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Clinical Conditions of MEH > Session 8 - Pituitary Disorders > Flashcards

Session 8 - Pituitary Disorders Flashcards

1
Q

State the 2 types of pituitary tumours (adenomas)

A
  • Non-functioning pituitary adenoma
    tumour cells themselves do not produce any hormone
  • Functioning adenoma (rarer)
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2
Q

What does non-functioning pituitary adenomas result in?

A

Hyposecretion
- Inadequate or nil production of one or more of the pituitary hormones due to physical pressure from the growing tumour on the glandular tissue

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3
Q

What are the clinical presentations of non-functioning pituitary adenomas?
Why do they occur?

A
  • Headaches
  • Visual problems; visual loss(pressure on optic chiasm)/ / double vision (lateral growth of tumour)
  • Vomiting
  • Nausea

they occur due to pressure on the surrounding structures in the vicinity of the tumour

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4
Q

What is the most common cause of Pituitary malfunction/disorders?

A

A pituitary benign tumour (Adenoma)

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5
Q

What does functioning pituitary adenoma result in?

A

Hypersecretion

- Overproduction of one or more of the pituitary hormones

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6
Q

What are the clinical symptoms of functioning pituitary adenoma?

A
  • Corresponds to the systemic effects of the over secreted hormone
  • may or may not show some degree of hormonal regulation in terms of negative feedback
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7
Q

How is the investigation and diagnosis of a suspected pituitary tumour carried out?

A
  • MRI scan to show the anatomy, size and topographical location of the tumour
  • Assessment of visual field defects
  • Assessment of endocrine function to determine whether there is a hormonal excess or deficiency
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8
Q

How is assessment of endocrine function carried out in order to assess pituitary function?

A
  • Measuring hormone in the blood (Blood test)

- Staining sections from a biopsy of the tumour with antibodies for the relevant hormone

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9
Q

Sate the 3 types of axis that are basal blood test sufficient in order to assess pituitary function

A
  • Thyroid axis
  • Gonadal axis
  • Prolactin axis
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10
Q

State the 2 types of axis that may need dynamic blood test

A
  • HPA axis

- GH axis

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11
Q

Which hormones are tested for in the blood fo the thyroid axis?

A

T4

TSH

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12
Q

Which hormones are tested for in the blood for Gonadal axis?

A
  • LH
  • FSH
  • Testerone: men
  • Oestrogen: women
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13
Q

Which hormones are tested for in the blood for Prolactin axis?

A

Serum prolactin

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14
Q

Which hormone is tested for in the blood for HPA axis?

A

Cortisol

  • 9 am
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15
Q

Which hormone is tested for in the blood for GH axis?

A
  • GH

- IGF1

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16
Q

What are the 2 types of tests that make up the dynamic blood test assessment?

A

Stimulation test

Suppression test

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17
Q

What does a stimulation dynamic blood test look for?

A

Suspected hormone deficiency

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18
Q

What does a suppressed dynamic blood test look for?

A

Suspected hormone excess

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19
Q

State the 2 types of stimulation tests used to assess deficiency in the APH (Adrenal) axis

A
  • Synacthen test

- Insulin stress test: response to hypoglycemic stress

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20
Q

State the type of suppression test used to assess hormone excess in the APH(Adrenal) axis

A

Dexamethasone (suppressing ACTH axis with steroids)

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21
Q

State the type of stimulation test used to assess deficiency in the GH axis

A

Insulin stress test - response to hypoglycemic stress

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22
Q

State the type of suppression test used to assess hormone excess in the GH axis

A

Glucose tolerance test - suppresses GH axis with glucose load

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23
Q

What is hypopituitarism?

A

Insufficient pituitary hormone production

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24
Q

What is the most common cause of hypopituitarism?

A

Pituitary adenoma

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25
Q

What are the rarer causes of pituitary adenoma?

A
  • Radiation therapy
  • Inflammatory disease
  • Head injury
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26
Q

What is the first hormone to be affected as a result of pituitary adenoma on the anterior pituitary gland?

A

Growth hormone GH

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27
Q

What is the second hormone to be affected as a result of pituitary adenoma on the anterior pituitary gland?

