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Fiser's ABSITE Ryan > Chapter 20 - Pituitary > Flashcards

Chapter 20 - Pituitary Flashcards

1
Q

What does the hypothalamus release?

A

TRH, CRH, GnRH, GHRH, dopamine into median eminence

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2
Q

What is the path of hormones released from the hypothalamus?

A

Median eminence, passes through neurohypophysis on was to adenohypophysis

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3
Q

What is the action of dopamine?

A

Inhibits prolactin secretion

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4
Q

What does the posterior pituitary (neurohypophysis) release?

A

ADH and oxytocin

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5
Q

What part of the hypothalamus does ADH come from? Regulation?

A

Supraoptic nuclei; regulated by osmolar receptors in hypothalamus

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6
Q

What part of the hypothalamus does oxytocin come from?

A

Paraventricular nuclei

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7
Q

What does the anterior pituitary (adenohypophysis) secrete?

A

ACTH, TSH, GH, LH, FSH, prolactin

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8
Q

Blood supply of the anterior pituitary?

A

Does not have its own blood supply; passes through neurohypophysis 1st

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9
Q

What is bitemporal hemianopia caused by?

A

Pituitary mass compressiong the optic nerve at chiasm

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10
Q

How do nonfunctional pituitary tumors present?

A

Almost always macroadenomas; present with mass effect and decreased ACTH, TSH, GH, LH, FSH

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11
Q

Treatment for nonfunctional pituitary tumors?

A

Transsphenoid resection

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12
Q

What are the contraindications to transspenoid resection?

A

Suprasellar extension, massive lateral extension, dumbbell-shaped tumor

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13
Q

Medical treatment for TSH- and FSH-/LH-secreting tumors?

A

Bromocriptine

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14
Q

What is the most common pituitary adenoma?

A

Prolactinoma

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15
Q

Size of most prolactinomas?

A

Microadenomas

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16
Q

Prolactin level in patients (majority) that don’t need surgery?

A

> 150

17
Q

Symptoms of prolactinoma?

A

Galactorrhea, irregular menses, decreased libido, infertility, decreased vision

18
Q

Treatment of prolactinoma?

A

Bromocriptine for most; transsphenoidal rsx for failure of medical management

19
Q

Treatment for macroadenoma prolactinomas?

A

Resection with hemorrhage, visual loss, wants pregnancy, CSF leak

20
Q

Treatment for microadeoma prolactinomas?

A

Resection if bromocriptine unsafe or ineffective (ok in pregnancy)

21
Q

Symptoms of acromegaly?

A

HTN, DM, gigantism

22
Q

Level of GH in acromegaly?

A

> 10 in 90%

23
Q

Preoperative treatment of acromegaly?

A

Octreotide; may be helpful, inhibits release of GH

24
Q

Life-threatening complications of acromegaly?

A

Cardiac symptoms (valve dysfunction, cardiomyopathy)

25
Q

Diagnosis of acromegaly?

A

Elevated IGF-1, growth hormone >5-10

26
Q

Treatment of acromegaly?

A

Transsphenoidal resection; XRT and bromocriptine as primary or secondary therapy

27
Q

What is Sheehan’s syndrome caused by?

A

Pituitary ischemia following hemorrhage and hypotensive episode

28
Q

1st sign of Sheehan’s syndrome?

A

Trouble lactating

29
Q

Other symptoms of Sheehan’s syndrome?

A

Amenorrhea, adrenal insufficiency, hypothyroidism

30
Q

What is a craniopharyngioma?

A

Calcified cyst, remnants of Rathke’s pouch

31
Q

Symptoms of craniopharyngioma?

A

Endocrine abnormalities, visual disturbances, headache, hydrocephalus

32
Q

Treatment for craniopharyngioma?

A

Surgery, XRT

33
Q

Frequent postop complication of craniopharyngioma-ectomy?

A

Diabetes insipidus

34
Q

What is the workup for bilateral pituitary masses?

A

Check axis; if ok, probably mets

35
Q

When does Nelson’s syndrome occur?

A

Following bilateral adrenalectomy

36
Q

What is Nelson’s syndrome?

A

Increased CRH causing pituitary enlargement, resulting in amenorrhea, visual problems (bitemporal hemianopia)

37
Q

What is hyperpigmentation from in Nelson’s syndrome?

A

Beta-MSH, a peptide byproduct of ACTH

38
Q

Treatment for Nelson’s syndrome?

A

Steroids

39
Q

What is Waterhouse-Friderichsen syndrome?

A

Adrenal gland hemorrhage that occurs after meningococcal sepsis infection; can lead to adrenal insufficiency

Fiser's ABSITE Ryan (50 decks)

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