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Endocrine > The Pituitary Gland Clinical Case & Discussion > Flashcards

The Pituitary Gland Clinical Case & Discussion Flashcards

1
Q

What disorders does hypersecretion of each of growth hormone, ACTH and prolactin correspond to?

A

GH hypersecretion - Acromegaly

ACTH - Cushing’s disease

Prolactin - hyperprolactinaemia

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2
Q

What are some clinical signs of acromegaly?

A
  • “Spade like” hands
  • Wide feet
  • Coarse facial features
  • Thick lips and tongue
  • Carpal tunnel syndrome
  • Sweatin
  • Pronounced jaw and brow ridges
  • Increased interdental spacing
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3
Q

What are some complications associated with acromegaly?

A
  • Headache
  • Chiasmal compression
  • Diabetes mellitus
  • Hypertension
  • Cardiomyopathy
  • Infertility
  • Sleep apnoea
  • Accelerated osteoarthritis
  • Colonic polyps and cancer
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4
Q

Investigations for acromegaly?

A
  • OGTT: failure of GH to be suppressed after glucose
  • IGF-1 levels (elevated in acromegaly)
  • MRI pituitary
  • Visual fields / fasting glucose / pituitary hormone screen
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5
Q

What causes Cushing’s Syndrome? Pituitary related causes?

A
  • Hypersecretion of cortisol from adrenal cortex

- Oversecretion of ACTH from pituitary (Cushing’s disease) can cause Cushing’s Syndrome

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6
Q

What does an excess of cortisol result in?

A
  • Tissue breakdown (weak skin, muscle, bone)
  • Sodium retention (hypertension & HF)
  • Insulin antagonism
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7
Q

Symptoms of Cushing’s Syndrome?

A
  • Skin atrophy
  • Spontaneous purpura (blood spots on skin)
  • Proximal myopathy
  • Osteoporosis
  • Growth arrest (in children)
  • Hirsutism (inappropriate hair growth)
  • Pink striae
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8
Q

What are some ACTH-independent causes of Cushing’s Syndrome?

A
  • Adrenal tumours

- Corticosteroid therapy

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9
Q

What is galactorrhoea?

A

Excessive or inappropriate production of milk

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10
Q

Symptoms of hyperprolactinaemia in women?

A
  • Galactorrhoea
  • menstrual irregularity
  • Infertility
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11
Q

Symptoms of hyperprolactinaemia in men?

A
  • Galactorrhoea
  • Impotence
  • Visual field abnormality
  • Headache
  • Extraocular muscle weakness
  • Anterior pituitary malfunction
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12
Q

Causes of hyperprolactinaemia?

A
  • Pregnancy
  • Lactation
  • Stress
  • Dopamine depleting / antagonistic drugs
  • Hypothyroidism
  • Pituitary lesions
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13
Q

What are some drugs that may cause hyperprolactinaemia?

A
  • Dopamine antagonists (neuroleptics / anti-emetics)
  • Dopamine depleting agents
  • Oestrogens
  • Some antidepressants
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14
Q

What are some clinical manifestations of hypopituitarism in adults?

A
  • Tiredness
  • Weight gain
  • Depression
  • Reduced libido
  • Impotence
  • Menstrual problems
  • Skin pallor
  • Reduced body hair
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15
Q

What are some clinical manifestations of hypopituitarism specific to children?

A
  • Reduced linear growth

- Delayed puberty

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16
Q

Common clinical sign of pituitary issues?

A
  • Visual field changes
17
Q

What is Cranial Diabetes Insipidus?

A
  • Where the hypothalamus (secretion by ant. pituitary) doesn’t produce enough ADH
  • Causes dilute urine and increased thirst
18
Q

What can be a good sign to look for showing pituitary enlargement on MRI?

A
  • Invasion into the cavernous sinus space

- Cavernous sinuses appear much smaller than usual

19
Q

What type of visual field defect is commonly associated with pituitary enlargement? Why?

A
  • Bi-temporal hemianopia
  • Loss of outer half of both left and right visual field, bc nasal fibres cross over at chiasm and so are compressed
  • Nasal fibres responsible for temporal vision and vice versa, bc of the shape of the retina
20
Q

Pharmacological management of hyperprolactinaemia?

A
  • Dopamine agonist
21
Q

Pharmacological management of acromegaly?

A
  • Somatostatin analogues

- GH antagonists

22
Q

What type of surgery is often done when needed for pituitary tumours? Brief description?

A
  • Transsphenoidal surgery
  • Endoscope / surgical instruments are put through the nose and enter the cranium via drilling through the sphenoid bone at the nasal cavity
23
Q

What are some of the beneficial effects of somatostatin analogue treatment in acromegaly?

A
  • Improve soft tissue overgrowth, sleep apnoea, sweating and headache in most patients
  • Normalize GH and IGF-1 in approx. 50% of patients
  • Induce tumour shrinkage in many
  • Reduce morbidity and mortality
24
Q

Other than surgery what treatments can be effective in pituitary tumours?

A
  • Hormone supplementation / hormone antagonists
  • Hyper-activation of certain glands causes hyperplasia, if antagonist to activating hormone given then less activation of the gland, and so the gland will shrink
25
Q

What are octreotide and lanreotide? How are they administered and to treat what condition?

A
  • Somatostatin analogues
  • Subcutaneous / intramuscular injections
  • treat acromegaly
26
Q

Adverse effects of somatostatin analogues?

A
  • Nausea / cramps / diarrhoea / flatulence
  • Cholesterol gallstones in 20-30%

(treatment can be expensive)

Endocrine (30 decks)

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