pituitary diseases Flashcards
(33 cards)
causes of raised prolactin
- breast feeding
- pregnancy
- stress
- sleep
- dopamine antagonists
- antipsychotics
- antidepressants
- hypothyroidism
- stalk lesions
- prolactinoma
what are the symptoms and signs in women for a prolactinoma
- early presentation
- galactorrhoea
- menstrual irregularity
- ammenorrhoea
- infertility
signs and symptoms in males of prolactinoma
- late presentation
- impotence
- visual field abnormal
- ant pit malfunction
investigations for prolactinoma
- serum prolactin concentration
- MRI pituitary
- visual fields check
- pituitary function tests
prolactinoma treatment
dopamine agonists
-cabergoline once to twice per week oral
side effects of dopamine agonists
- nausea
- vomiting
- low mood
what do dopamine agonists do
- prolactin normalised
- menstruation regained
- pregnancy
- tumour shrinkage
what is acromegaly
too much GH secreted
symptoms of acromegaly
- giant
- thickened soft tissues
- large hands
- snoring
- sleep apnoea
- hypertension
- cardiac failure
- headaches
- diabetes mellitus
- vision problems
- hypopituitarism
- colonic polyps
diagnosis of acromegaly
- measure IGF1
- GTT suppression test (normal - GH suppresses to <0.4, if acromegaly then GH unchanged)
- check visual fields
- CT or MRI pituitary
treatments for acromegaly
- pituitary surgery
- radiotherapy
DRUGS
somatostatin analogues
-sandostatin LAR
-Lanreotide
GH antagonist (most effective)
- pegvisomant
- SC injection 10-30mg per day
side effects of somatostatin analogues
- local stinging
- short term - flatulence, diarrhoea, abdo pains
- long term - gallstones
could you also use dopamine agonists for acromegaly
yes in some patients
what is cushing’s syndrome
excess cortisol
symptoms of cushing’s syndrome
- muscle wasting
- osteoporosis
- fractures
- thin skin
- striae
- bruising
- frontal balding in women
- conjunctival oedema
- psychosis
- depression
- hypertension
- acne
- excess hair
what is in excess in cushing’s syndrome
- cortisol
- mineralocorticoid
- androgen
tests to diagnose cushing’s
- overnight 1mg dexamethasone suppression test (cortisol <50 normal, >130 abnormal)
- urine free cortisol (<250 normal)
- diurnal cortisol variation (loss of diurnal variation is suspicious of cushing’s)
- 2 day 2mg/day dexamethasone suppression test (cortisol >130mmol/l = cushings)
causes of cushing’s
- mainly pituitary
- adenoma of adrenal
- ectopic ACTH production
- alcohol and depression
- steroid medication
non-drug treatment for cushing’s
pituitary
- hypophysectomy and external radiotherapy if recurs
- bilateral adrenalectomy
adrenal
-adrenalectomy
ectopic
- remove source
- or bilateral adrenalectomy
drug treatment for cushing’s
metyrapone
-if other treatment fails
ketoconazole
pasireotide LAR
what is pan hypopituitarism
a condition in which the production and secretion of all hormones by the pituitary gland is reduced.
pan hypopituitarism effects on anterior pituitary
- growth hormone: growth failure
- TSH: hypothyroidism
- LH/FSH: hypogonadism
- ACTH: hypoadrenal
pan hypopituitarism effects on posterior pituitary
diabetes insipidus
causes of hypopituitarism
- pituitary tumours
- other local brain tumours
- surgery
- granulomatous disease
- vascular diseases
- trauma
- secondary metastatic lesions
- hypothalamic disease
- autoimmune
- infection
