Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BRS Endocrinology > 1b// Hypopituitarism > Flashcards

1b// Hypopituitarism Flashcards

1
Q

What are the hormones secreted from the anterior pituitary?

A

Growth hormone (somatotrophin)
Prolactin
Thyroid stimulating hormone (TSH, thyrotropin)
Luteinising hormone (LH) and follicle stimulating hormone (FSH)
Adrenocorticotropic hormone (ACTH, corticotrophin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What cells do the hormones of the anterior pituitary come from?

A

somatotrophs
lactotrophs
thyrotrophs
gonadotrophs
corticotrophs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the intermediate between growth hormone and growth?

A

IGF1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is IGF-1 role?

A

IGF1 in children causes cell differentiation and growth

IGF1 in adults is anabolic e.g., building muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does prolactin do? (basic)

A

causes milk production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What happens to prolactin when the pituitary is damaged and why? (basic)

A

since it is negatively regulated, when the pituitary is damaged it goes up, because there is less dopamine to suppress it.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What type of circulation does the anterior pituitary have?

A

portal circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does portal circulation mean?

A

it has capillaries at both ends and doesn’t go to the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is primary and secondary disease?

A

primary disease= the gland itself fails

secondary disease= no signals from hypothalamus or anterior pituitary, their failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the hormones involved with thyroidism and where do they come from?

A

TRH= hypothalamus
TSH= pituitary
T3 and T4= thyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is primary hypothyroidism?

A

Autoimmune destruction of thyroid gland
T3 and T4 can no longer be produced
So T3/4 decrease
TSH and TRH increase (but usually only TSH is measured)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is secondary hypothyroidism?

A

pituitary tumour damages thyrotrophs
They no longer make TSH
TSH falls
Therefore so does T3/4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the hormones involved with adrenals and where do they come from?

A

CRH= hypothalamus
ACTH= pituitary
cortisol= adrenal cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is aldosterone and cortisol regulated by?

A

cortisol is regulated by ACTH

aldosterone is regulated by the renin-angiotensin system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is primary hypoadrenalism?

A

Destruction of adrenal cortex (e.g., autoimmune)
Therefore cortisol falls and CRH and ACTH increase
CRH is not normally measured
Aldosterone decreases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is secondary hypoadrenalism?

A

pituitary tumour damaging corticotrophs
No ACTH/ less
ACTH and cortisol falls
Aldosterone secretion is fine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the hormones involved in gonadism and where do they come from?

A

GnRH (gonadotrophin releasing hormone)= hypothalamus

LH and FSH= pituitary

testosterone= Testosterone is produced by the gonads (by the Leydig cells in testes in men and by the ovaries in women)

oestrogen= the ovaries

progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is primary hypogonadism?

A

e.g., destruction of testes (e.g., mumps) or ovaries (e.g., chemotherapy)

testosterone in men or oestrogen in women fall, LH and FSH increase

GnRH is not measured but would be high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is secondary hypogonadism?

A

e.g., pituitary tumour damages gonadotrophs

can’t make LH/ FSH

LH, FSH, oestrogen, testosterone fall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the causes of hypopituitarism?

A

Congenital
- rare
- usually due to mutations of transcription factor genes needed for normal anterior pituitary development
- I.e., the pituitary is not made

Deficient in GH and at least 1 moe anterior pituitary hormone
- so the pituitary is underdeveloped and small
- short stature
- hypoplastic (underdeveloped) anterior pituitary on MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How many axes does hypopituitarism effect?

A

1, some or all

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Is hypopituitarism only affecting the anterior pituitary?

A

Hypopituitarism often describes anterior pituitary disfunction, but certain processes- especially inflammation or surgery- may cause posterior pituitary dysfunction too

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is pituitary inflammation?

A

hypophytis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is total loss of both anterior and posterior pituitary?

A

panhypopituitarism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the hypothalamus and pituitary sensitive to?

A

radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What can radiation cause in the pituitary?

