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Endocrinology Y2 > Hyposecretion of Anterior Pituitary Hormones > Flashcards

Hyposecretion of Anterior Pituitary Hormones Flashcards

1
Q

Name the 5 hormones secreted by the adenohypophysis

A

Gonadotrophin (LH and FSH), somatrophin (GH), prolactin, thyrothrophin (TSH) and corticotrophins (ACTH)

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2
Q

Where is a primary endocrine disease situated, give an example of a site

A

In the endocrine gland (e.g. thyroid gland)

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3
Q

Where is a secondary endocrine disease situated

A

In the pituitary

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4
Q

Where is a tertiary endocrine disease site

A

Hypothalamus

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5
Q

What is panhypopituitarism?

A

Insufficient excretion of all adenohypophysial hormones

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6
Q

Which level of hypopituitarism is most common and least (primary/secondary/tertiary)

A

Primary is most, tertiary is least

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7
Q

How common is congenital panhypopituitarism

A

Rare

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8
Q

What mutation causes congenital panhypopituitarism

A

PROP1

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9
Q

What is PROP1

A

Transcription factor that allows the development of the pituitary gland to take place

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10
Q

Which hormone does a congenital PROP1 mutation always affect?

A

Growth hormone

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11
Q

What is he presentation of congenital hypopituitarism (2)

A

Short stature and a hypoplastic pituitary on an MRI

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12
Q

What things cause hypopituitarism (9)

A 
Congenital
Tumours
chemotherapy radiation
infection
traumatic brain injury
Infiltrative disease
Inflammation
Pituitary apoplexy
Peri-partum infarction
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13
Q

What are hypothalamic tumours known as

A

Craniopharyngiomas

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14
Q

What are pituitary tumours known as

A

Adenomas

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15
Q

What type of cancer tends to metastasise to the pituitary

A

Breast

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16
Q

What else is similar to a tumour that can compress the pituitary

A

Cysts

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17
Q

Which secretion/hormone is most and least resistant to damage via radiotherapy

A

Most is GH least is TSH

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18
Q

Which microorganism can infect and cause pituitary pathology

A

Meningitis

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19
Q

What is an example of an infiltrative disease? Which part of the physiology of the pituitary is used

A

Sarcoidosis, pituitary stalk

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20
Q

What is a pituitary apoplexy

A

Damage from bleeding

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21
Q

What is peri-partum infarction known as

A

Sheehans syndrome

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22
Q

What are the three types of hypopituitarism

A

Simmonds disease (normal hypopituitarism)
Sheehans syndrome
Pituitary apoplexy

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23
Q

What is an FSH/LH deficiency known as

A

Secondary hypogonadism

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24
Q

What is an ACTH deficiency known as

A

Secondary hypoadrenalism

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25
Q

What is a TSH deficiency known as

A

Secondary hypothyroidism

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26
Q

What symptoms are associated with secondary hypogonadism

A

Reduced libido, secondary amenorrhoea, erectile dysfunction

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27
Q

What symptoms are associated secondary hypoadrenalism

A

Fatigue

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28
Q

What symptoms are associated with secondary hypothyroidism

A

Fatigue (everything slows down)

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29
Q

What is panhypopituitarism also known as

A

Simmonds disease

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30
Q

What is simmonds disease more commonly known as

A

panhypopituitarism

31
Q

Who can be affected by sheehans syndrome

A

Only women

32
Q

Explain sheehans syndrome. Give cause + effect for three sciencey words at end

A

Lactotroph hyperplasia occurs during pregnancy making the pituitary bigger. Post-partum hypotension (e.g. due to post-partum haemorrhage) means the pituitary is severely deoxygenated due restricted blood flow bc the increased size is compressing the stalk.
Pituitary infarction -> ischaemia -> necrosis

33
Q

Where are all the blood vessels that oxygenate the pituitary found

A

Travelling down the stalk

34
Q

Where is sheehans syndrome less common

A

In developed countries due to improves obstetrics

35
Q

What are the symptoms of sheehans syndrome, and explain the symptoms regarding weight

A

Tiredness, anorexia, weight loss(lack ACTH outweighs the hypothyroidism), failure of lactation, failure of menses resuming

36
Q

Which parts of the pituitary are affected by sheehans syndrome

A

Only the adenohypophysis, neurohypophysis is usually completely unaffected

37
Q

What are the differences netween sheehans syndrome and a pituitary apoplexy

A

Pituitary apoplexy is not specific to women and presentation is rapid

38
Q

What can cause pituitary apoplexy

A

Pituitary adenomas infarcting or intra-pituitary haemorrhage

39
Q

What can precipitate a pituitary apoplexy

A

Anti-coagulants

40
Q

What is the first rapid presentation of a pituitary apoplexy

A

Headache

41
Q

Explain how a pituitary apoplexy can cause bitemporal hemianopia

A

Pituitary sits just below the optic chiasm, expansion can compress the optic chiasm causing bitemporal hemianopia

