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Endocrinology > Pituitary disorders > Flashcards

Pituitary disorders Flashcards

1
Q

the pituitary gland is known as

A

the conductor of the endocrine audience

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2
Q

Poster pituitary is derived from

A

brain- neuroectoderm (nerve cells)

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3
Q

features of the PP

A

fast acting- neurological

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4
Q

what does the PP release

A

Vasopressin (ADH) and oxytocin (produced in the hypothalamus)

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5
Q

Anterior pituitary is an

A

up growth of gut- hormone producing and secreting

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6
Q

hormones secreted by the AP

A
  • growth hormone (GH)
  • prolactin (PRL)
  • follicle-stimulating hormone (FSH)
  • luteinizing hormone (LH)
  • adrenocorticotropic hormone (ACTH)
  • thyroid-stimulating hormone (TSH)
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7
Q

Disorders of the pituitary are rare, and can manifest themselves as

A

either an over or under secretion of pituitary hormone.

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8
Q

Clinical presentation of pituitary tumours

A

1. Mass effect of tumour on local structure- visual loss, headache

2.Abnormality in pituitary function – hypo or hyper-secretion

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9
Q
A
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10
Q
A
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11
Q

most common pituitary tumour

A

Most commonly caused by pituitary adenoma- a benign pituitary tumour.

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12
Q

most pituitary tumours are

A

non functioning (do not produce any hormone) but can cause inadequate production of one or more pituitary hormone due to the physical pressure of the growing tumour on glandular tissue

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13
Q

symptoms of non-functioning tumour

A

Headaches

Visual loss

Nausea and vomiting

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14
Q

Functioning tumour (hyper-secreting)

A

Rarer

Clinical symptoms dependent on which pituitary hormone they are over-secreting and its systemic effects

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15
Q

investigations required if pituitary tumour is suspected

A
  • MRI scan
  • Assessment of visual field
  • Blood tests measuring hormone levels
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16
Q

picture of a nonrmal pituitary and its interactions with local structures

A
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17
Q

upwards (superior) growth of pituitary tumour causes

A

visial field loss due to compression on the optic chiasm

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18
Q

how would an upwards (superior) growth of pituitary tumour effect vision

A

bitemporal hemi-anopia

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19
Q

Sideways (lateral) growth of pituitary gland

A

would cause pain, double vission and left sided eye compressive problems

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20
Q

what cause a tumour to be hypo-functioning

A

pressure on gland by adenoma

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21
Q

hyper- functioning tumour

A

hypersecreting adenoma

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22
Q

When a tumour blocks the hypothalamic-pituitary access… which hormones will decrease

A

Hormones that decrease (due to being under positive control of hormones produced in the hypothalamus)

  • GH
  • LH/FSH
  • TSH
  • ACTH
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23
Q

When a tumour blocks the hypothalamic-pituitary access… which hormones will increase

A

Hormones that will increase (due to be under under negative control of hormones produced in the hypothalamus)

  • Prolactin (positive control by dopamine)
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24
Q

cause of hypopituitarism

A
  • Most commonly caused by a pituitary adenoma putting pressure on the pituitary glandular tissue.
    • Tumour could be blocking hypothalamic control of the pituitary
  • causes a progressive loss of anterior pitutiary function
  • posterior pit usually only affected if the tumour also affects hypothalamic function (secretion of ADH and oxytocin normally unaffected)
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25
Q

ADH deficiency

A

May occur from a hypothalamic tumour or pituitary tumour that has ended up in the hypothalamus.

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26
Q

Symptoms of ADH deficiency

A
  • Dilute urine
  • Dehydration
  • Increased thirst
  • Diabetes insipidus
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27
Q

GH deficiency

A

Loss of GH

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28
Q

GH deficiency hard to diagnose

A

Can be hard to diagnose because GH is released in a pulsatile fashion

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29
Q

symptoms of GH deficiency in adults

A

Adults (adenoma)

  • Decreased exercise tolerance
  • Decreased muscle tone
  • Increased body fat
  • Reduced sense of wellbeing
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30
Q

symptoms of GH deficiency in children

A

Children (idiopathic- specific mutations and autoimmune may be linked)

Short stature in children- can be treated with GH manufactured by recombinant DNA technology

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31
Q

Gonadotrophin deficiency

A

LH and FSH deficiency

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32
Q

symptoms of Gonadotrophin (LH and FSH) deficiency: general

A
  • Delayed puberty in children
  • Loss of secondary sexual characteristics in adult
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33
Q

symptoms of Gonadotrophin (LH and FSH) deficiency: female

A
  • Reduced libido
  • Infertility
  • Oligomenorrhea
  • Amenorrhea
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34
Q