A

hypopituitarism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Give an example for how radiation can be direct or indirect to the pituitary?

A

direct= hormone producing pituitary tumour

indirect= CNS tumour nearby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How is radiotherapy dose (Gy) linked to risk of HPA axis damage?

A

higher total dose= higher risk of HPA axis damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What cells in the pituitary are most sensitive to radiotherapy?

A

somatotrophs and gonadotrophs (growth hormone and LH and FSH) aka they are the first to decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

The sensitivity of gonadotrophs and somatotrophs to radiotherapy cause what issue?

A

infertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

For how long can the risk persist after radiotherapy last, and what do you therefore need to do?

A

up to 10 years
therefore annual assessments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is a haemorrhage?

A

acute blood loss from a damaged blood vessel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is an infarction?

A

death of tissue due to blockage in a vessel

34
Q

Do anterior and posterior pituitary have the same circulation?

35
Q

What does a patient suffering with hypopituitarism with decreased FSH/ LH say?

A

reduced libido
secondary amenorrhea
erectile dysfunction
reduced pubic hair

36
Q

What does a patient suffering with hypopituitarism with decreased ACTH say?

A

Fatigue
NB not a salt losing crisis (renin-angiotensin is fine)

37
Q

What does a patient suffering with hypopituitarism with decreased TSH say?

38
Q

What does a patient suffering with hypopituitarism with decreased GH say?

A

reduced quality of life
NB short stature only in children

39
Q

What does a patient suffering with hypopituitarism with decreased prolactin say?

A

inability to breastfeed

40
Q

What is Sheehan’s syndrome?

A

post-partum hypopituitarism

41
Q

What is Sheehan’s syndrome secondary to and why?

A

hypotension (PPH= postpartum hemorrhage)

42
Q

Where is Sheehan’s syndrome more common in the world?

A

developing countries

43
Q

What happens to the pituitary during Sheehan’s syndrome?

A

anterior pituitary enlarges in pregnancy (lactotroph hyperplasia)

44
Q

What does PPH cause?

A

leads to pituitary infarction

45
Q

What are the symptoms of Sheehan’s syndrome and why

A

lethargy (TSH)
anorexia (ACTH)
weight loss (GH- in adults GH decrease leads to weight loss)
failure of lactation (prolactin)

failure to resume menses post-delivery

  • TSH, ACTH, GH deficiency
46
Q

Does Sheehan’s syndrome affect the posterior pituitary?

47
Q

What is postpartum hypopituitarism?

A

Sheehan’s syndrome

48
Q

What is the best imaging to visualise the pituitary?

49
Q

What type of imaging do you use to see haemorrhages and fractures?

50
Q

What is bleeding (haemorrhage) into the pituitary called?

A

Pituitary Apoplexy

51
Q

How would you describe the presentation of pituitary apoplexy in someone with pre-existing pituitary tumours (adenomas)?

A

dramatic presentation

52
Q

How may the presentation of pituitary apoplexy first present?

A

as a pituitary adenoma

53
Q

What precipitates pituitary apoplexy?

A

anti-coagulants (blood thinners)

54
Q

What does pituitary apoplexy cause immediately?

A

severe sudden onset headache
and

visual field defect- compressed optic chiasm= bitemporal hemianopia

55
Q

What can cavernous sinus involvement in pituitary apoplexy cause?

A

diplopia and ptosis

56
Q

What is diplopia?

A

double vision

57
Q

What is ptosis?

A

upper eyelid of one or both eyes droops over your eye

58
Q

What cranial nerves are involved with diplopia?

59
Q

What cranial nerves are involved in ptosis?

60
Q

If the tumour of the pituitary gland presses, what can it cause?

A

cranial nerve palsy (lack of function of the cranial nerves)

61
Q

What cautions do you have to have while measuring the various hormones involved with the pituitary gland?

A

Cortisol- what time of day?
T4- circulating half life is 6 days
FSH/ LH- cyclical in women
GH/ ACTH- pulsatile (not always high)

62
Q

When is interpretation of pituitary hormones especially hard due to their variation?

