PITUITARY TUMOURS

Question 1

3 types of pituitary tumour

Answer 1

1. non-functioning
2. prolactinoma
3. acromegaly

Question 2

what do you call a pituitary tumour >1cm

Answer 2

macroadenoma

Question 3

what do you call a pituitary tumour <1cm

Answer 3

microadenoma

Question 4

what is a non-functioning tumour

Answer 4

a pituitary tumour which does not cause excess secretion of pituitary hormones

Question 5

how does a non-functioning tumour cause pathology

Answer 5

by growling v large and compressing surrounding structures

Question 6

what structures are compressed by macro adenoma pituitary tumours

Answer 6

optic chiasm

cranial nerves 3,4,6

Question 7

what are the symptoms of a non-functioning tumour

Answer 7

panhypopituitarism

hypoadrenalisim 
hypothyroidism 
hypogonadism 
diabetes insipidus 
GH deficiency

Question 8

what is a prolactinoma

Answer 8

a functional pituitary tumour which secreted prolactin

Question 9

what cells produce prolactin

Answer 9

lactotroph cells

Question 10

what is prolactin normally released for

Answer 10

stimulating breast milk production in pregnancy

Question 11

what are the effects of prolactin on dopamine and GnRH

Answer 11

increases dopamine (which surpassed prolactin)

decreased GnRH which causes a decrease in FSH and LH

Question 12

what are the symptoms of a micro prolactinoma

Answer 12

none

Question 13

what are the symptoms of a macro prolactinoma experienced by both men and women

Answer 13

bitemporal hemianopia
headaches
reduced fertility
reduced libido

Question 14

what are the female symptoms of prolactinoma

Answer 14

galactorrhea - milky discharge from breasts
amenorrhea - no periods
vaginal dryness
brittle bones

Question 15

what are the male symptoms of prolactinoma

Answer 15

genecomastia - breast development

erectile dysfunction

Question 16

how do you diagnose prolactinoma

Answer 16

raised serum prolactin levels

MRI pituitary

Pituitary function tests

Question 17

what is the first line drug for prolactinoma

Answer 17

CARBERGOLINE

dopamine agonists

Question 18

what are 3 side effects of dopamine agonists

Answer 18

nausea/vomiting
low mood
fibrosis

Question 19

when is surgery used for prolactinoma

Answer 19

macroadenoma or failed medial therapy

if surgery not possible -radiotherapy

Question 20

what is acromegaly

Answer 20

a benign functional tumour of the pituitary which secreted GROWTH HORMONE

Question 21

Symptoms of acromegaly

Answer 21

giantism 
thickened soft tissues (jaw hands, skin, sweating) 
snoring/sleep apnoea 
hypertension 
headaches 
diabetes mellitus 
local pituitary effects 
early CV death 
colon cancer and colonic polyps

Question 22

how do you diagnose acromegaly

Answer 22

IGF1 levels in blood

Glucose tolerance test

Question 23

how does glucose tolerance test work

Answer 23

normally GH is released during hypoglycaemia and should be suppressed with hyperglycaemia

if GH is not suppressed after inducing hyperglycaemia OR paradoxically increases OR remains high for a long time after then there is acromegaly

Question 24

1st line treatment for acromegaly

Answer 24

SURGERY

check glucose tolerance test after and if still high may need drug/radio therapy

Question 25

what drug therapy can be used for acromegaly (second line to surgery)

Answer 25

Sandostatin (shrinks tumour) 
dopamine agonist (best if tumour also secretes prolactin) 
GH antagonist (last line)