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Endocrine > Pituitary disease/tumours > Flashcards

Pituitary disease/tumours Flashcards

1
Q

Where is the optic chiasm in relation to the pituitary gland?

A

optic chiasm is above pituitary gland

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2
Q

How do pituitary masses cause chiasmal visual problems?

A

suprasellar pituitary masses grow up and compress the optic chiasm
causes bitemporal hemianopia

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3
Q

What does the pituitary gland do?

A

master gland in charge of other glands:
- thyroid
- adrenals
- ovaries/testes

has effect on breast milk production, growth and fluid balance

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4
Q

ACTH function

A

stimulates production/secretion of glucocorticoids from adrenal cortex

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5
Q

TSH function

A

stimulates production/secretion of thyroid hormones

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6
Q

What hormones does the anterior pituitary gland secrete?

A

ACTH
TSH
LH/FSH
PRL (prolactin)
GH

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7
Q

What hormone stimulates the release of ACTH?

A

CRH (corticotrophin releasing hormone)

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8
Q

What hormone stimulates the release of TSH?

A

TRH (thyrotrophin releasing hormone)

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9
Q

What hormone stimulates the release of LH/FSH?

A

GnRH (gonadotrophin releasing hormone)

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10
Q

What hormone stimulates the release of GH?

A

GHRH (growth hormone releasing hormone)

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11
Q

What inhibits growth hormone?

A

somatostatin

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12
Q

What inhibits prolactin?

A

dopamine

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13
Q

Hypopituitarism causes

A

Infective
Vascular - pituitary apoplexy, Sheehan’s
Immunological - antibodies
Neoplastic
Traumatic - skull fracture
Infiltration
Radiation damage
Empty sella syndrome
Functional - anorexia nervosa, starvation, emotional deprivation

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14
Q

What is gigantism?

A

excessive growth hormone before epiphyseal fusion (children)

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15
Q

What is acromegaly?

A

excessive growth hormone after epiphyseal fusion - will not get very tall as bones already fused

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16
Q

What are the new names for diabetes insipidus (cranial + nephrogenic)?

A

AVP deficiency = cranial DI
AVP resistance = nephrogenic DI

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17
Q

What is given when prolactin levels are high? (eg. in a prolactinoma)

A

dopamine agonist

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18
Q

When are cortisol levels measured?

A

9am if normal circadian rhythm (need to adjust for night shift workers)

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19
Q

When are testosterone levels measured?

A

9am
testosterone levels highest in morning + drops during day
should be fasted -> meals can lower testosterone

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20
Q

What type of test should be done if you are suspecting hormone excess?

A

suppression test

21
Q

What type of test should you do if you are suspecting hormone deficiency?

A

stimulation test

22
Q

Addison’s diagnostic test

A

ACTH stimulation

23
Q

Cushing’s diagnostic test

A

dexamethasone suppression

24
Q

Acromegaly diagnostic test

A

OGTT

25
Q

Why can cortisol levels not be measured if a patient is on the contraceptive pill?

A

contraceptive pills increase cortisol binding globulin so cortisol levels could look high when they’re not

need to be off pill 6 weeks before measurement

26
Q

What drugs affect prolactin levels?

A

antipsychotics
metoclopramide

26
Q

Treatment of non-functioning pituitary tumours

A

lost hormones need to be replaced: cortisol must be replaced that day
surgery for tumours that are growing or causing mass effect
pituitary radiotherapy - helps reduce recurrence rate

27
Q

What is synthetic vasopressin?

A

desmopressin

28
Q

Name functioning tumours of the pituitary gland in order of incidence

A

prolactinoma
acromegaly
Cushing’s
TSHoma
GNoma

29
Q

What is meant by the term functioning tumour?

A

produce hormones

30
Q

What is prolactinoma a tumour of?

A

lactotroph cells

31
Q

Macroprolactinoma size

A

> 1cm

32
Q

Do prolactinomas need surgery?

A

no
very responsive to dopamine agonists

33
Q

What causes acromegaly?

A

tumour of somatotroph cells producing GH

34
Q

Acromegaly symptoms and possible complications

A

gigantism - pre-puberty
post-puberty:
- sweating
- swelling
- growth of soft tissues

increased mortality, vascular disease, cardiomyopathy, respiratory disease, OA, malignancy and colonic polyps, sleep apnoea

35
Q

Acromegaly treatment

A

pituitary surgery (macroadenoma)
pituitary irradiation
long-acting somatostatin analogues
if mild/co-secrete PRL - dopamine agonists eg. cabergoline
IGF1 receptor antagonists

36
Q

What causes Cushing’s disease?

A

corticotroph adenoma
leads to increased ACTH, loss of diurnal rhythm and increase in adrenal cortisol production

37
Q

Cushing’s disease symptoms

A

central obesity
abdominal striae
thin skin
proximal myopathy
hypertension
osteoporosis
impaired glucose tolerance/diabetes
depression

38
Q

What is the difference between Cushing’s disease and Cushing’s syndrome?

A

Cushing disease occurs when Cushing syndrome is caused by an ACTH-producing pituitary tumor, whereas Cushing syndrome is the set of symptoms that results when there is a surplus of cortisol in the body

39
Q

How is Cushing’s syndrome diagnosed?

A

24h urinary free cortisol x2

low dose dexamethasone suppression test

midnight cortisols + plasma ACTH levels
CT adrenals
MRI pituitary
Inferior petrosal sinus sampling

40
Q

Treatment of Cushing’s disease?

A

pituitary surgery if you can locate a pituitary tumour

adrenal surgery if emergency, or very difficult to control disease

pituitary irradiation after surgery if not cured

drugs to prepare for surgery/waiting for radiotherapy to be effective:
- metyrapone, ketoconazole - block adrenal steroid production

treat complications - eg. diabetes, hypertension, hypopituitarism

41
Q

What is pituitary apoplexy?

A

sudden bleed into an existing pituitary tumour

42
Q

Pituitary apoplexy symptoms

A

sudden headache
vomiting
collapse
visual field loss
ophthalmoplegia

43
Q

How does the posterior pituitary appear on MRI?

A

bright spot - physiological
(if anterior pituitary is bright this is pathological)

44
Q

What does the posterior pituitary produce?

A

ADH (antidiuretic hormone)
oxytocin

45
Q

Diabetes insipidus symptoms

A

insatiable thirst
polyuria (cannot concentrate urine)

46
Q

How is diabetes insipidus diagnosed?

A

plasma and urine osmolalities - inappropriately dilute urine
water deprivation test if doubt remains

47
Q

Diabetes insipidus treatment

A

intranasal or oral desmopressin at night

Endocrine (21 decks)

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