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Endocrine Exam 1 > 10 - Clinical Overview of Hypothalamus and Pituitary Disorders > Flashcards

10 - Clinical Overview of Hypothalamus and Pituitary Disorders Flashcards

1
Q

Describe the relationship of the hypothalamus and pituitary

A

The hypothalamus is a branch and the pituitary is fruit hanging off

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2
Q

Describe the role of the hypothalamus

A
  • Controls output of the anterior pituitary by secreting “RELEASING HORMONES” which signal the release of hormones from the anterior pituitary
  • Also control the output of the posterior pituitary by DIRECT nerve stimulation
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3
Q

What are the 6 hormones released from the anterior pituitary?

A
  • Prolactin
  • Growth hormone (GH)
  • Thyroid stimulating hormone (TSH)
  • Follicle stimulating hormone (FSH)
  • Adrenocorticotropic hormone (ACTH)
  • Luteinizing hormone (LH)
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4
Q

What are the 2 hormones that are released from the posterior pituitary?

A
  • Antidiuretic hormone (ADH) or arginine vasopressin (AVP)

- Oxytocin

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5
Q

How do you access the pituitary gland surgically?

A

Through the nose - transsphenoidal surgery

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6
Q

What is important to remember about testing hormone levels for diagnosing disorders?

A

Can be different throughout the day

Example is Cushing’s Syndrome: increased midnight cortisol compared to normal people but apparently normal in the mornings

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7
Q

What does a deficiency of growth hormone in childhood cause?

A

Dwarfism

  • Short stature, micropenis, increased fat, high-pitched voice
  • Treat with GH replacement therapy with recombinant GH
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8
Q

What does a hypersecretion of growth hormone in youth lead to?

A
  • Giantism in children or adolescents

- Very rare

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9
Q

What does hypersecretion of growth hormone in adults lead to?

A

Acromegaly

  • Increased height, hand and foot sizes
  • Soft tissue swelling
  • Generalized visceromegaly—heart, tongue
  • Upper airway obstruction
  • Diabetes mellitus in 25%
  • Increased risk of colon polyps and cancer
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10
Q

When are GH levels the highest throughout the day?

A

Just before the onset of sleep

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11
Q

When are prolactin levels highest thorughout the day?

A

During REM sleep (4-6 am)

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12
Q

What causes hyperprolactinemia?

A

Most common benign neoplasm—50% of all functioning (secreting) pituitary tumors

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13
Q

What is the female presentation of hyperprolactinemia?

A
  • Amenorrhea
  • Galactorrhea
  • Infertility
  • Mild hirsutism
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14
Q

What is the male presentation of hyperprolactinemia?

A
  • Diminished libido or visual loss from optic nerve compression, headaches, gynecomastia, impotence
  • Males usually have larger tumors
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15
Q

How do you treat hyperprolactinemia?

A
  • Dopamine agonists
  • Surgery
  • Radiotherapy for aggressive tumors
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16
Q

What is the function of adrenocorticotropin hormone (ACTH)?

A

Stimulates the adrenal gland to produce corticosteroids and androgens

It peaks around 6 am and is lowest at midnight

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17
Q

What occurs in an ACTH deficiency?

A

Primary adrenal insufficiency or Addison’s disease

  • Fatigue
  • Weakness
  • Anorexia
  • Nausea
  • Vomiting
  • Weight loss
  • Low BP
  • Hypoglycermia
  • Depression

Treat with a glucocorticoid like hydrocortisone or prednisone

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18
Q

What occurs in an ACTH hypersecretion?

A

Cushing’s syndrome

- Most cases are iatrogenic because if you take too many steroids it causes hypersecretion of ACTH

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19
Q

What are the sypmtoms of Cushing’s disease?

A
  • Thin, brittle skin
  • Central obesity with moon facies, buffalo hump (dowagers hump)
  • Hypertension, purple striae and easy bruising
  • Glucose intolerance or diabetes mellitus
  • Acne, hirsutism, leukocytosis, lymphopenia, eosinopenia
20
Q

What are the consequences of Cushing’s disease?

A

Increased morbidity and mortality of 30-50% at five years—related to high incidence of cardiovascular complications, such as hypertension, and diabetes in up to 50% of cases, which are exacerbated by obesity.

21
Q

How do you treat Cushing’s syndrome?

A

Surgery followed by cortisol replacement

22
Q

What regulating hormone controls both FSH and LH secretion?

A

GnRH - Gonadotropin releasing hormone

23
Q

What occurs with a FSH/LH deficiency in women?

A

Women: menstrual irregularities, infertility, decreased vaginal secretions, decreased libido and breast atrophy, osteoporosis

24
Q

What occurs with a FSH/LH deficiency in men?

