Pituitary Gland

Question 1

What hormones are secreted from the anterior and posterior pituitary gland?

Answer 1

6 Anterior:

• LH
• FSH
• TSH
• Prolactin
• ATCH
• GH

2 Posterior:

• ADH
• Oxytocin

Question 2

What is a pituitary adenoma?

Answer 2

A benign tumour of the pituitary gland resulting in:

• excess hormone production of a particular hormon
• Mass effect
• Reduced production of all other hormones in the pituitary

Question 3

What condition is caused by excess GH

Answer 3

Acromegaly

Question 4

what condition is caused by excess ACTH / Cortisol

Answer 4

Cushings

Question 5

What condition is caused by excess prolactin

Answer 5

Prolactinoma

Question 6

What are the features of functioning and non functioning adenomas

Answer 6

Functions = hormone producing and therefore are identified earlier due to the effects of excess hormones

Non functioning = non hormone producing and therefore identified later due to mass effects

Question 7

What symptoms are caused due to mass effect?

Answer 7

1. Bitemporal hemianopia
2. CN III, IV and VI palsy
3. headaches
4. Change in appetite, temperature regulation, thirst, GCS etc if the hypothalamus is involved

Question 8

Features of a prolactinoma

Answer 8

1. Gynocomastia
2. decreased libido
3. Oligomenhorrea
4. menhorragia
5. Amenhorrea
6. Small testes
7. Impotence in males
8. loss of facial hair
9. osteoporosis
10. Decreased fertility

Question 9

Investigations in prolactinoma

Answer 9

1. Basal prolactin (Non stressful 9am-4pm)
2. TFTs
3. pregnancy test
4. MRI of pituitary

Question 10

Treatment of prolactinoma

Answer 10

Dopamine agonist + referral

Question 11

Signs of acromegaly

Answer 11

1. Growth of bone and soft tissues
2. Widely spaced teeth
3. Prognathism - protruding jaw
4. Boggy palms
5. Big tounge, big heart, bit thyroid
6. increased sweating
7. high BP, arrhythmias
8. Prominent forehead
9. Increased skin creases
10. Carpel tunnel and thenar eminence waisting

Question 12

Symptoms of acromegaly

Answer 12

1. headache
2. decreased libido
3. amenhorrea
4. galactorrhea

Question 13

Why do you get loss of libido and amenhorrea in acromegaly

Answer 13

because 1/3 of patients also have increased prolactin

Question 14

complications of acromegaly (ABCDE)

Answer 14

A - Arrhythmias
B - BP high 
C - Carpel Tunnel and Colorectal cancer
D - Diabetes
E - Enlarged hands, tongue, feet and goitre
F - Fields and bi temporal hemianopia

Question 15

Why is there a risk of getting Diabetes in Acromegaly?

Answer 15

Acromegaly is due to the increased secretion of GH and IGH (insulin like growth hormone) which acts as an “anti insulin” and causes diabetes

Question 16

What screening is required in people with acromegaly

Answer 16

Colonoscopy annually after the age of 40 due to the increased risk of colorectal cancer

Question 17

Investigations of acromegaly

Answer 17

Bloods:

• OGTT
• Glucose
• GH / IGF
• Calcium
• Phosphate

Bedside:

• ECG (arrhythmias)
• Urine dip (Glucose)

Other
- Visual fields

Question 18

Treatment of acromegaly

Answer 18

• Somatosatin anologues

- surgical removal

Question 19

Definition of cushings

Answer 19

Excess ATCH and therefore Excess cortisol due to either ATCH dependent (pituitary problem / ectopic tissue) or Non ATCH dependent (adrenal adenoma)

Question 20

Features of cushings disease

Answer 20

LEMON ON A STICK!

1. Increase central obestity
2. Moon face
3. Acne
4. Intrascapular fat pads
5. Frontal balding
6. Thin limbs
7. hyper pigmentation
8. osteoporosis
9. Diabetes

Question 21

Investigations of cushings disease

Answer 21

1. Low dose dexamethosone test (high dose is secdond line)
2. 24hr urinary cortisol
3. Plasma ATCH if any of the above are positive

Question 22

treatment of cushings disease

Answer 22

if drugs are the cause (steroids) = Stop the drugs

otherwise = surgery to remove pituitary adenoma

Question 23

definition of hypothalamic pituitary disease

Answer 23

decrease in all pituitary hormones

Question 24

What are the features of hypothalamic pituitary disease

Answer 24

1. Fatigue
2. Myalgia
3. hypotension (Low GH)
4. Diabetes insidious with polyuria and polydipsia (low ADH)
5. Hypothyroidism (low TSH)