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Year 2 - Endocrine > Pituitary gland clinical > Flashcards

Pituitary gland clinical Flashcards

1
Q

List 3 pituitary hyperfunction syndromes

A

Acromegaly,
Cushing’s disease
prolactinoma

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2
Q

Acromegaly and gigantism is an excess production of what pituitary hormone

A

GH

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3
Q

Cushing’s disease is an excess production of what pituitary hormone

A

ACTH

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4
Q

Prolactinoma is associated with an excess production of what

A

Prolactin

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5
Q

Symptoms (2) /signs (9) of acromegaly

A

Symptoms

  • Fatigue
  • Joint pain
  • Sweating
  • loss of sex drive

Signs

  • Coarse facial features
  • Large hands and feet
  • Thick lips and tongue
  • Carpal tunnel syndrome (pain, numbness and tingling in the hand + fingers)
  • Skin change - thicker, skin tags,
  • teeth separation
  • deep voice
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6
Q

Complications of acromegaly (6)

A

Cardiac problems
-Left ventricular hypertrophy, cardiomyopathy, arrhythmia

Hypertension

Sleep apnoea

Carpal tunnel syndrome

Diabetes mellitus

Osteoarthritis

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7
Q

What syndrome is associated with/a complication of acromegaly

A

Carpal tunnel syndrome (pain, numbness, tingling of hand and fingers due to compression of median nerve in wrist)

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8
Q

Biochemical diagnosis of acromegaly (2)

A

Elevated serum insulin-like growth factor-1 (IGF-1) - screens for acromegaly and confirms diagnosis

Oral glucose tolerance test - indicates acromegaly if increasing plasma glucose doesn’t suppress GH, so lack of suppression of GH

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9
Q

Investigations of acromegaly (4)

A

Elevated serum insulin-like growth factor-1 (IGF-1)

Oral glucose tolerance test

Serum GH

Pituitary MRI

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10
Q

Cushing’s syndrome v Cushing’s disease

A

Cushing’s disease is under the umbrella of Cushing’s syndrome but the term is specific to a problem in the pituitary gland that leads to excess cortisol production (usually pituitary tumour)

Cushing’s syndrome refers to clinical manifestation of pathological hypercortisolism from any cause other than the pituitary (i.e. excess cortisol production)

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11
Q

Cortisol antagonises what anabolic hormone

A

Insulin

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12
Q

Symptoms (1) /signs (12) of cushing’s disease/ Cushing’s syndrome (they have the same clinical features)

+ specific sign in children

A

Symptoms
-mood swings - irritable, depressed

Signs

  • weight gain - central obesity
  • facial plethora (round + red - ‘MOON FACE’)
  • buffalo hump - fat in back of neck and shoulders)
  • proximal muscle weakness
  • thin arms/legs compared to trunk
  • decreased sex drive
  • skin thinning/atrophy
  • hirsutism
  • osteoporosis
  • purpura (red/purple patches on skin)
  • purple striae
  • easy bruisability

growth arrest in children

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13
Q

ACTH independent causes of Cushing’s syndrome (2)

A

Autonomous adrenal cortisol overproduction,

Long term corticosteroids, e.g. asthma, IBD

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14
Q

ACTH dependent causes of Cushing’s syndrome (2)

A

Pituitary adenoma (–> cushing’s disease)

rarely, by ectopic ACTH-secreting tumours (i.e. an ACTH secreting tumour that arises outwith the pituitary, e.g. lung carcinoid tumour)

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15
Q

What is moon face a sign of

A

Cushing’s syndrome

refers to a round and red puffy face

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16
Q

Investigations of Cushing’s syndrome (biochemical diagnostic investigations (3))

A

Late night (11pm) salivary cortisol - elevated in cushing’s, low in normal person

Overnight dexamethasone suppression test (then morning cortisol measured) - +ve test for cushing’s if morning cortisol elevated >50nanomol/l, should be suppressed in normal person

24hr urinary cortisol test - show high levels of cortisol >50micrograms/hr, lower than this in a normal person

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17
Q

What type of tumour is a prolactinoma

+ pathophysiology of it

A

Pituitary adenoma

benign lactotroph adenomas hyperexpressing and hypersecreting prolactin leading to secondary hypogonadism via its inhibitory effects on gonadotrophin-releasing hormone (from hypothalamus) and pituitary gonadotrophins

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18
Q

Symptoms/signs of a prolactinoma

  • in women (3)
  • in men (3)
  • both (4)
A

Women

  • amenorrhoea (absence of menstrual periods) or oligomenorrhoea (irregular periods)
  • galactorrhoea (excessive production of milk)
  • acne
  • hirsutism (excessive body/facial hair)

