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Endocrinology 2 > Hypopituitarism > Flashcards

Hypopituitarism Flashcards

1
Q

what are the 6 hormones released by the anterior pituitary?

A
  • growth hormone
  • prolactin
  • thyroid stimulating hormone
  • luteinising hormone
  • follicle-stimulating hormone
  • adrenocorticotrophic hormone
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2
Q

name 2 causes of acquired hypopituitarism

A
  • tumours
  • radiation
  • infection eg. meningitis
  • traumatic brain injury
  • pituitary surgery
  • inflammatory (hypophysitis)
  • pituitary apoplexy
  • post-partum infarction
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3
Q

what is the name given to total loss of anterior and posterior pituitary function?

A

panhypopituitarism

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4
Q

which anterior pituitary hormones are most sensitive to radiotherapy?

A

gonadotrophins and GH

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5
Q

which hormone can increase after radiotherapy?

A

Prolactin due to loss of hypothalamic dopamine

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6
Q

when the gland itself is not working we call that?

A

primary failure

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7
Q

when the pituitary is not working, we call that?

A

secondary failure

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8
Q

In primary hypothyroidism, what would happen to TSH and fT4?

A
  • TSH high
  • fT4 low
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9
Q

In secondary hypothyroidism, what would happen to TSH and fT4?

A
  • TSH low
  • fT4 low
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10
Q

In primary hypoadrenalism, what would happen to cortisol and ACTH?

A
  • cortisol low
  • ACTH high
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11
Q

In secondary hypoadrenalism, what would happen to cortisol and ACTH?

A
  • low cortisol
  • low ACTH
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12
Q

In primary hypogonadism, what would happen to testosterone/oestrogen and LH/FSH

A
  • testosterone/oestrogen low
  • LH/FSH high
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13
Q

In secondary hypogonadism, what would happen to oestrogen/testosterone and LH/FSH

A
  • oestrogen/testosterone low
  • LH/FSH low
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14
Q

Why do we have to be aware of what time of day we test cortisol?

A

diurnal rythm

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15
Q

why do we have to pay attention to the 6-day half-life of T4?

A

there could be a delayed decrease in T4 shown in the blood

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16
Q

what do we need to consider when testing hypogonadism in women?

A

FSH and LH are cyclically released in women

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17
Q

why do we need to be careful when testing GH and ACTH?

A

they are pulsatile

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18
Q

How do we dynamically test ACTH, GH, TSH and FSH/LH?

A
  1. ACTH and GH are stress hormones –> put body into insulin induced hypoglycaemia –> should stimulate production of GH and cortisol if healthy
  2. Give TRH to stimulate TSH release if healthy
  3. GnRH to stimulate FSH + LH release if healthy
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19
Q

Treatment for growth hormone?

A
  1. Confirm deficiency
  2. assess QoL
  3. daily injection GH
  4. measure response by improved QoL and plasma IGF-1
20
Q

how do we treat TSH deficiency?

A

levothyroxine, once daily

aim for fT4 in middle of the reference range

21
Q

When treating TSH deficiency (secondary hypothyroidism) why do we aim for fT4 in middle of reference range?

A

Can’t use TSH levels to adjust, as TSH is the problem

22
Q

treatment for ACTH deficiency

A

Synthetic glucocorticoids:

  • prednisolone once daily AM
  • hydrocortisone 3x per day
23
Q

What is an adrenal crisis?

A

severe symptoms that can result in collapse and death due to intercurrent illness or not taking medication for hypoadrenalism

24
Q

why is adrenal crisis less severe in secondary hypoadrenalism patients?

A

they can still make aldosterone, as their adrenal cortex is not destroyed, so don’t have hypotension

25
Q

what are the sick day rules?

A
  1. steroid alert pendant/bracelet
  2. double steroid dose if fever/intercurrent illness
  3. If unable to take tablets (vomiting) inject IM or come to A&E
26
Q

What is the treatment for men with LH/FSH deficiency, fertility required?

A
  • inject FSH and LH to stimulate sperm production
27
Q

how long does it take for sperm production to occur after FSH and LH injection?

A

6-12 months

28
Q

what is the treatment for LH/FSH deficiency in men if no fertility is required?

A

Topical/IM injection of testosterone

29
Q

what would give the best response of FSH and LH treatment in men?

A

If hypogonadism developed after puberty

30
Q

How would you check for progress when giving LH and FSH treatment to men?

A

measure testosterone and semen analysis

31
Q

If no fertility is required, what treatment would you give to women with FSH and LH deficiency?

A

replace oestrogen and give progestogen if uterus intact

32
Q

If fertility is required for women, how would you treat LH and FSH deficiency?

A

induce ovulation by IVF by giving carefully timed injections of LH and FSH

33
Q

What’s the best radiological way to visualise the pituitary?

A

MRI

34
Q

How are pregnant women at risk of sheehan’s syndrome?

A

during pregnancy, pituitary gland enlarges due to lactotroph hyperplasia, needing more blood

haemorrhage during birth can reduce blood pressure and blood flow to the pituitary resulting in pituitary infarction

35
Q

What is the presentation of sheehan’s syndrome?

A
  • weight loss
  • anorexia
  • lethargy
  • failure of lactation
  • failure to resume menses post-delivery
36
Q

what is the presentation of pituitary apoplexy?

A

severe, sudden headache

37
Q

pituitary apoplexy is caused by what, most commonly, and what else, least commonly?

A

intra pituitary haemorrhage

less commonly infarction

38
Q

pituitary apoplexy could be the first presentation of what disease?

A

pituitary adenoma

39
Q

what can trigger pituitary apoplexy?

A

anti-coagulants

40
Q

what two complications can pituitary apoplexy cause?

A
  1. bitemporal hemianopia (compressed optic chiasm)
  2. If blood/swelling into cavernous sinus, can compromise cranial nerves causing diplopia and prosis
41
Q

what is diplopia?

A

double vision

42
Q

what is prosis?

A

droopy eyelid

43
Q

what could be the different causes of

  • Tired
  • No periods
  • Difficulty breastfeeding
  • Tearful

after pregnancy?

A
  • sheehan’s syndrome
  • primary hypothyroidism (immune system becomes active again after being immunosuppressed during pregnancy)
  • post-natal depression
  • anaemia
44
Q

What is the diagnosis, if these are blood results post-pregnancy?

Haemoglobin 130 g/L (115 – 165)

Mean cell volume 89 fl (80-100)

Oestradiol <70 pmol/l (>200)

LH 0.5 U/l (2-10 U/L)

FSH 0.8 U/l (1.5 – 10 U/L)

Prolactin <50 miU/L (<500 IU/L)

fT4 6.9 pmol/L (9-23)

TSH 0.09 mU/L (0.3 – 4.2)

9AM cortisol 75nmol/L (>350 nmol/L)

A

Sheehan’s syndrome (post-partum pituitary infarction)

45
Q

what is the treatment for Sheehan’s syndrome?

A
  • replace oestrogen + progestogen if no fertility required
  • if fertility is required, IVF
  • Replace T4 with levothyroxine to just above mid-range
  • glucocorticoids

Endocrinology 2 (17 decks)

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