Year 2 > Non-Functioning Tumours and Pituitary hormone testing > Flashcards

Non-Functioning Tumours and Pituitary hormone testing Flashcards

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1
Q

Name two structures in the parasellar area of the pituitary gland

A
  1. Optic chiasm

2. Hypothalamus

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2
Q

Describe the development of the pituitary gland (embryology)

A
  1. infundibulum becomes hypothalamus and infundibulum
  2. Rathe’s pouch stalk degenerates and the body of the pouch becomes the intermediate and anterior lobe of the pituitary glands
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3
Q

Where do craniopharyngiomas arise from

A
  1. Squamous epithelial remnants of Rathe’s such
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4
Q

Name the two types of craniopharyngiomas

A
  1. Adamantinous: cyst formation and calcification
  2. Squamous papillary: well circumscribed

These extend into suprasellar region

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5
Q

Age prevalence of craniopharyngiomas

A
  1. 5 to 14

2. 50 to 74

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6
Q

Clinical presentation of crnaiopharyngiomas

A
  1. Headaches (obstructive hydrocephalus)
  2. Polydipsia
  3. Polyuria
  4. Bitemporal hemianopia (presses against optic chiasm)
  5. Vomiting
  6. Raised ICP
  7. Weight increase
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7
Q

What would be seen in a CT for crnaiopharyngiomas

A

CYSTIC MASS

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8
Q

Diagnosis of craniopharyngiomas

A
  1. MRI

2. CT

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9
Q

What is Rathke’s cysts

A
  1. Single layer of epithelial cells with mucoid and cellular components in cyst fluid
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10
Q

Difference between Rathke’s cyst and craniopharyngiomas

A
  1. Intrasellar component (don’t usually extend to parasellar)
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11
Q

Clinical presentation of Rathke cyst

A

ASYMPTOMATIC:

  1. Headache
  2. Ammorheoa
  3. Hypopituitarism
  4. Hydrocephalus
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12
Q

When are meningiomas common

A

After radiotherapy

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13
Q

Clinical presentation of meningioma

A
  1. Visual acuity loss and visual field defects
  2. Endocrine dysfunction
  3. Focal seizures
  4. ICP raised
  5. Diplopia if third and 6th cranial palsy occurs
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14
Q

How is meningioma diagnosed

A

MRI with contrast

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15
Q

Why is an MRI done with contrast for meningioma

A

Because meningiomas can hypo intense to pituitary

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16
Q

What is lymphocytic hypophysitis

A
  1. Inflammation of pituitary gland due to an autoimmune reaction
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17
Q

Name three types of lymphocytic hypophysitis

A
  1. Lymphocytic adenohypophysitis
  2. Lymphocytic infindibuloneurohypophysitis
  3. Lymphocytic panhypophysitis
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18
Q

In what gender is LAH common in

A

Women

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19
Q

Age of presentation of LAH

A
  1. 35 - women
  2. 45 - men

Usually occurs postpartum

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20
Q

What is seen in a CT for LAH

A
  1. Stalk enlargement

2. Pituitary enlargement

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21
Q

What is non-functioning pituitary adenoma

A
  1. A type of intracranial tumours
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22
Q

Peak incidence for NFPA

A

20 and 60

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23
Q

Clinical presentation of non-functioning pituitary adenoma

A
  1. Large cerebral size
  2. Cavernous sinus invasion
  3. Lobulated suprasellar margins
  4. Visual disturbances
  5. Headaches
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24
Q

