Pituitary Flashcards
What is this a presentation of?
Paraesthesia of extremities, spade like hands, coarse facial features, widely spaced teeth, acanthosis nigricans, amenorrhoea, decreased libido, headache, sweating, arthralgia.
Acromegaly
What conditions are associated with acromegaly?
Increased glucose tolerance, diabetes mellitus, hypertension, left ventricular hypertrophy, increased colorectal carcinoma.
What is the main cause of acromegaly?
Growth hormone adenoma
How is suspected acromegaly investigated?
- Raised glucose and IGF-1
- OGTT to diagnose
- MRI scan of pituitary
- Visual field scan
- ECG, echo
What is the treatment for acromegaly?
- Trans-sphenoidal surgery 1st line
2. Adjunct - somatostatin analogues/radiotherapy
What is this a presentation of?
Polyuria, polydipsia, dehydration, dilute urine (raised plasma osmolality)
Diabetes insipidus
What are the cranial and nephrogenic causes of diabetes insipidus?
- Cranial - idiopathic, tumour, trauma, autoimmune, infiltration, vascular.
- Nephrogenic - inherited, high calcium, low potassium, lithium, CKD, post-obstructive uropathy.
How is diabetes insipidus diagnosed?
8 hour water deprivation test - when plasma osmolality reaches >300, give desmopressin. If urine osmolality increases then cranial cause, if not then nephrogenic cause.
What is the treatment for diabetes insipidus?
- Cranial - desmopressin
2. Nephrogenic - treat cause, thiazide diuretic
What is this a presentation of?
- Women - amenorrhoea, oligomenorrhoea, weight gain, dry vagina.
- Men - reduced libido, erectile dysfunction, mass effect, loss of facial hair, galactorrhoea, osteoporosis.
Hyperprolactinaemia
What are the causes of hyperprolactinaemia?
Prolactinoma, compression of pituitary stalk, dopamine antagonist, pregnancy, chest wall trauma, hypothyroidism.
What is the treatment for hyperprolactinoma?
Dopamine agonists (cabergoline/bromocriptine) are 1st line
