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Y2 BRS Endocrinology > Pituitary Tumours > Flashcards

Pituitary Tumours Flashcards

1
Q

What is a functioning pituitary tumour affecting somatotrophs?

A

Acromegaly

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2
Q

What is a functioning pituitary tumour affecting lactotrophs?

A

Prolactinoma

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3
Q

What is a functioning pituitary tumour affecting thyrotrophs?

A

TSHoma

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4
Q

What is a functioning pituitary tumour affecting gonadotrophs?

A

Gonadotrophinoma

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5
Q

What is a functioning pituitary tumour affecting corticotrophs?

A

Cushing’s disease (corticotroph adenoma)

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6
Q

What is the pituitary tumour classification relating to function?

A
  1. Excess secretion of a specific pituitary hormone
    eg prolactinoma
  2. No excess secretion of pituitary hormone
    (Non Functioning Adenoma)
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7
Q

What is the radiological (MRI) pituitary tumour classification relating to size?

A

Microadenoma <1cm (10mm)

Macroadenoma >1cm (10mm)

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8
Q

What are the radiological (MRI) pituitary tumour classifications?

A
  1. Sellar or suprasellar
  2. Compressing optic chiasm or not
  3. Invading cavernous sinus or not
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9
Q

How does a hyperprolactinaemia inhibit kisspeptin neurons?

A
  • Prolactin binds to prolactin receptors on kisspeptin neurons in the hypothalamus
  • Inhibit kisspeptin release
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10
Q

What is the result of a hyperprolactinaemia inhibiting kisspeptin neurons?

A

-Decrease in downstream GnRH/LH/FSH/T/Oest

  • Oligo-amenorrhoea
  • Low libido
  • Infertility
  • Osteoporosis
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11
Q

What is the presentation of prolactinomas?

A
  1. Menstrual disturbance
  2. Erectile dysfunction
  3. Reduced libido
  4. Galactorrhoea
  5. Subfertility
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12
Q

What are the other causes of an elevated prolactin?

A
  1. Physiological
  2. Pathological
  3. Iatrogenic
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13
Q

What are the other (physiological) causes of an elevated prolactin?

A
  1. Pregnancy/breastfeeding
  2. Stress: exercise, seizure, venepuncture
  3. Nipple/chest wall stimulation
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14
Q

What are the other (pathological) causes of an elevated prolactin?

A
  1. Primary hypothyroidism
  2. Polycystic ovarian syndrome
  3. Chronic renal failure
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15
Q

What are the other (iatrogenic) causes of an elevated prolactin?

A
  1. Antipsychotics
  2. Selective serotonin re-uptake inhibitors
  3. Anti-emetics
  4. High dose oestrogen
  5. Opiates
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16
Q

What must be excluded to confirm it is a ‘true’ (mild) elevation in serum prolactin?

A
  1. Macroprolactin

2. Stress of venepuncture

17
Q

What is macroprolactin?

A
  • ‘sticky prolactin’
  • a polymeric form of prolactin
  • an antigen–antibody complex of monomeric prolactin and IgG (normally <5% of circulating prolactin)
18
Q

How do you exclude stress of venepuncture?

A

By a cannulated prolactin series

19
Q

What is a cannulated prolactin series?

A

Sequential serum [prolactin] measurement 20 mins apart with an indwelling cannula to minimise venepuncture stress

20
Q

What is the first line treatment of prolactinoma?

A

Dopamine receptor agonist - cabergoline

21
Q

What is a pituitary tumour secreting excess GH referred to in children?

A

Gigantism

22
Q

What is a pituitary tumour secreting excess GH referred to in adults?

A

Acromegaly

23
Q

What are the symptoms of acromegaly?

A
  1. Sweatiness
  2. Headache
  3. Coarsening of facial features
    - Macroglossia
    - Prominent nose
  4. Large jaw - prognathism
  5. Increased hand and feet size
  6. Snoring & obstructive sleep apnoea
  7. Hypertension
  8. Impaired glucose tolerance/diabetes mellitus
24
Q

What is macroglossia?

A

Large tongue

25
Q

What is a large tongue called?

A

Macroglossia

26
Q

What is prognathism?

A

Large jaw

27
Q

What is a large jaw called?

A

Prognathism

28
Q

What is somatotrophin?

A

Growth hormone

29
Q

What is somatomedin?

A

IGF-1 (insulin-like growth factor)

30
Q

How is acromegaly diagnosed?

A
  1. Elevated serum IGF-1

2. Failed suppression of GH following oral glucose load (oral glucose tolerance test)

31
Q

What is the first line treatment of acromegaly?

A

Trans-sphenoidal pituitary surgery

32
Q

What medical treatment can be used prior to surgery to shrink resolution, or if surgical resection incomplete

A
  1. Somatostatin analogues eg octreotide – ‘endocrine cyanide’
  2. Dopamine agonists eg cabergoline (GH secreting pituitary tumours frequently express D2 receptors)
33
Q

What are symptoms of Cushing’s syndrome?

A
  1. Red cheeks
  2. Moon face
  3. Easy bruising
  4. Fat pads (buffalo hump)
  5. Thin skin
  6. Purple striae (stretch marks)
  7. Pendulous abdomen
  8. Poor wound healing
  9. Mental changes (depression)
  10. Osteoporosis
  11. Imparied glucose tolerance (diabetes)
  12. High BP
  13. Proximal myopathy (muscle weakness)
  14. Thin arms and legs
34
Q

How does Cushing’s syndrome occur?

A

Excess or cortisol (or other glucocorticoid)

35
Q

What are the causes of Cushing’s syndrome?

A
  1. ACTH dependent
    - Cushing’s disease (corticotroph adenoma)
    - Ectopic ACTH (lung cancer)
  2. ACTH dependent
    - Taking steroids by mouth (common)
    - Adrenal adenoma or carcinoma
36
Q

How do you investigate Cushing’s disease?

A
  1. Elevation of 24h urine free cortisol - increased cortisol secretion
  2. Elevation of late night cortisol – salivary or blood test – loss of diurnal rhythm
  3. Failure to suppress cortisol after oral dexamethasone (exogenous glucocorticoid) – increased cortisol secretion
37
Q

Once hypercortisolism is confirmed, how can you decide if it is ACTH dependent or not?

A

Measure ACTH

-if high, ACTH dependent

38
Q

What does non-functioning pituitary adenomas often present with?

A
  1. Visual disturbances - bitemportal hemianopia

2. Hypopituitarism

39
Q

Why can a non-functioning pituitary adenomas present with hypopituitarism?

A

Dopamine can’t travel down pituitary stalk from hypothalamus

Y2 BRS Endocrinology (9 decks)

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