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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

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2
Q

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

A

Benign tumour
Sporadic
5% MEN1

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3
Q

How are they classified

A 
Size
- Micro <1cm
- Macro >1cm 
Hormonal status
- Secretory
- Non-secretory
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4
Q

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

A

Prolactinoma = excess prolactin

  • Galactorrhoea
  • Menstrual disorder
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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

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6
Q

If large tumour what may it cause

A

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

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7
Q

How do you investigate

A

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

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8
Q

How do you Rx

A

Hormone therapy
Transphenoidal surgery
RT

Surgery if visual abnormality or hypersecretoin (except if prolactinoma)

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9
Q

What are DDx

A 
Pituitary hyperplasia
Cranipharyngioma -LL 
Meningioma
Brain mets
Lymphoma
Aneurysm
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10
Q

What is gigantism

A

Excess GH before epiphyseal growth plates fuse

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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

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12
Q

What are causes

A

Pituitary adenoma= most common

Ectopic from tumour e.g. carcinoid

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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
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14
Q

What are coarse facial features

A 
Prominent forehead
Eyebrows stick out
Enlarged jaw
Spaced out teeth
Thick lips and tongue - macroglossia
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15
Q

What are features of raised prolactin

A

Gynaecomastia
Galactorrhoea
Amenorrhoea

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16
Q

What are features of pituitary tumour

A

Hypopituitary
Headache
Bitemporal hemianopia

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17
Q

What are complications of acromegaly

A 
DM - GH anti-insulin
Carpal tunnel
Hypertension
Cardiomyopathy 
Sleep apnoea
Accerlerated OA
Colonic polyps / cancer
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18
Q

What is 1st line blood test for diagnosis

A

Serum IGF-1

GH stimulates release

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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

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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

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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
What are GH receptor antagonists
Once daily S/C injection | Very effective in decreasing IGF-1 but doesn't reduce tumour so ned surgery
26
When do you do RT
If failed surgical / medical | Will cause hypopituitary
27
What are DDX
Pregnancy OA Hypothyroid
28
What are physiological causes of hyperprolactin
Pregnancy Lactation Stress
29
What are pharmalogical causes
``` Da antagonists - Metoclopmaride / domperidone - Haloperidol / chlorpromazine Oestrogen Anti-depressants - SSRI Herbal ```
30
How does dopamine antagonist cause hyper-prolactin
Dopamine normally inhibits prolactin release (prolactin inhibiting hormone)
31
What are pathological causes of hyper-prolactin
``` Primary hypothyroid Prolactinoma PCOS Acromegaly Cushing ```
32
How do women present
``` Galactorrhoea Sore breasts Menstrual irregularity Infertility Decreased libido Weight gain ```
33
How do men present
``` Galactorrhoea Decreased facial hair Impotence Visual field defect - bitemporal hemianopia Extra-ocular weakness - Diplopia - Opthamoloplegia Optic atrophy Headache ```
34
How do you Dx prolactinoma
Serum prolactin Do U+E, TFT, pregnancy test Pituitary MRI
35
How do you treat microprolactinoma <10mm
Dopamine agonist
36
How do you treat macroprolacitnoma >10mm
Dopamine agonist - Rapid fall in serum PRL - Tumour shrinkage - Visual improvement
37
What is advised if on dopamine agonist
Increase calcium and fit D | Can cause reduced oestrogen / testosterone
38
What should you be careful in
Pregnancy as may increase tumour size
39
1st Rx prolactinoma (not other pituitary tumours)
MEDICAL first Consider surgery if fails All other conditions =. surgery first
40
What are indications for treatment of hyperprolacitn
Fertility Symptoms Bone density maintenance Existing or impending neurological S+S
41
What other investigations should be done for differentials
``` Prolactin LSH, FH, oestrodiol TFT bHCG Pregnancy test Drug history ```
42
How do you follow up agromegaly after surgery
``` Pituitary function test + OGTT 6 weeks after Serial MRI Regular IGF-1 Annual colonoscopy screening from age 50 EHCO ```
43
If patient presents with lethargy what would yo do
Baseline bloods | FBC, LFT, U+E, glucose, Ca, TFT
44
If these are normal what can you do
AP tests to look for pituitary cause TSH, LH, oestrodiol, prolactin, IGF-1, random cortisol MRI if abnormal
45
What causes hypopituituary
``` Compression by tumour Trauma Infection - TB Infiltration - Sarcoid Sheehan RT Immune ```
46
How do you Rx
Replace hormone
47
OSCE
Take Hx from this patient presenting with bitemporal hemianopia
48
What is pituitary apoplexy
Haemorrhage and or infarction of pituitary gland
49
What is often associated
Macroadenoma
50
What can occur
``` 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
What do you do if suspect
CT head Hormone profile Visual field

Endocrine (17 decks)

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