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Endocrinology > Pituitary physiology and pathology > Flashcards

Pituitary physiology and pathology Flashcards

1
Q

Which hormones are secreted from the anterior pituitary?

A

ACTH

TSH

LH/FSH

Growth hormone

Prolactin

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2
Q

Which two hormones are stored in the posterior pituitary?

A

Oxytosin

Vasopressin

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3
Q

How might a non-functioning adenoma present?

A

Temporal hemanopia - compression of the optic chiasm

Aquired squint - compression of cranial nerves 3, 4 or 6 causing extraocular muscle weakness

Hypoadrenalism
Hypothyroidism
Hypogonadism
(Diabetes Insipidus)
GH deficiency

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4
Q

What test can be performed if diabetes insipidus is suspected?

A

Water deprivation test

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5
Q

What are the physiological reasons for raised prolactin?

A

Breastfeeding

Pregnancy

Stress

Sleep

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6
Q

Which hormone, secreted from the hypothalamus, inhibits the secretion of prolactin?

A

Dopamine

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7
Q

What drugs can cause raised prolactin?

A

Dopamine antagonists e.g. metoclopramide

Antipsychotics e.g. phenothiazines

Antidepressants e.g. TCA

Other e.g. estrogens, coccaine

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8
Q

What are the pathological causes of prolactinoma?

A

Hypothyroidism

Stalk lesion e.g. RTA, iatrogenic

Prolactinoma

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9
Q

How might high prolactin present in females?

A

Galactorrhoea - 30-80%
Menstrual irregularity
Ammenorrhoea
Infertility

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10
Q

How might raised prolactin present in males?

A

Galactorrhoea - <30%
Visual field abnormal
Headache
Impotence
Anterior pituitary malfunction

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11
Q

Which gender tends to present early with raised prolactin?

A

Females

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12
Q

What investigations should be done if raised prolactin suspected?

A

Prolactin concentration

MRI Pituitary

Visual Fields - bitemporal hemanopia

Pituitary Function tests - ?other hormones affected

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13
Q

What features should be looked for on MRI of the pituitary in raised prolactin?

A

Microprolactinoma (<1cm)
Macroprolactinoma (>1cm)
Pituitary Stalk
Optic Chiasma

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14
Q

How is raised prolactin treated?

A

Dopamine agonists:

Bromocriptine

Quinagolide (norprolac)

Cabergoline (Dostinex)

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15
Q

Which dopamine agonist has the fewest side effects?

A

Cabergoline

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16
Q

What is acromegaly?

A

Excess of growth hormone

17
Q

How might acromegaly present before epiphyseal fusion?

A

Giantism

18
Q

What are the complications of acromegaly that might present?

A

Thickened soft tissues - skin, large jaw, sweaty, large hands

Hypertension

Cardiac failure

Headaches (vascular)

Snoring/Sleep apnoea

Diabetes mellitus

Local pituitary effects - visual fields, hypopituitarism

Early CV Death

19
Q

How is acromegaly diagnosed?

A

Insulin-like growth factor 1 (IGF1) is measured and compared to normal values for age and sex

Glucose tolerance test - GH should suppress to <0.4ug/l after glucose

There is no suppression in acromegaly or fails to suppress below 1ug/l

20
Q

What is the treatment for acromegaly?

A

Pituitary surgery

External radiotherapy to pituitary fossa

Retest GTT:
–GH <0.4ug/l = clinically satisfactory
–GH >1ug/l = needs drug therapy

Dopamine Agonist e.g. Cabergoline
Octreotide
Pegvisomant

21
Q

What is the most common functioning pituitary adenoma?

A

Prolactinoma

22
Q

What are the causes of pituitary hypofunction?

A

Primary or metastatic tumours

Traumatic brain injury

Subarachnoid haemorrhage

Infarction

Surgery or radiation

Granulomatous inflammation – sarcoidosis, tuberculous meningitis

Vascular diseases e.g. arteritis

Hypothalamic diseases e.g. syphillis

23
Q

How can Cushing’s disease be distinguished from obesity?

A

Thin Skin
Proximal myopathy
Frontal balding in women
Conjunctival oedema (chemosis)
Osteoporosis

24
Q

How can a pituitary pathology causing Cushing’s disease be distinguished from an adrenal pathology causing Cushing’s?

A

ACTH levels will be high in pituitary abnormality compared to very low in adrenal abnormality

25
Q

What is the treatment for Cushing’s due to pituitary pathology?

A

Hypophysectomy and external radiotherapy if recurs

26
Q

What are the signs and symptoms of pan hypopituitarism?

A

Menstrual irregularities (F)
Infertility, impotence
Gynaecomastia (M)
Abdominal obesity
Loss of facial hair (M)
Loss of axillary and pubic hair (M&F)
Dry skin and hair
Hypothyroid faces
Growth retardation (children)

27
Q

What is the treatment for diabetes insipidus?

A

Desmopressin

28
Q

What are the causes of cranial diabetes insipidus?

A

Familial - isolated in most cases
DIDMOAD (DI, DM, optic atrophy, deaf)

Acquired - Idiopathic in 50%

Trauma; road accidents, surgery, skull fracture

Tumour

Sarcoid

External irradiation

Meningitis

Endocrinology (12 decks)

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