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LCRS 1 > Hyposecretion of Anterior Pituitary Hormones > Flashcards

Hyposecretion of Anterior Pituitary Hormones Flashcards

1
Q

What is the difference between primary, secondary and tertiary endocrine gland disease?

A

Primary – problem with the endocrine gland/hormone released
Secondary – problem with the pituitary gland/hormone released
Tertiary – problem with the hypothalamus

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2
Q

What is the term given to decreased secretion of all anterior pituitary hormones?

A

Panhypopituitarism

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3
Q

What are three main types of panhypopituitarism?

A

Simmond’s Disease
Sheehan’s Syndrome
Pituitary Apoplexy

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4
Q

Describe the onset of Simmond’s disease

A

Very slow onset

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5
Q

State the cause of Sheehan’s syndrome

A

This is specific to WOMEN
It is caused by vasoconstrictor spasm of hypophysial arteries as a result of post-partum haemorrhage
This spasm causes pituitary infarction

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6
Q

What is pituitary apoplexy? Describe its onset.

A

This is similar to Sheehan’s syndrome but isn’t specific to women
It is caused by intra-pituitary infarction or haemorrhage potentially from a tumour This also has a RAPID presentation

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7
Q

Why is a single measurement of most hypothalamic hormones not useful?

A

Most hypothalamic hormones tend to be released in pulses

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8
Q

What type of test do you do to test if someone is producing a hormone?

A

Stimulation/provocation test

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9
Q

What is the name given to the secondary endocrine gland failure that results from a lack of corticotrophin release from the pituitary?

A

Hypoadrenocorticalism

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10
Q

What are the effects of a lack of somatotrophin in children and in adults?

A

Children – stunted growth (pituitary dwarfism)

Adults – loss of GH effects are uncertain

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11
Q

State some causes of short stature.

A

Genetic
Malnutrition
Emotional deprivation
Endocrine disorders

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12
Q

State some acquired causes of GH deficiency in children.

A 
Tumours of the hypothalamus and pituitary Other intracranial tumours nearby (e.g. optic nerve glioma)
Irradiation 
Head injury  
Infection or inflammation  
Severe psychosocial deprivation
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13
Q

As well as being its own hormone, GH stimulates the production of other hormones. State one important hormone that is stimulated by GH, its side of production and its effects.

A

IGF I = insulin-like growth factor I
It is produced in the LIVER
It mediates growth effects

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14
Q

What type of dwarfism is caused by a GH receptor defect?

A

Laron Dwarfism

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15
Q

Describe the IGF I levels in people with this Laron dwarfism.

A

LOW IGF I

Because functioning GH receptors are necessary for GH to stimulate the production of IGF I

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16
Q

Why are the Pygmies in Africa naturally short?

A

Their IGF I doesn’t function properly

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17
Q

Using GnRH as an example. State one example of tertiary hypopituitarism

A

Prader-Willi Syndrome

18
Q

What is the gold standard method of testing the ability of the pituitary to release growth hormone?

A

Insulin-induced hypoglycaemia

Hypoglycaemia is a potent stimulus for growth hormone release

19
Q

State three other triggers for an increase in GH release.

A

Arginine
Glucagon
Exercise

20
Q

Describe how the insulin-induced hypoglycaemia test is used to test GH secretion.

A

In a normal subject, the insulin-induced hypoglycaemia will give a massive rise in GH secretion
If you have a partial deficiency of GH then your response will be reduced

21
Q

State some of the effects of growth hormone therapy in children and what groups of children respond better

A

Increased linear growth
Decease in body fat
Younger children respond better
Obese children respond better

22
Q

How is the human recombinant GH used in GH therapy administered and how frequently must it be given?

A

Subcutaneous or Intramuscular

It is given daily or 4/5 times a week

23
Q

Describe the absorption, metabolism and duration of action of the GH therapy

A

It has a maximal plasma concentration after 4-6 hours
Metabolism – renal and hepatic with a short half-life (20 mins)
Duration of action – it works on protein synthesis so it’s duration of action is going to be quite long.
IGF I levels peak after around 20 hours

24
Q

State some adverse effects of GH therapy.

A

GH is also a cell stimulation hormone so there is an increased risk of tumours

25
Q

State some signs and symptoms of GH deficiency in adults.

A 
Decreased muscle mass  
Increased adiposity  
Increased waist: hip ratio  
Decrease HDL and increased LDL 
Reduced muscle strength and bulk 
Impaired psychological wellbeing and quality of life
26
Q

How can you diagnose GH deficiency in adults?

A

Lack of response to GH stimulation test

27
Q

What are the potential benefits of GH therapy in adults?

A

Improved body composition
Improved muscle strength and exercise capacity Normalisation of HDL-LDL
Increased bone mineral content
Improved psychological and mental wellbeing and quality of life

28
Q

What are the potential risks of GH therapy in adults?

A

Increased risk of cardiovascular accidents
Cardiomegaly
Increased susceptibility to cancer

29
Q

Causes of symmonds disease

A

Infiltrative diseases
Craniopharyngioma
Cranial injury
Following surgery

30
Q

Symptoms of symmonds disease

A

Impotence
Loss of libido
Hypotension
Tirednesss
Secondary amenorrhoea or oligomenorrhoea
Loss of body hair
Waxy skin

31
Q

Genetic causes of GH deficiency in children

A

Laron dwarfism
Syndromes- prader willi, downs and turners
Achondroplasia

32
Q

How is prader wili syndrome an example of tertiary hypopituitary disease

A

Hypogonadism is one of the aspects of this disorder and the problem is at the level of the hypothalamus

33
Q

Replacement APPH used for ACTH and what is monitored

A

Hydrocortisone

9am cortisol

34
Q

Replacement APPH used for TSH and what is monitored

A

Levothyroxine

Monitor T4

35
Q

Replacement APPH used for LH and FSH in women and what is monitored

A

HRT

Symptom improvement such as libido

36
Q

Replacement APPH used for LH/FSH in men and what is monitored

A

Testosterone undecanoate

Monitor libido and serum testosterone

37
Q

Replacement APPH used for GH and what is monitored

A

Give GH

Monitor IGF 1

38
Q

Nature of release of ACTH and GH

A

Pulsatile

39
Q

Nature of release of LH and FSH

A

Cyclical

40
Q

Signs of pituiraty apoplexy

A

Severe headache
Ptosis
Visual field defect

41
Q

Signs of sheehans syndrome

A

Lethargy
Anorexia
Failure of lactation
Failure to resume menses post delivery

42
Q

What happens to pituitary during pregnancy

A

Enlarges due to lactotroph hyperplasia

LCRS 1 (58 decks)

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