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Endo > Pituitary tumours > Flashcards

Pituitary tumours Flashcards

1
Q

What are the 5 types of pituitary tumours?

A

GH - Acromegaly //
Prolactin - Prolactinoma //
TSH - TSHoma //
Gn - gonadotrophinoma //
Corticotrophs - Cushing’s Disease (corticotroph adenoma)

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2
Q

What are the two radiological classifications of pituitary tumours?

A

Size (microadenoma <1cm, macroadenoma >1cm) // Location - sellar (compressing optic chiasm) or suprasellar (invading cavernous sinus)

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3
Q

What is the functional classification of pituitary tumours?

A

Excess secretion (functioning adenoma),
no excess secretion (non-functioning adenoma), can change other hormones of the gland

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4
Q

Are pituitary tumours more likely to be malignant or benign

A

Benign

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5
Q

How would you assess whether a pituitary tumour is benign or malignant?

A

Mitotic index (Ki-67), very rarely malignant
pituitary adenomas can have benign histology but malignant behaviour (affect surrounding structures)

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6
Q

What are the presentations of prolactinomas?

A

Menstrual disturbance, low libido, subfertility, galactorrhea
this is to prevent reproduction when there is lack of nutrition

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7
Q

mechanism of prolactinomas

A

Elevated levels of prolactin inhibit kisspeptin release therefore GnRH is not released nor FSH & LH (very common SAQ)

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8
Q

What are 2 physiological non-cancerous causes of elevated prolactin?

A

Pregnancy/Breastfeeding, Stress (exercise, venepuncture), nipple/chest wall stimulation

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9
Q

What are three pathological causes of elevated prolactin?

A

PCOS, Chronic Kidney Failure, Primary Hypothyroidism

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10
Q

What 5 types of drugs cause elevated prolactin?

A

Antipsychotics, SSRIs, Anti-emetics, high dose oestrogen, opiates

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11
Q

What is the first-line treatment for prolactinomas?

A

dopamine receptor agonists (cabergoline more specific)
bromocriptine, original

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12
Q

How do dopamine receptor agonists work?

A

Mimic dopamine, binds to D2 receptors on lactotrophs which inhibits release of prolactin (again easy SAQ)

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13
Q

What 2 symptoms do patients with acromegaly complain of?

A

Sweatiness and Headache

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14
Q

Aim of prolactinoma treatment

A

decrease serum prolactin and shrink prolactinoma

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15
Q

What are the 4 presentations of acromegaly?

A

Coarsening of facial features: macroglossia,
large jaw - prognathism,
increased hand and feet size,
sleep apnoea

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16
Q

What are two internal conditions that are concerned with acromegaly?

A

Hypertension, Impaired glucose tolerance (T2DM)

17
Q

How do you diagnose acromegaly?

A
  • Give oral glucose load, observe a paradoxical rise in GH (normally GH levels drop, but in acromegaly GH levels rise)
  • elevated serum IGF-1
18
Q

What is the first-line treatment of acromegaly?

A

Trans-spehnoidal pituitary surgery, break through sphenoidal sinus to access pituitary gland

19
Q

What medication can be given for acromegaly?

A

Somatostatin Analogues (octreotide), shrink tumour
Dopamine Agonists (cabergoline)

20
Q

What are some of the key symptoms in Cushing’s syndrome?

A

Proximal Myopathy (muscle weakness),
poor wound healing, not synthesising protein properly
purple striae
obese, pendulous abdomen
osteoporosis, stop making bones
impaired glucose tolerance and hypertension

21
Q

What are the two types of causes of Cushing’s syndrome?

A

ACTH dependent (too much ACTH)
independent (ACTH unimpaired)

22
Q

What are two examples of causes for each type of cause?

A

ACTH dependent - Cushing’s disease (corticotroph adenoma) and Ectopic ACTH (lung cancer) //
ACTH independent - steroids by mouth, adrenal adenoma

23
Q

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

A

Cushing’s syndrome is excess cortisol,
Cushing’s disease is corticotroph adenoma secreting ACTH

24
Q

How would you diagnose Cushing’s disease in 3 ways?

A

Elevated 24h urine free cortisol,
Elevated late night cortisol (use saliva or blood test),
Failure to suppress low dose dexamethasone (increased cortisol secretion)

25
Q

What blood test should be done after cortisol is checked?

A

ACTH

26
Q

What are non-functioning pituitary tumours and how do they present?

A

Pit tumours without excess secretion of hormones, present with visual disturbances (bitemporal hemianopia)

27
Q

What other hormone may be elevated in a non-functioning pituitary tumour?

A

prolactin - dopamine cannot travel down stalk to inhibit

Endo (13 decks)

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