Pituitary disorders

Question 1

What are the usual clinical presentation of pituitary tumours?

Answer 1

• Visual loss = pressure on optic chiasm

- Headache = lateral growth of the tumour

Question 2

What are biochemical assessments of pituitary disease?

Answer 2

• Thyroid axis = TSH
• Gonadal axis = LH + FSH
• Prolactin axis = Serum prolactin

Question 3

What are the dynamic assessments of HPA and GH axes?

Answer 3

Stimulation test = suspected hormone deficiency
Suppression test = suspected hormone excess

Adrenal axis

• Deficiency = stimulate adrenals by ACTH
• Excess = suppress ACTH with steroids

GH axis

• Deficiency = response to hypoglycamic stress
• Excess = suppress GH axis with glucose load

Question 4

What is prolactinoma?

Answer 4

Prolactin-secreting pituitary tumour

Question 5

What are the symptoms of hyperprolactinaemia in women?

Answer 5

• Menstrual disturbance
• Fertility problems
• Galactorrhea

Question 6

What are the symptoms of hyperprolactinaemia in men?

Answer 6

-Visual loss
-Lactation
-Erectile dysfunction
-Infertility
(usually present later than females)

Question 7

What is prolactin disinhibition and what is its importance?

Answer 7

• Blocking of the stalk as prolactin is under tonic inhibition by dopamine
• Prolactinomas are treated medically while non-functioning pituitary tumours are treated surgically

Question 8

How are prolactinomas treated?

Answer 8

• Dopamine agonists

- Bromocriptine or Cabergoline (reduces prolactin)

Question 9

What is non-functioning pituitary adenoma?

Answer 9

Pituitary tumour that leads to no secretion of biologically active hormones

Question 10

What are the clinical features of NFPA?

Answer 10

• Low testosterone
• Growth failure in children
• Menstrual cycle loss
• Infertility
• Loss of sex drive

Question 11

Treatment for NFPA?

Answer 11

Surgery

Question 12

What is acromegaly?

Answer 12

GH-secreting pituitary tumour that leads to large extremities (large hands and feet)

Question 13

What are long term complications of acromegaly if untreated?

Answer 13

• Premature cardiovascular death
• Disfiguring body changes
• Hypertension
• Diabetes

Question 14

What is the treatment for acromegaly?

Answer 14

• Surgical removal of tumour
• Dopamine agonist (reduce GH secretion)
• Somatostatin analogues (reduce GH secretion)
• Block GH receptor (e.g. pegvisomant)
• Radiotherapy

Question 15

What is cushing’s disease

Answer 15

ACTH-secreting tumour

Question 16

What are the clinical changes in appearance in cushing’s disease?

Answer 16

• Round pink face
• Round abdomen
• Thin skin (easy bruising)
• Red stretch marks on abdomen

Question 17

What is the treatment for cushing’s disease?

Answer 17

• Surgery
• Radiotherapy
• Medication to reduce effect of cortisol (e.g. ketoconazole, mitotane)

Question 18

What is the difference between Cushing’s disease and Cushing’s syndrome?

Answer 18

Cushing’s disease = due to tumour

Cushing’s syndrome = may be due to other pathologies (e.g. ectopic ACTH, steroid medication)

Question 19

What is Diabetes insipidus?

Answer 19

Large quantities of pale (insipid) urine

Question 20

How does Diabetes insipidus present?

Answer 20

-extreme thirst (polydipsia)

Question 21

What is the difference between cranial DI and nephrogenic DI?

Answer 21

• Cranial DI is vasopressin deficiency pituitary disease

- Nephrogenic DI is vasopressin resistance kidney disease

Question 22

What are the consequences of untreated DI?

Answer 22

• Severe dehydration
• Hypernatraemia
• Reduced consciousness
• Coma
• Death

Question 23

What is the treatment for cranial DI?

Answer 23

Synthetic vasopressin (Desmopressin)

Question 24

What is pituitary apoplexy?

Answer 24

A sudden vascular event in pituitary tumour (stroke) -> haemorrhage and/or infarction

Question 25

How does pituitary apoplexy clinically present?

Answer 25

• Sudden onset headache
• Double vision
• Cranial nerve palsy