Pituitary pathology Flashcards
What hormones does the anterior pituitary secrete?
- TSH
- ACTH
- FSH
- LH
- GH
- prolactin
What conditions may cause hyperfunction of the pituitary gland?
- adenoma
- carcinoma
What conditions may cause hypofunction of the pituitary gland?
- radiation
- surgery
- sudden haemorrhage
- ischaemic necrosis
What hormones are released from the posterior pituitary?
- ADH
- oxytocin
Diabetes insupidqius is a lack of ____ secretion
- Lack of ADH secretion
SIADH is ectopic production of ____ hormone
- ADH
Pituitary adenomas are associated with _____
- MEN 1
What is the most common cell type for a pituitary adenoma?
- prolactin
Prolactin secreting pituitary adenoma may cause what?
- infertility
- lack of libido
- amenorrhea
GH secreting adenoma may cause what?
- Gigantism
- acromegaly
ACTH secreting pituitary adenoma may cause?
- Cushing’s disease
Large adenomas of the pituitary gland may cause what?
- visual field defects
Some causes of pituitary hypofunction?
- primary or metastatic tumours
- traumatic brain injury
- subarachnoid haemorrhage
Craniopharyngioma is derived from what?
- remnants of Rathke’s pouch (anterior gland)
Symptoms of carniopharyngioma?
- headaches and visual disturbances
Name 2 syndromes associated with the posterior pituitary
- Diabetes insipidus
- SIADH
Explain the central and nephrogenic effect of diabetes insipidus?
- ADH deficiency
- renal resistance to ADH effects
What are the 2 regions of the adrenal glands?
- Medulla in middle
- Cortex outer
What are the 3 zones of the cortex of adrenal glands?
- zona glomerulosa
- zona fasciculata
- zona reticularis
What is the cortex of the adrenal glands responsible for?
- mineralocorticoids (aldosterone)
- cortisol
- sex steroids
The medulla of the adrenal glands has what cell type?
- neuroendocrine
Cushing’s is associated with what?
- too much production of cortisol from the cortex of the adrenal glands
- in response to over secretion of ACTH from anterior pituitary
Addison’s disease is associated with what?
- too little production of cortisol hormones from the adrenal cortex
Name a primary hyperaldosteronism condition?
- Conn’s syndrome
What is Conn’s syndrome
- hyperaldosteronism
- loss of potassium
- sodium retention
Name a hypercortisolism condition?
- Cushing’s
- too much cortisol
What occurs in Addison’s disease?
- potassium retention
- sodium loss
Describe phaeochromocytoma
- a neoplasm derived from chromaffin cells of the adrenal medulla
- secrete catecholamines
Side effects of phaeochromocytoma
- secondary hypertensions
Diagnosis of phaeochromocytoma
- urinary excretion of catecholamines and their metabolites
Phaeochromocytoma is associated with what?
- MEN 2
MEN 2 has what associated conditions?
- phaeochromocytoma
- medullary thyroid carcinoma
- parathyroid hyperplasia
Neuroblastoma is usually diagnosed by what age?
- 18months
What size of tumour defines a microadenoma?
- less than 1cm
What size of tumour defines a macroadenoma?
- more than 1cm
Non-functioning adenoma of the pituitary can cause what?
- hypoadrenalism
- Hypothyroidism
- hypogonadism
- diabetes insipidus
- GH deficiency
What is the treatment of choice in a non-functioning pituitary adenoma?
- transsphenoidal surgery
- hormonal replacement
Prolactin is under positive control from dopamine?
TRUE OR FALSE
- FALSE
- prolactin is under negative control from dopamine
- more dopamine = less prolactin
What are some physiological causes of raised prolactin?
- breast feeding
- pregnancy
- stress
- dopamine antagonist
- antipsychotics
Pathological causes of a raised prolactin?
- hypothyroidism (TRH increases)
- Stalk lesions
- prolactinoma tumour
Symptoms in females of prolactinoma?
- galactorrhoea
- menstrual irregularity
- amenorrhoea
- infertility
Symptoms in males of prolactinoma?
- late presentation
- impotence
- visual field abnormalities
Investigations for prolactinoma?
- serum prolactin
- MRI pituitary
- visual fields
- pituitary function test
Treatment for prolactinoma?
- cabergoline
Acromegaly is caused by what?
- Growth hormone excess
Symptoms of acromegaly?
- giant
- thickened soft tissue
- snoring
- hypertension
- headache
Diagnosis of acromegaly?
- IGF1 serum
- GTT suppression test (glucose tolerance)
Treatment of acromegaly?
- pituitary surgery
- radiotherapy
- somatostatin analogues
(Sandostatin)
What causes cushing’s disease?
- excess cortisol by pituitary disease
Cushing disease vs cushing syndrome
- disease = caused by pituitary
- syndrome = another cause
Symptoms of cushing syndrome
- protein loss
- proximal myopathy
- osteoporosis
- thin skin - striae
- obesity
How to investigate cushing syndrome?
- 1mg dexamethasone suppression test
What are some causes of cushing syndrome?
- not pituitary
- adenoma of adrenal
- ectopic production of ACTH
Treatment of cushing disease?
- transsphenoidal surgery
- radiotherapy
- bilateral adrenalectomy
Treatment of cushing syndrome?
- adrenalectomy
- metyrapone
Some effects of hypopituitarism?
- growth failure
- hypothyroidism
- hypogonadism
- hypoadrenalism
Investigations for pan hypopituitarism?
- 9am ACTH
- 9am cortisol
- synacthen test
Treatment of hypopituitarism?
- hormone replacement
- thyroxine
- hydrocortisone
- ADH
- GH
- Sex steroids
- testosterone replacement
Risks associated with testosterone replacement?
- polycythaemia
- excess RBC in blood
Pathology of the posterior pituitary can cause?
- diabetes insipidus
What is diabetes insipidus?
- lack of ADH
(Vasopressin) - inability to concentrate urine
Investigations for diabetes insipidus?
- water deprivation test
- osmolality ratio <2
Treatment of diabetes insipidus
- desmospray
- desmopressin
