HPA A&P, Pathophysiology

Question 1

what is part of the diencephalon at the base of the brain

Answer 1

hypothalamus

Question 2

what is the hypothalamus attached to

Answer 2

pituitary via infundibulum

Question 3

what does the hypothalamus store

Answer 3

stores and releases hormones that act on pituitary

Question 4

how is the pituitary attached to the hypothalamus

Answer 4

via hypophysial stalk, sits within the sella turcica

Question 5

how is the posterior pituitary attached

Answer 5

via neural connection-hypothalamohypophysial tract
aka neurohypophysis

Question 6

how is the anterior pituitary attached

Answer 6

via portal blood vessels-hypothalamic hypophyseal portal system
aka adenohypophysis

Question 7

how do hormones affecting the anterior pituitary travel

Answer 7

via hypophysial portal blood from hypothalamus
hormones released from pituitary will act on their target organs

Question 8

where are the Herring bodies

Answer 8

within posterior pituitary
terminal end of nerves that are extending form hypothalamus
where hormones are stored/released

Question 9

What does ADH do

Answer 9

increase water reabsorption within the kidney

Question 10

what stimulates ADH

Answer 10

blood pressure: if low, implies low volume
osmolality will also cause/change release
alcohol inhibits secretion of ADH

Question 11

What does TRH stimulate

Answer 11

TSH and inhibits prolactin

Question 12

what does GnRH stimulate

Answer 12

FSH and LH

Question 13

what is the effect of substance P

Answer 13

inhibits ACTH, stimulated GH, FSH, LH, prolactin

Question 14

what does the follicle-stimulating homrone target

Answer 14

granulosa cells within the ovaries to stimulate estrogen production and follicular maturation
sertoli cells within the testicles to promote speratogenesis

Question 15

where is ACTH made

Answer 15

within anterior pituitary

Question 16

what does ACTH target

Answer 16

cortex of the adrenal gland and will induce steroidogeneiss (primarily cortisol)

Question 17

where is the pineal gland located

Answer 17

within the central aspect of the brain

Question 18

what is the pineal gland made of

Answer 18

photoreceptive cells capable of secreting melatonin
regulates circadian rhythm

Question 19

how are pituitary adenomas characterizedd

Answer 19

microadenomas: typically asymptomatic
macroadenomas: m/c after hormone regulation or impinge on surrounding structures (mass effect)

Question 20

What is MEN syndrome

Answer 20

autosomal dominant disorders that predispose patients to endocrine tumors
multiple endocrine neoplasia
3 different subtypes based on endocrine tissues affected

Question 21

what do prolactimonas cause

Answer 21

increase prolactin levels
- breast milk production, gynecomastia

Question 22

what does GHRH act on

Answer 22

anterior pituitary

Question 23

what is excessive growth hormone and insulin-like growth factor (IGF-1) during childhood/adolescence

Answer 23

giantism

Question 24

what is excessive growth hormone during adulthood, after growth plates have closed

Answer 24

acromegaly

Question 25

what manages how GH affects the tissues

Answer 25

IGF

Question 26

what is most commonly associated with growth homrones secreting adenoma within the pituitary gland

Answer 26

acromegally

Question 27

what is most commonly associated with excessive GHRH

Answer 27

giantism

Question 28

what does acromegaly result in

Answer 28

frontal bossing
enlarged tongue
prognathism
“spade-like” hands, enlarged feet and face

Question 29

what are gene predispositions for gigantism

Answer 29

alternation in MEN1 gene
AIP (familial)
activation of oncogene gasp
x-linked duplication error

Question 30

what largely defines tonicity of intracellular and extracellular space

Answer 30

sodium

Question 31

what increases as sodium levels increase

Answer 31

osmolality

Question 32

What is SIADH

Answer 32

Syndrome of inappropriate antidiuretic hormone
-water reabsoprtion, retained fluid, increased extracellular fluid
decreased urine output, N/V, AMS, weight gain

Question 33

what is diabetes insipidus

Answer 33

not enough ADH, or not working appropriately
- volume out, dilute urine - hypernatremia (Dry Inside)
polyuria, polydipsia, weight loss, dehydration

Question 34

what is the presentation of central diabetes insipidus

Answer 34

polyuria, polydipsia, nocturia, decreased urine osmolality, decreased urine sodium

Question 35

what is the presentation of SIADH

Answer 35

typically associated with downstream hyponatremia
presentation can range from: thirst, anorexia, fatigue, DOE, vomiting, cramping, weight gain, seizure, neurologic damage

Question 36

what is hypopituitarism

Answer 36

lack of 1+ hormones typically secreted from anterior pituitary

Question 37

what is Panhypopituitiarism

Answer 37

no hormones coming from pituitary

Question 38

what is sheehan syndrome

Answer 38

ischemia (leading to necrosis) of pituitary due to postpartum hemorrhage

Question 39

what is a pituitary apoplexy

Answer 39

hemorrhage into pituitary

Question 40

what are the clinical presentations of hypopituitarism

Answer 40

symptoms depend on what hormone is affected
ACTH deficiency: decreased cortisol - N/V, fatigue, weakness, weight loss, can be fatal
TSH deficiency: hypothyroidism
TSH and LH deficiency: amenorrhea, testicular atrophy, decreased libido
GH deficiency: hypopituitary dwarfism, elevated BMI, osteoporosis

Question 41

what is pituitary dwarfism associated with

Answer 41

growth hormone deficiency
may be congenital or develop at later age