Pituitary disorders

Question 1

What is hypopituitarism?

Answer 1

Partial or complete deficiency of one or more pituitary hormones

Question 2

What hormones are secreted from the anterior pituitary>

Answer 2

GH
FSH and LH
Prolactin
TSH
ACTH

Question 3

What are the categories of causes of hypopitutarism?

Answer 3

Hypothalamus

Pituitary stalk

Pituitary gland

Question 4

What are causes of hypopituitarism from hypothalamus?

Answer 4

Kallman’s syndrome

Tumour

Infection e.g. TB or meningitis

Ishcameia

Question 5

What are causes of hypopituitarism from pituitary stalk ?

Answer 5

Surgery

Mass lesion e.g. craniopharyngioma

Meningioma

Carotid artery aneurysm

Question 6

What are causes of hypopituitarism from pituitary gland?

Answer 6

Pituitary adenoma: this is the most common

Irradiation

Infiltration e.g. amyloid, cancer, TB, hypophysitits

Ischaemia e.g pituitary apoplexy, Sheehan syndrome

Question 7

What are risk factors for hypopituitarism?

Answer 7

Tumours, apoplexy, surgery, cranial injury, TBI, inherited disorder

Question 8

What are Sx of hypopituitarism?>

Answer 8

Reduced GH: short, failure to thrive, obesity, hypoglycaemia, OP, reduced strength

Reduced FSH/LH: ED, reduced libido/ferility, oligomenorrhoea, small testes, breast atrophy

Reduced TSH: Sx of hypothyroidism

Reduced ACTH: Sx of addison’s e.g. abdominal pain, vomiting ( no skin pigmentation)

Due to tumour (if thats the cause): mass effect causing homonymous hemianopia,

Question 9

What Ix in hypopituitarism?

Answer 9

All pituitary hormones axes

U+Es, oestradiol/testosterone, IGF, short synacthen

MRI for tumour

Visual field testing

Question 10

What is Rx of hypopituitiarism?

Answer 10

Treat cause e.g. surgery

Replace lacking hormone/s

Question 11

What is acromegaly?

Answer 11

Excessive secretion of GH, usually due to somatotroph adenoma, causing a multi-system progressive disease

Question 12

What is function of GH>

Answer 12

Stimulates IGF1 in many procesess

Question 13

What are Sx of acromegaly?

Answer 13

Sweating, headaches
Increased hand, feet, tongue, interdental space size

Visual impairment due to effect on optic chiasm
Amenorrhoea 
Decreased libido
Sleep apnoea 
Organomegaly, cardiomyopathy

Question 14

What Ix in acromegaly?

Answer 14

Bloods: IGF1 raised, GH also raised (not as useful)
Glucose tolerance test: glucose fails to suppress GH

imaging: pituitary MRI or CT to show tumour

Question 15

What is Rx of acromegaly?

Answer 15

Surgery to remove tumour
Somatostatin analgoues e.g. ocreotide
Dopamine agonist may improve IGF1/GH responsiveness

Question 16

What is hyperprolactinaemia?

Answer 16

Elevated serum prolactin, usually caused by prolactinoma. Also can be due to compression of pituituary stalk (causing disinhibition by dopamine) and use of dopamine antagonists

Question 17

What drugs can cause hyperprolactinaemia?

Answer 17

Metoclopramide, haloperidol, oestrogens, MDMA, antipsychotics

Question 18

what are Sx of hyperprolactinaemia?

Answer 18

Usually in women with menstrual disturbance, infertility, weight gain later on in men with ED, also mass effects e.g. vision and headache and galactorrhoea

OP

Question 19

What Ix in hyperprolactinameia?

Answer 19

Bloods: basal PRL increased, check drugs

(preg test to rule out)

Imaging: CT or MRI brain - check for adenoma

THEN check the other pituitary hormones (to see if they’re affected) Can be a mass causing stalk effect

Question 20

What is Rx of hyperprolactinaemia?

Answer 20

Dopamine agonists e.g. cabergoline, bromocriptine

Surgery if visual field compromise

If occurs in pregnancy, just monitor and treat after