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Endocrinology 2 > Pituitary tumours > Flashcards

Pituitary tumours Flashcards

1
Q

what is the name of a functioning pituitary tumour of the lactotroph cells?

A

prolactinoma

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2
Q

what is the name of a functioning pituitary tumour of the somatotrophs?

A

acromegaly

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3
Q

what is the name of a functioning pituitary tumour of the thyrotrophs?

A

TSHoma

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4
Q

what is the name of a functioning pituitary tumour of the gonadotrophs?

A

gonadotrophinoma

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5
Q

what is the name of a functioning pituitary tumour of the corticotrophs?

A

cushing’s disease (corticotroph adenoma)

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6
Q

what is the difference between Cushing’s disease and Cushing’s syndrome?

A

cushing’s syndrome - is making too much cortisol for any cause -c could be a tumour of adrenals

cushing’s disease - too much ACTH specifically

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7
Q

What are the 6 classifications of a pituitary tumour?

A
  • size
  • sella or suprasellar
  • function
  • benign or malignant
  • compressing or not compressing optic chiasm
  • Invading cavernous sinus or not
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8
Q

a tumour is 1.5cm, is it a micro or macroadenoma?

A

macroadenoma

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9
Q

tumour <1cm is a?

A

microadenoma

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10
Q

tumour >1cm is a?

A

macroadenoma

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11
Q

a sella tumour means?

A

sitting in the sella turcica

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12
Q

a suprasellar tumour means?

A

risen above sella turcica and approaching optic chiasm

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13
Q

the mitotic ki67 index needs to be above what percentage to be classed as malignant?

A

3%

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14
Q
A
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15
Q

pituitary carcinomas account for what percentage of pituitary tumours?

A

<0.5%

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16
Q

hyperprolactinaemia causes what pathology?

A
  • Inhibits kisspeptin release
  • decreases downstream GnRH/LH/FSH/testosterone/oestrogen
  • leads to oligo-amenorrhoea, low libido, low fertility, osteoporosis
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17
Q

A patient presents with:

  • menstrual disturbance
  • erectile dysfunction
  • reduced libido
  • galactorrhoea
  • subfertility

What’s a likely diagnosis?

A

hyperprolactinaemia

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18
Q

name 3 physiological causes of elevated prolactin?

A
  • pregnancy/breastfeeding
  • stress eg. venepuncture
  • nipple/chest wall stimulation
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19
Q

name 3 pathological causes of elevated prolactin?

A
  • primary hypothyroidism
  • polycystic ovarian syndrome
  • chronic renal failure
20
Q

name 5 drugs that can elevate prolactin levels

A
  • antipsychotics
  • SSRIs
  • Anti-emetics
  • high dose oestrogen
  • opiates
21
Q

If you see a patient with a mild elevation in prolactin but no clinical features, which options do you think of?

A
  1. Macroprolactin
  2. Stress of venupuncture
22
Q

What is macroprolactin made of?

A

antigen-antibody complex of monomeric prolactin and IgG

23
Q

How can you eliminate the stress of venepuncture when checking prolactin levels?

A

cannulated prolactin series

24
Q

what is the treatment for a prolactinoma? Give an example of a drug.

A

dopamine receptor agonists eg. cabergoline

25
Is cabergoline safe in pregnancy?
yes
26
how do dopamine receptor agonists work?
Act like dopamine and inhibit prolactin production, and shrink tumour
27
pituitary tumours secreting excess GH results in?
* gigantism - children * acromegaly - adults
28
* sweatiness * headache * macroglossia * prominent nose * large jaw * increase hand and feet size * snoring and obstructive sleep apnoea * hypertension * impaired glucose tolerance / diabetes mellitus are symptoms of what?
acromegaly
29
Growth hormone acts in 2 ways, both directly and indirectly. How does it do this?
1. Acts on body tissues leading to growth and development 2. Acts on liver to stimulate production of IGF-1 (insulin-like growth factor), which then also stimulates growth and development of the body tissues
30
75g oral glucose load is given to a patient with acromegaly... what happens to GH levels?
You see an immediate spike/increase in GH levels
31
why is a random measurement of GH unhelpful?
GH is pulsatile
32
what is usually elevated in acromegaly, except for GH?
IGF-1
33
Once GH excess is confirmed in acromegaly, what else needs to be done?
pituitary MRI
34
What is the first line of treatment for acromegaly?
trans-sphenoidal pituitary surgery
35
36
What risk is someone at with untreated acromegaly?
increased cardiovascular risk
37
what medicines can be used to shrink a pituitary tumour in acromegaly before surgery?
* somatostatin analogues * dopamine agonists
38
why are dopamine agonists often given to acromegaly patients?
GH secreting pituitary tumours frequently express D2 receptors
39
give an example of a somatostatin analogue?
octreotride
40
give an example of a dopamine agonist?
cabergoline
41
These symptoms are a sign of? * red cheeks * fat pads * thin skin * moon face * easy bruising * purple striae * large abdomen * poor wound healing * proximal myopathy (muscle weakness) thin arms and legs * impaired glucose tolerance (diabetes) * osteoporosis * depression
Cushing's syndrome (excess cortisol)
42
Cushing's syndrome occurs due to what level of which hormone?
excess cortisol
43
State 4 causes of cushing's syndrome
1. Taking steroids by mouth 2. Pituitary adenoma (Cushing's disease) 3. ectopic ACTH eg. lung cancer 4. adrenal adenoma or carcinoma
44
How do we test for Cushing's disease?
* Elevated 24h urine free cortisol * Elevated late night cortisol - salivary or blood test * failure to suppress cortisol after oral dexamethasone (exogenous glucocorticoid) which would usually negatively feedback to pituitary and switch off ACTH
45
what is the treatment for a larger pituitary tumour that is approaching optic chiasm?
trans-sphenoidal surgery
46
would you operate on someone with a non-functioning pituitary tumour that isn't approaching the optic chiasm?
no

Endocrinology 2 (17 decks)

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