Clinical Aspects of Pituitary Disease Flashcards

1
Q

What are the endocrine orgons?

A

Hypothalamus

Pituitary gland

Thyroid gland

Parathyroid gland

Ovaries

Pancreas

Adrenal glands

Testis

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2
Q

What are the different classifications of pituitary disease?

A

Hypersecretion (tumours)

Hyposecretion (mostly tumours, other causes)

Space occupation

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3
Q

What are examples of diseases caused by hypersecretion of the pituitary gland?

A

Acromegaly (GH)

Cushing’s disease (ACTH)

Hyperprolactinaemia (prolactin)

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4
Q

What is hypersecretion of the pituitary gland usually caused by?

A

Tumours

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5
Q

What is hyposecretion of the pituitary gland usually caused by?

A

Mostly tumours, other causes

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6
Q

What is an example of a space occupation complication of the pituitary gland?

A

Optic chiasmal compression

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7
Q

What are some clinical features of acromegaly?

A

Spade like hands

Wide feet

Coarse facial features

Thick lips and tongue

Carpal tunnel syndrome

Sweating

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8
Q

What are some complications of acromegaly?

A

Headache

Chiasmal compression

Diabetes mellitus

Hypertension

Cardiomyopathy

Sleep apnoea

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9
Q

What disease is this?

A
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10
Q

What investigations are used to diagnose acromegaly?

A

OGTT (give carbohydrates and see if GH and IGF-1 is suppressed like it should be)

MRI (look for pituitary tumour)

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11
Q

What is Cushing’s syndrome caused by?

A

Excess corticosteroids

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12
Q

Is cortisol a catabolic or anabolic hormone?

A

Catabolic

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13
Q

What effects does cortisol have that leads to Cushing’s syndrome?

A

Tissue breakdown (causing weakness of skin, muscle and bone)

Sodium retention (cause hypertension and heart failure)

Insulin antagonism (may cause diabetes)

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14
Q

What is the clinical presentation of Cushing’s syndrome?

A
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15
Q

Is cushing’s syndrome due to hyper or hyposecretion of the pituitary gland?

A

Hypersecretion

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16
Q

Is acromegaly due to hyper or hyposecretion of the pituitary gland?

A

Hypersecretion

17
Q

What are some examples of ACTH dependent causes of Cushing’s syndrome?

A

Pituitary tumour (Cushing’s disease)

Ectopic ACTH secretion (such as lung carinoid)

18
Q

What are some ACTH independent causes of Cushing’s syndrome?

A

Adrenal tumour (adenoma or carcinoma)

Corticosteroid therapy (such as for asthma or IBD)

19
Q

What disease is this?

A

Cushing’s syndrome

20
Q

What is the clinical manifestation of hyperprolactinaemia?

A
21
Q

Is hyperprolactinaemia due to hyper or hyposecretion of the pituitary gland?

A

Hypersecretion

22
Q

What is the aetiology of hyperlacticaemia?

A
  • Physiological
    • Pregnancy, lactation, stress
  • Pharmacological
    • DA depleting and DA antagonist drugs
  • Pathological
    • Primary hypothyroidism
    • Pituitary lesions (prolactinoma or pituitary stalk pressure)
23
Q

What are some examples of drugs that may cause hyperprolactinaemia?

A
  • Dopamine antagonists
    • Neuroleptics
    • Anti-emetics
  • DA depleting agents
  • Oestrogens
  • Some antidepressents
24
Q

What are some clinical features of pituitary hypofunction?

A
  • Adults
    • Tiredness, weight gain, depression, reduced libido, impotence, menstrual problems
    • Skin pallor
    • Reduced body hair
  • Children
    • Reduced linear growth
    • Delayed puberty
25
Q

What is an example of a condition that is caused by pituitary hypofunction?

A

Cranial diabetes insipidus

26
Q

What causes cranial diabetes insipidus?

A

Hypothalamus does not produce enough vasopressin hormone

27
Q

What investigation is done for cranial diabetes insipidus?

A

Fluid deprivation test assess ability of kidneys to concentrate urine under the influence of ADH

28
Q

What is the differential diagnosis for cranial diabetes insipidus?

A
  • Idiopathic
  • Post-trauma
  • Metastatic carcinoma
  • Craniopharyngioma
  • Other brain tumours such as germinoma
  • Rare causes like sarcoidosis
29
Q

What investigation is used to see if there is space occupation due to the pituitary gland?

A

MRI

30
Q

What visual field defect is caused by a pituitary tumour?

A

Bitemporal hemianopia

31
Q

What is the management of prolactinoma?

A

Dopamine agonist

32
Q

What is the management of acromegaly due to pituitary tumour?

A

Somatostatin analogues

GH receptor antagonist

33
Q

What is the management of hyposecretion due to pituitary tumour?

A

Cortisol, T4, sex steroids, GH

Desmopressin

34
Q

What is the treatment of pituitary tumours?

A

Surgery (mostly transphenoidal)

Radiotherapy

35
Q

What approach is used for surgery for pituitary tumours?

A

Transsphenoidal

36
Q

What are some of the beneficial effects of somatostatin analogues in acromegaly?

A
  • Improve soft tissue overgrowth, sweating, headache, sleep apnoea in most patients
  • Normalise GH and IGF-1 levels in over 50% of patients
  • Induce tumour shrinkage in majority
  • Reduce morbidity and mortality from acromegaly
37
Q

What monthly injections can be given for the management of acromegaly?

A

Slow release octreotide and lanreotide

38
Q

What are some adverse effects of somatostatin analogues?

A
  • Nausea, cramps, diarrhoea, flatulence
  • Cholesterol gallstones
  • Slow release preparations required monthly injections
  • High cost
39
Q

What is prolactinoma treated with?

A

Dopamine agonist