Symposium - anterior pituitary disorders: Acromegaly and hypopituitarism

Question 1

What can happen if you have a pituitary tumour

Answer 1

• Gland too big
  
  • Presses on adjacent structures
• Excess hormone secretion
• Deficient Hormone secretion
  
  • Pressure on normal cells from tumour
  • Post Surgery or Radiotherapy

Question 2

How do we tackle a pituitary problem

Answer 2

1. Take the History
2. Examine the patient
3. Do relevant special investigations
4. Discuss management with Team & Patient
5. Decide on best Personalised treatment
   ○ Surgery
   ○ Radiotherapy
   ○ Medication
   ○ Watch & Wait

Question 3

Pituitary problems - examination

Answer 3

• ENT
• Biopsy of nasal mass **
• Vision
• Neuro
• BP
• General examination
** Histology – Pituitary Tumour

KS - Initial MRI scan

Question 4

What do you examine in the patient for when pituitary problems are suspected

Answer 4

• Face
• Hands
• Feet
• Skin (for skin tags)
• Visual fields

Question 5

What is acromegaly

Answer 5

• Acromegaly is a hormonal disorder that results from too much growth hormone (GH) in the body

Question 6

Clinical manifestations of acromegaly

Answer 6

• Prognathism
• Increased size of hands and feet
• Rings tight, carpal tunnel syndrome
• Skin tags in acromegaly(increases risk of colon cancer)

Question 7

Tests to confirm diagnosis of acromegaly

Answer 7

• Glucose tolerance test + growth hormones

- IGF-1

Question 8

Further tests to check pituitary

Answer 8

Vision - visual fields (goldmans)
Cardiac - ECG, echocardiogram
Lung function/sleep study - eg obstructive sleep apnoea
Colonoscopy

Question 9

Pituitary problems - treatment pathway

Answer 9

Discussion re diagnosis and management (MDT) –> visit to combined pituitary clinic (CPC) –> Advanced pituitary nurse, patient representative and pituitary surgeon(transsphenoidal hypophysectomy)

Question 10

NH post op tes

Answer 10

- Assess growth hormone 
Assess other hormones: 
- Free T4 
- Start thyroxine 
- Tetracosactrin (synacthen) test 
- Stop hydrocortisone 
- E and Urea normal 
- Prolactin

Question 11

How to make the IGF1 normal

Answer 11

Further surgery (no) 
- no safe surgical target 
Medications (Yes) 
- Dopamine agonist (carbergoline) 
- Long acting somatostatin analogue (Yes)

Question 12

Features of post op radiotherapy

Answer 12

• Significant residual tumour
• No further safe surgical target
• No medical treatment to reliably stop tumour growth
  Radiotherapy