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Flashcards in Pituitary Tumours Deck (75)
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1

At what size does an adenoma of the pituitary cross from a microadenoma to a macroadenoma?

<1cm = microadenoma
>1cm = macroadenoma

2

What structures can a non-functioning pituitary adenoma compress?

Optic chiasma
Cranial nerve 3,4,6

3

What effect does a non-functioning pituitary adenoma have on hormone release from the pituitary?

Too little hormone is released:
- Hypoadrenalism
- Hypothyroidism
- Hypogonadism
- Diabetes Insipidus
- GH deficiency

4

What symptom do patients usually notice if the pituitary adenoma is compressing the optic chiasm?

Bitemporal Hemianopoia
Loss of vision in both temporal fields

5

What are the 3 categories which cause a Prolactinoma?

Physiological
Drugs
Pathology

6

What physiological changes in the body cause a rasied prolactin?

breast feeding
pregnancy
stress
sleep

7

What drugs/medications are known to cause a raised prolactin?

- Dopamine antagonists eg metoclopramide
- Antipsychotics eg phenothiazines
- antidepressants eg TCAs, SSRIs
- other = oestrogens, coccaine

8

What pathological conditions cause a raised prolactin?

- Hypothyroidism
- Stalk lesions (iatrogenic/croad accident)
- Prolactinoma

9

Males usually present early with prolactin related disease, whilst females present late. TRUE/FALSE?

FALSE
females notice symptoms much earlier than men
e.g. irregular/no periods + infertility

10

What symptoms do males usually present with in a prolactinoma?

Impotence
Visual field abnormal
Headache

11

What symptoms do females experience in a prolactinoma?

Galactorrhoea (milk production)
Irregular/no periods
Infertility

12

How can a prolactinoma be tested for?

Serum prolactin concentration (Blood Test)
Pituitary MRI

13

What class of drugs are used to inhibit release of prolactin?

Dopamine agonists

14

What dopamine agonist is most commonly used?

Cabergoline (Dostinex)
- Once to Twice per week oral
- Least side effects

15

What are the advantages of dopamine agonists?

Prolactin level = normalised in 96%
Menstruation regained in 94%
Pregnancy rate 91% (Warn pts about this!)
Tumour shrinkage

16

What side effects are caused by dopamine agonists?

Nausea / Vomiting
Low Mood
Fibrosis (heart valves/retroperitoneal) {only at high doses e.g. used in parkinsons disease

17

In acromegaly, what hormone is in excess?

Growth Hormone

18

What can result if acromegaly presents before bones have fused?

Gigantism

19

What soft tissues are often found to be thickened in acromegaly?

skin
large jaw
large hands

20

What symptom is caused by a thickened nasopharynx in acromegaly?

Snoring/ Sleep Apnoea

21

What cardiovascular complications can arise from acromegaly?

Hypertension (heart), cardiac failure
Early CV Death

22

Patients with acromegaly are at risk of colonic polyps and colon cancer. TRUE/FALSE?

TRUE

23

What is the peripheral hormone that Growth Hormone stimulates?

IGF-1

24

What suppression test can be carried out to test for excess growth hormone?

Glucose Tolerance Test
75g Oral Glucose
Check at 0, 30, 60, 90, 120 min)
NORMALLY: GH suppresses to <0.4ug/l after glucose

Acromegaly: GH unchanged/no suppression
=> GH remains >1ug/l after glucose

25

Surgery is the first line treatment for acromegaly. TRUE/FALSE?

TRUE
**can sometimes also have radiotherapy alongside surgery**

26

How many micro and macroadenomas are cleared by surgery?

90% cure if microadenoma
50% cure if macroadenoma

27

What drugs can be used to treat acromegaly?

Somatostatin Analogues
Dopamine Agonists
GH Antagonists

28

How are somatostatin analogues usually administered?

Injection (IM or SC)

29

What are the advantages of somatostatin analogues

- Tumour shrinkage
- Can be used pre-op
- relieves headache in 1 hr
- Improved outcome

30

What are the short term adverse effects of somatostatin analogues?

- Local Stinging
- Flatulence
- Diarrhoea
- Abdominal pains