Hypersecretion

Question 1

Which hormones are associated with Hyperpituitary?

Answer 1

It usually only affects 1 hormone at a time-and symptoms are associated with that one
Symptoms common to all are optic chiasm compression (Bitemporal Hemianopia (lose sides of vision))

Question 2

What are the main causes with hyperpituitary?

Answer 2

Often associated with adenomas-can be anywhere along the pathway
But can also have ectopic (like cushings syndrome-lung ectropic adenoma)

Question 3

List the diseases associated with hyperpituiarism

Answer 3

ACTH->Cushings disease
TSH->Thyrotoxicosis
LH/FSH -> precocious puberty
Prolactin-Hyperprolactinomaemia
GH-> Gigantism, Acromegaly

Question 4

When is it normal to have high prolactin? When isn’t it? Why does it matter

Answer 4

Normal: Pregnancy, breasfeating
Abonomral: Prolactinoma (often micro) -most common Pit tumour

Issue: High prolactin suppresses GnRH pulsatility

Question 5

How does hyperprolactinaemia present in people?

Answer 5

In women-galactorrhoae (milk production), secondary amenorrhoa, loss of libido, infertility
In men-Galactorrhoae (rarer cause no oestrogen), loss of libido, erectile dysf, infertility, looks like testo deficiency

Question 6

How is prolactin regulated? How does it help treatment of prolactinadenoma +side effect?

Answer 6

Lactotrophs are under negative regulations by dopamine
Lactotrophs have D2 receptors-Dopamine agonist inhbits prolactin
Easily replace/faked with D2 receptor agonists-reduces tumour size and symptoms (can cause nausea, postural hypotension, depression, Impulse control disorder (patho gambling, hypersexuality)

Question 7

What are the two effects of excess GH and their symptoms?

Answer 7

In children-Gigantism -also many metabolic dysfunctions (diabetes, etc)
In adults-acromegaly (insidious in onset, progress very gradually-but untreated metabolic increase of mortality (CVD, RESP, Cancer)
Both usually caused by pit adenomas

Question 8

What grows in acromegaly? What are the symptoms caused by that?

Answer 8

PReiosteal bone, fibrous tissue and connective
Excress sweat, headache, enlargment of ridges, noses, hands, feet, lips, tomgue, protusion of jaw, carpal tunnerl syndrome

Question 9

What are the metabolic effects of acromegaly?

Answer 9

Excess GH
Normally in response to hypoglycemia
So excess-increased glucose production, less muscle uptake
Also increased insulin production and resistance -> diabetic

ALso high Prolactin-and present with hypergonadism

Question 10

What are the main complications of acromegaly?

Answer 10

Tissue growth can cause obstructive sleep apnea
Hypertesion
Cardiomypathy
Increased cancer risks

Question 11

What are the treatments for Acromegaly?

Answer 11

Surgery-removal of the tumour-1st line
While waiting:
somatostatin analogues-octreotide-endocrine cyanids-gallstones, nausea, diargahea
Dopamine agonits-(tumors often have D2 recept+coexpression of prolactin)-cabergoline (
Radiotherapy

Question 12

What are the diagnosis Methods of acromegaly?

Answer 12

Glucose induced supression of GH normally
so give them large glucose dose, and acromegalic patients have a sharp increase of GH,
Also check IGF-1 serum levels