Fiser.20.Pituitary

Question 1

what is the neurohypophysis?

Answer 1

posterior pituitary

Question 2

what is the adenohypophysis?

Answer 2

anterior pituitary

Question 3

what 5 hormones are released by the hypothalamus?

Answer 3

TRH, CRH, GnRH, GHRH, and DA

Question 4

where do hormones released by the hypothalamus go?

Answer 4

released into median eminence, passes through posterior pituitary on the way to the anterior pituitary

Question 5

what is the function of dopamine released by the hypothalamus?

Answer 5

inhibits prolactin secretion

Question 6

what two hormones are released by the posterior pituitary?

Answer 6

ADH and oxytocin

Question 7

what structure releases ADH in the posterior pituitary?

Answer 7

supraoptic nuclei

Question 8

what is the function of ADH released by the posterior pituitary?

Answer 8

osmolar receptors of the hypothalamus

Question 9

what structure releases oxytocin in the posterior pituitary?

Answer 9

paraventricular nuclei

Question 10

does the posterior pituitary contain cell bodies?

Answer 10

nope

Question 11

what percentage of the pituitary gland is made up by the anterior pituitary?

Answer 11

80%

Question 12

name six hormones released by the anterior pituitary

Answer 12

ACTH, TSH, GH, LH, FSH, prolactin

Question 13

what is unique about the blood supply to the anterior pituitary?

Answer 13

does not have its own direct blood supply, passes through the posterior pituitary - this is the first portal venous system

Question 14

why do pituitary masses cause bitemporal hemianopia?

Answer 14

pituitary masses compressing the optic nerve (CN2) at the chiasm

Question 15

what is the MCC of nonfunctional pituitary tumors

Answer 15

almost always macroadenomas

Question 16

how do pituitary macroadenomas present?

Answer 16

present with mass effect and decreased ACTH, TSH, GH, LH, FSH

Question 17

how are pituitary macroadenomas treated?

Answer 17

transsphenoidal resection

Question 18

name three contraindications to a transsphenoidal approach for pituitary tumor resection

Answer 18

suprasellar extension, massive lateral extension, dumbell-shaped tumor

Question 19

why do most pituitary tumors respond to bromocriptine?

Answer 19

its a dopamine agonist

Question 20

name these pituitary structures (anterior to left, posterior to right)

Answer 20

Question 21

what is the MC pituitary adenoma?

Answer 21

prolactinoma, mostly microadenomas

Question 22

what is the prolactin threshold before pts exhibit symptoms?

Answer 22

prolactin > 150

Question 23

what are the symptoms of prolactinoma?

Answer 23

galactorrhea, irregular menses, decreased libido, infertility

Question 24

what is the treatment of prolactinoma?

Answer 24

bromocriptine or cabergoline (DA agonists); transsphenoidal resection for failure to respond to medical management

Question 25

which medical treatment of prolactinoma is safe in pregnancy

Answer 25

bromocriptine

Question 26

when is resection of a pituitary prolactinoma macroadenoma indicated? (4)

Answer 26

hemorrhage, visual loss, wants pregnancy, or CSF leak

Question 27

what are the symptoms of acromegaly (5)

Answer 27

HTN, DM, gigantism, cardiac symptoms (valve dysfx, cardiomyopathy)

Question 28

why can acromegaly be life-threatening?

Answer 28

2/2 cardiac symptoms (valve dysfunction, cardiomyopathy)

Question 29

what subtype of pituitary adenoma usually causes acromegaly?

Answer 29

usually macroadenomas

Question 30

how do you diagnose acromegaly?

Answer 30

elevated IGF-1 (best test) or growth hormone \> 10 in 90% of patients

Question 31

what is the first-line treatment for acromegaly? (2)

Answer 31

octreotide or transsphenoidal resection

Question 32

what is the second-line treatment for acromegaly?

Answer 32

XRT and bromocriptine can be secondary therapy

Question 33

what is the underlying cause / pathophysiology of Sheehan's syndrome?

Answer 33

2/2 pituitary ischemia following hemorrhage and hypotensive episode during childbirth

Question 34

how does Sheehan's syndrome present?

Answer 34

post-partum trouble lactating is the first sign, can also have amennorhea, adrenal insufficiency, and hypothyroidism

Question 35

how do you treat Sheehan's syndrome?

Answer 35

hormone replacement

Question 36

what is the embryology and pathology a/w craniopharyngioma?

Answer 36

p/w benign calcified cyst, remnants of Rathke's pouch, grows along pituitary stalk to suprasellar location

Question 37

what are the sx a/w craniopharyngioma? (4)

Answer 37

a/w endocrine abnormalities, visual disturbances, headache, hydrocephalus

Question 38

how do you treat craniopharyngioma?

Answer 38

surgery to resect cyst

Question 39

what is the MC postop complication s/p craniopharyngioma resection?

Answer 39

diabetes insipidus

Question 40

how do you workup bilateral pituitary masses?

Answer 40

check pituitary axis hormones

Question 41

what is the likely cause of bilateral pituitary masses in the setting of normal pituitary axis hormones?

Answer 41

likely mets

Question 42

what is the underlying cause of Nelson's syndrome and associated pathophysiology?

Answer 42

occurs after bilateral adrenalectomy, increased CRH causes pituitary enlargement, resulting in amenorrhea and visual problems (bitemporal hemianopia)

Question 43

why do patients with Nelson's syndrome get hyperpigementation?

Answer 43

from the beta-MSH (melanocyte stimulating hormone) which is a peptide byproduct of ACTH

Question 44

what is the treatment for Nelson's syndrome?

Answer 44

steroids

Question 45

what is the underlying cause/pathophys of Waterhouse-Friderichsen syndrome?

Answer 45

adrenal gland hemorrhage that occurs after meningococcal sepsis infection --\> can lead to adrenal insufficiency