Pituitary Disorders

Question 1

This deck covers

Answer 1

Hypersecretion disorders:

• Cushing’s Disease
• Hyperprolactinaemia
• Acromegaly

Hyposecretion
including Cranial Diabetes Insipidus

Question 2

What is Acromegaly?

Answer 2

Excess production of Growth Hormone after the long bones fuse (i.e. in adults)

Question 3

How does acromegaly present?

Answer 3

• Enlarged hands/feet (rings dont fit, shoe size increases)
• Coarse facial features
• Thick lips & tongue
• Carpal Tunnel Syndrome
• Sweating

Question 4

What complications can arise from excess GH?

Answer 4

• Headaches
• Chiasmal Compression
• DM
• Hypertension
• Cardiomyopathy
• Sleep Apnoea
• Accelerated Osteoarthritis
• Colonic Polyps & adenoma

Question 5

How would you test someone for Acromegaly?

Answer 5

Visual Field Testing (chiasmal compression –> Bitemporal Hemianopia)

Screen potential patients for IGF-1 Elevation.

Confirm diagnosis with an OGTT, normally glucose loading suppresses GH.

MRI for pituitary tumour

Question 6

What is hyperprolactinaemia?

Answer 6

Excessive prolactin in the blood

Question 7

What can cause hyperprolactinaemia?

Answer 7

Physiological - Pregnancy/lactation/stress

Pharmacological - Dopamine antagonists/oestrogens/antidepressants

Pathological - Primary hypothyroidism or Pituitary tumour

Question 8

How do we classify the scales of prolactinoma?

Answer 8

A microprolactinoma is <10mm

A macroprolactinoma is >10mm

Question 9

How does hyperprolactinaemia present?

Answer 9

Women:

• Galactorrhoea
• Menstrual irregularity
• Infertility

Men:

• Impotence
• Visual field abnormalities
• Headache
• Extraocular muscle weakness
• Other pituitary malfunction
• Eventual galactorhea

Men present later due to less obvious early warning symptoms

Question 10

How do you manage hyperprolactinaemia/ how do you treat?

Answer 10

Test Serum PRL
Elevated? –> Pituitary MRI

Treat

• dopamine agonist: Cabergoline
• TRH replacement therapy
• surgery for prolactinoma if medication does not work.

Question 11

What is the primary management for all pituitary tumours?

Answer 11

Transphenoidal surgery to remove it +/- radiotherapy

Prolactinoma is the only one where we use drugs first

Question 12

What drug therapies are there for acromegaly?

Answer 12

Somatostatin Analogues

GH receptor antagonists

Question 13

What are the signs of hypopituitarism?

Answer 13

Tiredness
Weight gain
Depression
Lost libido
Impotence
Menstrual problems
Skin pallor
Reduced body hair

Question 14

What is Cranial Diabetes Insipidus?

Answer 14

A specific type of hypopituitarism in what there is no vasopressin released.

Question 15

How does CDI present?

Answer 15

No vasopressin means huge amounts of urine and consequent thirst

Risk of dehydration & hypokalemia

Question 16

What causes CDI?

Answer 16

Idiopathic
Trauma to pituitary (incl surgery)
brian tumours pressing on stalk

Question 17

How do we test for CDI?

Answer 17

Water deprivation test

Unlike normal they don’t conserve water, instead they keep pissing buckets.

Question 18

What could a pituitary tumour press on?

Answer 18

• Optic chiasm

- Cavernous sinus nerves

Question 19

What can be another cause for pituitary hypo secretion

Answer 19

Adrenal enzyme deficiency/ congenital adrenal hyperplasia: 21-hydroxylase deficiency

Question 20

What are the pros and cons of somatostatin analogues in acromegaly treatment?

Answer 20

Pros:

• Returns GH and IGF-1 levels to normal
• improves headaches
• Improves soft tissue overgrowth
• improves sweating
• Improves morbidity and mortality
• reduces the size of pituitary tumours.

Cons:

• Very expensive
• slow release: via IM or SC
• Nausea/cramps
• Cholesterol gallstones
• Diarrhoea and flatulence

Question 21

How do you treat for CDI?

Answer 21

• Cortisol
• GH
• Steroids
• Thyroxine