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MEH * > S8 Pituitary Disorders > Flashcards

S8 Pituitary Disorders Flashcards

1
Q

What is the clinical presentation of pituitary tumours?

A
  • visual loss
  • headache
  • hypo-/hyper-secretion (abnormality in pituitary function)
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2
Q

Why do you get visual field loss when a pituitary tumour grows upwards/superiorly?

A

It applies pressure on the optic chiasm

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3
Q

Why do you get double vision/pain when a pituitary tumour grows sideways/laterally?

A

Applies pressure to the nerve that controls eye movements and pain

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4
Q

A pituitary tumour can inhibit the function of the hypothalamic control on the pituitary gland, what does it affect? What is this called?

A
  • no positive control of GH, LH/FSH, TSH or ACTH
  • no negative control of prolactin (so prolactin levels increase)

Hypopituitarism

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5
Q

What does growth hormone deficiency lead to in children and adults?

A

Children - short stature

Adults - reduce quality of life

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6
Q

What does a gonadotropin deficiency result in?

A
  • delayed puberty in children
  • loss of secondary sexual characteristic in adults
  • loss of periods is an early sign for women
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7
Q

When can gonadotropin deficiency be commonly seen in men?

A

When using chemotherapy to treat prostate cancer, the drug inhibits testosterone

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8
Q

When can TSH and ACTH deficiencies occur?

A

They’re a late feature of pituitary tumours

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9
Q

What does TSH deficiency present as?

A
  • low thyroid hormones
  • cold
  • weight gain
  • tiredness
  • slow pulse
  • low T4
  • non-elevated TSH
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10
Q

What does ACTH deficiency present as? What can it result in?

A
  • low cortisol
  • tiredness
  • dizziness
  • low BP
  • low sodium
  • HPA axis will be affected

Hypoadrenal crisis which is life threatening

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11
Q

Which hormones are usually produced in excess when there’s abnormality in pituitary function?

Which are produced in excess more rarely?

A
  • prolactin
  • GH
  • ACTH
  • TSH
  • LH/FSH
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12
Q

What biochemical assessment do you carry out to assess pituitary disease affecting the thyroid axis, gonadal axis and prolactin axis?

A

A basal blood test

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13
Q

What biochemical assessment do you carry out to assess pituitary disease affecting the HPA axis, GH axis?

A

A dynamic blood test may be needed

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14
Q

Why does it matter when you do a blood test to asses the HPA axis?

A

Testing for cortisol levels - levels of cortisol vary throughout the day (usually tested at 9am when levels are at higher levels)

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15
Q

What is a dynamic blood test?

A

When you activate/suppress a hormonal axis and observe the response

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16
Q

When would you suppress and when would you stimulate in a dynamic assessment of HPA and GH axes?

A

Stimulate when suspected hormone deficiency

Suppress when suspected hormone excess

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17
Q

What do you stimulate and suppress for a dynamic assessment of the HPA/adrenal axis?

A

Stimulate adrenals by ACTH (using a synthetic form) or insulin stress test - induce hypoglycaemic stress by giving insulin by IV - usually hypoglycaemic stress should activate the HPA axis

Suppress ACTH axis with steroids

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18
Q

What do you stimulate and suppress for a dynamic assessment of the GH axis?

A

Stimulate using the insulin stress test (should stimulate GH release)

Suppress using the glucose tolerance test (increase blood glucose as increased blood glucose reduces GH release)

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19
Q

How do you do a radiological assessment of pituitary disease?

A

Use MRI

20
Q

What is a bi-temporal hemi-anopia suggestive of?

A

A pituitary tumour

21
Q

What is a prolactinoma?

A

A prolactin-secreting pituitary tumour

22
Q

When is a tumour considered a macro-adenoma or a micro-adenoma?

A

Macro-adenoma: more than 1cm

Micro-adenoma: less than 1cm

23
Q

How are prolactinomas treated?

