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Endocrinology 2 > Pituitary tumours > Flashcards

Pituitary tumours Flashcards

1
Q

what is the name of a functioning pituitary tumour of the lactotroph cells?

A

prolactinoma

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2
Q

what is the name of a functioning pituitary tumour of the somatotrophs?

A

acromegaly

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3
Q

what is the name of a functioning pituitary tumour of the thyrotrophs?

A

TSHoma

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4
Q

what is the name of a functioning pituitary tumour of the gonadotrophs?

A

gonadotrophinoma

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5
Q

what is the name of a functioning pituitary tumour of the corticotrophs?

A

cushing’s disease (corticotroph adenoma)

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6
Q

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

A

cushing’s syndrome - is making too much cortisol for any cause -c could be a tumour of adrenals

cushing’s disease - too much ACTH specifically

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7
Q

What are the 6 classifications of a pituitary tumour?

A
  • size
  • sella or suprasellar
  • function
  • benign or malignant
  • compressing or not compressing optic chiasm
  • Invading cavernous sinus or not
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8
Q

a tumour is 1.5cm, is it a micro or macroadenoma?

A

macroadenoma

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9
Q

tumour <1cm is a?

A

microadenoma

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10
Q

tumour >1cm is a?

A

macroadenoma

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11
Q

a sella tumour means?

A

sitting in the sella turcica

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12
Q

a suprasellar tumour means?

A

risen above sella turcica and approaching optic chiasm

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13
Q

the mitotic ki67 index needs to be above what percentage to be classed as malignant?

A

3%

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14
Q
A
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15
Q

pituitary carcinomas account for what percentage of pituitary tumours?

A

<0.5%

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16
Q

hyperprolactinaemia causes what pathology?

A
  • Inhibits kisspeptin release
  • decreases downstream GnRH/LH/FSH/testosterone/oestrogen
  • leads to oligo-amenorrhoea, low libido, low fertility, osteoporosis
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17
Q

A patient presents with:

  • menstrual disturbance
  • erectile dysfunction
  • reduced libido
  • galactorrhoea
  • subfertility

What’s a likely diagnosis?

A

hyperprolactinaemia

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18
Q

name 3 physiological causes of elevated prolactin?

A
  • pregnancy/breastfeeding
  • stress eg. venepuncture
  • nipple/chest wall stimulation
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19
Q

name 3 pathological causes of elevated prolactin?

A
  • primary hypothyroidism
  • polycystic ovarian syndrome
  • chronic renal failure
20
Q

name 5 drugs that can elevate prolactin levels

A
  • antipsychotics
  • SSRIs
  • Anti-emetics
  • high dose oestrogen
  • opiates
21
Q

If you see a patient with a mild elevation in prolactin but no clinical features, which options do you think of?

A
  1. Macroprolactin
  2. Stress of venupuncture
22
Q

What is macroprolactin made of?

A

antigen-antibody complex of monomeric prolactin and IgG

23
Q

How can you eliminate the stress of venepuncture when checking prolactin levels?

A

cannulated prolactin series

24
Q

what is the treatment for a prolactinoma? Give an example of a drug.

A

dopamine receptor agonists eg. cabergoline

25
Q

Is cabergoline safe in pregnancy?

A

yes

26
Q

how do dopamine receptor agonists work?

A

Act like dopamine and inhibit prolactin production, and shrink tumour

27
Q

pituitary tumours secreting excess GH results in?

A
  • gigantism - children
  • acromegaly - adults
28
Q
  • sweatiness
  • headache
  • macroglossia
  • prominent nose
  • large jaw
  • increase hand and feet size
  • snoring and obstructive sleep apnoea
  • hypertension
  • impaired glucose tolerance / diabetes mellitus

are symptoms of what?

A

acromegaly

29
Q

Growth hormone acts in 2 ways, both directly and indirectly. How does it do this?

A
  1. Acts on body tissues leading to growth and development
  2. Acts on liver to stimulate production of IGF-1 (insulin-like growth factor), which then also stimulates growth and development of the body tissues
30
Q

75g oral glucose load is given to a patient with acromegaly… what happens to GH levels?

A

You see an immediate spike/increase in GH levels

31
Q

why is a random measurement of GH unhelpful?

A

GH is pulsatile

32
Q

what is usually elevated in acromegaly, except for GH?

A

IGF-1

33
Q

Once GH excess is confirmed in acromegaly, what else needs to be done?

A

pituitary MRI

34
Q

What is the first line of treatment for acromegaly?

A

trans-sphenoidal pituitary surgery

35
Q
A
36
Q

What risk is someone at with untreated acromegaly?

A

increased cardiovascular risk

37
Q

what medicines can be used to shrink a pituitary tumour in acromegaly before surgery?

A
  • somatostatin analogues
  • dopamine agonists
38
Q

why are dopamine agonists often given to acromegaly patients?

A

GH secreting pituitary tumours frequently express D2 receptors

39
Q

give an example of a somatostatin analogue?

A

octreotride

40
Q

give an example of a dopamine agonist?

A

cabergoline

41
Q

These symptoms are a sign of?

  • red cheeks
  • fat pads
  • thin skin
  • moon face
  • easy bruising
  • purple striae
  • large abdomen
  • poor wound healing
  • proximal myopathy (muscle weakness) thin arms and legs
  • impaired glucose tolerance (diabetes)
  • osteoporosis
  • depression
A

Cushing’s syndrome (excess cortisol)

42
Q

Cushing’s syndrome occurs due to what level of which hormone?

A

excess cortisol

43
Q

State 4 causes of cushing’s syndrome

A
  1. Taking steroids by mouth
  2. Pituitary adenoma (Cushing’s disease)
  3. ectopic ACTH eg. lung cancer
  4. adrenal adenoma or carcinoma
44
Q

How do we test for Cushing’s disease?

A
  • Elevated 24h urine free cortisol
  • Elevated late night cortisol - salivary or blood test
  • failure to suppress cortisol after oral dexamethasone (exogenous glucocorticoid) which would usually negatively feedback to pituitary and switch off ACTH
45
Q

what is the treatment for a larger pituitary tumour that is approaching optic chiasm?

A

trans-sphenoidal surgery

46
Q

would you operate on someone with a non-functioning pituitary tumour that isn’t approaching the optic chiasm?

A

no

Endocrinology 2 (17 decks)

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