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BRS2 Endocrinology > Hypopituitarism > Flashcards

Hypopituitarism Flashcards

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1
Q

Name the anterior pituitary hormones

A
  1. GH
  2. Prolactin
  3. ACTH
  4. TSH
  5. LH
  6. FSH
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2
Q

What are the cells producing GH called?

A

Somatotrophs

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3
Q

What are the cells producing prolactin called?

A

Lactotrophs

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4
Q

What are the cells producing TSH called?

A

Thyrotrophs

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5
Q

What are the cells producing ACTH called?

A

Corticotrophs

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6
Q

What are the cells producing LH and FSH called?

A

Gonadotrophs

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7
Q

Which circulatory system do hypothalamic releasing or inhibitory factors travel in to regulate anterior pituitary hormone production?

A

Hypothalamo-hypophysial portal system

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8
Q

Production of which hormones could be compromised due to the gland itself failing (primary) or a regulatory organ failing (secondary)?

A

Thyroid - T3, T4
Adrenal Cortex - Cortisol
Gonads - LH, FSH

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9
Q

Production of which hormones could be compromised due to the gland itself failing (primary) or a regulatory organ failing (secondary)?

A

Thyroid - T3, T4
Adrenal Cortex - Cortisol
Gonads - LH, FSH

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10
Q

Cause of primary hypothyroidism

A

Hashimoto’s disease (autoimmune condition)

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11
Q

Most common cause of secondary hypothyroidism

A

Pituitary tumour (affecting tyrotrophs)

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12
Q

Which adrenal hormone is regulated by ACTH?

A

Cortisol

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13
Q

How are the T3, T4 and TSH levels affected in primary hypothyroidism?

A

T3, T4 fall
TSH increases

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14
Q

How are the T3, T4 and TSH levels affected in secondary hypothyroidism?

A

TSH falls
T3, T4 fall

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15
Q

How are the Cortisol and ACTH levels affected in primary hypoadrenalism?

A

Cortisol falls
ACTH increases

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16
Q

How are the Cortisol and ACTH levels affected in secondary hypoadrenalism?

A

ACTH falls
Cortisol falls

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17
Q

How are the testosterone (males), oestrogen (females), LH and FSH levels affected in primary hypogonadism?

A

Testosterone or Oestrogen fall
LH and FSH increase

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18
Q

How are the testosterone (males), oestrogen (females), LH and FSH levels affected in secondary hypogonadism?

A

LH and FSH fall
Testosterone or Oestrogen fall

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19
Q

What are the 2 types of hypopituitarism?

A

Congenital and Acquired

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20
Q

Which type of hypopituitarism is more common?

A

Acquired

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21
Q

Which type of hypopituitarism is characterised by GH deficiency and at least 1 more pituitary hormone?

A

Congenital

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22
Q

Short stature and hypoplastic anterior pituitary gland on MRI are related with which type of hypopituitarism?

A

Congenital

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23
Q

Pituitary adenomas, radiation damage to the pituitary, meningitis cause which type of hypopituitarism?

A

Acquired

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24
Q

What is the term used for total loss of anterior and posterior pituitary function?

