Pituitary Disorders Flashcards

1
Q

This deck covers

A

Hypersecretion disorders:

  • Cushing’s Disease
  • Hyperprolactinaemia
  • Acromegaly

Hyposecretion
including Cranial Diabetes Insipidus

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2
Q

What is Acromegaly?

A

Excess production of Growth Hormone after the long bones fuse (i.e. in adults)

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3
Q

How does acromegaly present?

A
  • Enlarged hands/feet (rings dont fit, shoe size increases)
  • Coarse facial features
  • Thick lips & tongue
  • Carpal Tunnel Syndrome
  • Sweating
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4
Q

What complications can arise from excess GH?

A
  • Headaches
  • Chiasmal Compression
  • DM
  • Hypertension
  • Cardiomyopathy
  • Sleep Apnoea
  • Accelerated Osteoarthritis
  • Colonic Polyps & adenoma
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5
Q

How would you test someone for Acromegaly?

A

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

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6
Q

What is Cushing’s Disease?

A

Excessive Glucocorticoids due to the excessive ACTH release from pituitary

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7
Q

How would cushing’s disease present?

A
  • 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)
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8
Q

What are the various causes of Cushing’s?

A

ACTH dependant:

  • Pituitary Tumour
  • Ectopic ACTH (Lung cancer)

ACTH independant:

  • Adrenal tumour
  • CCS therapy
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9
Q

How do we test for Cushing;s?

A

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

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10
Q

What is hyperprolactinaemia?

A

Excessive prolactin in the blood

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11
Q

What can cause hyperprolactinaemia?

A

Physiological - Pregnancy/lactation/stress

Pharmacological - Dopamine antagonists/oestrogens/antidepressants

Pathological - Primary hypothyroidism or Pituitary tumour

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12
Q

How do we classify the scales of prolactinoma?

A

A microprolactinoma is <10mm

A macroprolactinoma is >10mm

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13
Q

How does hyperprolactinaemia present?

A

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

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14
Q

How do you manage hyperprolactinaemia?

A

Test Serum PRL
Elevated? –> Pituitary MRI
Treat with dopamine agonist Cabergoline

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15
Q

What is the primary management for all pituitary tumours?

A

Transphenoidal surgery to remove it +/- radiotherapy

Prolactinoma is the only one where we use drugs first

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16
Q

What drug therapies are there for acromegaly?

A

Somatostatin Analogues

GH receptor antagonists

17
Q

What are the signs of hypopituitarism?

A
Tiredness
Weight gain
Depression
Lost libido
Impotence
Menstrual problems
Skin pallor
Reduced body hair
18
Q

What is Cranial Diabetes Insipidus?

A

A specific type of hypopituitarism in what there is no vasopressin released.

19
Q

How does CDI present?

A

No vasopressin means huge amounts of urine and consequent thirst

Risk of dehydration & hypokalemia

20
Q

What causes CDI?

A

Idiopathic
Trauma to pituitary (incl surgery)
brian tumours pressing on stalk

21
Q

How do we test for CDI?

A

Water deprivation test

Unlike normal they don’t conserve water, instead they keep pissing buckets.

22
Q

What could a pituitary tumour press on?

A
  • Optic chiasm

- Cavernous sinus nerves