anterior pituitary disorder-Table 1

Question 1

What are the hormones of the anterior pituitary?

Answer 1

FSH, LF, ACTH, TSH, Prolactin, GH FLAT P(I)G

Question 2

What are the hormones of the posterior pituitary?

Answer 2

Oxytocin and ADH

Question 3

Hypothalamus-pituitary-gonadal axis

Answer 3

Feminization or masculization, LHRH—>LH/FSH—> testosterone, estrogen, progesterone. Mediated by negative feedback loop

Question 4

Hypothalamus pituitary thyroid axis?

Answer 4

TRH—>TSH—>T4—>T3 , negative feedback loop, Metabolic control and appetite control

Question 5

Growth hormone axis?

Answer 5

GHRH—>GH—>(LIVER-IGF-1) AND TARGET ORGANS, HYPOGLYCEMIA WILL INCREASE GH, SOMATOSTATIN NEGATIVELY REGULATES AP

Question 6

HYPOTHALAMUS-PITUITARY ADRENAL AXIS

Answer 6

(emotion can increase CRH) CRH—>ACTH—>(ADRENALS-CORTISOL—>DOWN REGULATE IMMUNE SYSTEM AND GLYCOGENOLYSIS), MSH, (HYPOGLYCEMIA POSITIVELY AFFECTS AP)

Question 7

Addison’s dz

Answer 7

adrenals cannot release cortisol, low negative feedback on hypothalamus(high crh), high ACTH, high MSH(dark pigmentation)

Question 8

Prolactin axis

Answer 8

dopamine inhibit ap to secrete prolactin, Prolactin releasing factor(TRH) stimulates ap to produce prolactin, dopamine can be inhibited by antipsychotics, PRF can be stimulated by serotonin(SSRI and TCAs), dopamine can be increased by DA agonists.

Question 9

Hypothyroidisms affects on prolactin secretion

Answer 9

(high TSH/TRH), Low TH, low T3/T4, increased TRH to compensate will increase prolactin secretion …..

Question 10

Oxytocin axis

Answer 10

suckling, uterine distension—>oxytocin—>breast lactation, uterine/cervical contractions, psych effects(

Question 11

Vasopressin axis

Answer 11

baroreceptors(inc ANP-atria), osmoreceptors in hypothalamus(high tonicity)—>ADH—>vasculature(inc PVR), kidneys(inc aquaporins in collecting ducts)= increase bp

Question 12

What are the most common mechanism for hyperpituitarism?

Answer 12

Functioning Adenomas

Question 13

Hyperprolactinoma causes

Answer 13

Adenoma(secretes prolactin), damage to pituitary stalk, drugs(SSRI, antipsychotics, alpha-methyldopa, cocaine), hypothyroidism(inc TSH)

Question 14

What are the s/sx of prolactinomas?

Answer 14

females: amenorrhea and galactorrhea males: gynecomastia, decreased libido, ED and bitemopral hemianopsia(macroadenoma only=lateral visual field deficits)

Question 15

How do you dx hyperprolactinoma?

Answer 15

Prolactin levels and TSH levels, then MRI(r/o adenoma)

Question 16

What is the treatement for hyperprolctinoma?

Answer 16

Dopamine agonist(cabergoline and bromocriptine)

Question 17

What is acromegaly caused by?

Answer 17

Macroadenoma secreting GH often

Question 18

What are the clinical presentations of acromegaly?

Answer 18

onset 20-40s, gender equal, skeletal changes(first), corsening facial features, enlargement of hands/feet(ring doesn’t fit), deepening of voice, carpal tunnel syndrome, CHF(lastly)- ALWAYS IN Adult —can see bitemporal hemianopsia also

Question 19

What is the differnece between acromegaly and gigantism?

Answer 19

Gigantism occurs in children, while acromegaly occurs in adults

Question 20

How do you dx acromegaly?

Answer 20

IGF-1 level, can be done with direct GH level with 100g glucose(expect low growth hormone level- low glucose levels cause increased gh normally), MRI needed for diffinitive dx

Question 21

What is tx for acromegaly?

Answer 21

Transphenoidal resection(resect adenoma) or octreotide (rx), can include dopamine agonist(cabergoline/bromocriptine)

Question 22

PANHypopituitarism is caused by?

Answer 22

Pituitary apoplexy(hemorrhage) and sheehan’s syndrome(ischemia-postpartum), inflitrative disease(sarcoidosis, hemochromatosis, tb, syphilis), non-functioning adenoma, trauma, stroke, mass effect

Question 23

What are the clinical presentaiton of pituitary apoplexy?

Answer 23

acute HA, nausea, vomiting, altered mental status, low bp, low blood sugar(low cortisol)

Question 24

What are the clinical presentation sof sheehan’s syndorme?

Answer 24

Postpartum, extended amenorrhea(>3months), low bp during delivery, difficulty breastfeeding, hypotension(low cortisol), HELLP syndrome(high liver, low platelets)

Question 25

how do you dx hypopituitarism?

Answer 25

LH/FSH(changes first)—>GH—>TSH—>ACTH, Measure levels of AP hormones- and MRI (r/o adenoma or r/in apoplexy)

Question 26

How do you measure GH?

Answer 26

IGF-1 level or direct GH with insulin—> administer insulin=inducing hypoglycemia then see if GH increases. If GH is

Question 27

How do you measure ACTH?

Answer 27

Indirectly via cortisol

Question 28

How do you measure TSH?

Answer 28

directly via TSH, T3, T4

Question 29

How do you treat pituitary apoplexy?

Answer 29

surgical decompression and hormone replacement

Question 30

Empty sella syndrome clinical presents as?

Answer 30

often incidental, benign intracranial htn, HA and systemic hypertension in obese women

Question 31

how do you treat empty sella syndrome?

Answer 31

You don’t need to treat

Question 32

MRI contrast

Answer 32

illuminates everywhere there is CSF

Question 33

MRI without contrast

Answer 33

brain tissue should look like other brain tissue