Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endocrine > Pituitary Gland Clinical > Flashcards

Pituitary Gland Clinical Flashcards

1
Q

What causes hyper secretion from pituitary gland

A

Pituitary adenoma = most common

Carcinoma / hypothalamic defects = rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are pituitary adenoma’s and what can they be associated with

A

Benign tumour
Sporadic
5% MEN1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How are they classified

A 
Size
- Micro <1cm
- Macro >1cm 
Hormonal status
- Secretory
- Non-secretory
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the most common pituitary adenoma and what does it cause

A

Prolactinoma = excess prolactin

  • Galactorrhoea
  • Menstrual disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What other types can you get and what does this lead too

A

GH secretory

  • Acromegaly
  • Gigantism in children

ACTH secreting
- Cushing’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

If large tumour what may it cause

A

Radiographic abnormalities
Optic chiasma compression = UL bitemporal hemianopia
Headache if fossa stretched
Elevated ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do you investigate

A

Bloods - GH, prolactin, ACTH, FH, LSH, TFT
Visual field testing
MRI + contrast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do you Rx

A

Hormone therapy
Transphenoidal surgery
RT

Surgery if visual abnormality or hypersecretoin (except if prolactinoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are DDx

A 
Pituitary hyperplasia
Cranipharyngioma -LL 
Meningioma
Brain mets
Lymphoma
Aneurysm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is gigantism

A

Excess GH before epiphyseal growth plates fuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is acromegaly

A

Excess GH after growth plate sealed so no longitudinal growth as GH stimulates bone and soft tissue growth via IFF-1
Can still grow from soft tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are causes

A

Pituitary adenoma= most common

Ectopic from tumour e.g. carcinoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are features of Acromegaly

A 
Enlarged hands and feet
Coarse facial features
Sweating + headache = main features
Oily skin
Arthralgia 
Skin darkening
Aconthosis nigrican
Proximal muscle wasting 
Raised prolactin  
Pituitary tumour features
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are coarse facial features

A 
Prominent forehead
Eyebrows stick out
Enlarged jaw
Spaced out teeth
Thick lips and tongue - macroglossia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are features of raised prolactin

A

Gynaecomastia
Galactorrhoea
Amenorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are features of pituitary tumour

A

Hypopituitary
Headache
Bitemporal hemianopia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are complications of acromegaly

A 
DM - GH anti-insulin
Carpal tunnel
Hypertension
Cardiomyopathy 
Sleep apnoea
Accerlerated OA
Colonic polyps / cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is 1st line blood test for diagnosis

A

Serum IGF-1

GH stimulates release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What do you do if IGF-1 raised

A

Oral glucose tolerance test if raised - give glucose
Glucose should suppress GH as low glucose stimulates GH
Acromgealy = fail to suppress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What other investigations

A

Bloods - glucose, Ca, phosphate will be increased
MRI to look for pituitary
AP pituitary bloods - prolactin, short synthetic, TSH and T4, LSH, FH and oestrodiol
Visual field + acuity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why can’t you use GH levels

A

Fluctuates at different times

  • Stress / exercise / sleep / other hormones
  • Low BG increases GH
22
Q

How do you treat

A

Trans-sphenoidal surgery for tumour = 1st line
Do others if IGF-1 begins to rise again
Somatostatin analogue (octreotide) - GHIH
GH receptor antagonist
Pituitary RT

23
Q

What does somatostatin analogue do

A

Inhibits GH
Improves symptoms
Normalise GH and IGF-1 level
Induce tumour shrinkage

24
Q

What are SE

A

Nausea / cramps / diarrhoea
Cholesterol gall stones
Monthly injections = expensive

25
Q

What are GH receptor antagonists

A

Once daily S/C injection

Very effective in decreasing IGF-1 but doesn’t reduce tumour so ned surgery

26
Q

When do you do RT

A

If failed surgical / medical

Will cause hypopituitary

27
Q

What are DDX

A

Pregnancy
OA
Hypothyroid

28
Q

What are physiological causes of hyperprolactin

A

Pregnancy
Lactation
Stress

29
Q

What are pharmalogical causes

A 
Da antagonists 
- Metoclopmaride / domperidone 
- Haloperidol  / chlorpromazine 
Oestrogen
Anti-depressants - SSRI 
Herbal
30
Q

How does dopamine antagonist cause hyper-prolactin

A

Dopamine normally inhibits prolactin release (prolactin inhibiting hormone)

31
Q

What are pathological causes of hyper-prolactin

A 
Primary hypothyroid
Prolactinoma 
PCOS
Acromegaly
Cushing
32
Q

How do women present

A 
Galactorrhoea 
Sore breasts
Menstrual irregularity
Infertility
Decreased libido 
Weight gain
33
Q

How do men present

A 
Galactorrhoea
Decreased facial hair
Impotence
Visual field defect - bitemporal hemianopia
Extra-ocular weakness
- Diplopia 
- Opthamoloplegia
Optic atrophy
Headache
34
Q

How do you Dx prolactinoma

A

Serum prolactin
Do U+E, TFT, pregnancy test
Pituitary MRI

35
Q

How do you treat microprolactinoma <10mm

A

Dopamine agonist

36
Q

How do you treat macroprolacitnoma >10mm

A

Dopamine agonist

  • Rapid fall in serum PRL
  • Tumour shrinkage
  • Visual improvement
37
Q

What is advised if on dopamine agonist

A

Increase calcium and fit D

Can cause reduced oestrogen / testosterone

38
Q

What should you be careful in

A

Pregnancy as may increase tumour size

39
Q

1st Rx prolactinoma (not other pituitary tumours)

A

MEDICAL first
Consider surgery if fails
All other conditions =. surgery first

40
Q

What are indications for treatment of hyperprolacitn

A

Fertility
Symptoms
Bone density maintenance
Existing or impending neurological S+S

41
Q

What other investigations should be done for differentials

A 
Prolactin
LSH, FH, oestrodiol
TFT
bHCG
Pregnancy test
Drug history
42
Q

How do you follow up agromegaly after surgery

A 
Pituitary function test + OGTT 6 weeks after
Serial MRI
Regular IGF-1
Annual colonoscopy screening from age 50
EHCO
43
Q

If patient presents with lethargy what would yo do

A

Baseline bloods

FBC, LFT, U+E, glucose, Ca, TFT

44
Q

If these are normal what can you do

A

AP tests to look for pituitary cause
TSH, LH, oestrodiol, prolactin, IGF-1, random cortisol
MRI if abnormal

45
Q

What causes hypopituituary

A 
Compression by tumour
Trauma
Infection - TB
Infiltration - Sarcoid
Sheehan
RT
Immune
46
Q

How do you Rx

A

Replace hormone

47
Q

OSCE

A

Take Hx from this patient presenting with bitemporal hemianopia

48
Q

What is pituitary apoplexy

A

Haemorrhage and or infarction of pituitary gland

49
Q

What is often associated

A

Macroadenoma

50
Q

What can occur

A 
Headache 
Tachy / hypo / decreased GCS 
Hormone dysfunction 
- Give 200mg hydrocortisone stat as no cortisol
- Only replace others once cortisol 
- Thyroxine
- Sex hormones
- GH 
Visual field disturbance
51
Q

What do you do if suspect

A

CT head
Hormone profile
Visual field

Endocrine (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions