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Y2 Endocrine > Pituitary gland abnormalities (week 4) > Flashcards

Pituitary gland abnormalities (week 4) Flashcards

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1
Q

What are the hormones secreted by anterior pituitary gland

A

Prolactin
ACTH
TSH
GH
LH and FSH

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2
Q

What are the hormones secreted by posterior pituitary gland

A

Oxytocin
ADH

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3
Q

Function of prolactin

A

stimulate breast milk production, breast tissue growth

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4
Q

Function of ADH (anti diuretic hormone)

A

Controls how much water is excreted into urine

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5
Q

Function of GH

A

growth and development

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6
Q

Function of ACTH

A

stimulates adrenal cortex to produce cortisol

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7
Q

Function of oxytocin

A

Stimulates uterine contraction during labour
Promotes breastfeeding

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8
Q

Pituitary pathologies can be

A

Hyperfunction / hypofunction

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9
Q

Hyperfunction of the the pituitary is caused by

A

Secreting adenomas

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10
Q

Adenomas can be (function, size)

A

Secreting / non-secreting
Micro/Macro

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11
Q

How may macro adenomas cause hypopituitarism

A

Due to large infarction of the pituitary gland tissue

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12
Q

Symptoms of non-secreting adenomas

A

Headaches
Impaired visual field

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13
Q

Investigation for non-secreting adenomas

A

MRI
Hormone tests to exclude other causes

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14
Q

Management for non-secreting adenomas

A

Surgery
Radiotherapy

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15
Q

Types of secreting adenomas

A

Prolactinoma
GH secreting adenoma
ACTH secreting adenoma
TSH secreting adenoma (very rare)

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16
Q

What does TSH secreting adenoma cause

A

Secondary hyperthyroidism (very rare)

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17
Q

Most common secreting pituitary adenomas

A

Prolactinoma

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18
Q

Symptoms of hyperprolactinaemia due to prolactinoma

A

females - oligomenorrhea/amenorrhea, infertility, vaginal dryness, galactorrhea
Males- erectile dysfunciton, gynaecomastia, reduced facial hair
Both- headaches, low sex drive, impaired visual fields

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19
Q

Investigations for prolactinoma

A

Serum prolactin level
Serum level of other hormones
MRI

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20
Q

Results of investigations for prolactinoma

A

Raised prolactin
Decreased level of other hormones
Lesions / tumour seen on MRI

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21
Q

Management for small prolactinoma

A

Dopamine agonists
Hormone therapy - oestrogen

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22
Q

Management for larger prolactinoma

A

Surgery

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23
Q

What dopamine agonists are used for prolactinoma

A

cabergoline

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24
Q

Side effects of cabergoline (dopamine agonists)

A

Nausea / vomiting
low mood
obsessive compulsive behaviour

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25
If a patient with small prolactinoma has been taking dopamine agonists for over a year and has not experienced any symptoms, what should you do? - continue the treatment ?
Stop dopamine agonist because hyperprolactinaemia is likely to resolve Start again if hyperprolactinaemia persist
26
Hormone replacement therapy is used in prolactinoma if
fertility and galactorrhea are not issues
27
Types of causes of hyperprolactinaemia
Physiological Pathological - prolactinoma
28
Physiological causes of hyperprolactinaemia
Pregnancy Breastfeeding Anxiety Use of dopamine antagonists Use of anti-psychotics
29
Examples of dopamine antagonists
Risperidone Metoclopramide
30
What is SIADH (syndrome of inappropriate ADH production)
Excessive ADH production due to pathology in posterior pituitary / ectopic ADH
31
What damage to the brain can cause SIADH
subarachnoid haemorrhage (bleeding on the surface of the brain)
32
What are the non-pituitary cause of SIADH
Small cell lung cancer Lymphoma Infections Pneumothorax Cystic fibrosis Chemotherapy
33
What is a common PMH in patients with SIADH
Lung cancer (small cell lung cancer)
34
Symptoms of SIADH is caused by
hyponatraemia
35
Symptoms of SIADH
Muscle cramping Nausea Vomiting Confusion / reduced GCS level Seizures
36
Investigations for SIADH
Urea and electrolytes Plasma osmolarity Urine osmolarity Urine sodium MRI
37
Results for investigations for SIADH
U&E - hyponatraemia Plasma osmolarity - reduced Urine osmolarity - raised Urine sodium - raised
38
Why is there hyponatraemia in SIADH
Because excessive ADH causes excessive retaining of water = blood becomes very diluted = hyponatraemia and reduced plasma osmolarity
39
Why is urine osmolarity raised in SIADH
Because water is retained in the body and not passed out into the urine so urine becomes very concentrated
40
Management of mild SIADH
Fluid restriction Treat the underlying cause via surgery
41
Management of moderate-severe SIADH
Rapid correction of hyponatraemia by 1. Hypertonic saline 2. Loop diuretics 3. Democlocycline (tetracycline) 4. Vasopressin antagonist
42
Mechanism of democlocycline
Blocks ADH and induces partial nephrogenic diabetes insipidus
43
What is panhypopituitarism
reduction in all hormones produced by the pituitary gland
44
What causes panhypopituitarism
Surgery / radiotherapy Haemorrhage, infarction - Sheehan's TB meningitis Sarcoidosis
45
What is Sheehan's syndrome
Maternal hypopituitarism due to excessive bleeding during labour
46
Symptoms of panhypopituitarism
hypothyroidism - MOMS SO TIRED prolactin deficiency - oligo/amenorrhea, infertility, sexual dysfunction, breast atrophy, hypogonadism Adrenal deficiency GH deficiency - obesity, muscle weakness, reduced exercise tolerance ADH deficiency (diabetes insipidus)
47
Types of ADH deficiency
Cranial diabetes insipidus Nephrogenic diabetes insipidus
48
ADH deficiency (diabetes insipidus) can be due to
1. ADH production deficiency = cranial diabetes insipidus 2. Kidneys become ADH resistant i.e. they stop responding to ADH = nephrogenic diabetes insipidus
49
What chemical can cause nephrogenic diabetes insipidus
Lithium toxicity
50
Symptoms of ADH deficiency
Polyuria Polydipsia Thirst Lethargy Confusion/ reduced GCS Seizures
51
Investigations for ADH deficiency
U&E Plasma osmolarity 24 hour urine collection - urine sodium and urine osmolarity Fluid deprivation test
52
Results of investigations that suggests ADH
U&E - hypernatraemia Plasma osmolarity - raised Urine sodium - low Urine osmolarity - low Fluid deprivation test - urine becomes concentrated
53
Describe the fluid deprivation test
Deprive patients from fluid for a certain amount of time Then administer desmopressin (synthetic ADH) If urine becomes concentrated = ADH deficiency
54
How does ADH deficiency cause hypernatraemia and raised plasma osmolarity
Because more water is passed out into the urine making the blood very concentrated and urine very diluted
55
Treatment for ADH deficiency
Desmopressin
56
What is phaeochromocytoma
Catecholamine-releasing tumour arising from the adrenal gland
57
Where is phaeochromocytomas derived from
Chromaffin cells of adrenal medulla
58
Are phaeochromocytomas malignant
Only 10% are and metastasise to elsewhere
59
Apart from the adrenal medulla, do catecholamine releasing tumours appear at other sites
Yes but rare, sympathetic neurone = paraganglioma
60
Most common association with phaeochromocytoma
Persistent hypertension
61
Phaeochromocytomas mainly occur in which age group
30-50 years old
62
Symptoms of phaechromocytoma
Hypertension (can be episodic) Fatigue Sweating Palpitations Tremor Weight loss Anxiety Postural hypotension Hypertensive retinopathy
63
Symptoms of phaeochromocytomas can be exacerbated by
Stress Exercise Surgery Opiates Beta Blockers
64
Investigations for phaeochromocytoma
1. Plasma metanephrine 2. Urine metanephrine 3. Adrenal imaging 4. CT chest, abdomen, pelvis
65
What is metanephrine
Substance released when catecholamines are broken down
66
Management for phaeochromocytomas
1. Alpha blockade first then Beta blockade 2. surgery
67
Which one should be used first, alpha blockade or beta blockade
alpha blockade
68
Why should we use alpha and beta blockades before surgery for phaeochromocytoma
To increase blood volume and prevent hypertensive crisis
69
Example of an alpha blockade
Phenoxybenzamine
70
What is MEN syndrome
Multiple endocrine neoplasia; the formation of multiple hormone secreting tumours at multiple endocrine sites
71
What causes MEN syndrome
Mutation in tumour suppression gene
72
Inheritance pattern of MEN syndrome
Autosomal dominant
73
Types of MEN syndrome
MEN 1 MEN 2a MEN 2b
74
Conditions associated with MEN 1 (the P syndrome)
1. Pituitary adenoma (esp prolactinoma) 2. Parathyroid gland hyperplasia 3. Pancreatic tumours
75
What are the pancreatic tumours that can present in MEN 1
Insulinoma Gastrinoma
76
What type of pituitary adenoma is the most common in MEN 1
Prolactinoma (acromegaly second)
77
Describe the hormone level changes due to parathyroid gland hyperplasia
Serum Ca2+ elevated Serum PTH elevated Urine calcium:creatinine elevated
78
What symptoms are caused by hypercalcaemia (Stones, Bones, Groans, Moans)
Renal calculi Abdominal pain, nausea, vomiting Psychosis Lethargy Depression Painful bones Osteoporosis Fragility fractures Hypertension
79
Investigations for MEN 1
Genetic test Hormone level (Ca2+, PTH, prolactin, urine Ca:creatinine) Screen asymptomatic family members
80
What are the conditions associated to MEN 2a
1. Parathyroid hyperplasia 2. Medullary thyroid carcinoma 3. Phaeochromocytomas
81
What are the conditions associated to MEN 2b
1. Marfanoid 2. Neuroma 3. Medullary thyroid carcinoma 4. Phaeochromocytoma
82
Investigations for MEN 2
Genetic test For phaeochromocytoma -plasma and urine metanephrine For medullary thyroid carcinoma - calcitonin level and fine needle aspiration of the tumour For parathyroid hyperplasia
83
Management for MEN syndromes
Surgery

Y2 Endocrine (6 decks)

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