Pituitary Disorders Flashcards
This deck covers
Hypersecretion disorders:
- Cushing’s Disease
- Hyperprolactinaemia
- Acromegaly
Hyposecretion
including Cranial Diabetes Insipidus
What is Acromegaly?
Excess production of Growth Hormone after the long bones fuse (i.e. in adults)
How does acromegaly present?
- Enlarged hands/feet (rings dont fit, shoe size increases)
- Coarse facial features
- Thick lips & tongue
- Carpal Tunnel Syndrome
- Sweating
What complications can arise from excess GH?
- Headaches
- Chiasmal Compression
- DM
- Hypertension
- Cardiomyopathy
- Sleep Apnoea
- Accelerated Osteoarthritis
- Colonic Polyps & adenoma
How would you test someone for Acromegaly?
Visual Field Testing (chiasmal compression –> Bitemporal Hemianopia)
Screen potential patients for IGF-1 Elevation.
Confirm diagnosis with an OGTT, normally glucose loading suppresses GH.
MRI for pituitary tumour
What is Cushing’s Disease?
Excessive Glucocorticoids due to the excessive ACTH release from pituitary
How would cushing’s disease present?
- DM
- Na retention –> Hypertension & HF
- Thin skin
- Spontaneous purpura (looks like bruising)
- Proximal myopathy (weakness)
- Osteoporosis
- Pink striae
- Facial mooning, pendulous breasts & abdomen
- Hirsutism
- Oedema (fluid retention)
What are the various causes of Cushing’s?
ACTH dependant:
- Pituitary Tumour
- Ectopic ACTH (Lung cancer)
ACTH independant:
- Adrenal tumour
- CCS therapy
How do we test for Cushing;s?
Random Blood Cortisol
Overnight Dexamethasone Test & 24 hour free urine cortisol.
Confirm by repeating 24 hour urine cortisol.
Paired morning & midnight Cortisol & ACTH test
High Dose Dex Test (suppresses excess pituitary ACTH but not Ectopic)
Localise with MRI, CT adrenal r CT chest as appropriate
What is hyperprolactinaemia?
Excessive prolactin in the blood
What can cause hyperprolactinaemia?
Physiological - Pregnancy/lactation/stress
Pharmacological - Dopamine antagonists/oestrogens/antidepressants
Pathological - Primary hypothyroidism or Pituitary tumour
How do we classify the scales of prolactinoma?
A microprolactinoma is <10mm
A macroprolactinoma is >10mm
How does hyperprolactinaemia present?
Women:
- Galactorrhoea
- Menstrual irregularity
- Infertility
Men:
- Impotence
- Visual field abnormalities
- Headache
- Extraocular muscle weakness
- Other pituitary malfunction
- Eventual galactorhea
Men present later due to less obvious early warning symptoms
How do you manage hyperprolactinaemia?
Test Serum PRL
Elevated? –> Pituitary MRI
Treat with dopamine agonist Cabergoline
What is the primary management for all pituitary tumours?
Transphenoidal surgery to remove it +/- radiotherapy
Prolactinoma is the only one where we use drugs first