Pituitary tumours

Question 1

What are the three ways of classifying a pituitary tumour.

Answer 1

Radiological
Function
Benign or Malignant

Question 2

Describe the effects of Hyperprolactinaemia

Answer 2

Prolactin inhibits kisspeptin neurons
Which leads to decreases in downstream GnRH/LH/FSH/T/Oest
Which then causes low libido, infertility osteoporosis E.T.C

Question 3

Describe the clinical presentations of a Hyperprolactinoma.

Answer 3

Menstrual disturbance
Erectile dysfunction
Reduced libido
Galactorrhoea
Subfertility

Question 4

What are other physiological causes of an elevated prolactin

Answer 4

Pregnancy/breastfeeding
Stress: exercise, seizure, venepuncture
Nipple/chest wall stimulation

Question 5

What are other pathological (natural) causes of an elevated prolactin

Answer 5

Primary hypothyroidism
Polycystic ovarian syndrome
Chronic renal failure

Question 6

What are other Latrogenic causes of an elevated prolactin

Answer 6

JUST DRUGS IS FINE
Antipsychotics
Selective serotonin re-uptake inhibitors
Anti-emetics
High dose oestrogen
Opiates

Question 7

Once you have confirmed a true pathological elevation of serum prolactin what should be the next step.

Answer 7

Pituitary MRI

Question 8

What are the two main medical treatments of prolactinomas.

Answer 8

Dopamine receptor agonists mainstay of treatment
Cabergoline (bromocriptine)

Question 9

How do dopamine receptor agonists reduce prolactin and shrink prolactinomas?

Answer 9

They bind to D2 receptors to inhibit the release of prolactin from ANTERIOR PITUITARY LACTOTROPH.

Question 10

What is the name of the conditions caused by pituitary tumours in children and adults.

Answer 10

Children- Gigantism
Adults- Acromegaly

Question 11

What are the 2 main targets for Growth Hormone.

Answer 11

Body muscles and tissues
Liver

Question 12

What does the liver release in response to growth hormone.

Answer 12

Insulin-like Growth Factor (Somatomedin)
(IGF-1 and IGF-2)

Question 13

What can be used to diagnose acromegaly before pituitary MRI.

Answer 13

Failed suppression (‘paradoxical rise’) of GH following ORAL GLUCOSE LOAD.

Question 14

What are patients with acromegaly at increased risk for.

Answer 14

Cardiovascular events.

Question 15

What is the first line treatment of acromegaly

Answer 15

Surgery, trans sphenoidal pituitary surgery.

Question 16

what can be another complication of acromegaly relating to enlargement of the larynx/ pharynx

Answer 16

Obstructive sleep apnea

Question 17

What else can be used prior to surgery to shrink a tumour or if surgical resection is incomplete in acromegaly.

Answer 17

-Somatostatin analogues eg octreotide
-Dopamine agonists eg cabergoline
-Radiotherapy

Question 18

What does elevated levels of ACTH lead to

Answer 18

Cushings syndroms

Question 19

What causes elevated levels of ACTH

Answer 19

-Basophil Adenoma
-Overactive pituitary
-Chromophobe adenoma

Question 20

Give 3 symptoms of cushings syndrome

Answer 20

-Obesity and weight gain
-Purple or pink stretch marks noted on the breasts, arms, abdomen, and thighs
-Thinning, fragile skin
-Slow healing injuries
-Acne
-Hirsutism: excessive facial hair and body hair
-Muscle weakness
-Fatigue
-Glucose intolerance
-Increased thirst and urination
-Bone loss
-High blood pressure

Question 21

What are 3 investigations that can be done to diagnose cushings syndrome

Answer 21

-Testing for elevation of 24h urine free cortisol
-Salivary or blood test for night time cortisol (loss of diurnal rhythm)
-Failure to suppress cortisol after oral dexamethasone (exogenous glucocorticoid)

Question 22

What are the ACTH dependent causes of elevated cortisol.

Answer 22

-Cushing’s disease (corticotroph adenoma)
-Ectopic ACTH (lung cancer)

Question 23

What are the ACTH independent causes of elevated cortisol

Answer 23

-Taking steroids by mouth (common)
-Adrenal adenoma or carcinoma

Question 24

Once hypercortisolism is confirmed what should be done.

Answer 24

Measure ACTH

Question 25

Once elevated ACTH is confirmed what should then be done.

Answer 25

Pituitary MRI

Question 26

what do Non-Functioning Pituitary Adenomas often present with

Answer 26

Visual disturbances (bitemporal hemianopia)