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BRS YEAR 2 > Endo - Pituitary Tumours > Flashcards

Endo - Pituitary Tumours Flashcards

(61 cards)

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1
Q

What is functioning tumour of somatotrophs called?

A

Acromegaly

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2
Q

What is functioning tumour of lactotrophs called?

A

Prolactinoma

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3
Q

What is functioning tumour of gonadotrophs called?

A

Gonadotrophinoma

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4
Q

What is functioning tumour of thyrotrophs called?

A

TSHoma

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5
Q

What is functioning tumour of corticotrophs called?

A

Corticotroph adenoma

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6
Q

What are the 3 criteria for classifying pituitary tumours?

A

Function
Size
Benign vs malignant

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7
Q

What is a functioning tumour?

A

Secretes excess hormone

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8
Q

What is a non functioning pituitary adenoma?

A

Doesn’t secrete excess

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9
Q

What is a micro adenoma?

A

<1cm

Sellar

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10
Q

What is a macro adenoma?

A

> 1cm

Suprasellar

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11
Q

What other 2 questions do we need to ask when assessing tumour size?

A

Is it compressing on the optic chiasm?

Is it invading the cavernous sinus?

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12
Q

What is the risk when a tumour has invaded the cavernous sinuses?

A

There are to many cranial nerves and the internal carotid therefore removing a tumour in the cavernous sinus is too risky

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13
Q

How do we determine whether a tumour is malignant or benign?

A

Determined by mitotic index by ki67 index - if it is less than 3% then it’s benign

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14
Q

When may a benign tumour have malignant behaviour?

A

For example, if it causing a visual disturbance

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15
Q

Describe the secretion pattern of GnRH

A

Pulsatile

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16
Q

How does hyperprolactinemia cause hypogonadism?

A

Prolactin binds to prolactin receptors on kisspeptin neurones which inhibits the release of GnRh therefore we inhibit the release of FSH and Lh in turn causing T or Oestrogen to fall

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17
Q

What is the commonest functioning pituitary adenoma?

A

Prolactinoma

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18
Q

What is the normal range of prolactin?

A

<300 M mU/L

<600 F mU/L

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19
Q

What is the prolactin level in a prolactinoma?

A

> 5000 mU/L

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20
Q

What increases serum prolactin?

A

Increase in tumour size

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21
Q

What is the presentation in a prolactinoma?

A 
Menstrual disturbance 
Erectile dysfunction 
Low libido 
Galactorrhoea 
Subfertility
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22
Q

What are the 3 classes of causes for hyperprolactinemia?

A

Physiological
Pathological
Iatrogenic

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23
Q

What are physiological causes of increased PRL?

A

Prengancy/breast feeding
Stress: exercise, seizure, venepuncture
Nipple/chest wall stimulation

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24
Q

What are the pathological causes of increased PRL?

A

Primary hypothyroidism
PCOS
Chronic renal failure (PRL not excreted properly)

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25
What are the iatrogenic causes of increased PRL?
``` Anti-psychotic SSRI Anti-emetics High dose oestrogen Opiates ```
26
When should we consider other differentials aside from prolactinoma when looking at an increased PRL?
When we have confirmed it is a true elevation not a false positive If there are not 2 clinical features of prolactinoma and we've checked the drug chart
27
What do we consider after ruling out PRL?
Macroprolactin | Stress to venepuncture
28
What is macroprolactin?
Most prolactin is monomeric however in some people PRL will clump together and stick to IgG therefore during a blood test this will show up as high PRL - benign blood test error
29
What is the stress response to venepuncture?
Prolactin secreted in response to stress therefore we take patient to a relaxing unit and place needle in their arm for a long period, measuring PRL every 20 minutes waiting for PRL to fall
30
What should we do if we have rules out macroprolactin and stress for venepuncture?
Order a pituitary MRI
31
What is the first line treatment for prolactinoma?
DA receptor agonist such as cabergoline to normalise serum prolactin
32
Is cabergoline safe fro pregnant women?
Yes
33
When do we increase the dose of cabergoline?
When there is a bigger tumour
34
How does cabergoline work?
Binds to D2 receptors on lactotrophs therefore stimulates the inhibitory effect they have on PRL secretion, and there is less PRL secretion
35
What do we call a functioning Gh tumour in children?
Gigantism
36
What do we call a functioning GH tumour in adults?
Acromegaly
37
What is the onset of acromegaly and how does this affect its presentation as a tumour?
Insidious onset (10 years) therefore often reveals as a big tumour
38
What are the symptoms of acromegaly?
``` Sweatiness Headache Coarsening of facial features Spade like hands due to increased soft tissue size Large jaw (prognathism) Increase in foot and hand size Snoring/OSA Hypertension Impaired glucose tolerance/ diabetes mellitus ```
39
How does acromegaly cause headaches?
Due to IGF-1/GH behaviour, not because of tumour size
40
Why do we not measure GH to diagnose acromegaly?
GH is too pulsatile
41
How do we diagnose acromegaly?
Increased IGF-1 serum level with failed suppression test after 75g glucose load, instead a paradoxical rise is seen
42
What may we also see in acromegaly patients in terms of other hormones?
Increase in prolactin
43
What should we do after confirming excess GH?
Pituitary MRI
44
What is the first line treatment for acromegaly?
Surgery: trans-sphenoidal pituitary surgery due to increased CVD risk
45
What should we do prior to acromegaly surgery?
Somatostatin analogue e.g. ocreotide injection
46
What is a side effect of octreotide injection?
Endocrine cyanide therefore can disturb gut enzymes to cause diarrhoea
47
Why do GH tumours co-secrete PRL?
Some GH tumours have D2 receptors
48
When else may drugs be used for a GH tumour?
If surgical resection is incomplete
49
What is the con of using radiotherapy for Gh tumour?
Slow
50
What happens in Cushings syndrome?
Too much cortisol
51
What is the difference between Cushing's syndrome and disease?
Cushing's syndrome is when there is too much cortisol from any cause Cushing's disease is when there is a tumour causing increased ACTH therefore increased cortisol
52
What are the causes of Cushing's syndrome?
Too much steroids | Adrenal adenoma
53
What are the causes of Cushing's disease?
Corticotroph adenoma | Ectopic ACTH e.g. from lung cancer
54
How do we show Cushing's on a test?
We want to demonstrate that we have either lost diurnal cortisol rhythm or we can show that we have produced too much cortisol over a 24 hours period
55
Where can we test for cortisol?
Can be tested for in the saliva or the blood
56
What can we use to try and suppress cortisol?
We can give oral dexamethasone which is an exogenous glucocorticoid
57
What should we do once hypercortisolism is confirmed?
Measure ACTH - if that is high then we order a pituitary MRI
58
What do non functioning pituitary adenomas secrete?
They do not secrete any specific hormone
59
What do non functioning pituitary adenomas cause?
Often cause a visual disturbance such as bitemporal hemianopia
60
What may non functioning pituitary adenomas cause?
As they get larger they may disrupt the stalk and thus cause hypopituitarism
61
What is an exception to adenomas causing hypopituitarism?
Inhibitory dopamine won't be able to travel down the stalk therefore we may get hyperprolactinemia

BRS YEAR 2 (37 decks)

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