A

LH/FSH - Gonadotropins

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28
Q

What is the third hormone to be affected as a result of pituitary adenoma on the anterior pituitary gland?

A

TSH/ACTH

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29
Q

What is panhypopituitarism?

A

Deficiency of all the anterior pituitary hormones

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30
Q

When is the secretion of ADH and Oxytocin from the posterior pituitary affected?

A

If the tumour affects the hypothalamic function or alternatively if an inflammatory process is involved

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31
Q

What are the symptoms of Growth Hormone deficiency in adults?

A
  • quite subtle
  • a decrease in tolerance to exercise
  • decreased muscle strength
  • increased body fat
  • reduced sense of ‘wellbeing’
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32
Q

Why is a growth hormone deficiency difficult to diagnose?

A

GH secretion is pulsatile

- therefore a combination of direct and indirect measurements are required

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33
Q

Why does a growth deficiency in adults occur?

A

Mass effects from a pituitary adenoma

34
Q

What does growth hormone deficiency in childhood result in?

A

Pituitary Dwarfism

35
Q

Why is Pituitary dwarfism known as a proportionate type of dwarfism?

A

All body parts are in proportion to each other - no abnormalities in size in relation to other body parts

36
Q

What type of growth hormone deficiency is seen in Pituitary Dwarfism?

A

Complete or Partial deficiency

37
Q

What is the cause of GH deficiency in children?

A
  • Idiopathic (of unknown cause)

- in some cases, there have been specific gene mutations and autoimmune inflammation

38
Q

Below what percentile on the standard growth charts are individuals with Pituitary Dwarfism most likely to be placed?
Why is this?

A

Below 3rd percentile

- because the growth rate is slower than expected for age

39
Q

What are the effects on the sexual development of an individual with Pituitary Dwarfism?

A

Delayed or no sexual development

40
Q

What effect does GH deficiency have of fetal growth?

A

little effect

41
Q

What are the effects of GH deficiency on growth and stature from around 1 year of age until mid-teens?

A

Poor growth

Short stature

42
Q

What type of treatment is given to an individual with

growth hormone deficiency?

A

Growth Hormone Therapy

- Human GH manufactured by recombinant DNA technology

43
Q

What is Hypogonadism?

A

Gonadotropin deficiency

44
Q

What is the cause of Hypogonadism?

A

Mass effect from a pituitary adenoma

45
Q

Effect of gonadotropin deficiency in women of reproductive age

A
  • lack of libido
  • infertility
  • frequent menstrual period (oligomenorrhea)
  • abnormal absence of menstruation (amenorrhea)
46
Q

Effect of gonadotropin deficiency in men

A
  • decrease libido
  • impotence
  • enlarged breast tissue
  • lack of pubic hair
  • low testosterone
47
Q

Effects of gonadotropin in children

A

Delayed puberty

48
Q

What can cause a deficiency in TSH/ACTH?

A

Pituitary adenoma

49
Q

Clinical features of TSH deficiency

A
  • low thyroid hormone
  • cold
  • weight gain
  • tiredness
  • slow pulse
  • low T4
  • non-elevated TSH
50
Q

Clinical features of ACTH deficiency

A
  • low cortisol (most dangerous)
  • tired
  • dizzy
  • low BP
  • low sodium
51
Q

What are the causes of ADH deficiency?

A
  • A hypothalamic tumour or a pituitary tumour that has extended up into the hypothalamus
  • Cranial radiotherapy
  • pituitary surgery autoimmune infiltration
  • infections such as meningitis
52
Q

What are the results of ADH defciency?

A
  • Increased sensation of thirst (Polydipsia)

- Excess excretion of dilute urine resulting in dehydration

53
Q

What is the name of the type of diabetes that is linked to ADH deficiency?

A

Diabetes Insipidus

- the cranial form

54
Q

What is the difference between cranial DI and nephrogenic DI?

A

Cranial DI - vasopressin deficiency - pituitary disease

Nephrogenic DI- vasopressin resistance- kidney disease

55
Q

What are the types of pathology that causes cranial DI?

A
  • Inflammation
  • Infiltration
  • Malignancy
  • Infection
56
Q

What are the consequences of untreated DI?

