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Endocrinology Notes

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Medicine & Surgery

Endocrinology Disorders of the Pituitary

Causes of Pituitary Disorders

Hypersecretion - functioning tumours or drugs

Symptoms

Deficient Hormone GH

Growth retardation in children, excessive tiredness, muscle weakness Hypogonadism - reduced body hair, FSH/LH low libido, impotence in men, amenorrhoea, dyspareunia and hot flushes in women Weight gain, decreased energy, TSH sensitivity to cold, constipation, dry Pale appearance, weight loss, low BP, ACTH dizziness, tiredness Thirst and polyuria VP Hyposecretion - craniopharyngeoma, non-functioning pituitary tumours, radiotherapy, trauma, empty sella syndrome

Hypopituitarism Deficiency of hypothalamic releasing hormones Isolated deficiency of GH, LH, ACTH, TSH & vasopressin

Growth Failure Short Stature
 Thyroid function test - hypothyroidism
 GH status

 IGF-1 - GH undersecretion
 Assessment of bone age
 Karyotyping female - turner's syndrome Treatment Hypothyroidism - levothyroxine GH insufficiency - somatrophin injections

Acromegaly & Giantism GH excess due to a pituitary tumour
 Changes in appearance
 Visual fields defects/headaches
 Sweating Investigations GH levels Glucose tolerance test - diagnostic if there is no suppression of GH IGF-1 - almost always raised Visual field exam - bitemporal hemianopia MRI scan - pituitary adenoma Prolactinaemia Management & Treatment Surgery - trans-sphenoidal Pituitary radiotherapy after surgery Medical therapy o Somatostatin receptor agonist - octreotide o Dopamine agonists o GH antagonists - normalises IGF-1 levels

Hyperprolactinaemia

Caused by a small prolactin producing tumour , PCOS, primary hypothyroidism Applies pressure on the optic nerve resulting in bitemporal hemianopia Amenorrhea, breast milk production, loss of libido, headaches, oesteoporosis due to hypoestrogenism Investigations Visual fields Hypothyroidism must be excluded Anterior pituitary function - tumours MRI scan of pituitary Treatment Must be treated to avoid the long term effects of oestrogen deficiency
 Medical o Dopamine agonist - cabergoline/bromocriptine
 Trans-sphenoidal surgery
 Radiotherapy o Controls the growth but is slow in effect

Thyroid Disease Produces thyroxine, T4 and triiodothyronine, T3 These regulate the rate of metabolism and affect growth and rate of function of many systems Iodine and tyrosine are both used to for T 3 and T4 T4 is converted to T3 and reverse T3 by de-iodination T3 is rapidly excreted due to poor binding and further de-iodination Regulation Regulated by TRH from the hypothalamus

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