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MEH > MEH 11 Pituitary Disorders > Flashcards

MEH 11 Pituitary Disorders Flashcards

1
Q

Clinical presentation of pituitary tumours

A
  • pressure on surrounding structures&raquo_space; visual loss, headache, vomiting, nausea
  • abnormality on pituitary function&raquo_space; hyper/hypo secretion
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2
Q

Reason for visual field loss in pituitary tumours

A

Upwards (superior) growth of pituitary tumour
Pressure on the optic chiasm

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3
Q

Consequences of sideways (lateral) growth of pituitary tumour

A

Pain
Double vision

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4
Q

Consequences of upwards (superior) growth of pituitary tumour

A

Visual field loss due to pressure on optic chiasm causing bitemporal hemianopia

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5
Q

what is hypopituitarism?
What is it commonly caused by?

A
  • diminished hormone secretion by the anterior pituitary gland (+ADH)
  • pituitary adenoma
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6
Q

what does Growth hormone deficiency cause?

A

Short stature in children - pituitary dwarfism
Reduced quality of life in adults

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7
Q

what does Gonadotropin (LH + FSH) deficiency cause?

A
  • delayed puberty
  • loss of secondary sexual characteristics in adults
  • early sign: loss of periods
  • lack of libido
  • infertility + impotence
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8
Q

what does TSH deficiency cause?
Symptoms

A

Hypothyoidism
- low thyroid hormones
- weight gain
- fatigue
- bradycardia
- non elevated TSH
- low T4
- intolerance to cold

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9
Q

what does ACTH deficiency cause?

A

ACTH controls cortisol
- low cortisol
- tired
- dizziness
- hypotension
- hyponatraemia
Can be life threatening

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10
Q

What are the common hormones in excess in abnormalities in pituitary function?

A
  • prolactin
  • GH
  • ACTH
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11
Q

What are the rare hormones in excess in abnormalities in pituitary function?

A
  • TSH
  • LH/FSH
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12
Q

What does HPA stand for

A

Hypothalamic-pituitary-adrenal

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13
Q

What do you do if you think a hormone is too low?

A

Stimulation test

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14
Q

What do you do if you think a hormone is in excess?

A

Suppression test

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15
Q

Adrenal axis tests

A

Deficiency- synacthen test, insulin stress test
Excess- dexamethasone suppression test

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16
Q

GH axis tests

A

Deficiency: insulin stress test
Excess: glucose tolerance test

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17
Q

2 types of prolactin-secreting pituitary tumours

A

Large tumour = macro-adenoma (>1 cm)
Small tumour = micro-adenoma (<1 cm)

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18
Q

How are prolactinomas treated?

A
  • dopamine agonists
  • not operation
    Ensure patient isn’t pregnant
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19
Q

What does dopamine inhibit?

A

Prolactin

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20
Q

What does prolactin inhibit?

A

Luteinising hormone
Ovulation and secretion of sex hormones

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21
Q

Symptoms on hyperprolactinaemia in women

A
  • menstrual disturbance
  • fertility problems - hypogondasim
  • galactorrhea - excessive or inappropriate milk production
  • gynecomastia - hard breast tissue
22
Q

Galactorrhoea meaning and what is it a symptom of?

A
  • excessive/inappropriate milk production
    Hyperprolactinaemia
23
Q

Symptoms of hyperprolactinaemia in men

A
  • present later than women - no periods
  • larger tumours
  • low testosterone - hypogonadism
  • ED
  • may have mass symptoms e.g. visual loss
24
Q

What is Acromegaly
What is it due to?

A
  • Large extremities - Large hands and feet
  • due to GH secreting pituitary adenoma in adults
25
Q

Complications of untreated acromegaly

A
  • premature cardiovascular death
  • irreversible changes in appearance
  • increased risk of thyroid cancer
  • hypertension
  • diabetes
26
Q

Biochemical test to confirm acromegaly

A
  • oral glucose tolerance test with GH response
  • failure to suppress GH
  • elevated IGF-1
27
Q

Treatment of acromegaly

A
  • Surgical removal of tumour
  • Radiation therapy
  • Drugs e.g. dopamine receptor agonsits
28
Q

what causes Cushing’s disease

A

ACTH-secreting pituitary tumour

29
Q

Changes in appearance in Cushing’s disease

A
  • round pink face
  • round abdomen
  • thin skin
  • bruises easily
  • striae/stretch marks
  • osteoporosis- thin bones
  • high BP
    -diabetes
  • skinny arms and legs
30
Q

what is Diabetes insipidus

A

ADH not secreted
Large quantities of pale (insipid) urine

31
Q

Consequences of untreated diabetes inspidus

A
  • every dehydration
  • very high sodium levels
  • reduced consciousness
  • coma
  • death
32
Q

What organ produces IGFs?

A

Liver

33
Q

outline the clinical approach of the investigation of a suspected pituitary tumour

A
  • endocrine function assessment: hormone levels + biopsy of tumour w antibiotics for hormone
  • visual field defects assessment
  • MRI scan
34
Q

what is hypopituitarism often due to?

A

pituitary adenoma > progressive loss of anterior pituitary function

35
Q

what is panhypopoituitarism?

A

deficiency in all anterior pituitary hormones

36
Q

symptoms of gonadotropin deficiency

A

women - infertility, lack of libido, infrequent/no periods
men - ED, lack of libido

37
Q

what is the main consequence of ADH deficiency?

A

diabetes insipidius

38
Q

What is hyperpituitarism?
What is it commonly caused by?

A
  • Excess pituitary hormone production (prolactin, GH + ACTH)
  • due to functional hypersecreting pituitary adenoma
39
Q

what are the three main conditions caused by hyperpituitarism?

A

prolactin excess
GH excess
ACTH excess

40
Q

what is the most common cause of hyperprolactinaemia?
+ physiological causes

A

prolactinoma - pituitary adenoma that secretes prolactin

pregnancy
stress
Suckling
exercise
drugs

41
Q

how does hypogonadism arise from hyperprolactinaemia?

A
  • increased plasma prolactin
  • higher levels of dopamine for negative feedback
  • dopamine inhibits GnRH secretion
  • inhibition of FSH + LH secretion
42
Q

What is a pituitary apoplexy

A

Bleeding into or impaired blood supply of the pituitary gland

43
Q

Symptoms of pituitary apoplexy

A

Sudden onset headache
Double vision
Cardinal nerve palsy
Visual field loss
Hypopituitarism

44
Q

What is the most common causes of pituitary disorders?
Describe this

A

Pituitary adenoma
- benign tumour
- often non functioning (do not produce any hormones) - have negative effect due to pressure exerted

45
Q

Symptoms of ADH deficiency

A

Dehydration
Increased urination
Excessive thirst

46
Q

What hormones are most commonly affected by Hypopituitarism?

A
  • ACTH
  • ADH
  • TSH
  • Growth hormone
  • Gonadotrophin (LH/FSH)
47
Q

What hormones are most commonly affected in hyperpituitarism?

A

Prolactin
Growth hormone
ACTH

48
Q

What can a GH excess cause in childhood vs adulthood?

A

Childhood - gigantism
Adulthood - acromegaly

49
Q

Why can growth hormones excess cause diabetes mellitus?

A

GH antagonises insulin

50
Q

Example of dopamine receptor agonist

A

Cabergoline

MEH (23 decks)

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