Chapter 20 - Pituitary

Question 1

What does the hypothalamus release?

Answer 1

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

Question 2

What is the path of hormones released from the hypothalamus?

Answer 2

Median eminence, passes through neurohypophysis on was to adenohypophysis

Question 3

What is the action of dopamine?

Answer 3

Inhibits prolactin secretion

Question 4

What does the posterior pituitary (neurohypophysis) release?

Answer 4

ADH and oxytocin

Question 5

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

Answer 5

Supraoptic nuclei; regulated by osmolar receptors in hypothalamus

Question 6

What part of the hypothalamus does oxytocin come from?

Answer 6

Paraventricular nuclei

Question 7

What does the anterior pituitary (adenohypophysis) secrete?

Answer 7

ACTH, TSH, GH, LH, FSH, prolactin

Question 8

Blood supply of the anterior pituitary?

Answer 8

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

Question 9

What is bitemporal hemianopia caused by?

Answer 9

Pituitary mass compressiong the optic nerve at chiasm

Question 10

How do nonfunctional pituitary tumors present?

Answer 10

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

Question 11

Treatment for nonfunctional pituitary tumors?

Answer 11

Transsphenoid resection

Question 12

What are the contraindications to transspenoid resection?

Answer 12

Suprasellar extension, massive lateral extension, dumbbell-shaped tumor

Question 13

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

Answer 13

Bromocriptine

Question 14

What is the most common pituitary adenoma?

Answer 14

Prolactinoma

Question 15

Size of most prolactinomas?

Answer 15

Microadenomas

Question 16

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

Answer 16

> 150

Question 17

Symptoms of prolactinoma?

Answer 17

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

Question 18

Treatment of prolactinoma?

Answer 18

Bromocriptine for most; transsphenoidal rsx for failure of medical management

Question 19

Treatment for macroadenoma prolactinomas?

Answer 19

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

Question 20

Treatment for microadeoma prolactinomas?

Answer 20

Resection if bromocriptine unsafe or ineffective (ok in pregnancy)

Question 21

Symptoms of acromegaly?

Answer 21

HTN, DM, gigantism

Question 22

Level of GH in acromegaly?

Answer 22

> 10 in 90%

Question 23

Preoperative treatment of acromegaly?

Answer 23

Octreotide; may be helpful, inhibits release of GH

Question 24

Life-threatening complications of acromegaly?

Answer 24

Cardiac symptoms (valve dysfunction, cardiomyopathy)

Question 25

Diagnosis of acromegaly?

Answer 25

Elevated IGF-1, growth hormone >5-10

Question 26

Treatment of acromegaly?

Answer 26

Transsphenoidal resection; XRT and bromocriptine as primary or secondary therapy

Question 27

What is Sheehan's syndrome caused by?

Answer 27

Pituitary ischemia following hemorrhage and hypotensive episode

Question 28

1st sign of Sheehan's syndrome?

Answer 28

Trouble lactating

Question 29

Other symptoms of Sheehan's syndrome?

Answer 29

Amenorrhea, adrenal insufficiency, hypothyroidism

Question 30

What is a craniopharyngioma?

Answer 30

Calcified cyst, remnants of Rathke's pouch

Question 31

Symptoms of craniopharyngioma?

Answer 31

Endocrine abnormalities, visual disturbances, headache, hydrocephalus

Question 32

Treatment for craniopharyngioma?

Answer 32

Surgery, XRT

Question 33

Frequent postop complication of craniopharyngioma-ectomy?

Answer 33

Diabetes insipidus

Question 34

What is the workup for bilateral pituitary masses?

Answer 34

Check axis; if ok, probably mets

Question 35

When does Nelson's syndrome occur?

Answer 35

Following bilateral adrenalectomy

Question 36

What is Nelson's syndrome?

Answer 36

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

Question 37

What is hyperpigmentation from in Nelson's syndrome?

Answer 37

Beta-MSH, a peptide byproduct of ACTH

Question 38

Treatment for Nelson's syndrome?

Answer 38

Steroids

Question 39

What is Waterhouse-Friderichsen syndrome?

Answer 39

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