A

With tablets, not an operation

24
Q

What type of drug can you use to shrink a macro-prolactinoma?

A

A dopamine agonist as dopamine inhibits prolactin

25
Q

What does prolactin inhibit if it’s present in high levels?

A

LH secretion

26
Q

What are the symptoms of hyperprolactinaemia in women?

A
  • menstrual disturbance
  • fertility problems
  • galactorrhoea (milky discharge from nipple)
27
Q

What are the symptoms of hyperprolactinaemia in men?

A
  • larger tumours (macro-adenoma)
  • may present with mass symptoms such as visual loss
  • present later than women as they don’t have periods
  • any symptoms of low testosterone are non-specific
28
Q

How can you tell whether you have disinhibition or a prolactinoma based off of prolactin blood tests?

A

If less than 5000 it is disinhibition

If more than 5000 it is prolactinoma

29
Q

What is a non-functioning pituitary adenoma?

A

Adenoma means there’s no secretion of biologically active hormones or may secrete inactive hormones

30
Q

How do you treat a prolactinoma?

A

Use a dopamine agonist (to stimulate D2 receptors) - bromocriptine or cabergoline

31
Q

What is acromegaly? What can cause acromegaly?

A

Large extremities e.g. hands and feet

Occurs due to growth hormone excess -

  • growth hormone (GH) secreting pituitary tumour
  • genetics
32
Q

What are some long term complications of untreated acromegaly?

A
  • premature cardiovascular death
  • increased risk of colonic tumours
  • increased risk of thyroid cancer?
  • disfiguring body changes that may be irreversible
  • hypertension
  • diabetes
  • unpleasant symptoms
33
Q

What biochemical tests do you carry out to confirm acromegaly?

A
  • oral glucose tolerance tests - glucose should suppress the GH
34
Q

How is acromegaly caused by a tumour treated?

A
  • surgical removing of tumour (trans-sphenoid always hypophysectomy)
  • reduce GH secretion
  • block GH receptor
35
Q

What is Cushing’s disease?

A

An ACTH secreting pituitary tumour

36
Q

How does Cushing’s disease present?

A
  • round pink face
  • round abdomen
  • skinny with weak arms and legs
  • thin skin
  • easy bruising
  • stretch marks (purple/red) on abdomen
  • high blood pressure
  • diabetes
  • osteoporosis
37
Q

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

A

Disease is due to a pituitary tumour

Syndrome may be caused by other pathologies e.g. adrenal tumour, ectopic ACTH or steroid medication

38
Q

What is diabetes insipidus? What does it present as?

A

Not reabsorbing water in the kidneys

Large quantities of pale urine and extreme thirst due to fluid loss

39
Q

Why does diabetes insipidus occur?

A

Issues with the posterior pituitary glands secreting vasopressin (ADH) e.g. vasopressin not secreted

40
Q

What is cranial diabetes insipidus?

What is nephrogenic diabetes insipidus?

A

A vasopressin deficiency pituitary disease

A vasopressin resistance kidney disease

41
Q

What pathology can cause cranial diabetes insipidus?

A
  • inflammation
  • infiltration
  • malignancy
  • infection
42
Q

What are the consequences of untreated diabetes insipidus?

A
  • severe dehydration
  • hypernatraemia
  • reduced consciousness, coma and death
43
Q

How is cranial diabetes insipidus treated?

A

Synthetic vasopressin - nasal spray, tablets or injection

44
Q

What is pituitary apoplexy?

A

A stroke caused by a sudden vascular event in a pituitary tumour e.g. bleeding within the tumour (haemorrhage) or blood supply cut off (infarction)

45
Q

What is the clinical presentation of pituitary apoplexy?

A
  • sudden onset headache
  • double vision
  • visual field loss
  • cranial nerve palsy
  • hypopituitarism
46
Q

A deficiency of which hormone is most dangerous linked to pituitary apoplexy?

A

Cortisol deficiency

MEH * (22 decks)

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