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Endocrine > Pituitary Pathology > Flashcards

Pituitary Pathology Flashcards

1
Q

What are the causes of gynaecomastia?

A

Drugs

Liver cirrhosis

Lung Adenocarcinoma

Testicular failure/mumps

Testicular cancer

Haemodialysis

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2
Q

How is gynaceomastia managed?

A

Tamoxifen

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3
Q

What is hyperprolactinaemia?

A

Hypersecretion of prolactin

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4
Q

What drugs can cause gynaecomastia?

A

Spironolactone

Digoxin

Cannabis

Oestrogens

Cimetidine

Finasteride

Methyldopa

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5
Q

How does prolactinaemia present?

A

Galactorrhoea

Menstrual Irregularity/Amenorrhoea

Impotence

Headache

Infertility

Visual Field Abnormalities

Extraocular Muscle Weakness

Pressure Effects

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6
Q

What pressure effects can be seen in prolactinaemia?

A

Bitemporal hemianopia

Hypopituitarism

Cranial nerve palsies

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7
Q

What investigations are used in prolactinaemia diagnosis?

A

Full pituitary profile

MRI pituitary

Perimetry/visual field measurement

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8
Q

What is the management of microprolactinoma?

A

Dopamine agonists

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9
Q

What is the management of macroprolactinoma?

A

Trial of dopamine agonists

If affecting visual fields, then trans-sphenoidal surgery

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10
Q

What is dopamine also known as?

A

Prolactin inhibiting hormone

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11
Q

Give examples of dopamine agonists

A

Bromocriptine

Cabergoline

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12
Q

Give a complication of hyperprolactinaemia

A

Unrelated increased risk of osteoporosis

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13
Q

What is acromegaly?

A

Soft tissue overgrowth due to hypersecretion of growth hormone

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14
Q

What causes acromegaly?

A

Pituitary tumour

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15
Q

What is the mortality of acromegaly?

A

High mortality if untreated

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16
Q

How does acromegaly present?

A

Sweating

Doughy spade like hands

Wide feet

Coarse facial features

Headache

Oligo/amenorrhoea

Infertility

Thick lips

Large tongue/macroglossia

Prominent supra-orbital ridges

Prognathism/prominent lower jaw

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17
Q

What investigations are used in acromegaly diagnosis?

A

Elevated Insulin-Like-Growth-Factor (IGF-1)

MRI, identify pituitary tumour

>GH

>Blood glucose

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18
Q

How is acromegaly managed?

A

Somatostatin/GHIH Analogues

  • Take monthly
  • Used if unsuitable for transsphenoidal surgery or residual symptoms

GH Receptor Antagonist

Transsphenoidal surgery with radiotherapy

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19
Q

Give an example of a somatostatin

A

Octreotide

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20
Q

Give complications of acromegaly

A

Carpal Tunnel Syndrome

Headache

Chiasmal Compression

HTN

Cardiomyopathy

Obstructive sleep Apnoea

Colonic Polyps and carcinoma

Hypopituitarism

Osteoporosis

HF

Diabetes

21
Q

Why is diabetes a complication of acromegaly?

A

Growth hormone is antagonistic to insulin

22
Q

What is hypopituitarism?

A

Undersecretion of FSH, LH, GH, ACTH, TSH and vasopressin, depending on the area of the pituitary affected

23
Q

What is Panhypopituitarism?

A

When all hormones of the pituitary are affected in hypopituitarism

24
Q

What hormones are released from the anterior pituitary?

A

GH

TSH

Prolactin

ACTH/Cortisol

Luteinising hormone

Follicle stimulating hormone

25
Q

What hormones are released from the posterior pituitary?

A

Antidiuretic hormone/Vasopressin

Oxytocin

26
Q

What are the causes of hypopituitarism?

