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year 2 - endocrine > pituitary disease > Flashcards

pituitary disease Flashcards

1
Q

where is the pituitary gland located

A

dangles down from the hypothalamus and sits in the sella turcica of the sphenoid bone

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2
Q

what hormones are stored in the posterior pituitary

A

ADH and oxytocin

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3
Q

what does ADH do

A

acts to increase water reabsorption by increasing expression of aquaporin channels in the kidney in response to increase serum osmolarity (as a result of decreased water body)

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4
Q

what does oxytocin do

A

aids in the stimulation of uterine contraction and ejection of breast milk during breast feeding

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5
Q

which hypothalamic hormone is involved in the thyroid axis

A

TRH

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6
Q

which hypothalamic hormone is involved in the steroid axis

A

CRH

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7
Q

which hypothalamic hormone is involved in the growth axis

A

GHRH

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8
Q

which hypothalamic hormone is involved in the prolactin axis

A

dopamine

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9
Q

which hypothalamic hormone is involved in the sex axis

A

GRH

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10
Q

which pituitary hormone is involved in the thyroid axis

A

TSH

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11
Q

which pituitary hormone is involved in the steroid axis

A

ACTH

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12
Q

which pituitary hormone is involved in the growth axis

A

growth hormone

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13
Q

which pituitary hormone is involved in the prolactin axis

A

prolactin

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14
Q

which pituitary hormones are involved in the sex axis

A

FSH and LH

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15
Q

what is the target hormone for the thyroid axis

A

T3/T4

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16
Q

what is the target hormone for the steroid axis

A

cortisol

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17
Q

what is the target hormone for the growth axis

A

IGF1

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18
Q

what are the target hormones for the sex axis

A

testosterone, oestrogen and progesterone

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19
Q

what makes prolactin unique (2)

A
  • it is the only one with no target hormone
  • dopamine provides negative control over prolactin release, whereas all of the other hypothalamic hormones stimulate the anterior pituitary
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20
Q

hypopituitarism causes

A

can be isolated to a specific hormone or involve a complete lack of pituitary hormones (pan-hypopituitarism)

hypothalamus causes
- tumour
- infection (TB, meningitis, syphilis)
- genetic (Kallman syndrome, which is isolated deficit of gonadotrophs, associated with absent smell and colour blindness)

pituitary stalk causes
- surgery
- trauma
- carotid artery aneurysm
- tumour (meningioma, craniopharyngioma)

pituitary causes
- irradiation
- non-functioning adenoma
- infiltration (haemochromatosis, amyloid, sarcoid)
- ischaemia

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21
Q

what is Sheehan syndrome

A

pan hypopituitarism due to pituitary ischaemia and necrosis following a post-partum haemorrhage

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22
Q

Sheehan syndrome presentation

A

ischaemia due to bleeding of pituitary tumours

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23
Q

hypopituitarism presentation

A
  • lack of CRH (adrenal insufficiency)
  • absent TSH (hypothyroidism)
  • absent GHRH (central obesity, atherosclerosis, weakness, loss of balance)
  • lack of GRH in females (amenorrhoea, reduced fertility/libido, breast atrophy)
  • lack of GRH in males (erectile dysfunction, reduced libido, reduced muscle bulk, hypogonadism)
  • low blood pressure, can’t lactate if pregnancy, no response to stress
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24
Q

hypopituitarism diagnosis

A
  • static tests: TSH, T3/T4, FSH, LH, testosterone, IGF-1, prolactin
  • short synacthen: adrenal axis and ACTH
  • insulin tolerance test: adrenal and GH axis (should rise in the presence of hypoglycaemia induced by giving insulin)
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25
Q

hypopituitarism management

A
  • find and treat underlying cause
  • manage any hormone deficiencies
26
Q

what size is a microadenoma

A

< 10 mm

27
Q

what size is a macroadenoma

A

> 10 mm

28
Q

most common pitutiary tumour

A

prolactinoma

29
Q

pituitary tumour presentation

A
  • headache
  • visual field disturbance (bitemporal hemianopia due to compression of optic chiasm)
  • hormone symptoms (vary depending on hormone secreted/absent due to tumour)
30
Q

pituitary tumour diagnosis

A
  • hormone tests
  • MRI brain
31
Q

pituitary tumour management

A
  • trans-sphenoidal surgery and possible radiotherapy
  • appropriate hormone replacement or antagonism
32
Q

craniopharyngiomas are most common in

A

5-15 years old, then 60-70 years old

33
Q

what is a craniopharyngioma

A
  • not strictly pituitary tumour
  • tumour of Rathkes pouch (where pituitary originates)
34
Q

craniopharyngioma presentation in children

A

growth retardation

35
Q

craniopharyngioma presentation in adults

A

local mass effect or pituitary dysfunction (usually diabetes insipidus)

