Pituitary Disorders

Question 1

What is the effect of upwards growth of pituitary tumour?

Answer 1

Visual field loss due to compression of optic chiasm

Question 2

What is the effect of lateral growth of a pituitary tumour?

Answer 2

Pain

Double vision

Question 3

What happens to pituitary hormones with a pituitary hormone?

Answer 3

Decrease

• GH
• LH/FSH
• TSH
• ACTH

Increase
- prolactin

Question 4

What happens with a growth hormone deficiency?

Answer 4

Children

• short stature
• delayed puberty

Adults

• reduced quality of life
• loss of secondary sexual characteristics

Question 5

What happens with a TSH deficiency?

Answer 5

Low thyroid hormones
Weight gain
Tiredness
Bradycardia

Low T4
Non-elevated TSH

Question 6

What happens with ACTH deficiency?

Answer 6

Low cortisol
Tired
Dizziness
Low BP 
Low sodium

Question 7

How do you test for adrenal axis deficiency?

Answer 7

SynACTHen
- direct stimulation of adrenals

Insulin stress test
- response to hypoglycaemic stress

Question 8

How do you test for adrenal axis esxcess

Answer 8

Dexamethasone

- suppress ACTH axis with steroids

Question 9

How do you test for GH axis deficiency?

Answer 9

Insulin stress test

- response to hypoglycaemic stress

Question 10

How do you test for GH axis excess?

Answer 10

Glucose tolerance test

- suppress GH axis with glucose load

Question 11

How do you investigate suspected pituitary disease?

Answer 11

Radiology
- MRI

Bloods

• thyroid function
• LH
• FSH

Question 12

What is a prolactinoma?

Answer 12

Prolactin secreting tumour

Larger the tumour, the higher the prolactin

Question 13

What are symptoms of a prolactinoma?

Answer 13

Women

• Menstrual disturbance
• Galactorrhoea
• fertility problems

Men
- low testosterone symptoms are non specific`

Question 14

How do you manage prolactinomas?

Answer 14

Dopamine agonist

• shrinks tumour
• stimulates D2 receptore

Dopamine inhibits prolactin

Question 15

What are the effects of hyperprolactinaemia?

Answer 15

Prolactin inhibits LH secretion

Question 16

What is acromegaly?

Answer 16

Large extremities

• hands
• feet

Question 17

What causes acromegaly?

Answer 17

High GH

Often by GH-secreting tumour

Question 18

What are the long term complications of acromegaly?

Answer 18

Premature cardiovascular death
Increased risk of colonic tumours
Hypertension
Diabetes

Question 19

What tests confirm acromegaly?

Answer 19

Oral glucose tolerance test with GH response

Elevated IGF-1 level

Question 20

How do you treat acromegaly?

Answer 20

Surgical removal of tumour

Reduce GH secretion

• dopamine agonist
• somatostatin analogue

Block GH receptor
- pegvisomant

Question 21

What is Cushing’s disease?

Answer 21

ACTH secreting tumour

Question 22

What are the appearance changes in Cushings?

Answer 22

Round pink face
Skinny limbs
Thin skin 
Purple striae - abdomen 
Neck fat pad - hump

Question 23

What is Cushing’s syndrome?

Answer 23

High cortisol due to other conditions

• adrenal tumour
• ectopic ACTH
• steroid medication

Question 24

What is diabetes insipidus?

Answer 24

Reduced production of ADH

Question 25

What are the different types of diabetes insipidus?

Answer 25

Cranial

Nephrogenic

Question 26

What causes cranial diabetes insipidus?

Answer 26

Pituitary disease

• malignancy
• infection
• inflammation

Question 27

What causes nephrogenic diabetes insipidus?

Answer 27

Kidney disease

Question 28

What are the consequences of untreated diabetes insipidus?

Answer 28

Severe dehydration
Hypernatraemia
Reduced consciousness

Question 29

How do you manage diabetes insipidus?

Answer 29

Synthetic ADH

Question 30

What is pituitary apoplexy?

Answer 30

Vascular event in a pituitary tumour

• haemorrhage
• infarction

Question 31

What is the clinical presentation of pituitary apoplexy?

Answer 31

Sudden onset headache
Double vision 
Visual field loss
Cranial nerve palsy 
Hypopituitarism