How are pituitary adenomas classified

A
  1. Microadenomas without sella expansion
  2. Macroadenomas which extend above sella
  3. Macroadenomas with enlargement and invasion of floor or suprasellar extension
  4. Destruction of the sella
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25
Diagnostics of non-functioning pituitary adenomas
1. Test for absence of hormone secretion | 2. Test normal pituitary function
26
What surgical procedure is done to remove NFPA
1. Trans-sphenoidal surgery
27
How do we test for pituitary function
1. If peripheral target organ is working normally then that hormone is being secreted fine A LOT OF HORMONES ARE SECRETED BY THE PITUITARY GLAND
28
How do test the pituitary-thyroid axis for Primary hypothyroidism
Raised TSH low T4 (WE LOOK AT Ft4 in pituitary diseases)
29
Result of axis test in hypopituitary
Low T4 normal or low TSH
30
Test for Grave disease via axis
Suppressed TSH | High T4
31
Test for TSHoma via axis
High TF | High TSH
32
Test for hormone reisstance via the axis
High T4 | High TSH
33
Gonadal axis for men in primary hypogonadism
1. Low Testosterone, raised LH/FSH
34
Gonaldal axis for men with hypopituitary
Low Testosterone | Low LH and FSH
35
Testing the gonadal axis for men who have used anabolic
Low Testosterone and Low LH
36
When do we measure the gonadal axis
0900h fasted T and LH/FSH
37
Gonadal axis for females before puberty
Estradiol low | LH and FSH is low (FSH slightly greater)
38
Role of estradiol
Responsible for secondary sexual characteristics such as breast, widening of the hips
39
Gonadal axis for females during puberty
Pulsatile LH increase | Oestradiol increase
40
Gonadal axis for females post menarche
Mid-cycle surge in LH and FSH | Levels of estradiol increases through cycle
41
Gonadal axis for females with primary ovarian failure
1. High LH and FSH 2. Low estradiol 3. FSH > LH
42
Gonadal axis for females with hypopituitary
1. Ammenorrheoa 2. Low estradiol 3. Low FH and FSH
43
How do we test the HPA axis
1. Measure cortisol and syncathen test at 0900h
44
How do we diagnose hypopituitarism
Poor response to synacthen Low cortisol Low ACTH
45
How do we diagnose Primary Adrenal Insufficiency
Low cortisol High ACTH Poor response to synacthen
46
When is pulsatory GH secretion greatest
Night
47
What happens to GH levels with age
Decreases
48
What the reactor causes decrease in GH
Obesity
49
What two ways can we test the GH/IGF1 axis
1. Insulin stress test (GOLD STANDARD for assessing HPA axis) 2. Glucagon test
50
What is the insulin stress test
1. Insulin is injected into a patient's vein after which glucose levels are measured at regular interval
51
What response would we see in a norma functioning HPA axis for the insulin stress test
Gh réponse exceeds 20mU/L
52
What inhibits the action of prolactin
Dopamine
53
How do we monitor if prolactin is being produced properly by the pituitary
1. Measure prolactin or cannulated prolactin (3 samples over an hour to exclude stress of venipuncture)
54
What may raise prolactin levels
1. Stress 2. Antipsychotics 3. Stalk pressure 4. Prolactinoma
55
What is suppression testing
Where one substance is measured before and after the administration of a drug to determine is levels are stimulated or suppressed by the pituitary axis
56
How is Cushing's syndrome diagnosed
DEXAMETHASONE suppression testing
57
What is the dexamethasone suppression test
1. 1-2 mg dexamethasone is given which should suppress cortisol production in individuals who have a normal HPA axis 2. 8mg Dexamethasone is given which exerts a negative feedback mechanism
58
What is a positive dexamethasone suppression test for Cushing's syndrome
1. If cortisol level is not suppressed by low doses and ACTH is low then hypercortisolism is not being driven by ACTH - cushion's syndrome
59
What is a positive dexamethasone suppression test for cushion's disease
1. Cortisol is suppressed in high doses but not in low doses 2. ACTH is elevated Cushing's disease because pituitary has some feedback control
60
What suppression test is done for acromegaly
Oral glucose Gh suppression test
61
Stimulation tests for Chushing's
CRH stimulation
62
Stimulation test for TSHoma
TRH stimulation
63
Stimulating test for gonadotrophin deficiency
GnRH stimulation
64
Stimulation test for GH deficiency
Glucagon test
65
List two types of MRIs we do to look at the pituitary gland
T1 and T2 T1 - High-signal intensity images of fat (fatty marrow and orbital show up as bright images) T2 - Shows high water content structures like cerebrospinal fluid and cystic lesions
66
Pros of MRI
1. No ionising radiation | 2. Good at soft tissue and vascular structures
67
Pros of CT
1. Visualising bony structures and calcifications within soft tissues 2. Can be used when MRi is contraindicated
68
What are CTs used for
Tumour staging and diagnosis
69
Disadvantage of CT
1. Bad at soft tissue imaging 2. Use of intravenous contrast media 3. Exposure to radiation
70
Clinical presentation of GH deficiency
1. Short stature 2. Abnormal body composition 3. Reduced muscle mass
71
Clinical presentation of LH/FSH
1. Hypogonadism 2. Reduced sperm count 3. Infertility 4. Menstruation problems Testosterone deficiency in males, oestradiol and progesterone in females
72
How is primary adrenal insufficiency treated
1. Hydrocortisone replacement therapy | 2. Modified-Release HC
73
Describe thyroxine replacement therapy
1. 1.6 Micrograms/Kg/day | 2. LEVOTHYROXINE
74
When is a dose higher than 1.6 needed for LEVOTHYROXINE
1. patients on oestrogen and pregnancy
75
Describe growth replacement therapy
1. <60 (0.2-0.4 mg/day) | 2. >60 (0.1-0.2 mg/day)
76
When do we measure IGF1 levels following GH replacement
6 weeks after dose is started
77
What improvements do we see with people on GH replacement
Improves lipid profiles Body composition BMD
78
How is hypogonadism in males be treated
Testosterone replacement
79
Effects of testosterone replacement
1. Improves BMD 2. Libido 3. Muscle mass 4. Fat loss
80
In what forms can we get oestrogen replacement
1. Orally 2. Combined with progesterone 3. Tensdermal 4. Topical gels 5. Intravaginal creams
81
benefits of oestrogen replacement
Stops flushes, night sweats and improves vaginal atrophy Reduces CVD, osteoporosis and mortality
82
How is desmopressin given
1. SC 2. Orally 3. Nasally 4. Sub-lingually
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