36
Q

craniopharyngioma diagnosis

A
  • hormone tests
  • MRI brain
37
Q

craniopharyngioma management

A
  • trans-sphenoidal surgery and possible radiotherapy
  • appropriate hormone replacement or antagonism
38
Q

hyperprolactinaemia physiological causes

A
  • pregnancy
  • breastfeeding
  • stress
39
Q

hyperprolactinaemia pathological causes

A
  • hypothyroidism
  • pituitary tumour (prolactinoma)
  • compression or damage of pituitary stalk (trauma, surgery, tumour)
40
Q

hyperprolactinaemia pharmacological causes

A
  • anti-emetics (metoclopramide, domperidone)
  • anti-psychotics
41
Q

hyperprolactinaemia female presentation

A
  • galactorrhoea
  • reduced libido
  • amenorrhoea
  • oligomenorrhoea
  • infertility
42
Q

hyperprolactinaemia male presentation

A
  • erectile dysfunction
  • reduced facial hair
  • galactorrhoea
  • men tend to have less prominent galactorrhoea and present later, so more likely to experience pressure symptoms from tumour
43
Q

hyperprolactinaemia diagnosis

A
  • bloods: TFTs, prolactin, pregnancy test
  • MRI brain
44
Q

hyperprolactinaemia management

A
  • stop any dopamine drugs
  • 1st line: dopamine agonists (cabergoline, bromocriptine)
  • 2nd line: surgical excision of tumour
45
Q

acromegaly causes

A
  • caused by overproduction of growth hormones in adults, with the resultant disease (gigantism) seen in children
  • most cases caused by GH secreting pituitary tumour (may develop as part of MEN 1)
46
Q

acromegaly presentation

A
  • growth of hands, feet, lower jaw, brow and tongue
  • spade like hands and feet
  • tongue gets almost too big for mouth so can struggle to communicate
  • coarsening of facial features and widening of nose
  • headache, fatigue, sweating, weakness, arthralgia, reduced libido, amenorrhoea, snoring, thick skin
  • frontal bossing
  • symptoms of hypopituitarism or pituitary tumour (headache, bitemporal hemianopia)
47
Q

acromegaly complications

A
  • diabetes (because GH is an insulin antagonist)
  • malignancy (bowel cancer)
  • hypertension, LV hypertrophy and failure, increased risk of ischaemic heart disease, cardiomyopathy
  • prone to arthritis in joints due to overgrowth e.g. knees
  • hepatosplenomegaly due to over-growing of organs
  • increased mortality
48
Q

acromegaly diagnosis

A
  • bloods: increased glucose, calcium, PO4, high GH/IGF1 levels
  • glucose tolerance test (gold standard in diagnosis, should be done if GH/IGF1 levels are high, trying to suppress GH which can’t be done in acromegaly)
  • imaging: MRI pituitary
49
Q

acromegaly first line management

A

surgical excision of pituitary tumour and possible radiotherapy

50
Q

acromegaly second line mangement

A
  • somatostatin analogue (octreotide, sandostatin)
  • dopamine agonist (cabergoline)
  • GH antagonist (pegvisomant)
51
Q

describe the role of somatostatin analogues in acromegaly management

A
  • somatostatin is the natural analogue of GH, with the analogues serving to reduce secretion by providing negative feedback and blocking peripheral action
  • almost immediately relieve headache but take up a year to work
  • able to shrink tumour
  • side effects include GI upset and gallstones
52
Q

describe the role of dopamine agonists in acromegaly management

A

suppress GH secretion but not curative

53
Q

describe the role of GH antagonists in acromegaly management

A
  • block peripheral action of GH
  • don’t shrink tumour
54
Q

what is diabetes insipidus

A
  • passage of large volumes (> 3l) of water per day
  • can occur due to either reduced secretion of ADH or impaired response of the kidney to ADH
55
Q

central diabetes insipidus causes

A
  • occurs due to failure to secrete adequate amounts of ADH
  • idiopathic (most common), genetic, sarcoidosis, pituitary tumours, trauma to pituitary stalk
56
Q

nephrogenic diabetes insipidus causes

A
  • occurs due to kidney’s response to ADH becoming impaired
  • genetic, CKD, lithium, low potassium/high calcium
57
Q

diabetes insipidus presentation

A
  • dehydration
  • polydipsia
  • polyuria (extremely excessive, all consuming)
58
Q

diabetes insipidus diagnosis

A

water deprivation test
- with assessment of urine osmolarity will indicate if body is able to concentrate urine, if not then diabetes insipidus can be diagnosed (osmolality > 600 is indicative)
- two types can be differentiated by giving ADH and rechecking urine osmolarity, with concentration of urine being seen in central, but not nephrogenic

59
Q

central diabetes insipidus management

A

desmopressin (synthetic ADH)

60
Q

nephrogenic diabetes insipidus management

A

thiazide diuretics (generate hyponatraemia and drive water reabsorption)

year 2 - endocrine (6 decks)

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