Pituitary gland Flashcards by Jamie Craig

what is a pituitary microadenoma

<1cm

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what is a pituitary macroadenoma

> 1cm

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what are some of the complications of a non functional adenoma

compression on optic chiasma to cause bilateral hemianopia
compression on CN3,4,V1,V2,6
pushes out other pituitary cells to cause hypoadrenalism, hypogonadism, hypothyroidism, diabetes insipidus, GH deficiency

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physiological causes raised prolactin

breast feeding
stress
lack sleep
pregnancy

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pathological causes rasied prolactin

stalk lesions
hypothyroidism
prolactinoma

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pharmacological causes raised prolactin

dopamine antagonists
antipsychotics
antidepressants
oral contraceptives, oestrogens, cocaine

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prolactinoma presentation in men

impotence
visual field defect
anterior pituitary malfunction

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prolactinoma presentation in women

galactorrohea 
menstrual irregularity 
infertility 
amenorrhoea 
visual field abnormality

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investigation of prolactinoma?

serum prolacitn
MRI pituitary
visual fields for bilateral hemianopia
pituitary function testing

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management of prolactinoma

cabergoline
dopamine agonist drugs
surgery rarely required as cabergoline can control symptoms and can cause tumour shrinkage

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side effects cabergoline

low mood
nausea/vomiting
heart valve/retropritoneal fibrosis

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clinical features acromegaly

giant before episeal fusion 
thickened skin, jaw
sweaty, large hands 
sleep apnoea 
HTN and HF 
headaches 
diabetes 
visual field defects 
colonic polyps

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what causes headaches in acromegaly

vascular growth

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diagnosis of acromegaly?

IGF1
OGTT - expect glucose to suppress GH to <0.4ug/L after glucose dose but in acromegaly there is uncontrolled rise or unchanged 
visual field check 
CT/MRI
serum pituitary check

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first line treatment of acromegaly

surgery, radiotherapy can be considered

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2nd line treatment of acromegaly

octreotide to reduce GH and tumour

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side effects of octreotide

stinging locally 
flatulence 
diarrhoea 
abdo pain 
gallstones

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what can be used if a growth hormone tumour is co secreting prolactin

cabergoline for some

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what can be used last line for acromegaly

pegvisomant

binds to GH receptor to block GH

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causes of panhypopituitism

tumours 
local brain tumours 
iatrogenic/surgery 
sarcoid/tb 
polyarteritis 
trauma 
secondary mets
hypothalamic disease 
sheenan syndrome 
infection/meningitis

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what are the possible causes sheenan syndrome

blood loss in pregnancy causes hypotension and pituitary infarct
autoimmune

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signs/symptoms of panhypopituitism

menstrual irregularities 
infertility/impotence 
gynaecomastia 
obesity 
loss facial hair 
loss axillary/pubic hair 
dry skin/hair 
hypothyroid faces 
growth retardation

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diagnosis panhypopituitism

check pituitary function tests
sex hormones, TFT, growth hormones and prolactin
cortisol/ACTH - do cortisol 8/9am or a synacthen
in post menopause LH/FSH should be high
testosterone at 9am

features of familial diabetes insipidus

DIDMOAD 
diabetes insipidus 
diabetes mellitus 
optic atrophy 
deafness

causes of acquired diabetes insipidus

idiopathic trauma, surgery, fracture, RTA tumour, sarcoid, meningitis, external radiation

describe the water deprivation test

NBM for 8-12 hours | check serum and urine osmolalities for 8 hr then give DDAVP and if urine/serum osmol ratio>2 the not DI

management of DI

desmospray desmopressin oral or injection injection is more emergency or post surgery

where are somatotrophs found and what do they secrete

ant pituitary | GH

where are mammotrophs found and what do they secrete

ant pituitary | Prolactin

where are corticotrophs found and what do they secrete

ant pituitary | ACTH

where are thyrotrophs found and what do they secrete

ant pituitary | TSH

where are gonadotrophs found and what do they secrete

ant pituitary | FSH/LH

what is a pituitary adenoma and wehat may it secrete

benign pituitary tumour | can secrete any anterior pituitary homes or can be hypo/non functional

what pituitary adenoma is most common

prolactinoma

how common are poituitary carcinomas

very rare

cause of panhypopituitarism

``` primary/metastatic tumour apoplexy sheehans syndrome DI hypothalamic lesions sarcoid, TB, meningitis subarachnoid haemorrhage surgery/radiation traumatic injury ```

what is a craniopharyngioma

very rare tumour derived from remnant of rathke's pouch | slow growing, cystic and may calcify

cause of central DI

ADH deficiency | trauma, tumours and inflammatory disease of the pituitary glands

cause of nephrogenic DI

peripheral renal resistance to ADH

cause of congenital adrenocortical hyperplasia

autosomal recessive disorder with lack of enzyme required for biosynthesis reduced cortisol continues to stimulate ACTH release and causes hyperplasia

cause of acquired adrenocortical hyperplasia

endogenous ACTH | nodular hyperplasia is independent of ACTH but diffuse isnt

true/false - adrenocortical adenomas are usually functional

false

true/false - adrenocortical carcinomas are usually functional

true

describe the pathological features of an adrenocortical adenoma

well circumscribed and encapsulated small and 2/3cm yellow/yellow brown well differentiated with pale cytoplasm and small nuclei

describe the features of adrenocortical carcinomas

``` closely resemble adenoma metastasis is definite large size haemorrhage/necrosis lack clear cells capsular/vascular invasion ```

where do adrenocortical tumours spread

retroperitoneum/kidney peritoneum/pleura vascular, bone, liver, lung regional lymph nodes

exogenous causes of cushings

exogenous steroid use

endogenous causes cushings

ACTH producing adenoma | ectopic ACTH

cause of acute adrenal crisis

rapid withdrawal of steroid therapy crisis in patient with chronic adrenocortical insufficiency like stress, infection or not physiologically raising steroid dose massive adrenal haemorrhage

risk factors for massive adrenal haemorrhagwe

newborn infants anticoagulants DIC septicaemic infection

causes of chronic adrenocortical insufficiency

AA adrenalitis TB, histoplasma, HIV, kaposi's sarcoma metastatic breast/lung cancer sarcoid, haemachromatosis, amyloid

symptoms of addisons disease

``` weakness fatigue pigmentation anorexia nausea/vomiting diarrhoea ```

presentation of adrenal crisis?

``` vomiting abdominal pain hypotension shock death ```

complications of phaeochromocytoma

heart failure, infarction, arrhythmia, CVA

10% rules to phaeochromocytoma

``` 10% in children 10% bilateral 10% extra adrenal 10% FHx - more 25% 10% not HTN associated 10% malignant ```

features of MEN2A

phaeo, MTC, parathyroid hyperplasia

features of MEN2B

phaeo, MTC, neuromas, ganglioneuromas, marfanoid habitus