A
  • Severe hydration
  • Very high sodium level (hypernatraemia)
  • Reduced consciousness
  • Coma
  • Death
57
Q

What is the treatment for Cranial DI?

A 
Synthetic vasopressin(ADH): desmopressin
- either as nasal spray, tablets or injections
58
Q

What is Hyperpituitarism?

A

Excess pituitary hormone production from a hypersecreting adenoma

59
Q

Name the 3 main conditions caused by excess pituitary hormone production from a hypersecreting adenoma

A
  • Prolactin Excess
  • Growth Hormone
  • ACTH excess
60
Q

What is Hyperprolactinaemia?

A

An abnormally high prolactin level in the blood

61
Q

What is the most common cause of hyperprolactinaemia?

A

Prolactinoma- a pituiatry adenoma that secrets prolactin

62
Q

Why does hypogonadism occur as a result of hyperprolactinaemia?

A
  • higher levels of dopamine in the hypothalamus
  • inhibits GnRH secretion from the hypothalamus
  • FSH and LSH secretion inhibited from the anterior pituitary gland
63
Q

Symptoms of hyperprolactinaemia

A
  • Galactorrhea (unexplained milk production (rare in men))
  • Gynecomastia (hard breast tissue)
  • Hypogonadism (the diminished activity of testes and ovaries)
  • Amenorrhea (cessation of the menstrual cycle)
  • Erectile dysfunction
64
Q

What might be the cause of hyperprolactinaemia if serum prolactin was <5000 compared to > 5000?

A

<5000- non-functioning pituitary tumours

>5000- Prolactinoma (functioning pituitary adenoma)

65
Q

What is used to treat prolactinomas which can cause hyperprolactinaemia?

A

Dopamine agonists: D2 receptor

- Cabergoline

66
Q

What is uses to treat non-functioning pituitary tumours which can cause hyperprolactinaemia?

A

Surgery

- trans-sphenoidal

67
Q

What are the signs/symptoms of an individual with growth hormone excess?

A
  • broad nose
  • coarse facial features
  • thick lips
  • prominent supraorbital ridge
  • enlargement of hands and feet
  • skin greasy with excessive sweating
  • deepening of voice
68
Q

State the disorder in adulthood and childhood in which growth hormone in excess leads to respectively

A

Adulthood - Acromegaly (large extremities)

Childhood - Gigantism

69
Q

What is Gigantism caused by?

A

Pituitary Adenoma

- excess secretion of growth hormone prior to epiphyseal growth plate closing

70
Q

What is Acromegaly caused by?

A

Pituitary Adenoma

-excess secretion of growth hormone after epiphyseal growth plates are closed

71
Q

Give 3 changes in physical appearance that could occur in an individual as a result of having Acromegaly for several years

A

Large…

  • hands
  • feet
  • lower jaw
72
Q

What are the 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 and diabetes
73
Q

What are the biochemical tests to confirm Acromegaly?

A
  • Oral glucose tolerance test (OGTT) with GH response
  • Failure to suppress GH
  • Elevated IGF-1 level
  • Elevated mean GH - growth hormone day curve
74
Q

What are the treatments for Acromegaly?

A
  • Surgery to remove the adenoma
  • Radiation therapy
  • Drug therapy
    Reduce GH secretion or Block GH receptor
75
Q

What is the name of the surgery used to treat Acromegaly?

A

Trans-sphenoidal hypophysectomy surgery

76
Q

How is Drug therapy used to treat Acromegaly?

A
  • Reduce GH secretion by giving a dopamine agonist or somatostatin analogues
  • Block GH receptors by giving pegvisomant
77
Q

How is radiation therapy used to treat Acromegaly?

A
  • External beam: Multiple short bursts over several weeks

- Gamma knife: High concentration over a single time

78
Q

What is the name of the syndrome caused due to excess endogenous secretion of ACTH from the anterior pituitary gland?

A

Cushing Syndrome

79
Q

What is pituitary apoplexy?

A

Stroke

-A sudden vascular event in a pituitary tumour

80
Q

What are the clinical representation of pituitary apoplexy?

A
  • Sudden onset headache
  • Double vision
  • Cranial nerve palsy
  • Visual field loss
  • Hypopituitarism: cortisol deficiency most dangerous

Clinical Conditions of MEH (4 decks)

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