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372 Hypopituitarism Flashcards

1
Q

Considered the master glans together with the hypothalamus

A

Anterior pituitary

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2
Q

6 hormones by the anterior pituitary

A
  1. Prolactin PRL
  2. Growth hormone GH
  3. Adrenocorticotropic hormone ACTH
  4. Luteinizing hormone LH
  5. Follicle stimulating hormone LH
  6. Thyroid stimulating hormone TSH
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3
Q

Weight of the pituitary gland

A

600 mg

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4
Q

Blood supply of thre pituitary gland

A

Superior and Inferior hypophyseal arteries

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5
Q

Major blood source of the anterior pituitary gland allowing reliable transmission of hypothalamic peptide pulses without significant systemic dilution

A

Hypothalamic portal plexus

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6
Q

Direct ennervation of the pituitary gland

A

Hypothalamic neurons

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7
Q

True or false. Neuronal damage to the hypothalamus or pituitary stalk can alter ADH and oxytocin production

A

True

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8
Q

Hormones PRL is weakly homologous to

A

GH

Human placental lactogen hPL

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9
Q

Normal levels of prolactin in males? In females?

A

PRL
Females: 10-25 ug/L
Males: 10-20 ug/L

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10
Q

When is the highest secretory peaks of PRL

A

During REM sleep

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11
Q

Half life of PRL

A

50 minutes

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12
Q

What time does PRL peak

A

4:00-6:00 AM

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13
Q

How is PRL unique for other hormones

A

Central control mechanism is inhibitory

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14
Q

Weakly suppresses PRL

A

Glucocorticoids

Thyroid hormones

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15
Q

Induces PRL release

A

Vasoactive intestinal peptide (VIP)

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16
Q

Can transiently raise PRL levels

A 
Exercise
Meals
Sexual intercourse
Minor surgical procedures
General Anesthesia
Chest wall injury
Acute myocardial infarction
Acute stress
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17
Q

Can sucking induce PRL release? For how long

A

Yes. Sucking activates neural afferent pathways in the hypothalamus and increases PRL levels that lasts for 30-45 minutes

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18
Q

What is the effect of pregnancy on PRL levels

A

PRL levels increase 10x during pregnancy and deube within 2 weeks of parturition

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19
Q

Most abundant anterior pituitary hormone and constitute 50 of anterior pituitary cell population

A

Growth hormone GH

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20
Q

Hormone that is secreted in spikes to elicit GH pulses and the other hormone that sets the basal GH secretory tone

A

GHRH: elicits GH spikes
SRIH: sets BASAL GH tone

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21
Q

What induces GH and what suppresses GH

A

Estrogen: induces GH

Chronic glucocorticoids: suppresses GH

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22
Q

When is the highest peak of GH

23
Q

Leads to transient increase in GH

A 
An hour of sleep
Exercise
Physical stress
Trauma
Sepsis
24
Q

Contain the largest number of GH receptors

A

Liver and cartilage

25
Major source of circulating Insulin Growth like factor (IGF-1)
Liver
26
Conditions where IGF-1 is low
Cachexia Malnutrition Sepsis
27
Stimulator of ACTH synthesis and release
CRH
28
When does ACTH peak and when does it go nadir?
Peaks: 6 AM Nadir: midnight
29
Regulates synthesis and release of LH and FSH
Hypothalamic GnRH
30
True or false. Main function of the HPA axis is to maintain metabolic hemostasis and mediate neuroendocrine stress response
True
31
What is the character of the GnRH secretion
Pulsatile every 60-120 minutes
32
Slows GnRH pulse frequency but enhances gonadotropin response to GnRH
Progesterone
33
Other hormone of the TGF beta faimy that suppresses FSH? Stimulates FSH?
Suppress FSH: inhibin | Stimulates FSH: activin
34
Gene responsible for hypothalamic dysfunction and hypopituitarism
HESX1 gene
35
Resulta from defective hypothalamic GnRH associated wiht olfactory bulb a genesis or anosmia
Kallmann syndrome
36
Mutation seen in Kallmann syndrome
X-linked KAL gene mutation which impair embryonic migration of GnRH neurons hypothalamic olfactory placode to the hypothalamus
37
GNRH deficiency. Genetically heterogenous disorder charcaterised by mental retardation, renal abnormalities, obesity, hexadactyly
Bardet-Biedl Syndrome
38
Prader willis syndrome is a contiguous gene syndrome results from deletion of what gene?
Deletion of the paternal copies of the SNRPN gene on chromosome 15q
39
In cranial irradiation leading to hypothalamic damage, what is the most common deficiency? 2nd most common?
Most common: GH deficiency | 2nd: ACTH deficiency
40
Acute intra pituitary hemorrhage in postpartum
Sheehan syndrome
41
Endocrine emergency that results in severe hypoglycemia, hypotension and shock, CNS hemorrhage and death; results from acute intra pituitary hemorrhage
Apoplexy
42
Mean growth velocity. Peak growth rates in girls and boys?
Mean growth velocity: 6 cm per year Peak growth girls: 12 Peak growth boys: 13
43
In insulin tolerance test for GH, what is the normal response
GH more than 3 ug/L
44
In TSH test for PRL, what is the normal response
PRL more than 2 ug/L and increase of more than 200% of baseline
45
In insulin tolerance test for ACTH, what is the normal response
Cortisol increase more than 7 ug/dl or more than 20 ug/dl
46
In CRH test for ACTH, what is the normal response
Basal ACTH increases to 2- to 4- fold and peaks at 20-100 pg/ml
47
In metyrapone tests for ACTH, what is the normal response
Plasma cortisol less than 4 g/dl 11 Deoxycortisol more than 7.5 ACTH more than 75 pg/ml
48
In standard ACTH stimulation with cosyntropin, what is the normal response
Cortisol more than 21 g/dl
49
In TRH test for TSH, what is the normal response
TSH should increase by more than 5 mU/L unless thyroid hormones are increased
50
When do you say a person is short stature
Height is more than 3 standard deviation below mean age
51
When is GH replacement contraindicated
Active neoplasm Intracranial hypertension Uncontrolled DM and retinopathy
52
Total daily dose of glucocorticoid replacement
Hydrocortisone: Not to exceed 25 mg/daily Prednisone: 5 mg daily
53
Most common presenting feature of hypopituitarism
Hypogonadism
54
Causes of primary hypothyroidism
``` Autoimmune hypothyroidism Iatrogenic Drugs Congenital hypothyroidism Infiltrative disorders Goitrogens ```

Endocrine (15 decks)

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