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Endocrine- Clin Med > Hypothalamic and Pituitary Gland Disease > Flashcards

Hypothalamic and Pituitary Gland Disease Flashcards

1
Q

Hypophysis aka

A

pituitary gland

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2
Q

pituitary gland visualized by

A

MRI scanning

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3
Q

located ABOVE optic chiasm and pituitary gland

A

hypothalamus

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4
Q

located BELOW optic chiasm in sella turcica

A

pituitary gland

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5
Q

pituitary stalk

A

connects pituitary gland to hypothalamus

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6
Q

anterior pituitary lobe aka

A

adenohypophysis

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7
Q

posterior pituitary lobe aka

A

neurohypophysis

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8
Q

why does pituitary adenoma cause visual disturbances

A

lies right below optic chiasm

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9
Q

6 major hormones produces and released from anterior pituitary gland

A

PRL, GH, TSH, FSH, LH, and adrenocorticotropin hormone

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10
Q

innervation of posterior pituitary lobe

A

hypothalamic neurons that run though pituitary stalk innervate the posterior pituitary lobe

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11
Q

ADH and oxytocin produced and released from

A

produced in hypothalamus, transported to posterior pituitary where they are stored and released as needed

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12
Q

Impaired production of ALL OF the pituitary hormones

A

panhypopituitarism

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13
Q

Impaired production of 1 or more of the pituitary hormones

A

hypopituitarism

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14
Q

hypopituitarism acquired of inherited?

A

both

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15
Q

hypopituitarism dx

A

measure hormone levels you are suspicious of that have impaired production. Neuroimaging if appropriate (MRI)

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16
Q

Tx of hypopituitarism

A

hormone replacement therapy

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17
Q

most common type of pituitary adenoma

A

prolactinoma

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18
Q

most common cause of pituitary hormone hypersecretion and hyposecretion syndromes

A

pituitary adenoma

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19
Q

pituitary adenomas classified according to

A

size, function, and cell of origin

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20
Q

types of pituitary adenomas

A

gonadotrophs, throtrophs, corticotroph, lactotroph, somatotroph

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21
Q

if find pituitary micro-incidentaloma

A

Measure PRL if clinical suspicious of hyormonal hypersecretion.

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22
Q

If find pituitary incidentaloma larger than 5-9 mm

A

monitor with MRI

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23
Q

If pituitary macro- incidentaloma

A

RESECT if compressive sx present. Measure hormone levels. If abnormal- tx individual adenoma. If no compressive sx or hornomal alternations- monitor patient closely

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24
Q

PRL secreting adenoma

A

lactotroph adenoma

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25
Q

GH secreting adenoma

A

Somatotroph adenoma

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26
Q

normal PRL levels in men and women

A

10-25 micrograms/L in women, 10-20 in men

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27
Q

PRL synthesis

A

by lactotropes and mammosomatotropes in adenohypophysis

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28
Q

When is PRL secretion highest?

A

During REM sleep. also high after exercise, sexual intercourse, meals, and at times of acute stress

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29
Q

control of PRL is primarily inhibited with

A

dopamine

30
Q

30 year old female has history of infertility, oligomenorrhea, galactorrhea. You are suspicious of increased production of what endocrine hormone?

A

PROLACTIN

31
Q

Action of PRL

A

Females-induces and maintains lactation, decreases reproductive function, and suppresses sexual drive
Males- lowers Testosterone levels, decreases spermatogenesis, decreases libido, and causes reduced fertility

32
Q

physiologic or normal causes of hyperprolactinemia

A

pregnancy, nipple stimulation, stress

33
Q

pathologic causes of hyperprolactinemia

A

prolactinomas, decreased dopamine inhibition, hypothyroidism, macroprolactinemia

34
Q

clinical presentation of hyperprolactinemia in postmenopausal women

A

usually asymptomatic

35
Q

clinical presentation of hyperprolactinemia in males

A

decreased libido, impotence, infertility, gynecomastia, galactorrhea

36
Q

tx of prolactinomas

A

dopamine agonists- inhibits PRL secretion and dec size of adenoma

37
Q

what cells secrete GH

A

somatotroph and mammosomatotroph cells in anterior pituitary lobe

38
Q

most abundant anterior pituitary hormone

A

Gh

39
Q

highest levels of GH occur

A

at night (imp to sleep at night so kids can grow!). also during exercise, physical stress, trauma, sepsis

