Pituitary Gland Clinical Flashcards
Cushing’s disease is caused by what pituitary hypersecretion?
ACTH
agromegaly/gigantism is caused by what?
Excess pituitary Growth hormone secretion from pituitary
Hyperprolactinaemia is caused by what?
Excess prolactin secretion from pituitary
Lack of vasopressin secretion causes what?
Diabetes insipidus
Clinical features of acromegaly
Soft tissue overgrowth Spade-like hands Wide feet Coarse facial features Thick lips/tongue Carpal tunnel Sweating
What are the complications of acromegaly?
Headache Chiasmal compression DM HTN Cardiomyopathy Sleep apnoea
How is acromegaly diagnosed?
Can GH be suppressed? Elevated IGF-1 Blood GH OGTT Pituitary function normal otherwise Pituitary MRI
What is Cushing’s syndrome?
Excess corticosteroids
What are the high diagnostic value symptoms of Cushing’s?
Skin atrophy Spontaneous purpura Proximal myopathy Osteoporosis Growth arrest in children
What are the intermediate diagnostic value symptoms of Cushing’s?
Pink striae
Fascial mooning
Oedema
Hisutism
What are the causes of ACTH dependent Cushing’s?
Pituitary tumour
Ectopic ACTH secretion
What are the causes of ACTH independent Cushing’s?
Corticosteroid therapy
Adrenal tumour
What are the clinical manifestations of hyperprolactinaemia in women?
Galactorrhoea 30-80%
Menstrual irregularity
Infertility
What are the clinical manifestations of hyperprolactinaemia in men?
Galactorrhoea (<5%) Impotence Visual field abnormalities Headache Extraocular muscle weakness
What are the physiological causes of hyperprolactinaemia?
Pregnancy
Lactation
Stress
What are the pharmacological causes of hyperprolactinaemia?
DA depleting/antagonist drugs
What are the pathological causes of hyperprolactinaemia?
Primary hypothyroidism
Pituitary lesions
Which drugs may cause hyperprolactinaemia?
Dopamine antagonists (neuroleptics, antiemetics)
DA-depleting agents
Oestrogens
Some antidepressants
What are the clinical features of hypopituitarism in adults?
Tiredness Weight gain Depression Reduced libido Skin pallor Reduced bodyhair
What are the clinical features of hypopituitarism in children?
Reduced linear growth
Delayed puberty
What is the test for cranial diabetes insipidus?
Water deprivation test
What is the cause of cranial diabetes insipidus?
Hypofunction of vasopressin from the posterior pituitary
What is the differential diagnosis of cranial diabetes insipidus?
Idiopathic
Post-trauma
Metastatic carcinoma
Craniopharyngioma
What type of blindness is commonly caused by pituitary tumours?
Bitemporal hemianopia
How are pituitary tumours managed?
Transsphenoidal tumours
Replacement/suppression of hormones
How is a prolactinoma managed?
Dopamine agonists
How is acromegaly due to pituitary tumour managed?
Somatostatin analogues
GH receptor antagonists
What are the beneficial effects of somatostatin analogues in acromegaly
Improve symptoms Stop overgrowth Normalise GH/IGF-1 in >50% Induce tumour shrinkage Reduce morbidity/mortality
What adverse effects are associated with somatostatin anaglogues?
Nausea/cramps/diarrhoea
Cholesterol gallstones 20-30%
Very expensive
Monthly injections
How is a microprolactinoma treated?
Dopamine agonists
cabergoline, normoprolactinaemia
What is a microprolactinoma?
Prolactin secreting tumour of the pituitary <10mm
Galactorrhoea
Infertility
PRL <5000mU/L
What is a macroprolactinoma?
Prolactin secreting tumour of the pituitary >10mm
Respond well to dopamine agonists
