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Endocrinology > Non-fucntioning Tumours And Pituitary Hormone Testing 12.12.23 > Flashcards

Non-fucntioning Tumours And Pituitary Hormone Testing 12.12.23 Flashcards

1
Q

What are the type of pituitary mass lesions whic can be found in pituitary?

A

Non-functioning pituitary adenomas

Endocrine active pituitary adenomas

Malignant pituitary tumours: functional and non-functional pituitary carcinomas

Metastases in the pituitary (breast, lung, stomach, kidney)

Pituitary cysts: Rathke’s cleft cyst

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2
Q

Where do craniopharyngioma arise from?

A

Arises from squamous epithelial remnants of Rathke’s pouch (base of brain near pituitary)

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3
Q

What is Rathke’s pouch?

A

An evagination at the roof of the developing mouth in front of the buccopharyngeal membrane - gives rise to the anterior pituitary

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4
Q

What does Rathke’s pouch give rise to?

A

Anterior pituitary

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5
Q

What are the two types of craniopharyngioma?

A

Adamantinous - cyst formation and calcification

Squamous papillary - well circumscribed

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6
Q

What is the Rathke’s cyst?

A

Single layer of epithelial cells with mucous, cellular or serous compounds in cysts fluid —> it is derived from remnants of Rathke’s pouch

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7
Q

What is a meningioma? What is it a complication of?

A

Tumour of the meninges, complication of radiotherapy

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8
Q

What is the usual presentation of meningioma

A

Usually present with loss of visual acuity, endocrine dysfunction and visual field defects

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9
Q

What % of non-functioning pituitary adenomas account for primary intracranial tumours?

A

10-15%

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10
Q

What are three signs of aggressiveness in non-functioning pituitary adenomas

A

Large size

Cavernous sinus invasion

Lobulated suprasellar margins

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11
Q

What is the test for non-functioning tumours?

A

No specific test but absence of hormone secretion, test normal pituitary function

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12
Q

How do you test pituitary function? Which hormones do you test?

A

Test many hormones: GH, LH/FSH, ACTH, TSH and ADH

Cardiac rhythms and pulsatile

If the peripheral target organ is working normally, the pituitary is working

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13
Q

Deficiency of GH causes what?

A

Short stature
Abnormal body composition
Reduced muscle mass
Poor quality of life

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14
Q

Deficiency of FSH/LH causes what?

A

Hypogonadism
Reduced sperm count
Infertility
Menstruation problems

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15
Q

Deficiency of TSH causes what?

A

Hypothyroidism

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16
Q

Deficiency of ACTH causes what?

A

Adrenal failure
Decreased pigment

17
Q

Deficiency of ADH causes what?

A

Diabetes insipidus

18
Q

What result would you get for primary hypothyroidism? Where is there a problem with anatomically

A

Raised TSH and low Ft4 - problem is with the thyroid rather than anterior pituitary gland as TSH is being produced but Ft4 isn’t

19
Q

What result would you get for hypopituitary in PTA axis? Where is there a problem with anatomically?

A

Low or normal TSH with low Ft4 - problem with anterior pituitary gland because the cause of the low Ft4 is due to the low TSH from the pituitary gland

20
Q

What result would you get for Graves’ disease/hyperthyroidism? Where is there a problem with anatomically?

A

Suppressed TSH and high FT4 - problem with thyroid gland as there is excess Ft4 production therefore suppressed TSH production

21
Q

What result would you get for TSHoma (very rare)? Where is there a problem with anatomically

A

High Ft4 with normal or high TSH - there is a functioning tumour of pituitary gland therefore high Ft4

22
Q

What result would you get for Thyroid hormone resistance? Where is there a problem with anatomically

A

High Ft4 with normal or high TSH - Ft4 is being produced but it doesn’t work in the body, the body then senses this and produces more TSH

23
Q

What result would you get for primary hypogonadism in men? Where is there a problem with anatomically

A

Low testosterone with raised LH/FSH - testes aren’t producing testosterone due to radiotherapy, pituitary gland is working fine as LH and FSH are fine

24
Q

What result would you get for hypopituitary in HGA axis in men? Where is there a problem with anatomically

A

Low testosterone with normal or low LH/FSH - pituitary gland is the problem as less testosterone is being produced due to the low LH/FSH

25
Q

What result would you get for use of anabolic testosterone in men? Where is there a problem with anatomically

A

Low testosterone and suppressed LH - when someone is injecting testosterone their LH/FSH gets suppressed. If someone suddenly stops injecting testosterone it takes a while for their FSH/LH to start up again therefore for a while they will have low FSH/LH and testosterone and have secondary hypogonadism

26
Q

How do you measure testosterone levels

A

Fasted testosterone measured at 0900h and LH/FSH measurement

27
Q

What are levels of LH/FSH like before puberty?

A

Oeestradiol very low/undetectable with low LH and FSH although FSH slightly higher than LH

28
Q

What are levels of LH/FSH like during puberty?

A

Pulsatile LH increases and oestradiol increases

29
Q

What are levels of LH/FSH like during post-menarche?

A

Monthly menstrual cycle with LH/FSH, mid-cycle surge in LH and FSH and levels of oestradiol increase through cycle

30
Q

What are levels of LH/FSH like during primary ovarian failure (inc. menopause)?

A

High LH/FSH with FSH greater than LH and l ow oestradiol

31
Q

What are levels of LH/FSH like during hypopituitary?

A

Oligo or amenorrhoea with low oestradiol and normal or low LH and FSH

32
Q

What result would you get for primary adrenal insufficiency? Where is there a problem with anatomically

A

Low cortisol, high ACTH - poor response to Synacthen, problem with adrenal glands producing cortisol

(Synacthen - give ACTH and stimulate adrenal gland to produce cortisol)

33
Q

What result would you get for hypopituitarism HPA axis? Where is there a problem with anatomically

A

Low cortisol, low or normal ACTH, poor response to Synacthen - low cortisol due to problem with pituitary

(Synacthen - give ACTH and stimulate adrenal gland to produce cortisol)

34
Q

How do you measure GH/IGF1 axis?

A

IGF-1 and GH stimulation test - insulin stress test, glucagon test

35
Q

When is growth hormone level greatest? How is GH secreted

A

Night, secreted in pulses

36
Q

What are 4 reasons prolactin may be raised?

A

Stress

Drugs: antipsychotics

Stalk pressure

Prolactinoma

Endocrinology (12 decks)

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