Pituitary disorders Flashcards
What is hypopituitarism?
Partial or complete deficiency of one or more pituitary hormones
What hormones are secreted from the anterior pituitary>
GH FSH and LH Prolactin TSH ACTH
What are the categories of causes of hypopitutarism?
Hypothalamus
Pituitary stalk
Pituitary gland
What are causes of hypopituitarism from hypothalamus?
Kallman’s syndrome
Tumour
Infection e.g. TB or meningitis
Ishcameia
What are causes of hypopituitarism from pituitary stalk ?
Surgery
Mass lesion e.g. craniopharyngioma
Meningioma
Carotid artery aneurysm
What are causes of hypopituitarism from pituitary gland?
Pituitary adenoma: this is the most common
Irradiation
Infiltration e.g. amyloid, cancer, TB, hypophysitits
Ischaemia e.g pituitary apoplexy, Sheehan syndrome
What are risk factors for hypopituitarism?
Tumours, apoplexy, surgery, cranial injury, TBI, inherited disorder
What are Sx of hypopituitarism?>
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,
What Ix in hypopituitarism?
All pituitary hormones axes
U+Es, oestradiol/testosterone, IGF, short synacthen
MRI for tumour
Visual field testing
What is Rx of hypopituitiarism?
Treat cause e.g. surgery
Replace lacking hormone/s
What is acromegaly?
Excessive secretion of GH, usually due to somatotroph adenoma, causing a multi-system progressive disease
What is function of GH>
Stimulates IGF1 in many procesess
What are Sx of acromegaly?
Sweating, headaches
Increased hand, feet, tongue, interdental space size
Visual impairment due to effect on optic chiasm Amenorrhoea Decreased libido Sleep apnoea Organomegaly, cardiomyopathy
What Ix in acromegaly?
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
What is Rx of acromegaly?
Surgery to remove tumour
Somatostatin analgoues e.g. ocreotide
Dopamine agonist may improve IGF1/GH responsiveness
What is hyperprolactinaemia?
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
What drugs can cause hyperprolactinaemia?
Metoclopramide, haloperidol, oestrogens, MDMA, antipsychotics
what are Sx of hyperprolactinaemia?
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
What Ix in hyperprolactinameia?
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
What is Rx of hyperprolactinaemia?
Dopamine agonists e.g. cabergoline, bromocriptine
Surgery if visual field compromise
If occurs in pregnancy, just monitor and treat after