40
Q

effects of GH

A

stimulates cartilage growth and linear bone growth, increases body mass, impairs glucose tolerance, induces release of IGF

41
Q

Somastostain

A

growth hormone inhibiting hormone

42
Q

acromegaly

A

excessive secretion of GH and subsequent release of insulin like growth factor (IGF-1)

43
Q

mean age of acromegaly dx

A

40-45

44
Q

causes of acromegaly

A

most common cause - somatotroph. other causes- too much GHRH secretion by hypothalmic tumor, ectopic GHRH secretion by neuroendocrine tumors

45
Q

hyperphosphatemia common in what endocrine disorder

A

acromegaly

46
Q

Coarse hand and facial featrures, macroglossia. Patient with soft tissue and skin changes, bone and joint changes, colonic neoplasm, diverticula, hyperphosphatemia, hyperinsulinism, hypertriglyceridemia, hypercalciuria. Suspect

A

acromegaly

47
Q

when the anterior pituitary gland produces excess growth hormone (GH) after epiphyseal plate closure at puberty

A

acromegaly

48
Q

when the anterior pituitary produces excess GH BEFORE epiphyseal plate closure at puberty

A

gigantism

49
Q

Dx of acromegaly

A

GH levels, serum IGF-1

50
Q

tx for acromegaly

A

somatostain analogs, main goal is to reduce IGF-1 and GH levels. Resect somatotroph if possible. If medical and surgical therapy ineffective, radiation but takes 5-10 years to be effective

51
Q

long term management in acromegaly patient

A

measure IGF-1 levels every 3-4 months till stable, then every 6 months. other pituitary hormones yearly, MRI yearly. Colonoscopy at baseline, then every 3-4 years after if over 50 bc of risk of colonic neoplasm and diverticula

52
Q

cause of gigantism

A

d/t hypothalamic GHRH excess in children

53
Q

6 yo child presents with large hands and feet, coarse facial features, excessive sweating. Macrocephaly, moderate obesity, and very tall for age. Suspect

A

gigantism

54
Q

dx of gigantism

A

GH suppression test (If GH levels high after OGTT), PRL levels, Thyroid function tests

55
Q

tx of gigantism

A

surgery, somatostain analog

56
Q

dx of growth hormone deficiency

A

GH stimulation test, measurement of IGF-1 and IGFBP-3 (only in children), r/o diseases that can cause growth failure

57
Q

How might infants be affected from GH deficiency

A

prone to hypoglycemia, prolonged jaundice, microphallus, giant cell hepatitis

58
Q

tx of GH deficiency in kids

A

daily therapy GH via subq injection

59
Q

secretion of ADH/vasopression regulated by

A

osmoreceptors in hypothalamus

60
Q

central DI

A

caused by deficient secretion of ADH

61
Q

nephrogenic DI

A

normal ADH secretion from hypolthalmus, but impaired response- renal resistance

62
Q

sx in DI

A

polyuria, nocturia, polydipsia, neurologic sx as well

63
Q

tx in DI

A

desmopressin- decreases urine output (polyuria), nocturia. also low solute diet

64
Q

dx of DI

A

electrolyte abnormalities, urine osmolality decreased, water restriction test- decreased ADH release and minimal inc in urine osmolality. if desmopressin administered- urine osmolalility will normalize and be increased (after water restriction test)

65
Q

etiology of nephorogenic diabetes insipidus

A

renal resistance to ADH secretion. possible caused from lithium toxicity, hypercalcemia, hypokalemia, renal disease

66
Q

water restriction test in nephrogenic DI

A

normal levels of ADH secreted, but minimal or no increase in urine osmolality. Very dilute urine. Give desmopressin- still does not seem to help.

67
Q

tx of nephrogenic DI

A

correct underlying disorder, decreased dietary solute, diuretics, NSAIDS, desmopressin

68
Q

tx in gestational DI

A

desmopressin. fluid restriction to less than 1 L/day

69
Q

syndrome characterized by water retention and hyponatremia

A

SIADH

70
Q

dx of SIADH labs

A

hyponatremia, urine sodium conce over 40 meq/L, low serum osmolality, elevated urine osmolality

71
Q

max rate of correction in chronic hyponatremia

A

less than 9 meq/L in 24 hours. if severe, 4-6 meq/L

72
Q

tx of SIADH

A

fluid restriction, IV saline, sodium, loop diuretics, vasopressin receptor antagonists

Endocrine- Clin Med (10 decks)

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