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Lecture Notes - Endocrinology > Pituitary tumours and other Sellar disorders > Flashcards

Pituitary tumours and other Sellar disorders Flashcards

1
Q

How are pituitary adenomas classified

A

According to their size:
macroadenomas 1+ cm
Microadenomas

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2
Q

What are functioning pituitary tumours associated with

A

excess anterior pituitary hormone secretion

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3
Q

When is the peak age to develop a pituitary tumour

A

around 30-60 years

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4
Q

Males usually present earlier than females. true or false

A

false - women usually present before males

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5
Q

What are the most common pituitary macro adenomas

A

Non-functioning pituitary adenomas

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6
Q

What is responsible for tumours that occur in MEN1

A

Loss of function mutations of MEN 1

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7
Q

What are some of the presenting complaints of patients with a pituitary tumour

A

Hyper secretion of pituitary hormone
hypopituitarism
headache
compression of the surrounding structures such as the optic chiasm

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8
Q

How might a prolactin-secreting adenoma present

A

galactorrhoea
amenorrhoea
infertility
impotence

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9
Q

What do ACTH secreting adenomas cause

A

Cushing’s disease

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10
Q

What do GH secreting adenomas cause

A

acromegaly

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11
Q

How do TSH secreting adenomas present

A

secondary hyperthyroidism with or without a goitre

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12
Q

What might a pituitary tumour in the anterior pituitary result in

A

A decreased secretion of anterior pituitary hormones due to compression or destruction of the surrounding normal pituitary cells

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13
Q

How might a GH deficiency present

A 
Fatigue 
impaired psychological well-being 
reduced energy 
muscle strength and exercise capacity 
increased abdominal adiposity
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14
Q

How might an LH and FSH deficiency present in males

A 
Reduced libido 
impotence
infertility 
loss of body hir 
fine premolar wrinkles 
flushes
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15
Q

How might an LH and FSH deficiency present in females

A 
Oligomenorrhoea 
amenorrhoea
infertility 
dyspareunia 
breast atrophy 
flushes
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16
Q

How might a TSH deficiency present

A 
Fatigue 
apathy 
muscle weakness
cold intolerance 
constipation 
weight gain 
dry skin
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17
Q

How might an ACTH deficiency present

A 
fatigue 
weakness
nausea
vomiting
weight loss 
hypoglycaemia 
loss of pubic and axillary hair in females
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18
Q

How might a vasopressin (ADH) deficiency present

A

Polyuria
nocturia
polydipsia

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19
Q

What causes headaches

A

stretching or invasion of the dura

Large tumours with suprasellar extension may occasionally cause obstructive hydrocephalus

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20
Q

What might involve the optic chiasma (bitemporal visual field loss)

A

suprasellar extension of the tumour

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21
Q

What can cause hyperprolactinaemia which may cause hypogonadism

A

stalk compression

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22
Q

What may cause cranial nerve palsies and diplopia

A

Lateral extension and cavernous sinus invasion

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23
Q

What might inferior extension result in

A

CSF rhinorrhoea due to erosion of the sphenoid sinus

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24
Q

What are pituitary incidentalomas

A

Mass lesions (usually adenomas) that are deleted following radiological imaging of the skull or brain for another clinical reason

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25
Q

What are some investigations for suspected pituitary tumours

A

Basal and dynamic pituitary function tests
pituitary MRI
formal visual field assessment

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26
Q

What are 2 lab pitfalls we need to be aware of when measuring prolactin levels

A

Hook effect - assay uses antibodies that recognise two different sites on the prolactin molecule
Very high prolactin levels may be artifactual reported as normal or only modestly elevated

Hyperprolactinaemia may be due to decreased clearance of a complex of prolactin with IgG - macroprolactin

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27
Q

In what cases is IGF-1 levels high

A

In patients with GH secreting pituitary tumours causing acromegaly

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28
Q

Whate are some investigations for ADH deficiency

A

Measurement of serum and urine osmolality and sodium concentration and the water deprivation test

