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Flashcards

Pituitary

Liam Musselbrook Medicine English 22 cards

Cards in this deck (22)

  1. 1What does the anterior pituitary synthesise and secrete?- Growth hormone (GH)
    - Prolactin
    - Adenocorticotropic hormone (ACTH)
    - TSH
    - Gonadotrophin luteinising hormone (LH)
    - Follicle stimulating hormone (FSH)
  2. 2What does the posterior pituitary store and secrete? (hormones are produced in the hypothalamus, connected via pituitary stalk)- Anti-diuretic hormone (ADH)
    - Oxytocin
  3. 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
  4. 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
  5. 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
  6. 6What is the function of prolactin?- Stimulates breast milk production
    - Also inhibits GnRH and gonadotropin production
  7. 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
  8. 8Give other causes of hyperprolactinaemia- Breast stimulation / stress (transient)
    - Drug-induced
    - Idiopathic
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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%)
  16. 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
  17. 17What are the signs of Cushing's syndrome?- Moon face
    - Frontal bleeding
    - Striae
    - HTN
    - Pathological fractures
    - 'Buffalo hump'
    - Proximal myopathy
  18. 18What metabolic abnormality can be present in Cushing's syndrome due to the mineralcorticoid activity of cortisol?Hypokalaemia
  19. 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)
  20. 20What is panhypopituitism and how does it present?- Fatigue, myalgia, hypotension (GH/corticotropin deficiency)
    - Diabetes insipidus (ADH deficiency)
    - Hypothyroidism (TSH deficiency)
  21. 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
  22. 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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Medicine (Endocrine) Flashcards on Pituitary, created by Liam Musselbrook on 05/11/2017.
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