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Endo yr 2 > hypopituitarism > Flashcards

hypopituitarism Flashcards

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1
Q

hormones secreted by anterior pituitary

A

growth hormone, prolactin, LH, FSH, TSH, ACTH

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2
Q

Hormone stimulated by growth hormone

A

somatotrophin

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3
Q

hormone stimulated by TSH

A

thyrotrophin

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4
Q

hormone stimulated by ACTH

A

corticotrophin

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5
Q

what happens to pituitary during pregnancy?

A

anterior pituitary (specifically lactotroph ) gets bigger (hyperplasia) and blood supply doesn’t grow accordingly (increased risk when trauma ect.)

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6
Q

how does hypothalamus communicate with anterior pituitary?

A

portal circulation

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7
Q

what is the only anterior pit hormone regulated negatively (inhibited) and by what hormone?

A

prolactin by dopamine

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8
Q

what is primary vs secondary gland failure?

A

gland fails: primary, pituitary or hypothalamus fails; secondary

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9
Q

give most common cause of primary and secondary gland failure

A

1: autoimmune (last year) , 2: tumour in pituitary or hypothalamus

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10
Q

what happens to TSH and t3 / t4 levels in primary hypothyroidism?

A

TSH goes up and t3/t4 goes down

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11
Q

what is TRH and where is it released from?

A

thyrotropin releasing hormone from hypothalamus

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12
Q

what happens to TSH and t3 / t4 levels in secondary hypothyroidism?

A

tsh goes down and t3 t4 also go down

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13
Q

which hormone(s) stimulates cortisol?

A

ACTH from pituitary gland

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14
Q

what happens to aldosterone levels in primary and secondary hypoadrenalism?

A

not affected because aldosterone is stimulated by renin-angiotensin NOT from pituitary gland

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15
Q

what is primary hypoadrenalism also known as?

A

adisons disease

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16
Q

most common cause of primary hypoadrenalism

A

autoimmune

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17
Q

what happens in primary hypoadrenalism

A

destruction of adrenal cortex

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18
Q

what happens to cortisol and ACTH levels in primary hypoadrenalism?

A

acth up and cortisol down

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19
Q

what happens to cortisol and ACTH levels in secondary hypoadrenalism?

