Pituitary Disease Flashcards
What hormones are produced by the pituitary?
Anterior
- TSH
- ACTH
- GH
- FSH
- LH
- Prolactin
Posterior
- Oxytocin
- ADH
What is a pituitary adenoma?
Benign mass in pituitary gland
Can be life threatening due to mass effects and secretory effects
Microadenoma <1cm
Macroadenoma >1cm
Can be functioning or non-functioning
What are symptoms of non functioning pituitary adenomas?
Bitemporal hemianopia
Ocular palsy due to CN lesions
Headache
Hypopituitarism due to destruction of pituitary gland
Compression of hypothalamus leading to altered sleep/thirst/appetite
What are symptoms of functioning pituitary adenoms?
Means they are secreting hormones Acromegaly Cushing syndrome Hyperthyroidism Hyperprolactinaemia
What is hyperprolactinaemia?
Excessive production and secretion of prolactin
What are the causes of hyperprolactinaemia?
Pituitary adenoma Anti-emetics Haloperidol Pregnancy Breastfeeding Primary hypothyroidism (excess TSH stimulates prolactin formation)
What are the symptoms of hyperprolactinaemia?
Oligo/amenorrhoea Galactorrhoea Gynaecomastia Erectile dysfunction Decreased libido Infertility
How is hyperprolactinaemia diagnosed and managed?
MRI brain showing pituitary adenoma following high serum prolactin
Remove underlying cause
1st line= dopamine receptor agonist e.g. bromocriptine
-lifelong
-SE= N&V
-can lead to pulmonary/cardiac/retroperitoneal fibrosis so must monitor with ECHO and CXR
-symptoms return when drug is stopped
What is acromegaly?
Excessive production of growth hormone
Often due to functioning pituitary adenoma
What are the symptoms of acromegaly?
Enlarged hands and feed Protruding jaw and forehead Intradental spacing Headache Bitemporal hemianopia HTN Tightening of rings Macroglossia Fatigue Excess sweating Signs of hyperglycaemia
How is acromegaly diagnosed?
Elevated insulin like growth factor 1
OGTT (after)
- normally this suppresses growth hormone secretion
- levels >2mu/ml
MRI brain to look for pituitary adenoma
How is acromegaly treatment?
Somatostatin analogue to shrink tumour pre operatively
Surgery to remove the tumour
What is panhypopituitarism?
Deficiency in all pituitary hormones
What are the symptoms of panhypopituitarism?
Fatigue Myalgia GH/corticotropin deficiency Diabetes insipidus Hypothyroidism Hypotension
What are the causes of panhypopituitarism?
Obliteration of pituitary by tumour
Surgical removal/irradiation
Ischaemic necrosis due to hypotensive shock
Destruction of hypothalamus