Men

  • erectile dysfunction
  • gynaecomastia
  • decreased body/facial hair

Both

  • infertility
  • loss of libido
  • visual field abnormalities (possibly bitemporal hemianopia)
  • osteoporosis
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19
Q

Causes of hyperprolactinaemia

  • physiological causes (2)
  • pharmacological causes (1)
  • pathological causes (2)
A

physiological

  • pregnancy/ breast feeding
  • stress

Pharmacological
-Dopamine antagonists (dopamine usually inhibits prolactin secretion from AP)

Pathological

  • primary hypothyroidism
  • prolactinoma
20
Q

Drugs that can cause hyperprolactinaemia (3)

A

Dopamine antagonists
Dopamine depleting agents
Oestrogens

21
Q

Biochemical diagnosis of prolactinoma

A

Serum prolactin - elevated

22
Q

Clinical features of hypopituitarism in adults (8)

A 
Fatigue
Weight gain
Depression
Reduced libido
Impotence (erectile dysfunction)
Amenorrhoea/ galactorrhoea
Headache
Cold intolerance
23
Q

Clinical features of hypopituitarism in children (2)

A

Failure to thrive/short stature

Delayed puberty - lack of body hair, underdeveloped testes,

24
Q

2 types of diabetes insipidus

A

Central diabetes insipidus (DI), -due to defective synthesis or release of ADH from the hypothalamo-pituitary axis;

Nephrogenic DI
-due to renal insensitivity to ADH

25
Q

Clinical features of diabetes insipidus (2)

A

polydipsia (increased thirst/drinking)

polyuria - large volumes of hypotonic urine

26
Q

Is diabetes insipidus associated with pituitary hypo or hyper function + why

A

Hypofunction

- as it involves defective release of ADH from the posterior pituitary

27
Q

Hypopituiarism is a deficiency of what potential hormones

A

AP
-FSH/LH, GH, ACTH, TSH

PP

  • vasopressin (ADH)
  • oxytocin
28
Q

Describe the consequences of a space occupying lesion in the pituitary region (imaging techniques,, visual field assessment).

A

Compresses the optic chiasm –> bitemporal hemianopia

29
Q

Difference between functional and non-functional neoplasms of the endocrine system

A

Functional - hypersecreting hormones

Non-functional - non-secretory

30
Q

Imaging investigation of a pituitary tumour

A

Pituitary MRI

31
Q

Examination of someone with a pituitary tumour

A

Visual field assessment - bitemporal hemianopia (only if large enough to compress optic chiasm)

32
Q

Treatment of a prolactinoma

A

Dopamine agonist, e.g. cabergoline

  • decreases serum prolactin within hours
  • shrinks tumour within weeks
33
Q

Treatment of ACTH deficiency

A

Oral corticorticosteroids (hydrocortisone or prednisolone) since adrenal grands are not getting stimulated to produce steroid hormones

34
Q

What is a pituitary apoplexy

A

Infarction of or haemorrhage into the pituitary gland

-initial sudden headache
+/- nausea/vomiting followed by rapidly worsening visual defect

35
Q

Treatment of hypopituitarism

A

Hormone replacement of whatever hormone is deficient

36
Q

Treatment of TH deficiency/hypothyroidism

A

Levothyroxine

37
Q

Treatment of gonadotrophin-releasing hormone (GnRH) deficiency

  • males
  • females
A

Males

  • testosterone if fertility not desired
  • injectable gonadotrophin if fertility desired

Females

  • oestrogen if fertility not desired
  • injectable gonadotrophin if fertility desired
38
Q

Treatment of GH deficiency

A

Recombinant GH (somatotropin)

39
Q

Treatment of ADH deficiency (from posterior pituitary), i.e. central diabetes insipidus

A

Desmopressin ( synthetic analogue of antidiuretic hormone (ADH))

40
Q

1st line treatment of all pituitary tumours except prolactinoma

A

Transphenoidal surgical resection

41
Q

Treatment modalities of pituitary tumours (3)

A

Surgery - transphenoidal
Medication
Radiotherapy

42
Q

Why is the use of pituitary radiotherapy declining

A

Acts slowly and can cause hypopituitarism if too strong

43
Q

What differentiates micro and macroprolactinoma

A

Microprolactinoma <10mm

44
Q

Pituitary hyperfunction most commonly due to what pathology

A

pituitary adenoma; carcinomas RARE

45
Q

Histology of pituitary adenoma

A

Cells of same appearance as normal gland (but usually only one cell type seen, i.e. only acidophils or basophils)

Tumour is classed by what hormone it’s excessively producing

Year 2 - Endocrine (21 decks)

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