Pituitary Disorders Flashcards

(37 cards)

1
Q

What are pituitary disorders most commonly caused by ?

A

Pituitary adenoma , a benign pituitary tumour. Most of these tumours are non functioning , meaning that they do not produce any hormone themselves , but cause an inadequate production of one or more pituitary hormones due to the physical pressure of the growing tumour on the glandular tissue.

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2
Q

What are functioning pituitary tumours ?

A

Also known as hyper-secreting tumours , they are much rarer. And their clinical symtposms are dependant on which pituitary hormone they are over secreting.

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3
Q

What are common symptoms of pituitary adenoma ? ( non-functioning )

A

Headaches

Visual problems

Nausea

Vomiting

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4
Q

What is hypopituitarism ?

A

Most commonly caused by a pituitary adenoma putting pressure on the pituitary glandular tissue

There is a progressive loss of anterior pituitary function.

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5
Q

What hormones are most commonly affected first in hypopituitarism ?

A

Growth hormone

LH

Follicle stimulating hormone

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6
Q

Why is the secretion of oxytocin and ADH normally unaffected in hypopituitarism?

A

Because the posterior pituitary gland is normally only affected if the tumour also affects the hypothalamic function or if an inflammatory process is involved

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7
Q

What are the. Sytmpksmof GH deficiency?

A

Decreased exercise tolerance

Decreased muscle tone

Increased body fat

Reduced sense of well-being

If GH is released in a pulsatile fashion

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8
Q

Is GH deficiency hard or easy to diagnose ?

A

Very hard to diagnose

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9
Q

The common cause of GH deficiency in adults in pituitary adenoma , what is it in children ?

A

Idiopathic - unknown cause

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10
Q

Outline the effects GH deficiency has on fetal development , child development

A
  1. Has little effect on fetal development
  2. From aged 1-mid teens , GH deficiency can result in poor growth and short stature. This results in Pituitary dwarfism.
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11
Q

What hormones come under gonadotropin?

A

LH and FSH

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12
Q

What are the consequences of a deficiency in Gonadotrophin?

A

Can result in lack of libido , infertility and oligomenorrhea ( infrequent menstruated period ) , the absence of menustration in women

in men : decreased libido , cause impotence ( inability to achieve an erection)

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13
Q

What symptoms of TSH deficiency?

A

Feeling cold

Weight gain

Bradycardia

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14
Q

Symptoms of Adrenocorticotropic hormone deficiency

A

Tiredness

Low blood pressure

Dizziness

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15
Q

What can ADH deficiency result from ?

A

Hypothalamic tumour or pituitary tumour that has extended up into the hypothalamus

Other causes include cranial radiotherapy

Autoimmune infiltration

Infections such as meningitis

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16
Q

Symptoms of ADH deficiency

A

Dehydration

Increased sensation of thirst

Excess secretion of dilute urine

17
Q

What does hyperpitutarism usually caused by ?

A

Hypersecreting pituitary adenoma

18
Q

What are the three most commonly affected hormones affected in hyperpituitarism ?

A

Prolactin

GH

ACTH

19
Q

What is hyperprolactinaemia ? And what is it most commonly caused by ?

A

The most common form of pituitary disorder. Most commonly caused by a prolactinoma - a pituitary adenoma that secretes prolactin.

Other causes are pregnancy , suckling , stress and exercise.

20
Q

What are symptoms of hyperprolactinaemia?

A
  1. Galactorrhoea - spontaneous flow of milk from the breast which is unassosiated with just nursing or childbirth.
  2. Gynecomastia : male breast tissue increases in size , this is non cancerous tissue.
  3. Hypogonadism : diminished function of the gonadotropin hormones which results in less sex hormones due to testes / ovaries not functioning properly.
  4. Erectile dysfunction
  5. Amenorrhea : abscence of menustration
21
Q

Why patients with hyperprolactinaemia often have a decreased production in sex hormones ?

A

This is because the increased concentration of plasma prolactin increases negative feedback on the hypothalamus causing an increase in the production of dopamine ( prolactin release inhibiting hormone ) .

However the increased dopamine levels decrease the release of GNRH ( gonadotropin releasing hormone )

22
Q

What is the first line of treatment for someone with hyperlipidaemia?

A

Dopamine receptor agonist which is usually sufficient in most cases.

23
Q

What is the cause of GH excess ?

A

Large growth hormone secreting pituitary adeonmas

24
Q

What are local mass effects of GH. Excess ?

A

Headaches

Visual field defects

Cranial nerve palsies

25
What are systemic effects of excess GH ?
Broad nose , thick lips , enlarged hands & feet , excessive sweating , deepening of the voice In childhood , this can result in gigantism. While in adults , acromegaly occurs ( large hands , feet & lower jaw ).
26
Why does diabetes develop with excess GH ?
Antagonises insulim - meaning several metabolic conditions such as diabetes mellitus can occur.
27
How are prolactinomas treated ?
With tablets - not operations.
28
Biochemical tests to confirm acromegaly ?
Elevated IGF-1 level Elevated mean GH
29
How to treat patients with acromegaly ?
1. Surgical removal of tumour 2. Reduce GH secretion using dopamine agonist. 3. Block GH receptor 4. Radiotherapy
30
What is cushings disease ?
Associated with an increase in ACTH | .
31
What are classical changes in appearance in people with cushings disease ?
Round pink face with round abdomen Skinny and weak arms and legs Thin skin and easy bruising Red stretch marks ( striae) on abdomen High blood pressure and diabetes Osteoporosis
32
What is the difference between cushings disease and Cushing’s syndrome ?
Cushings disease is due to a pituitary tumour whereas Cushing syndrome is due to other pathologies.
33
What is diabetes insipidus
There are different forms of diabetes insipidus One is cranial DI which is where there is ADH deficiency pituitary disease. Another form is nephrogenic DI : where kidney cells are resistant to ADH.
34
What are the consequences of untreated diabetes insipidus?
Severe dehydration Very high sodium levels which could lead to hypernatraemia Reduced consciousness , coma , death
35
How is cranial diabetes insipidus treated ?
Responds brilliantly to synthetic vasopressin
36
What is pituitary apoplexy?
Apoplexy is an old fashioned word for stroke. Often caused by a sudden vascular event in a pituitary tumour. This can be caused by bleeding in the tumour ( haemorrhage ) or blood supply cut off ( infaraction )
37
What is clinical presentation of pituitary apoplexy ?
Double vision Sudden onset headache Visual field loss Cranial nerve palsy Hypopituitarism ( cortisol deficiency most dangerous ) NEEDS PROMPT DIAGNOSIS AND TREATMENR