The Pituitary Gland Clinical Case & Discussion

Question 1

What causes the vast majority of hypersecretive pituitary disorders?

Answer 1

Pituitary tumours

Question 2

In hypersecretive pituitary disorders, what are the three hormones which are affected in acromegaly, Cushing’s and hyperprolactinaemia?

Answer 2

Acromegaly - GH

Cushing’s - ACTH

Hyperprolactinaemia - Prolactin

Question 3

Which of the posterior pituitary diseases can be involved in a hyposecreting disorder?

Answer 3

Vasopressin

Question 4

What are some clinical features of acromegaly?

Answer 4

Spade like hands
Wide feet
Coarse facial features
Thick lips and tongue
Carpal tunnel syndrome
Sweating

Question 5

What should be considered when diagnosing acromegaly?

Answer 5

Can the GH be suppressed?
Is IGF-1 elevated?
Is the rest of the pituitary function normal?
Is there a pituitary tumour on the MRI?
Is vision normal?

Question 6

In basic terms what causes Cushing’s syndrome?

Answer 6

Excess corticosteroids

Question 7

What are the consequences of cushing’s syndrome?

Answer 7

Tissue breakdown - weakness of skin, muscle and bone
Sodium retention - may cause HTN and HF
Insulin antagonism - may cause DM

Question 8

What are some symptoms of high value in Cushing’s disease?

Answer 8

Skin atrophy
Spontaneous pupura
Proximal myopathy
Osteoporosis
Growth arrest in children

Question 9

What two classifications may Cushing’s disease be in relation to ACTH?

Answer 9

ACTH-dependant

ACTH-independant

Question 10

What are the causes of ACTH-dependant Cushing’s syndrome?

Answer 10

Pituitary tumour - Cushing’s DISEASE

Ectopic ACTH secretion e.g. lung carcinoid

Question 11

What are the causes of ACTH-independant Cushing’s syndrome?

Answer 11

Adrenal tumour (adenoma or carcinoma)

Corticosteroid therapy (e.g. for asthma, IBD)

Question 12

What are some physiological causes of hyperprolactinaemia?

Answer 12

Pregnancy, lactation, stress

Question 13

What are some pharmacological causes of hyperprolactinaemia?

Answer 13

DA depleting drugs and DA antagonist drugs

Question 14

What are some pathological causes of hyperprolactinaemia?

Answer 14

Pituitary hypothyroidism
Pituitary lesions (prolactinoma or pituitary 'stalk pressure')

Question 15

Give some classes of drugs which may cause hyperprolactinaemia

Answer 15

Dopamine antagonists
DA_depleting agents
Oestrogens
Some antidepressants

Question 16

What are some clinical features in adults of hypopituitarism?

Answer 16

Tiredness, weight gain, depression, reduced libido, impotence, menstrual problems
Skin pallor
Reduced body hair

Question 17

What are some clinical features in children of hypopituitarism?

Answer 17

Reduced linear growth

Delayed puberty

Question 18

What is Diabetes Insipidus?

Answer 18

Usually results from a lack of ADH and is characterised by extreme thirst and excretion of high levels of very dilute urine

Question 19

What test should be done to exclude DI?

Answer 19

Water deprivation test

Question 20

What is the drug treatment for a hypersecreting prolactinoma (pituitary tumour)

Answer 20

Dopamine agonists

Question 21

What are the two drug therapies for hypersecreting pituitary tumours causing acromegaly?

Answer 21

Somatostatin analogues

GH receptor analogues

Question 22

What are the drug therapies for treating hyposecretion caused by a pituitary tumour?

Answer 22

Cortisol, T4, sex steroids, GH, desmopressin

Question 23

What is a microprolactinoma?

Answer 23

A tiny pituitary tumour which causes hyposecretio of prolactin

Question 24

What is the drug treatment for microprolactinoma?

Answer 24

Dopamine agonists