Session 8 Lecture 2

Question 1

What happens if you have growth hormones deficiency?

Answer 1

In childhood - results in pituitary dwarfism. Proportionate type dwarfism

Question 2

What are the symptoms of GH defunct in adults?

Answer 2

Dec tolerance to exercise, dec muscle strength, inc body fat and reduced sense of well’being

Question 3

What is GH defence in adults usually due to?

Answer 3

Mass effect from a pituitary adenoma

Question 4

What is GH deficiency in children usually due to?

Answer 4

Idiopathic (of unknown cause) but specific gene mutations and autoimmune inflammation have been identified

Question 5

What are the symptoms of GH deficiency in children?

Answer 5

Poor growth, short stature

Question 6

What are the treatments of GH deficiency?

Answer 6

Human GH manufactured by recombinant DNA technology

Question 7

What is the most common cause of pituitary malfunction?

Answer 7

Benign tumour (adenoma)

Question 8

What affect can benign pituitary tumour have?

Answer 8

Cause inadequate reduction is pituitary hormones due to physical pressure form the tumour

Question 9

Clinical presentation of pituitary tumours?

Answer 9

Visual loss, headache (due to pressure on the optic nerve), hyper or hyposecretion

Question 10

What are the clinical symptom of hypersecreting tumours?

Answer 10

Symptoms usually correspond to the systemic effects of the over-secreted hormone

Question 11

What do the investigations of a suspected pituitary tumour involve?

Answer 11

Delineation of the anatomy, size and topographical location of the pituitary,
Assessment of visual field and defects
Assessment of endocrine function

Question 12

How do you measure hormone levels?

Answer 12

FBC or staining sections from a biopsy of the tumour with antibodies for the relevant hormone

Question 13

What is hypopituitarism?

Answer 13

Insufficient pituitary hormone production

Question 14

What is the most common result of pituitary adenoma?

Answer 14

Hypopituitarism

Question 15

What are the rarer causes of hypopituitarism?

Answer 15

Radiation therapy, inflammatory disease and head injury

Question 16

Which hormones are the first to be affected in hypopituitarism?

Answer 16

GH ad LH/FSH

Question 17

What is defunct in all anterior pituitary hormones referred to as?

Answer 17

Pan hypopituitarism

Question 18

When is secretion of ADH and oxytocin from posterior pituitary affected?

Answer 18

If tumour affects hypothalamic function or an inflammatory response involved

Question 19

What happens if you have gonadotropin deficiency?

Answer 19

Lack of libido, infertility and oligomenorrhea/amenorrhea

Question 20

What is gonadotropin deficiency usually due to?

Answer 20

Mass effect from pituitary adenoma

Question 21

What happens in TSH deficiency?

Answer 21

Low thyroid hormones, weight gain, tiredness, slow pulse

Question 22

What happens in ACTH deficiency?

Answer 22

Low cortisol, tired, dizzy Ess., low sodium

Question 23

What happens in ADH deficiency?

Answer 23

Excess excretion of dilute urine resulting in dehydration and an inc sensation of thirst (DIABETES INSIPIDUS)

Question 24

What are the three main conditions caused by excess pituitary hormone production?

Answer 24

Prolactin excess, growth hormone excess and ACTH excess

Question 25

What is the normal physiological function of prolactin?

Answer 25

Initiate and maintain lactation

Question 26

What is another name for dopamine?

Answer 26

PIH - prolactin release inhibiting hormone

Question 27

What is prolactin section regulated by?

Answer 27

PRH and PIH (dopamine)

Question 28

What are the symptoms of hyperprolactinaemia?

Answer 28

Galactorrhea, gynecomastia, hypogonadism, anemorrhea and erectile dysfunction

Question 29

What does hypogonadism due to hyperprolactinaemia result from?

Answer 29

Higher levels of opine in the hypothalamus which inhibits GnRH therefore inhibits FSH and LH.

Question 30

What is the most common cause of hyperprolactinaemia?

Answer 30

Prolactinoma - pituitary adenoma that secretes prolactin

Question 31

What is the first line of treatment for someone with prolactin excess?

Answer 31

Cabergoline - dopamine receptor agonist

Question 32

What happens if you have a growth hormone excess in children?

Answer 32

Leads to gigantism

Question 33

What are the systemic effects of growth hormone excess?

Answer 33

Direct causes of GH itself and through stimulation of IGF1 production

Question 34

Why does it take a long time to diagnose someone with GH excess?

Answer 34

The effects of increased activation of GH and IGF receptors take several years to manifest as a change in physical appearance

Question 35

How does excess growth hormones in adults present as?

Answer 35

ACROMEGALY - large extremities - hands, feet and lower jaw. Can also be seeping of the voice

Question 36

Describe some more complex effects of GH excess

Answer 36

GH antagonises the actions of insulin therefore several metabolic complications may also manifest inc diabetes mellitus and inc serum IGF (linked to cancer)

Question 37

What treatments are available to people with acromegaly?

Answer 37

Surgery to remove adenoma, radiation therapy and drug therapy

Question 38

What happens with excess ACTH?

Answer 38

Cushing's syndrome