted by a functional pituitary tumour?
Prolactin GH ACTH
32
Which hormones are rarely over-secreted by a functional pituitary tumour?
TSH LH, FSH
33
What is a prolactinoma?
A prolactin-secreting pituitary tumour
34
Which secretes more prolactin - a macro-prolactinoma or a micro-prolactinoma?
Macro-prolactinoma
35
What does a prolactinoma cause?
Hyperprolactinaemia - high levels of prolactin in the blood
36
What are the symptoms of hyperprolactinaemia in women?
Gynecomastia - hard breast tissue Galactorrhea - abnormal milk production Amenhorrea Hypogonadism - reduced activity of ovaries
37
What are the consequences of hyperprolactinaemia in men?
Hypogonadism - reduced activity of testes Erectile dysfunction
38
Are macro-prolactinomas more common in men or women? Why?
Men realise symptoms later tumour grows in the meanwhile
39
Why does hyperprolactinaemia cause hypogonadism?
High prolactin means hypothalamus secretes more dopamine due to negative feedback Dopamine also inhibits GnRH release from hypothalamus Less LH and FSH released from anterior pituitary
40
Which symptoms of a prolactinoma do men tend to present with?
Symptoms due to mass effect of tumour | e.g. headaches, double vision, visual field loss
41
What do non-functioning pituitary tumours and prolactinomas have in common?
Both give increase in prolactin
42
How are non-functioning pituitary tumours distinguished from prolactinomas?
Prolactin <5000 due to disinhibition of prolactin by non-functioning pituitary tumour Prolactin >5000 due to secretion of prolactin by prolactinoma
43
Why is it important to distinguish between prolactinomas and non-functioning pituitary tumours?
Because prolactinomas are treated medically But non-functioning pituitary tumours are treaed surgically
44
How is prolactinoma treated?
Dopamine agonists
45
What is an example of a dopamine agonist?
Cabergoline
46
What do dopamine agonists do?
Stimulate D2 receptor
47
What is the result of treating a prolactinoma with dopamine agonists?
Dopamine inhibits prolactin secretion | Tumour will shrink in size
48
Do men or women present later with prolactinomas? Why?
Men | have no periods so realise symptoms later
49
What are some physiological causes of hyperprolactinaemia?
Pregnancy, suckling
50
What are some medical causes of hyperprolactinaemia?
Anti-pysychotic drugs Anti-depressants
51
What is an example of dopamine antagonists?
Anti-psychotic drugs
52
What is the cause of acromegaly?
Pituitary adenoma secreting growth hormone
53
How are the symptoms of acromegaly brought about?
Increased GH | Increased IGF-1
54
How long does it take for the symptoms of acromegaly to present?
Several years
55
What are the signs of acromegaly?
``` Broad nose Coarse facial features Thick lips Prominent supraorbital ridge Enlargement of hands and feet ```
56
How are blood tests used to confirm acromegaly?
Elevated GH Failure to suppress GH with glucose Elevated IGF-1
57
How is acromegaly treated?
Surgery to remove adenoma Radiation therapy Dopamine agonists Somatostatin analogues GH receptor antagonists
58
How can dopamine agonist treat acromegaly?
Reduces GH secretion
59
Give an example of a GH receptor antagonist?
Pegvisomant
60
What is the consequence of growth hormone excess during childhood? Why?
Gigantism epiphyseal plates have not yet closed bones continue to grow in length
61
What can cause a deficiency in ADH?
Hypothalamic tumour Pituitary tumour that has extended upwards into hypothalamus Infection, autoimmune conditions
62
What is the function of ADH?
Increases expression of aquaporin channels in kidneys | giving increased reabsorption of water
63
What happens in ADH deficiency?
Lack of aquaporin channels in kidneys reduced reabsorption of water more urine produced, dilute urine
64
What are the consequences of ADH deficiency?
Larger quantities of dilute urine Dehydration Increased thirst
65
What is ADH deficiency called when the consequences arise?
Diabetes insipidus - cranial type
66
What is another type of diabetes insipidus? What causes it?
Nephrogenic type Caused by kidney disease kidneys don't respond to ADH, resistant to it
67
What are some of the complications of diabetes insipidius?
Hypernatraemia - high sodium levels
68
How is cranial diabetes insipidus treated?
Desmopressin - acts as replacement of ADH
69
How is desmopressin given?
Nasal spray Tablets Injections
70
What is apoplexy?
Stroke - sudden vascular event
71
What is a pituitary apoplexy?
Suddent vascular event in pituitary tumour
72
What are the types of pituitary apoplexy? How are they different?
Haemorrhage - bleeding within tumour Infarction - lack of blood supply, ischaemia giving cell death
73
How does pituitary apoplexy present?
Sudden onset headache Bitemporal hemi-anopia Double vision Hypopituitarism
74
What are the consequences of a functional pituitary tumour secreting TSH?
Hyperthyroidism symptoms, thyrotoxicosis
75
What is particular about hyperthyroidism caused by a pituitary adenoma?
TSH levels remain raised with raised thyroid hormone levels too Because pituitary adenoma isn't inhibited by raised thyroid hormone levels, still secretes TSH
76
What is measured in a blood test when a pituitary tumour is suspected?
Free T4, TSH LH, FSH Testosterone in men Oestriadiol in women Serum prolactin
77
Which dynamic blood tests are carried when a pituitary tumour is suspected?
GH, IGF1 9am cortisol - cortisol is highest in morning
78
What are the two types of dynamic assessments of HP axes?
Stimulation test Suppression test
79
When is a stimulation test used?
When suspect a hormone deficiency
80
How does a stimulation test work?
Try and stimulate release of a particular hormone
81
How are the results of a stimulation test interpreted?
If hormone levels don't increase | means hormone deficiency
82
When is a suppression test used?
When suspect a hormone excess
83
How does a suppression test work?
Try and suppress the release of a particular hormone
84
How are the results of a suppression test interpreted?
If hormone levels don't decrease | means hormone excess
85
What is the stimulation test for GH deficiency?
Give insulin person becomes hypoglycaemic growth hormone should increase
86
What is the suppression test for GH excess?
Give glucose person becomes hyperglycaemic growth hormone should decrease
87
What imaging techniques are used when investigating a pituitary tumour?
MRI
88
What other tests are done when investigating a pituitary tumour?
Assessing visual fields - bi-temporal hemi-anopia

Endocrinology (14 decks)

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