29
Q

When is the insulin tolerance test contraindicated

What should be done instead

A

Patients with a history of epilepsy or ischaemic heart disease
Glucagon test

30
Q

What is the preferred imaging modality for the pituitary gland

A

MRI

31
Q

What are the treatment options for patients with pituitary tumours

A

Surgery - reduce local compression effects, reduce excess hormone secretion

32
Q

What is the first line surgery for almost every case

A

Trans-sphenoidal

33
Q

How should secondary adrenal insufficiency be treated

A

Hydrocortisone but only after excluding or treating adrenal insufficiency

34
Q

Why does fluid balance have to be very carefully monitored post operatively

A

to watch for the possible development of diabetes insipius

35
Q

How does diabetes insipidus present

A

poluria

36
Q

What in the patients urine can be tested as a quick test for diabetes insipidus

A

Specific Gravity

37
Q

How is diabetes insipidus diagnosed

A

If the plasma osmolality is high or plasma sodium is over 145mmolL in the presence of an inappropriately low urine osmolality/ SG

38
Q

What drug can be given if sodium is too high and they are not managing to drink enough

A

desmopressin

39
Q

What must be checked 7-10 days post op and why

A

Serum sodium as there is a risk of hyponatraemia

40
Q

How is cerebral salt wasting treeated

A

saline administration

41
Q

how is the syndrome of inappropriate ADH (SIADH) treated

A

fluid restriction

42
Q

What are the indications of radiotherapy following a pituitary surgery

A

shrink residual or recurrent tumour

reduce the likelihood of regrowth treat persistent hormone hyper secretion

43
Q

What are some short term complications of radiotherapy on the pituitary

A

hair loss
headache
nausea

44
Q

What are some long term complications of radiotherapy on the pituitary

A

Hypopituitarism

Visual impairment

45
Q

What is included in the follow up from pituitary surgery

A

Visual acuity and fields

Pituitary function testing including serum cortisol 0am

46
Q

When should a pituitary MRI be repeated

A

4 months after the surgery - so that the immediate inflammatory post op changes do not influence the results

47
Q

What is pituitary apoplexy

A

Acute hemorrhagic infarction of a pituitary tumour resulting in gland destruction and compression of surrounding structures by the oedematous enlarged pituitary tumour

48
Q

How does pituitary apoplexy present

A 
acute headache 
meningism 
visual impairment 
ophthalmoplegia 
sometimes altered consciousness
49
Q

What are some investigations for pituitary apoplexy

A

PItuitary MRI and pituitary function tests

50
Q

What is the treatment for pituitary apoplexy

A

Life saving IV Hydrocortisone replacement

Surgery within 8 days although not for those with no significant problems

51
Q

What is Sheehan’s syndrome

A

Pituitary gland necrosis caused by hypertension due to postpartum haemorrhage

52
Q

How might patients with Sheehan’s syndrome present

A

After delivery
failure of lactation
failure to resume menses
fatigue, weight loss, anorexia

53
Q

What is empty sella syndrome characterised by

A

an enlarged sella filled with CSF

54
Q

What might primary empty sella syndrome be due to

A

a defective and enlarged diaphragma sella opening

55
Q

What might cause empty sella syndrome

A

A developmental anomaly
increased intracranial pressure
compression and posterior displacement of the anterior pituitary

56
Q

Who is empty sella syndrome more common in

A

middle aged women

57
Q

What might secondary empty sella syndrome be due to

A

infarction
surgery
radiotherapy of a pituitary adenoma

58
Q

What are craniopharyngiomas

A

benign tumours that arise from squamous epithelial remnants of Rathke\s pouch

59
Q

What do craniopharyngiomas commonly cause

A

diabetes insipidus

60
Q

What are the major presenting symptoms of craniopharyngiomas

A

Growth retardation in children and visual abnormalities in adults

61
Q

What are meningiomas

A

Usually benign tumours arising from the meninges

62
Q

What are germ cell tumours usually associated with

A

simultaneous lesions in the pineal gland

63
Q

What might abscess in the pituitary result form

A

local spread - e.g. from sphenoid sinusitis

or may be secondary to septicaemia

64
Q

What is lymphocytic hypophysitis characterised by

A

lmphocytic infiltration of the anterior pituitary followed by fibrosis

65
Q

Who does lymphocytic hypophysitis affect

A

women most commonly during pregnancy or the postpartum period

66
Q

What is sarcoidosis

A

An inflammatory granulomatous multisystem disorder that may affec multiple organs such as the eyes, skin, lungs, joints and CNS

67
Q

What is hereditary haemochromatosis

A

An inherited disorder characterised by increased intestinal iron absorption and iron deposition in various grans due to mutations in the HFE gene

68
Q

Traumatic brain injury may result in what

A

hypopituitarism

69
Q

What are the 3 main complications of pituitary surgery

A

Cerebral infection
diabetes insipidus
hypopituitarism

Lecture Notes - Endocrinology (40 decks)

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