A

Males: decreased libido and potency, decreased muscle mass with weakness, reduced beard and body hair growth, soft testes and osteoporosis

25
Q

How do you treat FSH/LH deficiencies?

A

Females
- Replace estrogen and progesterone, use gonadotropins for ovulation

Males
- Testosterone replacement and hCG to restore fertility

26
Q

What occurs in FSH/LH hypersecretion?

A

Gonadotropin-producing tumors usually only secrete a small amount of excess FSH/LH

The tumor itself could cause problems though…

  • Compress pituitary stalk leading to less LH and hypogonadism
  • Compression of optic chiasm leading to visual problems
27
Q

How do you treat FSH/LH hypersection?

A

If small, just monitor

If large, surgery and radiation

28
Q

What does a TSH deficiency lead to?

A
  • Fatigue
  • Dry skin
  • Cold
  • Hair loss
  • Weight gain with poor appetite
  • Puffy face
  • Hands and feet (myxedema)

Treat with daily levothyroxine

29
Q

What does a TSH hypersecretion lead to?

A
  • Heat intolerance
  • Palpitations
  • Weight loss with increased appetite
  • Goiter
  • Periorbital edema and proptosis (exophthalmia)

Treat with surgery followed by somatostatin analogue

30
Q

What is Graves?

A

Autoimmune hyperthyroidism

Treat with anti-thyroid drugs

31
Q

Now onto posterior pituitary problems…

A

Remember ADH and oxytocin are the two hormones secreted from the posterior pituitary

32
Q

What is the function of ADH?

A
  • Reduces water excretion by increasing concentration of urine
  • Secretion is regulated by the “effective” osmotic pressure of body fluids - osmoreceptors
33
Q

What happens in the case of an ADH deficiency?

A

Diabetes insipidus

  • Abnormally large volumes of dilute urine
  • Idiopathic or vascular and many other causes
  • Urinary frequency, enuresis and/or nocturia, thirst and polydipsia

Treat with synthetic ADH

34
Q

What occurs with ADH hypersecretion?

A

SIADH = syndrome of inappropriate anti diuretic hormone

  • Decreased volumes of highly concetrated urine
  • Hyponatremia and water retetnion
35
Q

What are the consequences of acute SIADH?

A

If acute, water intoxication; headache, confusion, anorexia, nausea, vomiting, coma, convulsions, death

36
Q

How do you treat SIADH?

A

Acute: Restrict fluids, give hypertonic (3%) saline

Chronic: give a diuretic

37
Q

What is pituitary apoplexy?

A

Bleeding into or impaired blood supply of the pituitary gland at the base of the brain

38
Q

What causes pituitary apoplexy?

A

Intrapituitary hemorrhagic vascular events

This can occur

  • Spontaneously in preexisting adenoma
  • Postpartum (Sheehan’s syndrome)
  • In association with diabetes, hypertension, sickle cell anemia or acute shock
39
Q

How severe is pituitary apoplexy?

A

Endocrine emergency

40
Q

What are the symptoms of pituitary apoplexy?

A
  • severe headache
  • bilateral visual changes
  • in severe cases, cardiovascular collapse, loss of consciousness
41
Q

What can pituitary apoplexy lead to?

A

May result in severe hypoglycemia, hypotension, CNS hemorrhage and death

42
Q

How do you treat pituitary apoplexy?

A
  • Surgery (if loss of vision or consciousness has occurred

- If still awake, high dose of glucocorticoids

43
Q

Case 2

  • 56 year old man
  • 50 lb weight gain
  • Forehead growth
  • Excessive sweating
  • Feeling very hot
  • High blood pressure
  • Enlarged tongue
A

Diagnosis: acromegaly

Treatment: growth hormone receptor antagonists, surgery, somatostatin analogues, radiation (or any combo)

44
Q

Case 3

  • 24 year old female
  • Weakness
  • 35 lb weight loss
  • Low blood pressure
  • Lightheaded and dizzy
  • High serum calcium, potassium and urea
  • Low serum sodium
A

Diagnosis: Addison’s disease

Treatment: Glucocorticoid

45
Q

Case 4

  • 30 year old woman
  • Dealing with infertility for 2 years
  • Amenorrhea 10 months ago
  • Breast secretions, decreased libido
A

Diagnosis: Pregnancy

Test for serum prolactin

46
Q

Case 5

  • 54 year old man
  • Polyuria
  • Polydypsia
  • Head trauma 5 months ago
  • Diluted urine
A

Diagnosis: deficiency of antidiuretic hormone (ADH) or vasopressin

Endocrine Exam 1 (18 decks)

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