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Metabolism, Endocrinology And Haematology > Pituitary Disorders > Flashcards

Pituitary Disorders Flashcards

1
Q

What are pituitary disorders most commonly caused by ?

A

Pituitary adenoma , a benign pituitary tumour. Most of these tumours are non functioning , meaning that they do not produce any hormone themselves , but cause an inadequate production of one or more pituitary hormones due to the physical pressure of the growing tumour on the glandular tissue.

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2
Q

What are functioning pituitary tumours ?

A

Also known as hyper-secreting tumours , they are much rarer. And their clinical symtposms are dependant on which pituitary hormone they are over secreting.

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3
Q

What are common symptoms of pituitary adenoma ? ( non-functioning )

A

Headaches

Visual problems

Nausea

Vomiting

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4
Q

What is hypopituitarism ?

A

Most commonly caused by a pituitary adenoma putting pressure on the pituitary glandular tissue

There is a progressive loss of anterior pituitary function.

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5
Q

What hormones are most commonly affected first in hypopituitarism ?

A

Growth hormone

LH

Follicle stimulating hormone

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6
Q

Why is the secretion of oxytocin and ADH normally unaffected in hypopituitarism?

A

Because the posterior pituitary gland is normally only affected if the tumour also affects the hypothalamic function or if an inflammatory process is involved

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7
Q

What are the. Sytmpksmof GH deficiency?

A

Decreased exercise tolerance

Decreased muscle tone

Increased body fat

Reduced sense of well-being

If GH is released in a pulsatile fashion

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8
Q

Is GH deficiency hard or easy to diagnose ?

A

Very hard to diagnose

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9
Q

The common cause of GH deficiency in adults in pituitary adenoma , what is it in children ?

A

Idiopathic - unknown cause

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10
Q

Outline the effects GH deficiency has on fetal development , child development

A
  1. Has little effect on fetal development
  2. From aged 1-mid teens , GH deficiency can result in poor growth and short stature. This results in Pituitary dwarfism.
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11
Q

What hormones come under gonadotropin?

A

LH and FSH

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12
Q

What are the consequences of a deficiency in Gonadotrophin?

A

Can result in lack of libido , infertility and oligomenorrhea ( infrequent menstruated period ) , the absence of menustration in women

in men : decreased libido , cause impotence ( inability to achieve an erection)

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13
Q

What symptoms of TSH deficiency?

A

Feeling cold

Weight gain

Bradycardia

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14
Q

Symptoms of Adrenocorticotropic hormone deficiency

A

Tiredness

Low blood pressure

Dizziness

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15
Q

What can ADH deficiency result from ?

A

Hypothalamic tumour or pituitary tumour that has extended up into the hypothalamus

Other causes include cranial radiotherapy

Autoimmune infiltration

Infections such as meningitis

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16
Q

Symptoms of ADH deficiency

A

Dehydration

Increased sensation of thirst

Excess secretion of dilute urine

17
Q

What does hyperpitutarism usually caused by ?

A

Hypersecreting pituitary adenoma

18
Q

What are the three most commonly affected hormones affected in hyperpituitarism ?

A

Prolactin

GH

ACTH

19
Q

What is hyperprolactinaemia ? And what is it most commonly caused by ?

A

The most common form of pituitary disorder. Most commonly caused by a prolactinoma - a pituitary adenoma that secretes prolactin.

Other causes are pregnancy , suckling , stress and exercise.

20
Q

What are symptoms of hyperprolactinaemia?

A
  1. Galactorrhoea - spontaneous flow of milk from the breast which is unassosiated with just nursing or childbirth.
  2. Gynecomastia : male breast tissue increases in size , this is non cancerous tissue.
  3. Hypogonadism : diminished function of the gonadotropin hormones which results in less sex hormones due to testes / ovaries not functioning properly.
  4. Erectile dysfunction
  5. Amenorrhea : abscence of menustration
21
Q

Why patients with hyperprolactinaemia often have a decreased production in sex hormones ?

A

This is because the increased concentration of plasma prolactin increases negative feedback on the hypothalamus causing an increase in the production of dopamine ( prolactin release inhibiting hormone ) .

However the increased dopamine levels decrease the release of GNRH ( gonadotropin releasing hormone )

22
Q

What is the first line of treatment for someone with hyperlipidaemia?

A

Dopamine receptor agonist which is usually sufficient in most cases.

23
Q

What is the cause of GH excess ?

A

Large growth hormone secreting pituitary adeonmas

24
Q

What are local mass effects of GH. Excess ?

A

Headaches

Visual field defects

Cranial nerve palsies

25
Q

What are systemic effects of excess GH ?

A

Broad nose , thick lips , enlarged hands & feet , excessive sweating , deepening of the voice

In childhood , this can result in gigantism.

While in adults , acromegaly occurs ( large hands , feet & lower jaw ).

26
Q

Why does diabetes develop with excess GH ?

A

Antagonises insulim - meaning several metabolic conditions such as diabetes mellitus can occur.

27
Q

How are prolactinomas treated ?

A

With tablets - not operations.

28
Q

Biochemical tests to confirm acromegaly ?

A

Elevated IGF-1 level

Elevated mean GH

29
Q

How to treat patients with acromegaly ?

A
  1. Surgical removal of tumour
  2. Reduce GH secretion using dopamine agonist.
  3. Block GH receptor
  4. Radiotherapy
30
Q

What is cushings disease ?

A

Associated with an increase in ACTH

.

31
Q

What are classical changes in appearance in people with cushings disease ?

A

Round pink face with round abdomen

Skinny and weak arms and legs

Thin skin and easy bruising

Red stretch marks ( striae) on abdomen

High blood pressure and diabetes

Osteoporosis

32
Q

What is the difference between cushings disease and Cushing’s syndrome ?

A

Cushings disease is due to a pituitary tumour whereas Cushing syndrome is due to other pathologies.

33
Q

What is diabetes insipidus

A

There are different forms of diabetes insipidus

One is cranial DI which is where there is ADH deficiency pituitary disease.

Another form is nephrogenic DI : where kidney cells are resistant to ADH.

34
Q

What are the consequences of untreated diabetes insipidus?

A

Severe dehydration

Very high sodium levels which could lead to hypernatraemia

Reduced consciousness , coma , death

35
Q

How is cranial diabetes insipidus treated ?

A

Responds brilliantly to synthetic vasopressin

36
Q

What is pituitary apoplexy?

A

Apoplexy is an old fashioned word for stroke. Often caused by a sudden vascular event in a pituitary tumour. This can be caused by bleeding in the tumour ( haemorrhage ) or blood supply cut off ( infaraction )

37
Q

What is clinical presentation of pituitary apoplexy ?

A

Double vision

Sudden onset headache

Visual field loss

Cranial nerve palsy

Hypopituitarism ( cortisol deficiency most dangerous )

NEEDS PROMPT DIAGNOSIS AND TREATMENR

Metabolism, Endocrinology And Haematology (23 decks)

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