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Z.Fiser > Fiser.20.Pituitary > Flashcards

Fiser.20.Pituitary Flashcards

1
Q

what is the neurohypophysis?

A

posterior pituitary

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2
Q

what is the adenohypophysis?

A

anterior pituitary

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3
Q

what 5 hormones are released by the hypothalamus?

A

TRH, CRH, GnRH, GHRH, and DA

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4
Q

where do hormones released by the hypothalamus go?

A

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

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5
Q

what is the function of dopamine released by the hypothalamus?

A

inhibits prolactin secretion

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6
Q

what two hormones are released by the posterior pituitary?

A

ADH and oxytocin

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7
Q

what structure releases ADH in the posterior pituitary?

A

supraoptic nuclei

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8
Q

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

A

osmolar receptors of the hypothalamus

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9
Q

what structure releases oxytocin in the posterior pituitary?

A

paraventricular nuclei

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10
Q

does the posterior pituitary contain cell bodies?

A

nope

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11
Q

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

A

80%

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12
Q

name six hormones released by the anterior pituitary

A

ACTH, TSH, GH, LH, FSH, prolactin

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13
Q

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

A

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

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14
Q

why do pituitary masses cause bitemporal hemianopia?

A

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

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15
Q

what is the MCC of nonfunctional pituitary tumors

A

almost always macroadenomas

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16
Q

how do pituitary macroadenomas present?

A

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

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17
Q

how are pituitary macroadenomas treated?

A

transsphenoidal resection

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18
Q

name three contraindications to a transsphenoidal approach for pituitary tumor resection

A

suprasellar extension, massive lateral extension, dumbell-shaped tumor

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19
Q

why do most pituitary tumors respond to bromocriptine?

A

its a dopamine agonist

20
Q

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

A
21
Q

what is the MC pituitary adenoma?

A

prolactinoma, mostly microadenomas

22
Q

what is the prolactin threshold before pts exhibit symptoms?

A

prolactin > 150

23
Q

what are the symptoms of prolactinoma?

A

galactorrhea, irregular menses, decreased libido, infertility

24
Q

what is the treatment of prolactinoma?

A

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

25
Q

which medical treatment of prolactinoma is safe in pregnancy

A

bromocriptine

26
Q

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

A

hemorrhage, visual loss, wants pregnancy, or CSF leak

27
Q

what are the symptoms of acromegaly (5)

A

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

28
Q

why can acromegaly be life-threatening?

A

2/2 cardiac symptoms (valve dysfunction, cardiomyopathy)

29
Q

what subtype of pituitary adenoma usually causes acromegaly?

A

usually macroadenomas

30
Q

how do you diagnose acromegaly?

A

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

31
Q

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

A

octreotide or transsphenoidal resection

32
Q

what is the second-line treatment for acromegaly?

A

XRT and bromocriptine can be secondary therapy

33
Q

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

A

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

34
Q

how does Sheehan’s syndrome present?

A

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

35
Q

how do you treat Sheehan’s syndrome?

A

hormone replacement

36
Q

what is the embryology and pathology a/w craniopharyngioma?

A

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

37
Q

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

A

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

38
Q

how do you treat craniopharyngioma?

A

surgery to resect cyst

39
Q

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

A

diabetes insipidus

40
Q

how do you workup bilateral pituitary masses?

A

check pituitary axis hormones

41
Q

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

A

likely mets

42
Q

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

A

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

43
Q

why do patients with Nelson’s syndrome get hyperpigementation?

A

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

44
Q

what is the treatment for Nelson’s syndrome?

A

steroids

45
Q

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

A

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

Z.Fiser (22 decks)

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