A

Panhypopituitarism

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25
Which anterior pituitary hormones are most sensitive to radiotherapy?
GH and gonadotrophins
26
How long after radiotherapy does the risk of pituitary damage persist?
Up to 10 years after
27
What are the symptoms presented by reduced levels of FSH and LH?
* Reduced libido * Secondary amenorrhoea * Erectile dysfunction * Less pubic hair
28
What is the symptom presented by reduced levels of TSH?
Fatigue
29
What is the symptom presented by reduced levels of ACTH?
Fatigue
30
What are the symptoms presented by reduced levels of GH?
* Reduced quality of life * Short stature in children
31
What is the symptom presented by reduced levels of prolactin?
Inability to breastfeed
32
What is the condition causing post-partum hypopituitarism secondary to hypotension called?
Sheehan's Syndrome
33
Why is Sheehan's Syndrome secondary to hypotension?
1. Hypotension caused by post-partum haemorrhage 2. PPH leads to pituitary infarction
34
Why does the anterior pituitary enlarge during pregnancy?
Lactotroph hyperplasia
35
What are the symptoms presented with Sheehan's Syndorme?
* Lethargy, anorexia, weight loss - TSH/ACTH/GH deficiency * Failure of lactation - PRL deficiency * Failure to resume menses post-delivery
36
What causes pituitary apoplexy?
Bleeding (haemorrgae) into the pituitary
37
What may be the first presentation of pituitary adenoma?
Pituitary apoplexy
38
How would we treat pituitary apoplexy?
Anti-coagulants (blood thinners)
39
What are the main symptoms of pituitary apoplexy?
Severe sudden onset headache Visual field defect
40
What does cavernous sinus involvement in pituitary apoplexy lead to?
Diplopia (IV, VI) or Ptosis (III)
41
What causes the visual field defect in pituitary apoplexy or pituitary adenoma?
Compressed optic chiasm
42
What is the term given for the visual defect in pituitary apoplexy or adenoma?
Bitemporal hemianopia
43
Which conditions present with bitemporal hemianopia?
Pituitary apoplexy and pituitary adenoma
44
What are the stress hormones released by anterior pituitary?
GH and ACTH
45
What are the stress hormones released by anterior pituitary?
GH and ACTH
46
What does the “stress” in stress hormones indicate?
Insulin induced hypoglycaemia (<2.2mM)
47
How is hypopituitarism diagnosed?
Dynamic pituitary function test (Biochemical) Pituitary MRI (Radiological)
48
Which hormone stimulates TSH release?
TRH (Tyrotroph Releasing Hormone)
49
Which hormone stimulates LH/FSH release?
GnRH (Gonadotrophin Releasing Hormone)
50
When should cortisol level be checked and why?
Early in the morning as cortisol has a diurnal rhythm
51
Which anterior pituitary hormone axis does not need hormone replacement?
Prolactin
52
How is GH deficiency treated?
Daily injections (not oral)
53
How is response to GH replacement measured?
QoL Assesment Plasma IGF-1
54
How is TSH deficiency treated?
Levothyroxine - once a day
55
How is response to TSH deficiency treatment measured?
fT4 above the middle of reference range (TSH levels won't indicate anything)
56
How is ACTH deficiency treated?
Either: Prednisolone - once a day AM (e.g 3mg) or Hydrocortisone - 3 times a day (10/5/5mg)
57
What is the difference between prednisone and prednisolone?
* Prednisone is a prodrug, which is converted into prednisolone in the liver. * Prednisolone is the active drug and particularly prescribed to patients with liver dysfunction.
58
Who is at risk of adrenal crisis?
Primary or secondary hypoadrenalism patients
59
What is adrenal crisis triggered by?
Triggered by an intercurrent illness (in patients with hypoadrenalism)
60
What are the symptoms of adrenal crisis?
* Dizziness * Hypotension * Vomiting * Weakness * Potential collapse and death
61
What is the purpose of sick day rules for patients with adrenal insufficiency?
To prevent collapse and death during adrenal crisis
62
What are the sick day rules for patients with adrenal insufficiency?
* Steroid alert bracelet * Double the glucocortocoid dose if fever/ illness * Inject IM or come to A&E if unable to take oral tablets due to vomiting
63
How is FSH/LH deficiency treated in men with **no** fertility required?
Topical or IM testosterone
64
How is FSH/LH deficiency treated in men with fertility required?
Gonadotropin injections
65
Why does testosterone replacement not provide fertility?
Sperm production is dependent on LH and FSH
66
How is response to gonadotropin replacement in men measured?
Testosterone levels measured Semen analysis
67
How is FSH/LH deficiency treated in women with no fertility required?
Oral or topical oestrogen Additional progesterone if uterus is intact
68
Why is the additional progesterone needed in oestrogen replacement therapy if uterus is intact?
To prevent endometrial hyperplasia
69
How is FSH/LH deficiency treated in women with fertility required?
* Ovulation can be induced by carefully timed gonadotropin injections * Possibly IVF

BRS2 Endocrinology (3 decks)

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