A

both down

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20
Q

most common cause of secondary hypoadrenalism

A

pituitary tumour

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21
Q

common cause of primary hypogonadism in females

A

chemotherapy causing destruction of ovaries

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22
Q

common cause of primary hypogonadism in males

A

mumps

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23
Q

levels of LH, FSH, testosterone, oestrogen in secondary hypogonadism

A

all down

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24
Q

causes of hypopituitarism

A

congenital or acquired

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25
is congenital or acquired hypopituitarism more common?
acquired
26
problem behind congenital hypopituitarism?
mutations of transcription factor genes needed for anterior pituitary development
27
what hormonal and growth deficiencies are seen in congenital hypopituitarism?
GH and at least 1 more anterior pit hormone and short stature
28
what is seen on MRI of hypopituitarism
hypoplastic (underdeveloped) anterior pituitary gland
29
does the term hypopituitarism more commonly refer to anterior dysfuncrtion, posterior or both?
usually anterior
30
in what cases does hypopituitarism also affect the posterior pituitary? (and so in these cases the term is used for that posterior dysfunction too)
inflammation (hypophysitis) or surgery
31
what is total loss of anterior and posterior pit function?
panhypopituitarism
32
WHAT ARE 8 causes of acquired hypopituitarism?
Tumours eg adenomas, metastases, cysts Radiation (hypothalamic/pituitary damage) Infection eg meningitis Traumatic brain injury Pituitary surgery Inflammatory (hypophysitis) Pituitary apoplexy - haemorrhage (or less commonly infarction) Peri-partum infarction (Sheehan’s syndrome)
33
what parts of the HPA axis are sensitive to radiotherapy?
hypothalamus and pituitary
34
what pituitary cells and equivalent hormone are most sensitive to radiotherapy?
GH and gonadotrophin
35
what do doctors need to do when giving radiotherapy to ensure HPA axis health and why?
annual assessment for up to 10 years later bc radiotherapy kills DNA so rapidly growing cells die fast but slow growing cells: brain cells so pituitary cells may take up to 10 yrs
36
FSH LH related presentations of hypopituitarism in both genders
reduced pubic hair reduced libido
37
FSH LH related presentations of hypopituitarism in females
secondary amenorrhoea
38
FSH LH related presentations of hypopituitarism in males
erectile dysfunction
39
ACTH related presentations of hypopituitarism
fatigue (note) NOT a salt losing crisis (renin- angiotensin)
40
TSH related presentations of hypopituitarism
FATIGUE
41
GH related presentations of hypopituitarism
Reduced quality of life NB short stature only in children
42
Prolactin related presentations of hypopituitarism
inability to breastfeed
43
some emphasised presentations in specifically Sheehans syndrome (post party hypopit)
anorexia, weight loss, lethargy (ACTH, TSH, (GH)) AMMENORHEA after delivery not lactating
44
is posterior pit common involved in Sheehans?
no
45
What is the best radiological way to visualise the pituitary gland and why?
MRI: tumor and soft tissue, may reveal specific pit pathology (apoplexy, adenoma ect) (CT not so good at delineating pit gland)
46
what is an empty sella and how serious?
After tumour is gone pituitary is squished and theres empty space but they are COMPLETELY FINE ( if they can make the horm- you test for them) you just need to reassure them
47
what is pituitary apoplexy?
bleeding into the pituitary
48
who more commonly gets pituitary apoplexy?
people with pre existing pituitary adenomas (tumours) (might not be known)
49
what is a pituitary adenoma? (is it common is it serious?)
usually benign tumour, 1/5 people have one that doesn't even matter and hasn't been diagnosed
50
how can pituitary apoplexy be solved?
anti coagulants (blood thinners)
51
symptoms of pituitary apoplexy?
severe sudden onset headache visual field defect (compressed optic chiasm, bitemporal hemianopia cavernous sinus (vein thing remember?) involvement may lead to diplopia (IV, VI), ptosis (III)
52
what to consider when measuring cortisol in blood to diagnose hypopit?
time of day
53
what to consider when measuring T4 in blood to diagnose hypopit?
circulating t1/2 6 days
54
what to consider when measuring FSH/LH in blood to diagnose hypopit?
cyclical in women
55
what to consider when measuring GH/ ACTH in blood to diagnose hypopit?
pulsatle
56
what's a better way to test for hypopit since pit hormones are pulsatile and dynamic?
1)cause a stress effect by inducing hypoglycaemia (<2.2mM). 2)this stimulates GH and ACTH release 3) acth stimulates cortisol which is the thing measured
57
Treatment of GH deficiency 2 non invasive
Assess Quality of Life (QoL) using NICE guidance specific questionnaire
58
Treatment of GH deficiency 2 invasive
Confirm GH deficiency on dynamic pituitary function test Daily injection (no oral option)
59
how to measure response to GH treatment
improvement in QoL plasma IGF-1
60
what replacement is given in Treatment of TSH deficiency
levothyroxine
61
what Dif is there in treatment for TSH def as a result of hypopit compared to primary hypothyroidism?
1) you can't measure TSH to adjust the dose of levothyroxine given
62
what t4 level should you aim for in replacement therapy? (since u can't measure tsh u measure this)
above middle of reference range
63
what hormone is replaced in Treatment of ACTH deficiency
cortisol
64
what are the 2 replacement option drugs in Treatment of ACTH deficiency
Prednisolone once daily AM eg 3mg Hydrocortisone three times per day eg 10mg/5mg/5mg
65
what is adrenal crisis?
patients with primary or secondary adrenal failure can get this when they are ill with smith (any common stuff)
66
adrenal crisis features
dizziness, hypotension, vomiting, weakness, collapse, even rarely death
67
what do adrenal failure patients (ppl taking steroid replacements) need to do when ill?
wear steroid bracelet take double dose of their steroid (go to A &E or inject themselves if they are vommiting and can't take oral steroid)
68
why do they need this when ill?
body is in extra stress, they lack cortisol: stress responce hormone, they need to manage the stress
69
Treatment of FSH/LH deficiency - men
Replace testosterone – topical (put on skin and is absorbed) or intramuscular most popular
70
Treatment of FSH/LH deficiency - men check for efficiency
Measure plasma testosterone
71
can testosterone replacement help fertility?
no, Replacing testosterone does not restore sperm production
72
why Replacing testosterone does not restore sperm production
(this is dependent on FSH)
73
alternativeTreatment of FSH/LH deficiency - men for fertility ?
induction of spermatogenesis by gonadotropin injections
74
when best responce to gonadotropin injections in men?
if secondary hypogonadism has developed after puberty
75
gonadotropin injection check for efficiency
Measure testosterone and semen analysis
76
how long dies sperm prod take with gonadotropin injections and what does this mean for when u need to get it?
Sperm production may take 6-12 months ( need to do it around a year before kids)
77
Treatment of FSH/LH deficiency - women- no fertility - what is replaced and how?
oestrogen oral or topical
78
what extra is required for oestrogen replacement?
Will need additional progestogen if intact uterus to prevent endometrial hyperplasia (cancer)
79
Treatment of FSH/LH deficiency - women- fertility yes
Can induce ovulation by carefully timed gonadotropin injections (IVF)
80
Which anterior pituitary hormone axis does not need hormone replacement for everyone and why?
prolactin bc not everyone needs to breastfeed lol

Endo yr 2 (11 decks)

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