Presentations
- Abdominal pain
- Anosmia
- Dehydration
- Delayed or precocious puberty
- Dizziness
- Galactorrhoea
- Headaches
- Hypernatraemia / Hyponatraemia
- Hyperphagia / Anorexia
- Hypotension
- Nausea
- Neonatal hypoglycaemia
- Polyuria, polydipsia
- Short stature
- Visual loss or vision changes
- Vomiting
- Weight gain or weight loss
Conditions
- Pituitary lesions, such as:
- craniopharyngioma
- pars intermedia cysts
- Rathke cleft cysts
Anterior pituitary hormone deficiencies
- Acquired pituitary hormone deficiencies:
- craniopharyngioma and other space occupying lesions, such as germinoma and pilocytic astrocytoma
- post-surgery
- Congenital hypopituitarism (multiple pituitary hormone deficiencies):
- ectopic posterior pituitary
- genetic causes of hypopituitarism:
- interrupted pituitary stalk syndrome
- septo-optic dysplasia
- Pituitary hormone deficiencies:
- ACTH deficiency – central hypoadrenalism
- growth hormone (GH) deficiency
- gonadotrophin deficiency (hypogonadotrophic hypogonadism)
- Kallmann syndrome
- thyroid-stimulating hormone (TSH) deficiency – central hypothyroidism
- Prader–Willi syndrome
Disorders of pituitary hormone excess
- Cushing syndrome
- Pituitary gigantism / acromegaly:
- Prolactinoma:
- Thyrotropinomas
Disorders of salt and water balance
- Arginine vasopressin deficiency (AVP-D)
- Arginine vasopressin resistance (AVP-R)
- Cerebral salt wasting (CSW)
- Congenital or acquired:
- germ cell tumour
- Langerhans cell histiocytosis
- Pontine myelinosis (rapid correction of chronic hyponatraemia)
- Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Non-functioning pituitary adenomas
- Functional pituitary adenomas:
- corticotropinomas secreting (Cushing disease)
- somatropinomas secreting (acromegaly)
- thyrotropinomas secreting
- Pituitary apoplexy
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Anatomy of hypothalamic-pituitary connections
- Causes and treatments for electrolyte, hypothalamus, and pituitary gland disorders
- Feedback systems for adrenal, gonads, thyroid, and growth hormone
- Functions of the hypothalamus
- Growth hormone’s role in childhood and adult life
- Histology of the normal pituitary gland and of pituitary tumours
- Insulin-like growth factors' (IGFs’) roles and their binding proteins in growth and differentiation
- Natural history of pituitary tumour types
- Normal and abnormal anatomy, embryology, and physiology of the hypothalamus and pituitary gland
Acromegaly
- Causes of elevated IGF-1
- Differentiate between excess growth hormone secretion from functioning pituitary tumour and that of secondary to excess growth hormone-releasing hormone
- Indication for pituitary imaging in acromegaly
- Properties of serum growth hormone and IGF-1 assays
- Somatostatin receptor subclasses, and relevance to therapeutics
- Somatostatin’s role in negative regulation of somatotrope
Diabetes insipidus
- Desmopressin (DDAVP) pharmacology
- Differential diagnoses, including nephrogenic diabetes insipidus and chronic water excess (primary polydipsia)
- Loss of thirst regulation secondary to pituitary / hypothalamic disease and/or surgery
- Management principles of diabetes insipidus unmasked by cortisol and/or thyroid hormone replacement
- Primary causes, including genetics
- Regulation of salt and water balance, including regulation of free water clearance by cortisol and thyroid hormone
- Salt and water balance and limitations of measuring electrolytes, osmolality, and urinary specific gravity, and measurement of strict fluid balance
- Secondary causes and natural history of diabetes insipidus, including:
- infiltrative disorders
- metabolic cause
- surgery
- trauma
- tumours
Prolactinoma
- The mechanism of differing dopamine agonists, particularly with respect to dosing and side effects
- The role of dopamine in negative regulation of lactotrophs
Acromegaly
- Glucose suppression test for diagnosis of acromegaly
- IGF-1 assays
- Interpret glucose suppression test for diagnosis of acromegaly
- Properties of serum prolactin assays
- Serum growth hormone
Investigations
- Ophthalmoscopy of optic nerve
- Principles of and indications for imaging of the hypothalamus and pituitary:
- Properties, principles, and indications for basal and dynamic biochemical investigation of hypothalamo-pituitary disease, including dynamic testing, such as:
- corticotropin-releasing factor
- glucagon / arginine
- gonadotropin-releasing hormone (GnRH)
- OGT for GH excess
- overnight dexamethasone test
- synacthen testing
- thyrotropin-releasing hormone (TRH)
- water deprivation and stimulated copeptin
- Visual field testing and more complex field testing
Procedures
- Clinical assessment of thyroid adequacy and over-replacement
- Pituitary irrradiation and pituitary surgery
- Pre-, peri- and postoperative management of patients with pituitary disease, with emphasis on management of endocrine disturbances
Prolactinoma
- Indication for pituitary imaging in hyperprolactinaemia
- Properties of serum prolactin assays
- Causes and treatments for disorders of the hypothalamus and pituitary
- Differentiate between hyperprolactinaemia from functioning pituitary tumour versus ‘stalk effect’
Central hypoadrenalism
- Adrenal hormone replacement pharmacology
- Monitoring difficulties without feedback hormone
- Over-replacement signs
- Requirements for physical stress and illness
- Stress replacement and precautions
Central hypothyroidism
- Monitoring difficulties
- Over-replacement signs
- Thyroid hormone replacement pharmacology
Functioning pituitary tumours
- Treatments / pharmacology of dopamine agonists, including:
- bromocriptine
- cabergoline
- lanreotide
- octreotide
- somatostatin analogues
GH deficiency
- IGFs’ role and their binding proteins in growth and differentiation
