Pituitary Gland Clinical Flashcards
What condition does hypersecretion of GH cause?
Acromegaly (gigantism)
What condition does hypersecretion of ACTH cause?
Cushing’s disease
What condition does hypersecretion of prolactin cause?
Hyperprolactnaemia
What hormones can be hyposecreted by the anterior pituitary gland?
- FSH/LH
- GH
- ACTH
- TSH
What hormone can he hyposecreted by the posterior pituitary?
Vasopressin
What can a SOL of the pituitary gland lead to?
Optic chiasmal compression
What are the clinical soft tissue overgrowth features of acromegaly?
- spade like hands (rings)
- wide feet (shoes)
- coarse facial features
- thick lips & tongue
- carpal tunnel syndrome
- sweating
What are the possible complications of acromegaly?
- headache
- chiasmal compression
- diabetes mellitus
- hypertension
- cardiomyopathy
- sleep apnoea
- accelerated OA
- colonic polyps & CA
How is acromegaly diagnosed?
- Oral glucose tolerance test
- Can GH be suppressed?
- Is insulin-like growth factor-1 (IGF1) elevated?
- Is the rest of the pituitary normal?
- Is there a pituitary tumour of MRI?
- Is vision normal?
What is Cushing’s syndrome a result of?
Excess corticosteroids
What type of hormone is cortisol?
Catabolic
What physiological changes does excess cortisol lead to?
-Tissue breakdown (Causes weakness of skin, muscle and bone)
-Sodium retention (May cause hypertension and heart failure)
-Insulin antagonism
(May cause diabetes mellitus)
What are the high value signs and symptoms of Cushing’s syndrome?
- Skin atrophy
- Spontaneous purpura
- Proximal myopathy
- Osteoporosis
- Growth arrest in children
What are the intermediate value signs and symptoms of Cushing’s syndrome?
- Pink striae
- Facial mooning and hirsutism
- Oedema
What are the non-specific signs and symptoms of Cushing’s syndrome?
- Central obesity
- Hypertension
What are the ACTH-dependent causes of Cushing’s syndrome?
- Pituitary tumour (Cushing’s disease)
- Ectopic ACTH secretion (e.g. lung carcinoid)
What are the ACTH-independent causes of Cushing’s syndrome?
- Adrenal tumour (adenoma or carcinoma)
- Corticosteroid therapy (e.g. for asthma, IBD)
How can hyperprolactinaemia manifest itself in a women?
- Galactorrhoea (30-80%)
- Menstrual irregularity
- Infertility
How can hyperprolactinaemia manifest itself in a man?
- Galactorrhoea (<5%)
- Impotence
- Visual field abnormalities
- Headache
- Extrocular muscle weakness
- Anterior pituitary malfunction
What are the physiological causes of hyperprolactinaemia?
- Pregnancy
- Lactation
- Stress
What are the pharmacological causes of hyperprolactinaemia?
DA depleting and DA antagonist drugs
What are the pathological causes of hyperprolactinaemia?
- Primary hypothyroidism
- Pituitary lesions (prolactinoma or pituitary stalk tumour)
What drugs may cause hyperprolactinaemia?
-Dopamine antagonists
such as neuroleptics (e.g. chlorpromazine) and anti-emetics (e.g. metoclopramide)
-DA depleting agents
-Oestrogens (not in OCP dosage)
-Some antidepressants
-Don’t forget to ask about homeopathic or herbal remedies
What are the clinical features of hypopituitarism in adults?
-Tiredness
-Weight gain
-Depression
-Reduced libido
-Impotence,
Menstrual problems
Skin pallor
-Reduced body hair