Oligomenorrhea

A
  • infrequent menstrual periods
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35
Q

Amenorrhea

A
  • absence of periods
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36
Q

symptoms of Gonadotrophin (LH and FSH) deficiency: male

A
  • Reduce libido
  • Impotence
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37
Q

Impotence

A
  • inability to achieve erection of orgasm)
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38
Q

TSH and Adrenocorticotropic hormone deficiency

A

Late features of pituitary tumours

  • TSH and ACTH deficiency
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39
Q

TSH deficiency

A
  • Low thyroid hormones
  • Symptoms:
    • Cold
    • weight gain
    • tiredness
    • slow pulse
    • low T4 and non-elevated TSH
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40
Q

ACTH deficiency

A
  • Low cortisol
  • Symptoms:
    • Tired
    • dizzy
    • low BP
    • low sodium
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41
Q

sumamry of hypopituitarism

A
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42
Q

hyperpituitarism

A

Caused by a hypersecreting pituitary adenoma

43
Q

three hormoens most commonly saffecte dby hyperpituitarism

A

Prolactin

GH

ACTH

44
Q

two rarer hormones affected by hyperpituitarism

A

TSH

LH/FSH

45
Q

prolactin excess

A

Most common form of pituitary disorder.

46
Q

most common cause of prolactin excess

A

prolactinoma

47
Q

what is classes as a large tumour

A

macro-adenoma = >1cm

48
Q

other causes of prolactin excess

A

Pregnancy

Suckling

Stress

Exercise

49
Q

symptoms of prolactin excess

A

Galactorrhoea (milky nipple discharge)

Gynecomastia (proliferation of male breast glandular tissue)

Hypogonadism (low testosterone symptoms)

Amenorrhea (absence of period)

Erectile dysfunction

50
Q

Galactorrhoea

A

(milky nipple discharge)

51
Q

Gynecomastia

A

(proliferation of male breast glandular tissue)

52
Q

Hypogonadism

A

(low testosterone symptoms)

53
Q

MOA of prolactin

A
  • Increased conc of plasma prolactin increases negative feedback on the hypothalamus
  • Increase in production of dopamine to try and bring prolactin back within normal limits
  • This decreases release of GnRHà diminished sex hormone production
54
Q

prolactin excess treatment

A

Treated with drugs not an operation- Dopamine receptor agonist (dopamine inhibits prolactin e.g. bromocriptine)

Never send patients for surgery until prolactin is known

Make sure pt isn’t pregnant

Surgery (rare)

Radiotherapy (rare)

55
Q

GH excess cause

A

Large growth-hormone secreting pituitary adenoma

56
Q

symptoms of GH excess

A

Headaches

Visual field defects

Cranial nerve palsies

57
Q

signs of growth hormone excess

A

Broad nose

Coarse facial features

Thick lips

Prominent superorbital ridge

Enlarged hands and feet

Greasy skin

Excessive sweating

Deepening of voice

58
Q

in children GH excess is

A

gigantism

59
Q

in adults GH excess is

A

acromegaly

60
Q

MOA of GH excess

A
  • Systemic effects are through both the direct actions of GH and through the stimulation of local IGF-1 production
  • Usually takes years to develop
  • GH antagonises insulin –> diabetes mellites can occur. Increased IGF-1 associated with cancer
61
Q

GH excess treatment

A
  • Surgery to remove adenoma
  • Radiation or drug therapy
  • E.g. somatostatin analogues, GH receptor antagonists
62
Q

ACTH stands for

A

Adrenocorticotropic hormone

63
Q

ACTH excess is the cause of

A

cushings syndrome

64
Q

symptoms of cushins syndrome

A

Hyperglycaemia

Hypertension

Purple striae

Abdominal obesity

Buffalo hump

Moon-shaped face

65
Q

summary of hyperpituitarism

A
66
Q
A
67
Q

Hyperprolactinaemia caused by

A

Prolactinoma

prolactin > 5,000 then high prolactin
is likely to be due to active prolactin secretion (prolactinoma)

68
Q

prolactin is under tonic inhibitory control by

A

dopamine

anything blocking the stalk will lead to prolactin disinhibition (increase in prolactin)

69
Q

prolactin directly inhibits …… secretion

A

LH

70
Q

If prolactin < 5,000

A

the high prolactin might be due to disinhibition (‘stalk effect’) rather than active prolactin secretion

71
Q
A
72
Q

Biochemical assessment of pituitary disease types

A

Basal blood tests

Dynamic blood tests

73
Q

basal blood tests sufficient

A
  • Thyroid axis
    • T4
    • TSH
  • Gonadal axis
    • LH, FSH
    • Testosterone (men)
    • Oestradiol (women)
  • Prolactin axis
    • Serum prolactin
74
Q
A
  • HPA
    • 0900 cortisol
  • GH axis
    • GH/IGf-1
75
Q