42
Q

Explain how a pituitary apoplexy can cause ptosis, mention nerve and area

A

Expansion of the pituitary can cause compression of CNIII

43
Q

What is ptosis

A

Droopy eyelid

44
Q

Explain how a pituitary apoplexy can cause diplopia, mention the area and the nerves compressed

A

pituitary apoplexy can cause the pituitary to interfere with structures in the cavernous sinus such as CNIV and CNV

45
Q

Are basal plasma levels of adenohypophysial hormones a useful indicator of hypopituitarism and why

A

No because the hormones released are pulsatile (LH, FSH, GH ACTH) and T4 has a half life of 6 days

46
Q

What are stimulated dynamic pituitary function tests and what do you administer for each hormone

A

Administering a releasing hormone to stimulate release and then measuring levels
Insulin stimulates GH and ACTH release via lowering blood glucose
TRH stimulates TSH
GnRH stimulates LH and FSH

47
Q

What radiological method would you use to diagnose panhypopituitarism

A

MRI

48
Q

What technique is used to treat hypopituitarism

A

Hormone replacement therapy

49
Q

When testing for suspected ACTH deficiency, which hormone do you test for and why

A

Cortisol because ACTH has a low plasma half-life

50
Q

Replacement and check for deficienct ACTH

A

Hydrocortisone and check for serum cortisol

51
Q

Replacement and check for deficient TSH

A

Thyroxine and check for serum T4

52
Q

Replacement and check for deficient LH/FSH In women

A

Eostrogen plus progestogen, check for symptoms improvement and withdrawal bleeds

53
Q

Replacement and check for deficient LH/FSH in men

A

Testosterone and check for symptom improvement and serum testosterone

54
Q

Replacement and check for deficient GH

A

GH and check IGF1/use a growth chart in children

55
Q

What are the consequences of prolactin deficiency in each gender

A

Men not that deep, women will be unable to breastfeed due to prolactin being critical for milk ejection

56
Q

What has to be administered with oestrogen to women for secondary hypogonadism

A

Progestogen

57
Q

What can happen to the female uterus if progestogen is not administered with oestrogen

A

Endometrial hyperplasia

58
Q

What is given for men who have secondary hypogonadism, route of administration and how often

A

Testosterone injection every three months

59
Q

What are 7 causes of short stature

A

Endocrine disorders, genetic causes, emotional deprivation, systemic disease, malnutrition, malabsorption, skeletal dysplasia

60
Q

Where is the problem with Prader-Willi syndrome? What is affected? What’s it associated with? How to treat?

A

Hypothalamus, lack of GHRH, associated with obesity and learning difficulties, treatment with GH

61
Q

Lack of which hormone causes pituitary dwarfism? When and how does this present? What are the causes?

A

GH, from childhood, pituitary won’t develop fully due to damage/genetic mutations

62
Q

Achondroplasia is caused by a mutation in which protein?

A

Fibroblast growth factor 3 receptor (FGF3)

63
Q

What is achondroplasia? How does it present?

A

Abnormality in growth plate chondrocytes, presents as short arms and legs but normal trunk

64
Q

What is a chondrocyte

A

Cartilage cells

65
Q

What is Laron dwarfism? How can it be treated?

A

Problems with the GH receptors on the liver, treated with IGF1

66
Q

Why are random GH tests shit

A

Because GH release is pulsatile

67
Q

Name the GH provocation tests (4)

A

Insulin, GHRH, glucagon and exercise

68
Q

How does the insulin GH provocation test work

A

Insulin induces hypoglycaemia which stimulates the release of GH

69
Q

What do you administer with the GHRH in the provocation test

A

Arginine

70
Q

How does the glucagon provocation test work

A

Glucagon makes you feel ill, the stress of vomiting then induces glucagon release

71
Q

In what population is the exercise provocation test useful for

A

Small children

72
Q

What are the consequences of GH deficiency in adults

A 
Reduces lean mass
Increased adiposity
Reduced muscle strength&bulk
Decreased HDL and increased LDL
Impaired psychological well-being
73
Q

What are the risks of GH therapy (2)

A

Increased risk of cancer (but no evidence for this), and treatment costs £42k for an adult for all their life

Endocrinology Y2 (18 decks)

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