pituitary diseases

Question 1

causes of raised prolactin

Answer 1

• breast feeding
• pregnancy
• stress
• sleep
• dopamine antagonists
• antipsychotics
• antidepressants
• hypothyroidism
• stalk lesions
• prolactinoma

Question 2

what are the symptoms and signs in women for a prolactinoma

Answer 2

• early presentation
• galactorrhoea
• menstrual irregularity
• ammenorrhoea
• infertility

Question 3

signs and symptoms in males of prolactinoma

Answer 3

• late presentation
• impotence
• visual field abnormal
• ant pit malfunction

Question 4

investigations for prolactinoma

Answer 4

• serum prolactin concentration
• MRI pituitary
• visual fields check
• pituitary function tests

Question 5

prolactinoma treatment

Answer 5

dopamine agonists

-cabergoline once to twice per week oral

Question 6

side effects of dopamine agonists

Answer 6

• nausea
• vomiting
• low mood

Question 7

what do dopamine agonists do

Answer 7

• prolactin normalised
• menstruation regained
• pregnancy
• tumour shrinkage

Question 8

what is acromegaly

Answer 8

too much GH secreted

Question 9

symptoms of acromegaly

Answer 9

• giant
• thickened soft tissues
• large hands
• snoring
• sleep apnoea
• hypertension
• cardiac failure
• headaches
• diabetes mellitus
• vision problems
• hypopituitarism
• colonic polyps

Question 10

diagnosis of acromegaly

Answer 10

• measure IGF1
• GTT suppression test (normal - GH suppresses to <0.4, if acromegaly then GH unchanged)
• check visual fields
• CT or MRI pituitary

Question 11

treatments for acromegaly

Answer 11

• pituitary surgery
• radiotherapy

DRUGS
somatostatin analogues
-sandostatin LAR
-Lanreotide

GH antagonist (most effective)

• pegvisomant
• SC injection 10-30mg per day

Question 12

side effects of somatostatin analogues

Answer 12

• local stinging
• short term - flatulence, diarrhoea, abdo pains
• long term - gallstones

Question 13

could you also use dopamine agonists for acromegaly

Answer 13

yes in some patients

Question 14

what is cushing’s syndrome

Answer 14

excess cortisol

Question 15

symptoms of cushing’s syndrome

Answer 15

• muscle wasting
• osteoporosis
• fractures
• thin skin
• striae
• bruising
• frontal balding in women
• conjunctival oedema
• psychosis
• depression
• hypertension
• acne
• excess hair

Question 16

what is in excess in cushing’s syndrome

Answer 16

• cortisol
• mineralocorticoid
• androgen

Question 17

tests to diagnose cushing’s

Answer 17

• overnight 1mg dexamethasone suppression test (cortisol <50 normal, >130 abnormal)
• urine free cortisol (<250 normal)
• diurnal cortisol variation (loss of diurnal variation is suspicious of cushing’s)
• 2 day 2mg/day dexamethasone suppression test (cortisol >130mmol/l = cushings)

Question 18

causes of cushing’s

Answer 18

• mainly pituitary
• adenoma of adrenal
• ectopic ACTH production
• alcohol and depression
• steroid medication

Question 19

non-drug treatment for cushing’s

Answer 19

pituitary

• hypophysectomy and external radiotherapy if recurs
• bilateral adrenalectomy

adrenal
-adrenalectomy

ectopic

• remove source
• or bilateral adrenalectomy

Question 20

drug treatment for cushing’s

Answer 20

metyrapone
-if other treatment fails
ketoconazole
pasireotide LAR

Question 21

what is pan hypopituitarism

Answer 21

a condition in which the production and secretion of all hormones by the pituitary gland is reduced.

Question 22

pan hypopituitarism effects on anterior pituitary

Answer 22

• growth hormone: growth failure
• TSH: hypothyroidism
• LH/FSH: hypogonadism
• ACTH: hypoadrenal

Question 23

pan hypopituitarism effects on posterior pituitary

Answer 23

diabetes insipidus

Question 24

causes of hypopituitarism

Answer 24

• pituitary tumours
• other local brain tumours
• surgery
• granulomatous disease
• vascular diseases
• trauma
• secondary metastatic lesions
• hypothalamic disease
• autoimmune
• infection

Question 25

symptoms and signs of anterior hypopituitarism

Answer 25

- Menstrual irregularities (F) - Infertility, impotence - Gynaecomastia (M) - Abdominal obesity - Loss of facial hair (M) - Loss of axillary and pubic hair (M&F) - Dry skin and hair - Hypothyroid faces - growth retardation (children)

Question 26

what is replacement therapy for hypopituitarism

Answer 26

- thyroxine 100-150mcg/day - hydrocortisone 10-25mg/day - ADH - desmospray or desmopressin tablets - GH nightly - HRT/oest/prog pill for females - testosterone for males

Question 27

how does testosterone replacement work

Answer 27

- IM injection every 3-4 weeks (sustanon) - Skin gel (testogel, tostran) - Prolonged IM injection 10-14 wks (nebido) - (Oral tablets (restandol))

Question 28

risks of testosterone replacement

Answer 28

- risk of stroke/MI - prostate enlargement - hepatitis only for oral tablets

Question 29

effects of giving growth hormone in adults

Answer 29

- Improves well being and Quality of life - Decreases abdominal fat - Increases muscle mass, strength, exercise capacity and stamina - Improves cardiac function - Decreases cholesterol and increases LDL - Increases bone density - Given by daily SC injection

Question 30

causes of cranial diabetes insipidus

Answer 30

- familial - idiopathic - trauma - tumour - sarcoid - meningitis - ext irradiation

Question 31

what is diabetes insipidus

Answer 31

an uncommon disorder that causes an imbalance of fluids in the body. This imbalance leads you to produce large amounts of urine. It also makes you very thirsty even if you have something to drink

Question 32

what is the water deprivation test

Answer 32

- Check serum and urine osmolalities for 8h, and then 4h after giving IM DDAVP. - If Ur/Serum Osmol ratio >2 then it is normal, otherwise DI

Question 33

treatment of diabetes insipidus

Answer 33

``` desmospray -nasally 10-60 mcg/day desmopressin oral tablets -100-1000 mcg per day desmopressin injection -1-2 mcg IM per day ```