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Year 2 Collin > Endo 2 - Hypersecretion of APG Hormones > Flashcards

Endo 2 - Hypersecretion of APG Hormones Flashcards

1
Q

What is hyperpituitarism?

A

Symptoms associated with excess production of APG hormones

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2
Q

What can cause hyperpituitarism?

A

Pituitary tumour

Can also be ectopic (ectopic = non-endocrine tissue)

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3
Q

What is hyperpituitarism often associated with?

A

Visual field defects (& cranial nerve defects)

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4
Q

What is the optic chiasm?

A

The place where the fibres of the nasal retinae cross.

Compression of Optic chiasm = loss of temporal fields of vision

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5
Q

Excess ACTH (corticotrophin) can cause?

A

Cushings disease

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6
Q

Excess TSH (thyrotrophin) can cause?

A

Thyrotoxicosis

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7
Q

Excess LH/FSH (gonadotrophins) can cause?

A

Precocious puberty in children

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8
Q

Excess prolactin can cause?

A

Hyperprolactinaemia

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9
Q

Excess GH can cause?

A

Gigantism (children/teenagers) or acromegaly (adults)

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10
Q

Physiological reasons why prolactin may be high?

A

Pregnancy or breastfeeding

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11
Q

Pathological reasons why prolactin may be high?

A

Prolactinoma (micro adenoma in the pituitary - <10mm)

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12
Q

What is the most common functioning pituitary tumour?

A

Prolactinoma

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13
Q

What can high prolactin levels suppress?

A

High prolactin suppresses GnRH pulsatility - potentially causing secondary hypogonadism

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14
Q

How can hyperprolactinaemia present in women?

A
  1. Galactorrhoea (milk production outside of lactation)
  2. Secondary amenorrhoea (or oligomenorrhoea)
  3. Loss of libido
  4. Infertility
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15
Q

What is oligomenorrhoea?

A

Infrequent periods

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16
Q

What is secondary amenorrhoea?

A

When menstruation has started then it switches off

17
Q

How can hyperprolactinaemia present in men?

A
  1. Infertility
  2. Erectile dysfunction
  3. Loss of libido
  4. Galactorrhoea uncommon (men don’t have enough oestrogen usually to prime the breast)
18
Q

What is secreted by the hypothalamus that inhibits prolactin secretion?

A

Dopamine.

19
Q

How can hyperprolactinaemia be treated?

A

D2 receptor agonist

20
Q

Usually, pituitary tumours involve neurosurgeons, etc to treat. What is different about a prolactinoma.

A

Medical treatment is first line. D2 receptor agonists decrease prolactin secretion and reduce tumour size

21
Q

Name 2 D2 receptor agonists.

A
  1. Bromocriptine

2. Cabergoline (1st line D2 receptor agonist - taken 1/2 a week for 3 years)

22
Q

What are the side effects of D2 receptor agonists?

A
  1. Nausea and vomiting (moreso Bromocriptine)
  2. Postural hypotension
  3. Dyskinesias
  4. Depression
23
Q

What is excess GH usually due to?

A

Benign pituitary adenoma which secretes GH

24
Q

Is acromegaly identified easily?

A

No.
It can be insidious in onset and also signs and symptoms progress gradually.

Untreated, excess GH can cause increased morbidity and mortaility

25
Q

Excess GH can cause?

A

CV Disease
Respiratory complications
Cancer

26
Q

What grows in acromegaly?

A
  1. Periosteal bone
  2. Cartilage
  3. Fibrous tissue
  4. Connective tissue
  5. Internal organs (cardiomegaly, splenomegaly, hepatomegaly, etc)
27
Q

What are the clinical features of acromegaly?

A
  1. Excessive sweating
  2. Headache
  3. General coarseness of features (e.g. nose, hands and feet bigger, lips thicken), enlargement of supraorbital ridges
  4. Enlarged tongue
  5. Mandible grows (protrusion of lower jaw)
  6. Carpal tunnel syndrome (can squash median nerve)
  7. Enlarge chest
28
Q

What are the metabolic effects of acromegaly?

A

Excess GH causes increased endogenous glucose production & decreased muscle uptake. This means increased insulin production which increases insulin resistance - causing impaired glucose tolerance and predisposition to T2DM

29
Q

What are the complications of acromegaly?

A
  1. Increased cancer risk (e.g. colonic cancer - screening done)
  2. Obstructive sleep apnoea - bone/soft tissue changes surrounding upper airway causes narrowing/collapse during sleep
  3. Hypertension (GH/IGF-1 directly on vascular tree / GH mediated renal sodium absorption)
  4. Cardiomyopathy - hypertension, DM, toxic effects of excess GH on myocardium
30
Q

Acromegaly often involves co-secretion of what hormone in addition to GH?

A

Prolactin.

Hyperprolactinaemia will cause secondary hypogonadism

31
Q

What is the gold standard in diagnosing acromegaly?

A

“paradoxical rise” in GH following oral glucose load (GH should actually decrease)

32
Q

How is acromegaly treated?

A
  1. Surgery (trans-sphenoidal) - FIRST LINE
  2. Medical -
    Somatostatin analogue (e.g. Octreotide) / D2 receptor agonists (e.g. cabergoline)
  3. Radiotherapy (can be slow)
33
Q

Somatostatin analogues may cause side-effects in?

A

The GI system. Nausea, diarrhoea, gallstones may occur

Year 2 Collin (114 decks)

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