Dynamic assessment of HPA and GH axes types of tests

A

stimulation and suppression test

76
Q

stimulation tests used for

A

suspected hormone deficiency

77
Q

supression test used in

A

suspected hormone excess

78
Q

test for suspected adrenal axis deficiency

A
  • Direct stimulation of adrenals by ACTH (synACTHen test )
  • Response to hypoglycaemic stress (insulin stress test)
79
Q

test for suspected adrenal axis excess

A

Supress ACTH axis with steroids (dexamethasone suppression test)

80
Q

test for suspected GH axis deficiency

A

Response to hypoglycaemic stress (insulin stress test)

81
Q

test for suspected GH axis excess

A

Supress GH axis with glucose load (glucose tolerance test)

82
Q

Radiological assessment of pituitary disease

Using MRI

A
83
Q

Specific conditions caused by Pituitary disorders

A

Acromegaly

Cushing’s disease

Diabetes insipidus

Pituitary apoplexy

84
Q

Acromegaly

A

“large extremities’

  • Acromegaly is a rare condition where the body produces too much growth hormone, causing body tissues and bones to grow more quickly.
  • Over time, this leads to abnormally large hands and feet, and a wide range of other symptoms.
  • Acromegaly is usually diagnosed in adults aged 30 to 50 but can affect people of any age. When it develops before puberty, it’s known as “gigantism”.
85
Q

cause of acromegaly

A

GH-secreting pituitary tumour- can be visualised using a PET scan

86
Q

symptoms of acromegaly

A
  • Swollen hands and feet
  • Tiredness and difficulty sleeping
  • Gradual changes in facial features
    • Brow
    • Lower jaw
    • Nose getting larger
    • Teeth become more space
  • Numb ness and weakness in hands caused by a compressed nerve (carpal tunnel syndrome)
87
Q

long term complications of acromegaly

A
  • Long term complications
  • Premature CVS death
  • Increase risk of colonic tumour
  • Increase risk of thyroid cancer
  • Disfiguring body changes may be irreversible
  • Hypertension
  • Diabetes
88
Q

Biochemical tests to confirm acromegaly

A
  • OGTT with GH response
  • Failure to supress GH<1ug/:
  • Elevated IGF-1
  • Growth hormone day curve – elevated mean GH
89
Q

acromegaly treatment

A
  • Surgical removal of tumour (through nose)
  • Medical treatment
    • Reduce GH secretion:
      • Dopamine agonist- bromocriptine
      • Somatostatin analogues- octreotide
    • Block GH receptor- pegvisomant
  • Radiotherapy
    • External beam- multiple short bursts over several weeks
    • Gamma knife
    • High conc over single time
90
Q

examples of acromegaly

A
91
Q

cushings syndrome caused by

A

ACTH (adrenocorticotropic hormone) pituitary tumour

92
Q

classical changes in appearance of Cushings disease patients

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 bp and diabetes
  • Osteoporosis.
93
Q

cushings disease vs cushings syndrome

A
  • CD caused by pituitary tumour
  • CS may be caused by other pathologies
    • Adrenal tumour
    • Ectopic ACTH
    • Steroid medication
94
Q

Examples of cushings disease

A
95
Q

what does insipidus mean

A

large quantities of pale urine

96
Q

how many types of diabetes insipidus

A
  • Cranial DI
  • Nephorgenic DI
  • Dispogenic DI
  • Gestational DI
97
Q

cranial DI

A
  • Lack of ADH (p.pituitary)
  • ADH usually decreases urine output to increase BP by increasing reabsorption of water in the kidneys
98
Q

causes of cranial DI

A

Inflammation

Infiltration

Malignancy

Infection

99
Q

nephrogenic DI

A

Vasopressin resistant kidney disease

100
Q

symptoms of diabetes insipidus

A
  • Large quantities of pale (insipid) urine
  • Extreme thirst due to fluid loss
101
Q

consequences of untreated DI

A

Severe dehydration

Very high sodium levels (hypernatremia)

Reduced consciousness, coma and death

102
Q

treatment of DI

A
  • Cranial DI responds well to synthetic vasopressin (ADH)
  • Desmopressin nasal spray, tablets or injection
    *
103
Q

Pituitary apoplexy

A

‘Apoplexy’ is the old-fashioned word for stroke

  • Sudden vascular event in a pituitary tumour
    • Haemorrhage
    • Infarction
104
Q

clinical presentation of pituitary apoplexy

A

Sudden onset of headache

Double vision

Visual field loss

Cranial nerve palsy

Hypopituitarism (cortisol deficiency)

Endocrinology (12 decks)

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