Anterior Pituitary

Question 1

Posterior pituitary is an extension of what

Answer 1

Hypothalamus

Question 2

What is secreted by post pit

Answer 2

ADH and oxytocin

Question 3

Give chain of effect for each hormone secreted by hypothalamus –> ant pit –> target organ –> hormone –> effect:

Corticotropin releasing hormone

Answer 3

CRH –> adrenocorticotropic hormone –> adrenal gland –> cortisol –> stress

Question 4

Give chain of effect for each hormone secreted by hypothalamus –> ant pit –> target organ –> hormone –> effect:

thyrotropin releasing hormone

Answer 4

TRH –> thyroid stim hormone –> thyroid –> T4 –> metabolic activity

Question 5

Give chain of effect for each hormone secreted by hypothalamus –> ant pit –> target organ –> hormone –> effect:

GHrH

Answer 5

GHrH –> GH –> Liver –> ILGF1 –> growth

Question 6

Give chain of effect for each hormone secreted by hypothalamus –> ant pit –> target organ –> hormone –> effect:

GnRH

Answer 6

GnRH –> FSH/LH –> reproductive organs –> test/est –> reproduction

Question 7

What is prolactinoma

Answer 7

benign prolactin secreting tumor

Question 8

What will pt with prolactinoma present as

Answer 8

Women: amenorrhea + galactorrhea (microadenomas, present earlier), no visual field defecits
Men: decreased libido (macroadenomas) bitemporal heminopsia

Question 9

Evaluation of someone with s/s of prolactinoma

Answer 9

1. check meds
2. check TSH (hypothyroidism can induce hyperprolactinemia)
3. prolactin level (if not caused by meds/hypothyroidism)
4. MRI to find tumor if prolactin level elevated

Question 10

Tx of prolactinoma

Answer 10

Cabergoline > bromocriptine (side effects) dopamine antagonists
Surgery, radiation only if not responsive to med tx (rare)

Question 11

What is acromegaly pathophys

Answer 11

benign GH secreting tumor (but comes w increased risk of cancer)

Question 12

Pt presentation of acromegaly

Answer 12

kids: gigantism
adults: growth of hands, feet, visceral organs, diabetes

Question 13

Leading cause of mortality with acromegaly

Answer 13

Diastolic CHF

Question 14

Dx of acromegaly

Answer 14

IGF1
if elevated, then glucose suppression test (glucose should fail to suppress GH)
MRI to locate tumor

Question 15

Tx acromegaly

Answer 15

surgical resection

octreotide (somatostatin) only if residual tissue after surgery

Question 16

Two forms of hypopituitarism

Answer 16

Acute and Chronic

Question 17

Acute hypopituitarism will be

Answer 17

Sudden and devastating

Question 18

Pathophysiology of acute hypopituitarism

Answer 18

infection infarction or iatrogenic

Question 19

Patient presentation of acute hypopituitarism

Answer 19

Symptoms of no cortisol and no T4:

hypotension with compensatory tachycardia and lethargy/coma

Question 20

Dx of acute hypopituitarism

Answer 20

Check T4 and cortisol levels

Question 21

Tx of acute hypopituitarism

Answer 21

Replace T4 and cortisol

Question 22

Sheehan’s syndrome

Answer 22

Pregnancy - prolonged delivery and blood loss then pituitary infarct and then coma

Question 23

Apoplexy

Answer 23

Known tumor –> then sudden nuchal rigidity, obtunded, headache

Question 24

Chronic hypopituitarism pathophys

Answer 24

autoimmune, deposition dz, tumor

Question 25

Chronic hypopituitarism presentation

Answer 25

Body sacrifices LH/FSH and GH to maintain TSH and ACTH

so decreased libido, problems with menstruation
fatiguability

Question 26

Chronic hypopituitarism dx

Answer 26

insulin stimulation test (potential dangerous)

insulin should dec BG which would inc EPI, NE and SHOULD inc GH but in pos ins stim test it would fail to inc GH

Question 27

Chronic hypopituitarism tx

Answer 27

Replace hormones and fix underlying dz

Question 28

Empty sella syndrome

Answer 28

anatomic variant, without a pituitary they’d be dead so do nothing