The Pituitary Gland (Clinical)

Question 1

What are the possible problems associated with pituitary disease?

Answer 1

Hypersecretion
Hyposecretion
Space occupation

Question 2

What are the clinical features of acromegaly?

Answer 2

Soft tissue overgrowth- "spade-like" hands, wide feet, coarse facial features, thick lips and tongue, carpal tunnel syndrome and excess sweating
Complications:
Headache
Chiasmal compression
Diabetes mellitus
Hypertension
Cardiomyopathy
Sleep apnoea
Accelerated osteoarthritis
Colonic polyps

Question 3

What is the cause of acromegaly?

Answer 3

Hypersecretion of growth hormone

Question 4

What is the cause of Cushing’s disease?

Answer 4

Hypersecretion of ACTH

Question 5

What is the cause of hyperprolactinaemia?

Answer 5

Hypersecretion of prolactin

Question 6

How is acromegaly investigated?

Answer 6

Serum insulin-like growth factor 1 testing
Oral glucose tolerance test
Random serum growth hormone
Check for pituitary tumour on MRI

Question 7

What are the pathological effects of excess corticosteroids in Cushing’s syndrome?

Answer 7

Tissue breakdown
Sodium retention
Insulin antagonism

Question 8

What are the signs and symptoms of Cushin’s syndrome?

Answer 8

High value:
-Skin atrophy
-Spontaneous purpura
-Proximal myopathy
-Osteoporosis
-Growth arrest in children
Intermediate value:
-Pink striae
-Facial mooning and hirsutism
-Oedema
Non-specific:
-Central obesity
-Hypertension

Question 9

What are the causes of Cushing’s syndrome?

Answer 9

ACTH-dependent:
-Pituitary tumour (Cushing's disease)
-Ectopic ACTH secretion
ACTH-independent:
-Adrenal tumour
-Corticosteroid therapy

Question 10

What are the signs and symptoms of hyperprolactinaemia in women?

Answer 10

Galactorrhea
Menstrual irregularity
Infertility

Question 11

What are the signs and symptoms of hyperprolactinaemia in men?

Answer 11

Galactorrhea
Impotence
Visual field abnormalities
Headache
Extraocular muscle weakness
Anterior pituitary malfunction

Question 12

What are the causes of hyperprolactinaemia?

Answer 12

Pregnancy
Lactation
Stress
Dopmamine depleting and dopamine antagonist drugs
Primary hypothyroidism
Pituitary lesions

Question 13

What drugs can cause hyperprolactinaemia?

Answer 13

Dopamine antagonists
Dopamine depleting agents
Oestrogens
Some antidepressants
Some homeopathic/herbal remedies

Question 14

What are the clinical features of hypopituitarism?

Answer 14

Adults:
-Tiredness
-Weight gain
-Depression
-Reduced libido
-Impotence
-Menstrual problems
-Skin pallor
-Reduced body hair
Children:
-Reduced linear growth
-Delayed puberty

Question 15

What are the causes of cranial diabetes insipidus?

Answer 15

Idiopathic
Post-trauma
Metastatic carcinoma
Craniopharyngioma
Other brain tumours
Sarcoidosis (rare)

Question 16

How is pituitary hypersecretion managed?

Answer 16

Dopamine agonists for prolactinoma

Somatostatin analogues or GH receptor antagonists for acromegaly

Question 17

How is pituitary hyposecretion managed?

Answer 17

Cortisol, T4. sex steroids, GH, desmopressin

Question 18

How is a pituitary tumour managed?

Answer 18

Surgery (mainly transsphenoidal)

Radiotherapy

Question 19

What are the benefits of somatostatin analogues in acromegaly?

Answer 19

Imrpove soft tissue overgrowth, sweating, headache and sleep apnoea in most patients
Normalise GH and IGF-1 levels
Induce tumour shrinkage
Reduce morbidity and mortality

Question 20

What are the adverse effects of somatostatin analogues?

Answer 20

Nausea
Cramps
Diarrhoea
Flatulence
Cholesterol gallstones

Question 21

How does a macroporlactinoma tend to respond to a dopamine agonist?

Answer 21

Rapid fall in serum PRL
Tumour shrinkage
Visual improvement
Often recovery of pituitary function
Most tumours shrink by at least half