A

Tumour compression

  • Craniopharyngioma
  • Metastases
  • Pituitary tumour

Trauma

Infection

  • TB
  • Sarcoidosis

Sheehan’s

Infarction/ischaemia

27
Q

How does hypopituitarism present?

A

Fatigue

Weight gain

Depression

Impotence

Reduced libido

Oligomenorrhoea/Amenorrhoea

Pallor

Reduced body hair

Reduced linear growth and delayed puberty in children

28
Q

How is hypopituitarism managed?

A

Hormone replacement, in this order

  • Cortisol, most important to correct first as deficiency can make patient’s most unwell
  • Thyroxine
  • Sex hormones
  • GH, if necessary

Desmopressin, for diabetes Insipidus

29
Q

What is the origin of the anterior pituitary?

A

Derived from Rathke’s pouch

30
Q

What is the origin of the posterior pituitary?

A

Neural origin, nerve fibres originating in supraoptic and paraventricular nuclei in the hypothalamus

31
Q

What are the functions of cortisol?

A

>Gluconeogenesis

>Proteolysis

>Lipolysis

>Sensitivity of peripheral blood vessels to catecholamines, narrowing the vessel lumen

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32
Q

What is the prognosis of Cushing’s?

A

Poor if untreated

33
Q

What are the primary causes of hypercortilsoism?

A

Adrenal adenoma

Adrenal carcinoma

Adrenal hyperplasia

34
Q

What are the causes of secondary hypercortilsolism?

A

Pituitary tumour secreting ACTH/Cushing’s disease

Ectopic causes

  • Small cell lung cancer
35
Q

What is the most common cause of hypercortilsolism?

A

Pituitary tumour/Cushing’s disease

36
Q

How does Cushing’s present?

A

Red, Moon face

Centripetal weight gain

  • Neck and stomach
  • Thin arms and legs
  • Due to tissue breakdown, but it is not known why fat redistributes after being broken down in other areas

Depression

Hirsutism

Oedema

Abdominal pink striae

Purpura

Easily bruised

Skin atrophy/thinning

Purpura

Osteoporosis

Buffalo hump

Impotence/Low libido

HTN

Hyperglycaemia

Poor wound healing

37
Q

What investigations are used in Cushing’s diagnosis?

A

High 24 hour urinary cortisol

Dexamethasone Suppression Test

HTN

>Glucose and Insulin

CT/MRI, assessing for pituitary tumour

CXR, assessing for small cell lung cancer

38
Q

What is the first line diagnostic test of Cushing’s?

A

24 hour urinary cortisol/overnight dexamethasone suppression test

39
Q

Give complications of Cushing’s disease?

A

HTN

Diabetes

Hypokalaemia

Osteoporosis

40
Q

How is Cushing’s managed?

A

Pituitary tumour removal/Trans-sphenoidal surgery

Gradually decrease exogenous medications

Adrenal steroid inhibitors

Adrenalectomy

41
Q

Give an example of an adrenal steroid inhibitor

A

Metyrapone

42
Q

Give complications of an adrenalectomy

A

Nelson’s syndrome

  • >pigmentation
  • >pituitary size

Adrenal insufficiency

43
Q

Give a complication of Transsphenoidal surgery

A

Hypopituitarism

44
Q

Describe high dose dexamethasone test

A

Should suppress ACTH as negative feedback and cortisol should decrease

45
Q

What are the causes of hyperprolactinaemia?

A

Pregnancy

Lactation/Breast feeding

Stress

Drugs

Hypothyroidism

Pituitary Lesions/Prolactinoma

Poly cystic ovarian syndrome

46
Q

What drugs can cause hyperprolactinaemia?

A

Metoclopramide

Domperidone

Phenothiazines

Haloperidol

47
Q

What is the first line investigation for acromegaly?

A

Elevated Insulin-Like-Growth-Factor (IGF-1)

48
Q

What biochemical abnormality is associated with Cushings?

A

Hypokalaemic metabolic alkalosis

Endocrine (7 decks)

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