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endocrine system 1 > Pituitary Gland Clinical > Flashcards

Pituitary Gland Clinical Flashcards

1
Q

What condition does hypersecretion of GH cause?

A

Acromegaly (gigantism)

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2
Q

What condition does hypersecretion of ACTH cause?

A

Cushing’s disease

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3
Q

What condition does hypersecretion of prolactin cause?

A

Hyperprolactnaemia

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4
Q

What hormones can be hyposecreted by the anterior pituitary gland?

A
  • FSH/LH
  • GH
  • ACTH
  • TSH
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5
Q

What hormone can be hyposecreted by the posterior pituitary?

A

Vasopressin

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6
Q

What can a SOL of the pituitary gland lead to?

A

Optic chiasmal compression

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7
Q

What are the clinical soft tissue overgrowth features of acromegaly?

A
  • spade like hands (rings)
  • wide feet (shoes)
  • coarse facial features
  • thick lips & tongue
  • carpal tunnel syndrome
  • sweating
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8
Q

What are the possible complications of acromegaly?

A
  • headache
  • chiasmal compression
  • diabetes mellitus
  • hypertension
  • cardiomyopathy
  • sleep apnoea
  • accelerated OA
  • colonic polyps & CA
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9
Q

How is acromegaly diagnosed?

A
  • oral glucose tolerance test
  • can GH be suppressed?
  • is insulin-like growth factor-1 (IGF1) elevated?
  • is the rest of the pituitary function normal?
  • is there a pituitary tumour on MRI?
  • is vision normal?
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10
Q

What is Cushing’s syndrome a result of?

A

Excess corticosteroids

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11
Q

What type of hormone is cortisol?

A

Catabolic

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12
Q

What physiological changes does excess cortisol lead to?

A

tissue breakdown
- causes weakness of skin, muscle and bone

sodium retention
- may cause hypertension and heart failure

insulin antagonism
- may cause diabetes mellitus

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13
Q

What are the high value signs and symptoms of Cushing’s syndrome?

A
  • skin atrophy
  • spontaneous purpura
  • proximal myopathy
  • osteoporosis
  • growth arrest in children
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14
Q

What are the intermediate value signs and symptoms of Cushing’s syndrome?

A
  • pink striae
  • facial mooning and hirsutism
  • oedema
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15
Q

What are the non-specific signs and symptoms of Cushing’s syndrome?

A
  • central obesity

- hypertension

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16
Q

What are the ACTH-dependent causes of Cushing’s syndrome?

A
  • pituitary tumour (Cushing’s disease)

- ectopic ACTH secretion (e.g. lung carcinoid)

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17
Q

What are the ACTH-independent causes of Cushing’s syndrome?

A
  • adrenal tumour (adenoma or carcinoma)

- corticosteroid therapy (eg for asthma, IBD)

18
Q

How can hyperprolactinaemia manifest itself in a women?

A
  • galactorrhoea (30-80%)
  • menstrual irregularity
  • infertility
19
Q

How can hyperprolactinaemia manifest itself in a man?

A
  • galactorrhoea (<5%)
  • impotence
  • visual field abnormalities
  • headache
  • extrocular muscle weakness
  • anterior pituitary malfunction
20
Q

What are the physiological causes of hyperprolactinaemia?

A
  • pregnancy
  • lactation
  • stress
21
Q

What are the pharmacological causes of hyperprolactinaemia?

A

DA depleting and DA antagonist drugs

22
Q

What are the pathological causes of hyperprolactinaemia?

A
  • primary hypothyroidism

- pituitary lesions (prolactinoma or pituitary stalk tumour)

23
Q

What drugs may cause hyperprolactinaemia?

A

dopamine antagonists

  • neuroleptics (eg chlorpromazine)
  • anti-emetics (eg metoclopramide)

DA depleting agents

Oestrogens (not in OCP dosage)

Some antidepressants

24
Q

What are the clinical features of hypopituitarism in adults?

A
  • tiredness
  • weight gain
  • depression
  • reduced libido, impotence, menstrual problems
  • skin pallor
  • reduced body hair
25
Q

What are the clinical features of hypopituitarism in children?

A
  • reduced linear growth

- delayed puberty

26
Q

Cranial Diabetes Insipidus: differential diagnosis

A
  • idiopathic (autoimmune hypophysitis)
  • post trauma including pituitary surgery
  • metastatic carcinoma
  • craniopharnygioma
  • other brain tumours (germinoma)
  • rare causes (sarcoidosis)
27
Q

What investigation can be carried out for cranial diabetes insipidus?

A

Water deprivation test

28
Q

How should pituitary hypersecretion be managed?

A
  • dopamine agonists (prolactinoma)
  • somatostatin analogues (acromegaly)
  • GH receptor antagonist (acromegaly)
29
Q

How should pituitary hyposecretion be managed?

A
  • cortisol, T4, sex steroids, GH

- desmopressin

30
Q

How should pituitary tumours be managed?

A
  • surgery (most transsphenoidal)

- radiotherapy

31
Q

When is pituitary surgery usually an option?

A

Non-functional pituitary tumours and Cushing’s disease

32
Q

What are the beneficial effects of somatostatin analogues in acromegaly?

A

improves

  • soft tissue overgrowth
  • sweating
  • headache
  • sleep apnoea

Normalise GH and IGF-1 levels in over 50% of patients

Induce tumour shrinkage in the majority

Reduce morbidity and mortality

33
Q

What are the adverse effects of somatostatin analogues?

A
  • nausea, cramps, diarrhoea, flatulence (often transient)
  • cholesterol gallstones occur in 20-30% (mostly asymptomatic)
  • slow release preparations require monthly IM/SC injections
  • high cost (£6-12,000 annually)
34
Q

Why is pituitary radiotherapy use declining?

A
  • acts slowly

- causes hypopituitarism

35
Q

What is the size range for micoprolactinoma?

A

<10mm

36
Q

What is the treatment for microprolactinoma?

A

dopamine agonists

37
Q

What can cabergoline restore in micoprolactinoma?

A
  • normoprolactinaemia
  • ovulatory cycles
  • fertility restored in 70-90%
38
Q

What is the usual presentation of someone with micoprolactinoma?

A

Usually women with

  • galactorrhoea,
  • amenorrhoea
  • infertility
  • serum PRL <5000mU/I (N<500)
39
Q

What happen to most microprolactinomas?

A

Most shrink

40
Q

What is the size range for macroprolactinomas?

A

> 10mm

41
Q

What is the typical response of a macroprolactinoma to a dopamine agonist?

A
  • rapid fall in serum PRL (hours)
  • tumour shrinkage (days/weeks)
  • visual improvement (often within days)
  • often recovery of pituitary function
42
Q

What is the management for acromegaly?

A

Monthly injections of slow-release octreotide and lanreotide

endocrine system 1 (25 decks)

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