Pituitary Pathology

Question 1

What are the causes of gynaecomastia?

Answer 1

Drugs

Liver cirrhosis

Lung Adenocarcinoma

Testicular failure/mumps

Testicular cancer

Haemodialysis

Question 2

How is gynaceomastia managed?

Answer 2

Tamoxifen

Question 3

What is hyperprolactinaemia?

Answer 3

Hypersecretion of prolactin

Question 4

What drugs can cause gynaecomastia?

Answer 4

Spironolactone

Digoxin

Cannabis

Oestrogens

Cimetidine

Finasteride

Methyldopa

Question 5

How does prolactinaemia present?

Answer 5

Galactorrhoea

Menstrual Irregularity/Amenorrhoea

Impotence

Headache

Infertility

Visual Field Abnormalities

Extraocular Muscle Weakness

Pressure Effects

Question 6

What pressure effects can be seen in prolactinaemia?

Answer 6

Bitemporal hemianopia

Hypopituitarism

Cranial nerve palsies

Question 7

What investigations are used in prolactinaemia diagnosis?

Answer 7

Full pituitary profile

MRI pituitary

Perimetry/visual field measurement

Question 8

What is the management of microprolactinoma?

Answer 8

Dopamine agonists

Question 9

What is the management of macroprolactinoma?

Answer 9

Trial of dopamine agonists

If affecting visual fields, then trans-sphenoidal surgery

Question 10

What is dopamine also known as?

Answer 10

Prolactin inhibiting hormone

Question 11

Give examples of dopamine agonists

Answer 11

Bromocriptine

Cabergoline

Question 12

Give a complication of hyperprolactinaemia

Answer 12

Unrelated increased risk of osteoporosis

Question 13

What is acromegaly?

Answer 13

Soft tissue overgrowth due to hypersecretion of growth hormone

Question 14

What causes acromegaly?

Answer 14

Pituitary tumour

Question 15

What is the mortality of acromegaly?

Answer 15

High mortality if untreated

Question 16

How does acromegaly present?

Answer 16

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

Question 17

What investigations are used in acromegaly diagnosis?

Answer 17

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

MRI, identify pituitary tumour

>GH

>Blood glucose

Question 18

How is acromegaly managed?

Answer 18

Somatostatin/GHIH Analogues

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

GH Receptor Antagonist

Transsphenoidal surgery with radiotherapy

Question 19

Give an example of a somatostatin

Answer 19

Octreotide

Question 20

Give complications of acromegaly

Answer 20

Carpal Tunnel Syndrome

Headache

Chiasmal Compression

HTN

Cardiomyopathy

Obstructive sleep Apnoea

Colonic Polyps and carcinoma

Hypopituitarism

Osteoporosis

HF

Diabetes

Question 21

Why is diabetes a complication of acromegaly?

Answer 21

Growth hormone is antagonistic to insulin

Question 22

What is hypopituitarism?

Answer 22

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

Question 23

What is Panhypopituitarism?

Answer 23

When all hormones of the pituitary are affected in hypopituitarism

Question 24

What hormones are released from the anterior pituitary?

Answer 24

GH

TSH

Prolactin

ACTH/Cortisol

Luteinising hormone

Follicle stimulating hormone

Question 25

What hormones are released from the posterior pituitary?

Answer 25

Antidiuretic hormone/Vasopressin Oxytocin

Question 26

What are the causes of hypopituitarism?

Answer 26

Tumour compression * Craniopharyngioma * Metastases * Pituitary tumour Trauma Infection * TB * Sarcoidosis Sheehan's Infarction/ischaemia

Question 27

How does hypopituitarism present?

Answer 27

Fatigue Weight gain Depression Impotence Reduced libido Oligomenorrhoea/Amenorrhoea Pallor Reduced body hair Reduced linear growth and delayed puberty in children

Question 28

How is hypopituitarism managed?

Answer 28

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

Question 29

What is the origin of the anterior pituitary?

Answer 29

Derived from Rathke's pouch

Question 30

What is the origin of the posterior pituitary?

Answer 30

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

Question 31

What are the functions of cortisol?

Answer 31

\>Gluconeogenesis \>Proteolysis \>Lipolysis \>Sensitivity of peripheral blood vessels to catecholamines, narrowing the vessel lumen

Influences cognition

Question 32

What is the prognosis of Cushing's?

Answer 32

Poor if untreated

Question 33

What are the primary causes of hypercortilsoism?

Answer 33

Adrenal adenoma Adrenal carcinoma Adrenal hyperplasia

Question 34

What are the causes of secondary hypercortilsolism?

Answer 34

Pituitary tumour secreting ACTH/Cushing's disease Ectopic causes * Small cell lung cancer

Question 35

What is the most common cause of hypercortilsolism?

Answer 35

Pituitary tumour/Cushing's disease

Question 36

How does Cushing's present?

Answer 36

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

Question 37

What investigations are used in Cushing's diagnosis?

Answer 37

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

Question 38

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

Answer 38

24 hour urinary cortisol/overnight dexamethasone suppression test

Question 39

Give complications of Cushing's disease?

Answer 39

HTN Diabetes Hypokalaemia Osteoporosis

Question 40

How is Cushing's managed?

Answer 40

Pituitary tumour removal/Trans-sphenoidal surgery Gradually decrease exogenous medications Adrenal steroid inhibitors Adrenalectomy

Question 41

Give an example of an adrenal steroid inhibitor

Answer 41

Metyrapone

Question 42

Give complications of an adrenalectomy

Answer 42

Nelson's syndrome * \>pigmentation * \>pituitary size Adrenal insufficiency

Question 43

Give a complication of Transsphenoidal surgery

Answer 43

Hypopituitarism

Question 44

Describe high dose dexamethasone test

Answer 44

Should suppress ACTH as negative feedback and cortisol should decrease

Question 45

What are the causes of hyperprolactinaemia?

Answer 45

Pregnancy Lactation/Breast feeding Stress Drugs Hypothyroidism Pituitary Lesions/Prolactinoma Poly cystic ovarian syndrome

Question 46

What drugs can cause hyperprolactinaemia?

Answer 46

Metoclopramide Domperidone Phenothiazines Haloperidol

Question 47

What is the first line investigation for acromegaly?

Answer 47

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

Question 48

What biochemical abnormality is associated with Cushings?

Answer 48

Hypokalaemic metabolic alkalosis