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Endocrine Pathology > Clinical Aspects of Pituitary Disease > Flashcards

Clinical Aspects of Pituitary Disease Flashcards

1
Q

What does primary refer to?

A

The gland

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2
Q

What does secondary refer to?

A

The pituitary gland

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3
Q

What does tertiary refer to?

A

Releasing hormones from the hypothalamic region acting on the pituitary

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4
Q

Function of parathyroid glands

A

Help to regulate the calcium levels in the blood

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5
Q

What to the adrenal glands help to trigger?

A

The fight or flight response

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6
Q

If there is a lack of hormone at a primary level, the feedback will make the hormone produce LESS or MORE hormones?

A

More

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7
Q

Hypersecretion of GH leads to….

A

Acromegaly

Gigantism

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8
Q

Hypersecretion of ACTH leads to…

A

Cushing’s disease

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9
Q

Hypersecretion of prolactin leads to….

A

Hyperprolactinaemia

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10
Q

What causes hypersecretion of hormones?

A

Tumours

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11
Q

Space occupation of the pituitary gland can lead to what?

A

Optic chiasmal compression

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12
Q

Presentation of acromegaly

A 
Spade like hands
Wide feet / increased shoe size 
Coarse facial features
Thick and large lips and tongue 
Prognathism 
Interdental spaces
Carpal tunnel syndrome
Sweating and oily skin 
Headache 
Chiasmal compression 
DM
HTN
Cardiomyopathy 
Sleep apnoea
Accelerated OA
Colonic polyps and cancer
Features of pituitary tumour
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13
Q

What happens in acromegaly due to the excess GH?

A

Soft tissue overgrowth

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14
Q

Questions to ask yourself if you think it is acromegaly

A 
Can GH be suppressed?
Is IGF-1 elevated?
Is the rest of pituitary function normal?
Is there a pituitary tumour on MRI?
Is vision normal?
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15
Q

Presentation of Cushing’s syndrome

A 
Weakness of skin, muscle and bone
HTN
Heart failure
DM
Skin atrophy 
Spontaneous purpura 
Proximal myopathy 
Osteoporosis 
Growth arrest in children
Pink striae
Facial mooning
hirsutism 
Oedema (non-specific)
Central obesity
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16
Q

Why does cushing’s syndrome cause a lot of weakness?

A

As cortisol is a catabolic hormone

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17
Q

Causes of cushing’s syndrome

A

ACTH dependent
- pituitary tumour (cushings disease)
- Ectopic ACTH secretion (e.g. lung carcinoid)
ACTH independent
- Adrenal tumour (adenoma or carcinoma)
- Corticosteriod therapy (e.g. for asthma, IBD)

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18
Q

Presentation of hyperprolactinaemia in women

A

Galactorrhoea 30-80%
Menstrual irregularity
Infertility

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19
Q

Presentation of hyperprolactinaemia in men

A 
Galactorrhoea < 5%
Impotence
Visual field abnormalities
Headache
Extraocular muscle weakness
Anterior pituitary malfunction
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20
Q

Physiological causes of hyperprolactinaemia

A

Pregnancy
Lactation
Stress

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21
Q

What drugs can cause hyperprolactinaemia?

A

DA depleting and DA antagonistic drugs

  • anti-emetics
  • neuroepileptics
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22
Q

Causes of hyperprolactinaemia

A 
Pregnancy 
Stress
Lactation 
DA depleting/antagonistic drugs 
Primary hypothyroidism 
Pituitary lesions (prolactinoma or pituitary stalk pressure)
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23
Q

Presentation of pituitary hypofunction in adults

A 
Tiredness
Weight gain 
Depression 
Reduced libido 
Impotence
Menstrual problems
Skin pallor
Reduced body hair
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24
Q

Presentation of pituitary hypofunction in children

A

Reduced linear growth

Delayed puberty

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25
Q

What can lack of vasopressin lead to?

A

Diabetes insipidus

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26
Q

What test is done to detect diabetes insipidus?

A

Water deprivation test

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27
Q

Differential diagnosis for cranial diabetes insipidus?

A 
Idiopathic
Post trauma (including pituitary surgery)
Metastatic carcinoma
Craniopharyngioma
Other brain tumours e.g. germinoma
Rare causes e.g. sarcoidosis
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28
Q

What nerves lie in close anatomical relation to the pituitary gland?

A 
Oculomotor 
Trochlear
Opthalmic 
Abducens 
Maxillary
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29
Q

Medical Treatment of a prolactinoma

A

Dopamine agonist

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30
Q

Medical treatment for acromegaly

A

Somatostatin analogues

GH receptor antagonist

31
Q

What does pituitary radiotherapy cause?

