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Endocrine > Pituitary Pathology > Flashcards

Pituitary Pathology Flashcards

1
Q

describe hypopituitarism

A

reduced function of the pituitary gland, can be isolated to a specific hormone or all hormones - panhypopituitarism

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2
Q

list causes of hypopituitarism

A

hypothalamic - tumour, genetic, infection eg TB, syphilis or meningitis
pituitary stalk - trauma, surgery, aneurysm
pituitary - radiation, non-functioning adenoma or ischaemia

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3
Q

what is sheenans syndrome

A

pan hypopituitarism due to ischaemia and necrosis following a post partum haemorrhage, presents with failure to lactate

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4
Q

how does hypopituitarism present

A

insufficiency of specific hormones eg hypothyroidism etc

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5
Q

what are the signs and symptoms of reduced GHRH

A

atherosclerosis and lack of balance

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6
Q

what are the signs and symptoms of reduced GRH in males and females

A

males - ED, reduced libido and muscle bulk

females - amenorrhoea, reduced fertility and libido

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7
Q

what is the management of hypopituitarism

A

once underlying cause is established treat it and manage any hormone deficiencies correctly

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8
Q

what type of tumour is a pituitary tumour normally

A

bengin adenoma

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9
Q

define a microadenoma and macroadenoma

A

microadenoma - <1cm

macroadenoma - >1cm

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10
Q

what is a non-functioning adenoma

A

a pituitary tumour that does not secrete any hormones

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11
Q

what is the most common type of pituitary tumour

A

prolactinoma, secretes excess prolactin

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12
Q

how does a pituitary tumour present

A

pressure headache
bitemporal hemianopia
hormonal symptoms depending on what is being over or under secreted

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13
Q

list the investigations for a pituitary tumour

A

MRI of brain

hormonal testing

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14
Q

how is a pituitary tumour treated

A

surgical removal via trans-sphenoidal approach

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15
Q

list some physiological causes of hyperprolactinaemia

A

breast feeding
pregnancy
stress
sleep

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16
Q

list some pathological causes of hyperprolactinaemia

A

prolactinoma
hypothyroidism
compression of pituitary stalk through trauma

17
Q

list some drugs that cause hyperprolactinaemia

A

anti-emetics eg metaclopramide and anti-psychotics

both inhibit dopamine

18
Q

describe the presentation of hyperprolactinaemia in both females and males

A

females - galactorrhoea, reduced libido, amenorrhoea

males - reduced facial hair, ED, galactorrhoea less common

19
Q

what is the first line treatment of hyperprolactinaemia

A

dopamine agonists eg cabergoline and bromocriptine

must also stop any dopamine antagonists

20
Q

what is the second line treatment of hyperprolactinaemia

A

surgical excision of the tumour if drugs are ineffective

21
Q

what is acromegaly

A

excessive growth hormone production usually due to pituitary adenoma

22
Q

acromegaly is usually part of what condition

A

MEN 1 tumours

23
Q

what is the presentation of acromegaly

A

giantism in children if bones haven’t fused
growth of soft tissues in hand, feet, jaw and tongue
widening of the nose
pituitary tumour symptoms

24
Q

what investigations are carried out for acromegaly

A

IGF1 and glucose - high

glucose tolerance test to confirm diagnosis

25
Q

what is the 1st line treatment of acromegaly

A

surgical excision of tumour with radiotherapy

26
Q

what is the 2nd line treatment of acromegaly

A

give somatostatin analogue (reduces secretions of GH and will shrink tumour)
examples are octreotide and sandostatin

27
Q

what are the side effects of somatostatin analogues

A

GI upset and gallstones

28
Q

are dopamine agonists effective in treating acromegaly

A

yes as they suppress GH secretion but do not cure the condition

29
Q

what is diabetes insipidus

A

passing large volumes of urine (>3L each day)

30
Q

define central DI and nephrogenic DI

A

central - occurs when pituitary fails to secrete ADH eg due to tumour, genetics or sarcoidosis
nephrogenic - occurs when the kidneys fail to respond to the secretion of ADH eg due to CKD, genetics or drugs such as lithium

31
Q

how does diabetes insipidus present

A

polydipsia
polyuria
dehydration

32
Q

what test diagnoses diabetes insipidus

A

water deprivation test, assesses the bodys ability to concentrate urine by measuring urine osmolarity

33
Q

diabetes insipidus is excluded when serum osmolarity is

A

> 600

34
Q

to determine the difference between central and nephrogenic DI what is given following water deprivation test

A

ADH, central DI will respond to it and urine osmolarity is restored

35
Q

outline the management of central and nephrogenic DI

A

central - synthetic ADH (desmopressin)

nephrogenic - thiazide diuretics to generate hyponatraemia which drives water reabsorption in the kidneys

Endocrine (11 decks)

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