Pituitary Pathology Flashcards
What are the causes of gynaecomastia?
Drugs
Liver cirrhosis
Lung Adenocarcinoma
Testicular failure/mumps
Testicular cancer
Haemodialysis
How is gynaceomastia managed?
Tamoxifen
What is hyperprolactinaemia?
Hypersecretion of prolactin
What drugs can cause gynaecomastia?
Spironolactone
Digoxin
Cannabis
Oestrogens
Cimetidine
Finasteride
Methyldopa
How does prolactinaemia present?
Galactorrhoea
Menstrual Irregularity/Amenorrhoea
Impotence
Headache
Infertility
Visual Field Abnormalities
Extraocular Muscle Weakness
Pressure Effects
What pressure effects can be seen in prolactinaemia?
Bitemporal hemianopia
Hypopituitarism
Cranial nerve palsies
What investigations are used in prolactinaemia diagnosis?
Full pituitary profile
MRI pituitary
Perimetry/visual field measurement
What is the management of microprolactinoma?
Dopamine agonists
What is the management of macroprolactinoma?
Trial of dopamine agonists
If affecting visual fields, then trans-sphenoidal surgery
What is dopamine also known as?
Prolactin inhibiting hormone
Give examples of dopamine agonists
Bromocriptine
Cabergoline
Give a complication of hyperprolactinaemia
Unrelated increased risk of osteoporosis
What is acromegaly?
Soft tissue overgrowth due to hypersecretion of growth hormone
What causes acromegaly?
Pituitary tumour
What is the mortality of acromegaly?
High mortality if untreated
How does acromegaly present?
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
What investigations are used in acromegaly diagnosis?
Elevated Insulin-Like-Growth-Factor (IGF-1)
MRI, identify pituitary tumour
>GH
>Blood glucose
How is acromegaly managed?
Somatostatin/GHIH Analogues
- Take monthly
- Used if unsuitable for transsphenoidal surgery or residual symptoms
GH Receptor Antagonist
Transsphenoidal surgery with radiotherapy
Give an example of a somatostatin
Octreotide
Give complications of acromegaly
Carpal Tunnel Syndrome
Headache
Chiasmal Compression
HTN
Cardiomyopathy
Obstructive sleep Apnoea
Colonic Polyps and carcinoma
Hypopituitarism
Osteoporosis
HF
Diabetes
Why is diabetes a complication of acromegaly?
Growth hormone is antagonistic to insulin
What is hypopituitarism?
Undersecretion of FSH, LH, GH, ACTH, TSH and vasopressin, depending on the area of the pituitary affected
What is Panhypopituitarism?
When all hormones of the pituitary are affected in hypopituitarism
What hormones are released from the anterior pituitary?
GH
TSH
Prolactin
ACTH/Cortisol
Luteinising hormone
Follicle stimulating hormone
What hormones are released from the posterior pituitary?
Antidiuretic hormone/Vasopressin
Oxytocin
What are the causes of hypopituitarism?
Tumour compression
- Craniopharyngioma
- Metastases
- Pituitary tumour
Trauma
Infection
- TB
- Sarcoidosis
Sheehan’s
Infarction/ischaemia
How does hypopituitarism present?
Fatigue
Weight gain
Depression
Impotence
Reduced libido
Oligomenorrhoea/Amenorrhoea
Pallor
Reduced body hair
Reduced linear growth and delayed puberty in children
How is hypopituitarism managed?
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
What is the origin of the anterior pituitary?
Derived from Rathke’s pouch
What is the origin of the posterior pituitary?
Neural origin, nerve fibres originating in supraoptic and paraventricular nuclei in the hypothalamus
What are the functions of cortisol?
>Gluconeogenesis
>Proteolysis
>Lipolysis
>Sensitivity of peripheral blood vessels to catecholamines, narrowing the vessel lumen
<immune>
<p>Influences cognition</p></immune>
What is the prognosis of Cushing’s?
Poor if untreated
What are the primary causes of hypercortilsoism?
Adrenal adenoma
Adrenal carcinoma
Adrenal hyperplasia
What are the causes of secondary hypercortilsolism?
Pituitary tumour secreting ACTH/Cushing’s disease
Ectopic causes
- Small cell lung cancer
What is the most common cause of hypercortilsolism?
Pituitary tumour/Cushing’s disease
How does Cushing’s present?
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
What investigations are used in Cushing’s diagnosis?
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
What is the first line diagnostic test of Cushing’s?
24 hour urinary cortisol/overnight dexamethasone suppression test
Give complications of Cushing’s disease?
HTN
Diabetes
Hypokalaemia
Osteoporosis
How is Cushing’s managed?
Pituitary tumour removal/Trans-sphenoidal surgery
Gradually decrease exogenous medications
Adrenal steroid inhibitors
Adrenalectomy
Give an example of an adrenal steroid inhibitor
Metyrapone
Give complications of an adrenalectomy
Nelson’s syndrome
- >pigmentation
- >pituitary size
Adrenal insufficiency
Give a complication of Transsphenoidal surgery
Hypopituitarism
Describe high dose dexamethasone test
Should suppress ACTH as negative feedback and cortisol should decrease
What are the causes of hyperprolactinaemia?
Pregnancy
Lactation/Breast feeding
Stress
Drugs
Hypothyroidism
Pituitary Lesions/Prolactinoma
Poly cystic ovarian syndrome
What drugs can cause hyperprolactinaemia?
Metoclopramide
Domperidone
Phenothiazines
Haloperidol
What is the first line investigation for acromegaly?
Elevated Insulin-Like-Growth-Factor (IGF-1)
What biochemical abnormality is associated with Cushings?
Hypokalaemic metabolic alkalosis