A

right after injury

63
Q

What can you do to make it easier to measure the various hormones involved with the pituitary gland?

A

dynamic pituitary function tests, they stimulate the anterior pituitary

64
Q

What are the “stress” hormones from the pituitary?

A

GH and ACTH

65
Q

How can you measure ACTH and GH?

A

the patient is deliberately put under “stress” to increase ACTH and GH

they are put into hypoglycaemia (<2.2mM)= stress

Insulin induced hypoglycaemia stimulates GH release and ACTH release (cortisol is measured)

66
Q

How do you measure TSH and FSH and LH?

A

TRH stimulates TSH release
GnRH stimulates FSH and LH

these are both dynamic tests

67
Q

What is empty sella?

A

thin rim of pituitary tissue

68
Q

What is empty sella syndrome?

A

the person had a tumour before, but it was ok to live with
and then it infarcted and the body got rid of the dead cells
leaving empty space

69
Q

How do you treat hypopituitarism (basic)?

A

GH, TSH, FSH, LH, ACTH= replace
prolactin= no need to replace

70
Q

How do you treat GH deficiency?

A
  • NICE guidelines
  • First confirm GH deficiency on dynamic pituitary function test
  • Asses quality of life (QoL) using specific questionnaire
  • Daily injection (no oral option)

Measure response by…
- Improvement in QoL
- Plasma IGF-1

71
Q

How do you treat TSH deficiency?

A
  • Replace once daily with levothyroxine
  • TSH will be low, so you can’t use this to adjust dose as you do in primary hypothyroidism

Therefore, aim for a fT4 above the middle of the reference range

72
Q

How do you treat ACTH deficiency?

A
  • Replace cortisol rather than ACTH
  • It’s difficult to mimic diurnal variation of cortisol
  • 2 main options in the UK using synthetic glucocorticoids…
  1. PREDNISOLONE
    - Once daily AM e.g., 3mg
    - Better but only a little bit, it can’t do the steady rise at night
  2. HYDROCORTISONE
    - 3x per day
    - E.g., 10mg, 5mg, 5,mg
73
Q

Do hormones generally have a long or short half life?

74
Q

What are the sick day rules for patients with ACTH deficiency?

A
  • Patients with primary adrenal failure (Addison’s) or secondary adrenal failure (ACTH deficiency) are at risk of ‘adrenal crisis’ triggered by intercurrent illness
  • Patients who take replacement steroid e.g., prednisolone, hydrocortisone must be told the sick day rules
    1. Steroid alert pendant/ bracelet
    2. Double steroid dose (glucocorticoid not mineralocorticoid) if fever/ intercurrent illness
    3. Unable to take tablets (e.g., vomiting), inject IM or come straight to A and E
75
Q

What are adrenal crisis features (5)?

A

dizziness, hypotension, vomiting, weakness, can result in collapse and death

76
Q

How do you treat FSH/ LH deficiency in males with no fertility required?

A

replace testosterone- topical or intramuscular (most popular)

measure plasma testosterone

replace testosterone does not mean replaced fertility (this requires FSH)

77
Q

How do you treat FSH/ LH deficiency in males with fertility required?

A

induction of spermatogenesis by gonadotrophin injections

best response is secondary hypogonadism has developed after puberty

measure testosterone and semen analysis

sperm production may take 6-12 months

FSH and LH x2 a week

78
Q

How do you treat FSH/ LH deficiency in females with no fertility required?

A

replace oestrogen
- oral or topical

will need additional progesterone if intact uterus to prevent endometrial hyperplasia

79
Q

How do you treat FSH/ LH deficiency in females with fertility required?

A

can induce ovulation by carefully timed gonadotrophin injections (IVF)

80
Q

What usually causes pituitary apoplexy?

A

sudden haemorrhage or infarction of anterior pituitary, usually due to pre-existing adenoma

BRS Endocrinology (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions