Clinical Aspects of Pituitary Disease

Question 1

When they grow where can pituitary tumours press on?

Answer 1

Optic chiasma

Question 2

What causes acromegaly?

Answer 2

Hypersecretion of GH

Question 3

What causes Cushing’s Disease?

Answer 3

Hypersecretion of ACTH

Question 4

What causes hyperprolactinaemia?

Answer 4

Hypersecretion of prolactin

Question 5

What can there be hyposecretion of from the pituitary?

Answer 5

Anterior - (FSH/LH, GH, ACTH, TSH)

Posterior (vasopressin_

Question 6

What are some clinical features of acromegaly?

Answer 6

Spade like hands 
Wide feet 
Coarse facial features
Thick lips and tongue 
Widening of interdontal spaces 
Carpal tunnel syndrome
Headaches 
Sweating

Question 7

What are some complications of acromegaly?

Answer 7

Headache 
Chiasmal compression 
DM 
Hypertension 
Cardiomyopathy
Sleep apnoea (breathing difficulty when sleeping)
Accelerated osteoarthritis 
Colonic polyps and colonic carcinoma

Question 8

Why is there accelerated osteoarthritis in acromegaly?

Answer 8

Due to the increase in soft tissue there is more pressure on the joints

Question 9

What are the 2 key blood tests for acromegaly?

Answer 9

OGTT

Insulin growth like factor -1 (IGFR-1)

Question 10

What are the further investigations for acromegaly?

Answer 10

CT
MRI
to see if there is any tumour present

Question 11

What is Cushing’s disease?

Answer 11

Excess cortisol from the PG

Question 12

What is Cushing’s syndrome?

Answer 12

Excess cortisol from the adrenal cortex

Question 13

What are high value symptoms of cushing’s syndrome?

Answer 13

Skin atrophy 
Spontaneous purpura 
Proximal myopathy
Osteoporosis 
Growth arrest in children

Question 14

What are intermediate symptoms of cushing’s disease?

Answer 14

Pink striae
Facial mooning & hirsutism
Oedema

Question 15

Are all cases of cushing’s syndrome due to a pituitary tumour?

Answer 15

No

Question 16

What is meant by ACTH dependent cushing’s?

Answer 16

The excess cortisol release is driven by excess ACTH release

Question 17

What is meant by ACTH independent cushing’s?

Answer 17

ACTH is normal

But cortisol is high

Question 18

What can cause excess ACTH?

Answer 18

Pituitary tumour (Cushing's disease)
Ectopic ACTH secretion

Question 19

Give an example of something that can cause ectopic ACTH secretion?

Answer 19

Lung carcinoid

Question 20

What can cause ACTH independent Cushing’s disease?

Answer 20

Adrenal tumour 
Corticosteroid therapy  (using high dosage of steroid for long periods of time)

Question 21

What are the investigations for Cushing’s?

Answer 21

24hr urinary cortisol
Dexamethasone suppression test
MRI - tumours PG?

Question 22

What should DEX suppression test do in normal people?

Answer 22

Lowers the level of cortisol in the body

Question 23

What are clinical manifestations of hyperprolactinaemia in women?

Answer 23

Menstrual irregularity
Infertility
Galactorrhoea (milky nipple discharge)

Question 24

What are the clinical features of hyperprolactinaemia in men?

Answer 24

Galactorrhoea Impotence (inability to achieve an erection)
Visual field abnormalities 
Headache 
Extraocular muscle weakness 
Anterior pituitary malfunction

Question 25

What are physiological causes of prolactinaemia?

Answer 25

Pregnancy Lactation Stress

Question 26

What are some pharmacological causes of prolactinaemia?

Answer 26

DA deplteting | DA antagonist

Question 27

What are some pathological causes of prolactinaemia?

Answer 27

Primary hyperthyroidism | Pituitary lesions

Question 28

Which drugs may cause prolactinaemia?

Answer 28

DA antagonists DA depleting durgs Oestrogens Some anti-depressants

Question 29

What are clinical features of pituitary hypofunction in adults?

Answer 29

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

Question 30

What are clinical features of pituitary hypofunction in children?

Answer 30

Reduced linear growth | Delayed puberty

Question 31

What causes cranial diabetes insipidus?

Answer 31

Lack of vasporessin

Question 32

What can cause Diabetes insipidus?

Answer 32

``` Idiopathic Post trauma Metastatic carcinoma Other brain tumours Rare causes e.g sarcoidosis ```

Question 33

What type of visual loss can a pituitary tumour cause?

Answer 33

Bitemporal hemianopia?

Question 34

If there is a pituitary tumour what is the preferred Rx?

Answer 34

Surgery Transsphenoidal Radiation if surgery is not possible

Question 35

What is the drug treatment for hypersecreting pituitary tumours?

Answer 35

DA agonists Somatostain analogues GH receptor antagonist

Question 36

What is the drug treatment for hyposecreting pituitary tumours?

Answer 36

``` Cortisol T4 Sex steroids GH Desmopressin ```

Question 37

What are the beneficial effects of somatostatin analogues in acromegaly?

Answer 37

Improves soft tissue overgrowth, sweating, headaches, sleep apnoea Normalise GH and IGF-1 in 50% Induce tumours shrinkage in majority

Question 38

What are the side effects of somatostatin analogues in acromegaly?

Answer 38

``` Nausea Cramps Diarrhoea Flatulence Cholesterol gallstones High cost ```

Question 39

What is prolactinoma?

Answer 39

Tumour of the PG secreting Prolactin

Question 40

What is a microprolactinoma?

Answer 40

When prolactinoma is <10mm

Question 41

How is microprolactinoma treated?

Answer 41

Dopamin agonists

Question 42

What are symptoms of microprolactinoma?

Answer 42

Galactorrhoea, Amenorrhoea, infertility & | Serum PRL <5000 mU/l (N<500)

Question 43

What is a macroprolactinoma?

Answer 43

Prolactinoma >10mm

Question 44

What do macroprolactinomas typically respond to?

Answer 44

Dopamine agonists