A

Hypopituitarism

32
Q

Benefits of somatostatin analogues in acromegaly

A

Improves soft tissue overgrowth, sweating, headache and sleep apnoea in most patients
Normalise GH and IGF-1 levels in over 50% of patients
Induce tumour shrinkage in the majority
Reduce morbidity and mortality

33
Q

What somatostain analogue drugs are used to treat acromegaly and how often are they given?

A

Octreotide and Lanreotide

Monthly injections of slow release

34
Q

Side effects of somatostatin analogues

A 
Nausea
Cramps 
Diarrhoea
Flatulence 
Cholesterol gallstones in 20-30% (mostly asymptomatic)
35
Q

To be classed as a microprolactinoma, what size must it be?

A

< 10mm

36
Q

What is a microprolactinoma treated with?

A

Dopamine agonist

37
Q

To be classed as a macroprolactinoma, what size must it be?

A

> 10mm

38
Q

What is the dopamine agonist used to treat micro-macro prolactinoma?

A

Cabergoline

39
Q

Drugs that affect dopamine

A

Anti-emetics

Anti-psychotics

40
Q

What puts your prolactin up?

A 
Prolactinoma 
Stress
Seizures
Drugs
Pregnancy
41
Q

What visual problem is commonly seen in pituitary problems?

A

Bitemporal hemaniopia

42
Q

What can TRH also interfere with?

A

Prolactin

43
Q

Who commonly gets hyperparathyroidism?

A

Middle aged women

44
Q

What do the levels of FSH/LH do post menopause? Why?

A

They go UP

As less oestrogen for negative feedback

45
Q

What is characteristic about the levels of cortisol?

A

It has a circadian rhythm

46
Q

When is the nadir of cortisol?

A

Midnight

47
Q

When is the peak level of cortisol and what would this be expected to be?

A

> 300

48
Q

What does the synacthen test stimulate?

A

The adrenal gland

49
Q

What can compression of the pituitary stalk lead to?

A

Hyperprolactinaemia

50
Q

What is GH used for in adults?

A

Bone health
Muscle health
Repair

51
Q

What does transsphenoidal mean?

A

Up through the nose

52
Q

What would be measured if suspect acromegaly?

A

IGF-1 (more stable to measure than GH)

Glucose tolerance test

53
Q

Which hormones reduce your sugar?

A

Cortisol

GH

54
Q

What is there an increased risk of with increased GH and therefore what is offered?

A

Bowel cancer

Colonoscopy screening offered

55
Q

If you have more fat, what does this do to your testosterone levels?

A

Lowers them

56
Q

Definition of polycythaemia

A

An abnormally increased concentration of haemoglobin in the blood, either through the reduction of plasma volume or an increase in cell numbers

57
Q

Levels of sex hormones / gonadotrophins in Klinefelters XXY

A

Increased testosterone

Decreased FSH/LH

58
Q

What is the test for Klinfelters?

A

Karyotype for XXY

59
Q

What is testicular feminisation?

A

Rare disorder where born genetically male but genitals may appear between male and female due to the androgen receptors not responding properly

60
Q

What is testicular feminisation also known as?

A

Androgen insensitivity syndrome

61
Q

What is a main side effect when taking testosterone?

A

It thickens the blood

62
Q

What has to be taken into account when taking testosterone in respect to the prostate?

A

Testosterone can make prostate cancer grow

So when older monitor prostate levels

63
Q

What is the haematocrit?

A

The ratio of the volume of red blood cells to the total volume of blood

64
Q

What could be used to treat very “thickened” blood?

A

Blood letting/venesection

65
Q

What is vitamin D’s relationship to calcium?

A

Vitamin D helps to absorb calcium

66
Q

Why do you get excessive sweating and oily skin in acromegaly?

A

Sweat gland hypertrophy

67
Q

What is raised in acromegaly in 1/3rd of cases and therefore presents as what?

A

Prolactin

Galactorrhoea

68
Q

Complications of acromegaly

A

HTN
DM (>10%)
Cardiomyopathy
CRC

69
Q

Investigations of acromegaly

A
  1. Serum IGF-1 levels
  2. Confirmation by lack of suppression of GH following documented hyperglycaemia during an oral glucose load
    Can do an OGTT
    - normal patients = suppressed with hyperglycaemia
    - may demonstrate impaired glucose tolerance which is associated with acromegaly
    Pituitary MRI may show tumour
70
Q

Why can GH not be used as an investigation for acromegaly?

A

GH levels vary during the day

71
Q

1st line management for acromegaly in the majority of patients

A

Transsphenoidal surgery

72
Q

Management of acromegaly

A

Transsphenoidal surgery
Somatostatin analogues
Pegvisomant (GH receptor antagonist)
Dopamine agonists

73
Q

Who can external irridation be used in in acromegaly?

A

Older patient following patients or following failed medical /surgical treatment

74
Q

Treatment for galactorrhoea

A

Bromocriptine

Endocrine Pathology (11 decks)

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