1 / 48

Pituitary disorders

Pituitary disorders. Narendra Reddy Clinical Lecturer Diabetes, Endocrinology & Metabolism University of Warwick. Grand round, UHCW, June 14 th 2011. Plan…. Pituitary anatomy Pituitary physiology Evaluation of Pituitary mass Pituitary dysfunction in Elderly Clinical scenarios/Images.

tuyet
Download Presentation

Pituitary disorders

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Pituitary disorders Narendra Reddy Clinical Lecturer Diabetes, Endocrinology & Metabolism University of Warwick Grand round, UHCW, June 14th 2011

  2. Plan…. • Pituitary anatomy • Pituitary physiology • Evaluation of Pituitary mass • Pituitary dysfunction in Elderly • Clinical scenarios/Images

  3. Pituitary anatomy

  4. Pituitary anatomy

  5. Sagittal view

  6. Coronal view

  7. Coronal view

  8. Hormones

  9. Evaluation of Pituitary mass • Local effects • Hypersecretion • Hyposecretion

  10. Pituitary hormone profile • Somatotroph – GH IGF-1 • Gonadotroph – FSH,LH Testo/Oest • Thyrotroph – TSH FT4,FT3 • Corticotroph – ACTH Cortisol (SST) • Lactotroph - Prolactin • Neurohypophysis Vasopressin (U&E, Paired Osmol)

  11. Case • 82 yr old male • Headache, diplopia, vomiting- Acute • Hypotension- 90/45 mmHg & III N palsy • PMH- IHD, Hypertension • Drugs- Antihypertensives, Aspirin • Diagnosis?

  12. Investigations • 9 am Testo- <0.4 (10-26) • LH- 1.2, FSH- 0.7 (2-10) • IGF-1 – 4.8 (10-35) • PrL- 322 (<300) • FT4 8.8 (10-19.5), TSH 2.0 (0.5-4.5) • SST – 30’ Cortisol 213 nmol/L • Na - 122; Pl Osm & U Osm - normal

  13. Pituitary apoplexy

  14. Pituitary apoplexy

  15. Pituitary apoplexy

  16. Pit apoplexy guidelines

  17. Chronic hypopit’ symptoms • GH- lethargy, reduced strength • LH/FSH- libido, infertility, menstrual • TSH – hypothyroid • PrL- lack of milk in breastfeeding females • ACTH – pallor • Vasopressin – Diabetes Insipidus

  18. Hypopituitarism • Pituitary tumours • Radiotherapy • Apoplexy,Sheehan syndrome • Infiltrative disorders • Infective- TB, Pit abscess • Trauma • Metastasis • Russell viper snake bite • PIT-1, HESX-1, PROP-1, KAL-1, SOX-2, DAX-1, AVP-Neurohypophysin-II

  19. Dynamic tests • Insulin Tolerance Test- ACTH & GH • Glucagon test – ACTH & GH • SST- adrenocortical function • Clomifene test – Gonadotrophin • GnRH & TRH- rarely used

  20. To take home…. • Adenomas do not cause DI • GH>FSH/LH>TSH>ACTH • Long term hypopit patients, treated with steroids can unmask DI • ACTH def–No Pigment/Hyperkalaemia

  21. 84 pts over 65 yrs (avg 72.5 yrs) • 1975 to 1996 • 64 % VF defects • 20 % hypopituitarism • 7% pituitary apoplexy • TSA safe in elderly

  22. Pit tumours in elderly

  23. Pituitary Incidentalomas 10% incidence in 18902 pituitaries Minimum 20 years F/U 18-86 years Local, hypersecretion, hyposecretion 10.6% < 1cm 24.1 % if >1cm MRI – 1, 2 & 5 years- stop if no size Hypopit, VF defects & size increase- Sx Mark Molitch,Best Practice in Clinical Research 23 (2009) 667–675

  24. Case • 42 yr man • Headaches Reduced libido Erectile dysfunction

  25. 2007 20 days 9 months 3 years

  26. Prolactinoma • Micro <1cm ; Macro > 1cm • Medical treatment- Cabergoline • Surgery- DA resistance/intolerance • Radiotherapy • DA Rx – Cardiac Valve fibrosis 1st line- Sx 2ndline- Mx 3rd line-Dx

  27. Case • 20 year old boy • Visual field problems • Enlarged nose • Carpal tunnel Syndrome

  28. Acromegaly

  29. Photos please...

  30. 1st line- Sx 2nd line- Mx 3rd line- Dx

  31. Case • 40 years old lady • 10 years of Diabetes • Hypertension • Hyperlipidaemia • Osteoporosis • Wt gain • Acne

  32. Cushings disease

  33. Dr Harvey Cushing

  34. Management • ONDMST - Cortisol > 50 • 24 hr Urine Free Cortisol • LDDMST >50 • HDDMST • CRH stimulation test • Petrosal sinus sampling • Surgery • Radiotherapy • B/L Adrenalectomy 1st line- Sx 2nd line-Dx 3rd line- Sx

  35. Non functioning Pit Adenomas(NFA)

  36. NFA

  37. ?????

  38. Rathkes cyst

  39. ???

  40. Craniopharyngioma

  41. 40 yr old female,Hypothyroid

  42. ?????

  43. Lymphocytic hypophysitis

  44. Lymphocytic hypophysitis • Young women • Auto immune • Prodromal illness • VF defects • Hormone deficiencies • Bx- diagnostic

  45. Meningioma

  46. Hormones !!

More Related