Fichas
Pituitary
Fichas del conjunto (22)
- 1What does the anterior pituitary synthesise and secrete?- Growth hormone (GH)
- Prolactin
- Adenocorticotropic hormone (ACTH)
- TSH
- Gonadotrophin luteinising hormone (LH)
- Follicle stimulating hormone (FSH) - 2What does the posterior pituitary store and secrete? (hormones are produced in the hypothalamus, connected via pituitary stalk)- Anti-diuretic hormone (ADH)
- Oxytocin - 3Discuss pituitary adenomas: associations and classifications- Benign tumours of the glandular tissue
- Some associated with MEN I/IIa
- <1cm = microadenoma
- >1cm = macroadenoma
- Classified as 'functioning' or 'non-functioning' based on whether they are secretory or not - 4How does can a non-functioning adenoma present?- Bitemporal hemianopia
- Ocular palsies
- Hypopituitarism: destroys normal functioning tissue
- Signs of raised ICP e.g. headache
- Hypothalamic compression symptoms: altered appetite/thirst/sleep cycle - 5How can a functional pituitary adenoma present?- Acromegaly: excess GH
- Hyperprolactinaemia: excess prolactin
- Cushing's syndrome: excess ACTH
- Can also cause mass effects as with non-functioning adenomas
- *Many tumours can secrete multiple hormones, but tumours producing TSH, LH or FSH are very rare - 6What is the function of prolactin?- Stimulates breast milk production
- Also inhibits GnRH and gonadotropin production - 7Describe the clinical features of hyperprolactinaemia- Galactorrhoea
- Oligo/amenorrhoea
- Decreased libido
- Subfertility in males
- Arrested puberty in younger patients
-In long term, may develop osteoporosis due to androgen/oestrogen deficiency - 8Give other causes of hyperprolactinaemia- Breast stimulation / stress (transient)
- Drug-induced
- Idiopathic - 9Outline the treatment of a prolactinoma- Dopamine agonists 1st line:
> Lifelong bromocriptine/ropinarole
> SEs: N&V, dizziness, syncope
> Associated with pulmonary, cardiac and retroperitoneal fibrosis (monitor with CXR and echo)
> Usually shrink tumours
> Symptoms usually recur on stopping - 10What is acromegaly?- Excess GH production
- Stimulates skeletal and soft-tissue growth
- In children it causes gigantism (if prior to epiphyseal plate closure)
- In adults it causes acromegaly
- Almost exclusively due to pituitary tumour - 11What investigations are useful for diagnosing/monitoring acromegaly?- Raised IGF-1 level: correlates with GH levels over the past 24hrs, mainly used for monitoring treatment rather than diagnosis
- Glucose tolerance test: normally will suppress GH secretion, in acromegaly concentrations are >2mcg/ml at 2 hours - 12What are the symptoms of acromegaly?- Change in appearance
- Increased hand/foot size
- Tiredness
- Excessive sweating
- Poor libido
- Symptoms of diabetes
- Headaches
- Visual deterioration
- Symptoms of hypopituitarism - 13What are the signs of acromegaly?- Protruding mandible
- Prominent supraorbital ridge
- Interdental separation
- Large tongues
- Spade-like hands/feet
- Tight rings
- Visual field defects
- HTN - 14Outline the management of acromegaly- Somatostatin analogues to shrink tumour (short term prior to surgery, long term if surgical removal not possible)
- Surgical management: transphenoidal approach - 15What is Cushing's syndrome and what are the different causes?- Symptoms of increasing circulating glucocorticoid
- Most commonly due to exogenous steroids
- ACTH-dependent causes:
> Cushing's disease (65%): pituitary adenoma
> Ectopic ACTH secreting tumour (10%)
- ACTH independent causes: excess adrenal cortisol production due to adrenal tumour or nodular hyperplasia (25%) - 16What are the symptoms of Cushing's syndrome?- Central weight gain
- Change of appearance
- Depression
- Insomnia
- Poor libido
- Thin skin/easy bruising
- Excess hair growth / acne
- Diabetes symptoms - 17What are the signs of Cushing's syndrome?- Moon face
- Frontal bleeding
- Striae
- HTN
- Pathological fractures
- 'Buffalo hump'
- Proximal myopathy - 18What metabolic abnormality can be present in Cushing's syndrome due to the mineralcorticoid activity of cortisol?Hypokalaemia
- 19Discuss the diagnosis of Cushing's syndrome- Confirm raised cortisol
- Dexamethasone suppression test
- Plasma ACTH: if undetectable, adrenal cause likely
- If ACTH detectable, perform high dose dexamethasone suppresion test to differentiate pituitary vs ectopic (no suppression indicates ectopic) - 20What is panhypopituitism and how does it present?- Fatigue, myalgia, hypotension (GH/corticotropin deficiency)
- Diabetes insipidus (ADH deficiency)
- Hypothyroidism (TSH deficiency) - 21What are the different causes of panhypopituitism?- Pituitary causes:
> Obliteration of pituitary by tumour
> Surgical removal/irradiation
> Ischaemic necrosis due to hypotensive shock
- Hypothalamic causes:
> Tumour (craniopharyngoma)
> Infarction
> Sarcoid
> Infection - 22Outline the diagnosis of panhypopituitism- Pituitary hormones: low
- Effector gland hormones: low
- Low response to stimulation tests
- Imaging to localise the pathology
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- (Endocrine) Medicine Fichas sobre Pituitary, creado por Liam Musselbrook el 05/11/2017.
- Creado por
- Liam Musselbrook
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