01a: Ant Pit

Question 1

Disruption of hypothalamus connection/blood supply to anterior pituitary will cause hypersecretion of (X) ant pit hormone. Why?

Answer 1

X = prolactin

Normally under inhibitory regulation by DA from hypothalamus

Question 2

List some intrinsic hypothalamic peptides that, if increased, will also cause hyperprolactinemia.

Answer 2

TRH (ex: hypothyroidism) and VIP (ex: breast stimulation)

Question 3

Prolactin levels greater than (X) value is always from (Y) cause.

Answer 3

X = 250 ng/mL
Y = prolactinoma

Question 4

Most common pituitary adenoma

Answer 4

Prolactinoma

Question 5

Clinical symptoms of hyperprolactinemia in women

Answer 5

1. Galactorrhea (30-80%)
2. Amenorrhea
3. Infertility
4. Hirsutism
5. Osteoporosis

Question 6

Clinical symptoms of hyperprolactinemia in men

Answer 6

1. Galactorrhea (under 10%)
2. Impotence
3. Hypogonadism
4. Mass effects (visual, eye muscles, HA)

Question 7

Prolactin adenomas can be medically treated with:

Answer 7

DA agonists

Bromocriptine or Cabergoline

Question 8

T/F: DA agonists treat prolactinomas by inhibiting prolactin synthesis/secretion, but don’t treat mass effects of tumor.

Answer 8

False - also cause reduction in tumor size

Question 9

T/F: Surgical success and tumor recurrence rates are both low for prolactin microadenomas.

Answer 9

False - both high (over 70% success, 50% recurrence over 5y)

Question 10

T/F: Both pituitary micro- and macro-adenomas have high surgical success rates.

Answer 10

False - macroadenomas difficult to cure with surgery (success about 30%)

Question 11

Which two opposing peptides regulate GH secretion?

Answer 11

Stim: GHRH
Inhib: Somatostatin

Question 12

GH is secreted in (constant/pulsatile) fashion. List some states/molecules that stimulate its secretion.

Answer 12

Pulsatile (and more secreted at night);

Hypoglycemia, exercise, stress, AA

Question 13

Actions of GH are primarily due to its (direct/indirect) effect on tissues.

Answer 13

Indirect (via secretion of IGF-1/somatomedin C)

Question 14

T/F: Unlike GH and its pulsatile secretion, IGF-1 level is constant.

Answer 14

True

Question 15

T/F: Nighttime GH levels in normal person can spike as high as the levels seen in acromegaly patient.

Answer 15

True - but acromegaly patients lose normal pulsatile rhythm of GH

Question 16

(Hyper/hypo)-secretion of (X) causes gigantism in kids and acromegaly in adults.

Answer 16

Hypersecretion

X = GH

Question 17

Acromegaly, if left untreated, can lead to which devastating complications?

Answer 17

1. CV disease (HT, cardiomyopathy)
2. Cancers (colon)
3. Resp impairment (sleep apnea)
4. Skeletal overgrowth/deformity; arthralgias

Question 18

Diagnosis of acromegaly confirmed by:

Answer 18

Administering glucose load and demonstrating that GH secretion is not suppressed (below 2 ng/mL)

Question 19

Majority of acromegaly patients have (micro/macro)-adenomas. How are these patients treated?

Answer 19

Macroadenomas (due to insidious nature of disease);

Meds (surg/radiation have low success rate for macroadenomas)

Question 20

Unlike true Cushing’s, pseudo-Cushing’s has preserved:

Answer 20

Circadian rhythm control of cortisol

Question 21

Treatment of Cushing’s disease - which, by definition, is due to (X) - is primarily via (Y).

Answer 21

X = pit adenoma (ACTH-secreting)
Y = surg (most are microadenomas)

Question 22

If the first-line Rx option for Cushing’s disease doesn’t provide cure, what are other options?

Answer 22

1. Radiation/gamma knife therapy
2. Med therapy

(first-line = surg)

Question 23

Inferior pituitary growth into (X) structure results in which key symptom?

Answer 23

X = sphenoid sinus

Nasal discharge of CSF

Question 24

Superior pituitary growth into (X) structure results in which key symptom?

Answer 24

X = hypothalamus

Hormonal imbalances

Question 25

Lateral pituitary growth into (X) structure results in which key symptom?

Answer 25

X = cavernous sinus

Eye movement issues/diplopia

Question 26

(X) adrenal mass lights up bright white on T2 weighted images due to (high/low) (Y).

Answer 26

X = pheo
High
Y = catecholamines

Question 27

The DIRECT cause of osteomalacia in adults and rickets in children is (low/high) levels of (X).

Answer 27

Low

X = serum phosphate (so low Ca-P and poor bone mineralization)

Question 28

Any chronic granulomatous disease, like Sarcoidosis, can result in high serum and urine (X).

Answer 28

X = Ca

Macrophages have active 1a hydroxylase

Question 29

(X) are the most numerous anterior pituitary cell types

Answer 29

X = somatotrophs

Question 30

Pheochromocytomas can occur at (X) landmark of the aorta, where (Y) chromaffin body is located

Answer 30

X = bifurcation (into common iliacs)
Y = Organ of Zuckerkandl

Question 31

Traid of precocious puberty, cystic bone lesions, and unilateral café-au-lait spotting

Answer 31

McCune-Albright Syndrome