15.1 - 15.2 Anterior & Posterior Pituitary

Question 1

Impaired renal response to ADH, usually due to inherited mutations or drugs (lithium or demeclocycline), no response to desmopressin

Answer 1

Nephrogenic DI

Question 2

ADH deficiency due to hypothalamic or posterior pituitary pathology (tumor, trauma, infection, inflammation)

Answer 2

Central Diabetes Insipidus

Question 3

Treatment for central DI

Answer 3

desmopressin (ADH analog)

Question 4

Excessive ADH secretion –> hyponatremia & low serum osmolality –> mental status change and seizures

Answer 4

SIADH

Question 5

1. Ectopic production (small cell)
2. CNS trauma
3. Pulmonary infection
4. Drugs (cyclophosphomide)

Answer 5

Causes of SIADH

Question 6

Treatment for SIADH

Answer 6

free water restriction or demeclocycline

Question 7

Benign tumor of anterior pituitary cells

Answer 7

Pituitary adenoma

Question 8

What do you call a pituitary adenoma that produces hormones?

Answer 8

Functional

Question 9

What do you call a pituitary adenoma that does NOT produce hormones?

Answer 9

Nonfunctional

Question 10

Nonfunctional pituitary adenomas present with mass effect. Give three examples.

Answer 10

1. Bitemporal hemianopsia (loss of peripheral vision in both eyes)
2. Hypopituitarism
3. Headache

Question 11

Most commonly produced hormone by functional pituitary adenoma

Answer 11

prolactin

Question 12

Prolactinoma symptoms in female

Answer 12

galactorrhea and amenorrhea

Question 13

prolactinoma symptoms in male

Answer 13

decreased libido and headaches

Question 14

treatment of prolactinoma

Answer 14

dopamine agonists (bromocriptine or cabergoline) or surgery

Question 15

Growth hormone adenoma in a child

Answer 15

gigantism

Question 16

growth hormone adenoma in an adult

Answer 16

acromegaly

Question 17

growth hormone adenoma is associated with

Answer 17

secondary diabetes mellitus

Question 18

How would you diagnose GH adenoma?

Answer 18

1. elevated GH and IGF-1

2. Lack of GH suppression by oral glucose

Question 19

treatment for GH adenoma

Answer 19

octreotide (somatostatin analogue), GH receptor antagonists, surgery

Question 20

ACTH adenoma –>

Answer 20

cushing syndrome (rare)

Question 20

ACTH adenoma –>

Answer 20

cushing syndrome (rare)

Question 21

Insufficient production of hormones by anterior pituitary

Answer 21

hypopituitarism

Question 21

Insufficient production of hormones by anterior pituitary

Answer 21

hypopituitarism

Question 22

Causes of empty sella syndrome

Answer 22

herniation of the arachnoid and CSF into the sella compresses and destroys the pituitary gland, so pituitary gland is “absent” (empty sella) on imaging

Question 22

Causes of hypopituitarism

Answer 22

1. Pituitary adenoma (adults) or craniopharyngioma (children) 2. Sheehan syndrome 3. Empty sella syndrome

Question 23

role of ADH

Answer 23

controls movement of free water in collecting ducts

Question 23

woman presents with poor lactation and lack of pubic hair following giving birth

Answer 23

Sheehan syndrome (pituitary infarct)

Question 24

two hormones released by posterior pituitary

Answer 24

ADH and oxytocin

Question 25

role of ADH

Answer 25

controls movement of free water in collecting ducts and dct

Question 26

- polyuria & polydipsia - hypernatremia & high serum osmolality - low urine osmolality and specific gravity

Answer 26

Diabetes insipidus (central or nephrogenic)

Question 27

diagnosis of diabetes insipidus is made by

Answer 27

water deprivation fails to increase urine osmolality

Question 28

Response to desmopressin of central vs. nephrogenic DI

Answer 28

Central DI will respond to desmopressin, but nephrogenic DI will NOT.

Question 29

symptoms of acromegaly

Answer 29

- enlarged bones of hands, feet, and jaw - growth of visceral organs leading to dysfxn - enlarged tongue

Question 30

function of oxytocin

Answer 30

mediates uterine contraction during labor and release of breast milk (let-down) in lactating mothers