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PBS 602 Pathophysiology > Neuroendocrine > Flashcards

Neuroendocrine Flashcards

1
Q

Anterior Pituitary Gland (anterior lobe):

A

i. Hypothalamic-Pituitary-Growth Hormone Axis -> Growth
ii. Hypothalamic-Pituitary-Prolactin Axis -> Lactation
iii. Hypothalamic-Pituitary-Thyroid Axis -> Thyroid gland function
iv. Hypothalamic-Pituitary-Adrenal Axis -> Adrenal gland physiology
v. Hypothalamic-Pituitary-Gonadal Axis -> Sex Hormones & Reproduction

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2
Q

Posterior Pituitary Gland (Posterior lobe):

A

i. Antidiuretic Hormone (ADH) -> Water homeostasis, plasma volume & osmolality.
ii. oxytocin -> uterine contraction and lactation.

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3
Q

hypothalamus

A

It integrates neural signals from brain

⇒ converts those signals into chemical messages (largely peptides) which regulate the secretion of pituitary hormones

⇒ pituitary hormones alter the activities of peripheral endocrine organs.

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4
Q

The majority of hypothalamic releasing factors are secreted in a __________________

A

cyclical or pulsatile, rather than continuous, manner.

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5
Q

(1) Hypothalamic-Pituitary-Growth Hormone Axis

A

Somatotrophs of the anterior pituitary gland produce and secrete growth hormone.

-> insulin-like growth factors, especially insulin-like growth factor 1 (IGF-1) -> by hepatocytes in response to GH.

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6
Q

Factors that Increase GH secretion

A

• Environmental factors can Increase GH, such as:

  • • Hypoglycemia
  • • Sleep, exercise
  • • Adequate nutritional status.

Endogenous biological inputs

  • • Hypothalamic GHRH,
  • • Sex steroids (during puberty)
  • • Dopamine & Ghrelin
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7
Q

Ghrelin

A

endogenous growth hormone-releasing peptide

on a receptor that is distinct from the GHRH receptor.

The majority of ghrelin is secreted by gastric fundal cells during the fasting state

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8
Q

ANTERIOR PITUITARY GLAND CELL TYPE

A
  • Somatotroph
  • Lactotroph
  • Thyrotroph
  • Corticotroph
  • Gonadotroph
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9
Q

Hypothalamic control of Anterior pituitary

A
  • Through: hypothalamic-pituitary portal vascular system.
  • FSH & LH
  • GH
  • Prolactin
  • ACTH
  • TSH
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10
Q

Hypothalamic control of Posterior pituitary

A
  • Through: direct neural connection between hypothalamus & posterior pituitary
  • ADH
  • Oxytocin
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11
Q

Primary

A

underlying abnormality is in the target organ

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12
Q

Secondary

A

underlying abnormality is in the pituitary gland

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13
Q

Tertiary

A

underlying abnormality is in the hypothalamus

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14
Q

(1) Hypothalamic-Pituitary-Growth Hormone Axis.

A
  • Somatotrophs of the anterior pituitary gland produce and secrete growth hormone.
  • GH
  • IGF-1
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15
Q

GH

A
  • first expressed at high concentrations during puberty;
  • it is secreted in a striking pulsatile manner ⇒ largest pulses usually occurring at night during sleep.
  • Most of anabolic effects of GH are mediated by

⇒ insulin-like growth factors, especially insulin-like growth factor 1 (IGF-1)

⇒ a hormone released into the circulation by hepatocytes in response to GH.

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16
Q

IGF-1

A
  • hepatocytes contribute the overwhelming majority of detectable IGF-1 in the circulation.
  • IGF-1 is protein-bound and stable in the circulation for longer periods of time at steady concentrations.
    • IGF-1 measurements represent an integrated surrogate for GH activity that is stable throughout the day
  • > IGF-1 levels are a more appropriate tool than GH levels in screening for acromegaly.
17
Q

Factors that Increase GH secretion

A

• Environmental factors can Increase GH, such as:

  • • Hypoglycemia
  • • Sleep, exercise
  • • Adequate nutritional status.
  • Endogenous biological inputs that promote GH release include:
    • • Hypothalamic GHRH,
    • • Sex steroids (during puberty)
    • • Dopamine & Ghrelin
18
Q

Ghrelin

A
  • endogenous growth hormone-releasing peptide
  • acts synergistically with GHRH to promote GH release, acting on a receptor that is distinct from the GHRH receptor.
  • The majority of ghrelin is secreted by gastric fundal cells during the fasting state
19
Q

Factors that Decrease GH secretion

A

Environmental factors can increase GH, such as:

  • Hyperglycemia
  • Sleep deprivation
  • Poor nutritional status.

Endogenous biological inputs that promote GH release include

  • Somatostatin
  • IGF-1 & GH.
20
Q

GH and IGF-1 replacement or stimulators

A

1) Somatropin
2) Somatrem
3) Sermorelin
4) Tesamorelin
5) Mecasermin

21
Q

Growth Hormone Excess

A

1) Gigantism
2) Acromegaly

22
Q

Gigantism

A

occurs if GH is secreted at abnormally high levels in children before closure of the epiphyses because increased IGF-1 levels promote excessive longitudinal bone growth

23
Q

Acromegaly:

A

after the epiphyses close, abnormally high levels of GH result in acromegaly. This condition occurs because IGF-1, although it can no longer stimulate long bone growth, can still promote growth of organs and cartilaginous tissue.

24
Q

(i) Inhibitors of GH release

A

Octreotide & Lanreotide (Synthetic, longer acting peptide analogues of somatostatin).

For Acromegaly

Used to control GI bleeding from esophageal varices

25
Q

Antagonists of GH receptor:

A
  • Pegvisomant
  • Indications: Acromegaly & Cushing’s disease
  • allow once-daily dosing
26
Q

Hypothalamic-Pituitary-Prolactin Axis

A
  • under tonic inhibition by hypothalamic release of dopamine
  • interrupts the hypothalamicpituitary portal system results in decreased secretion of most anterior pituitary gland hormones but causes increased prolactin release.
  • Prolactin secretion does not appear to be regulated by any identified negative feedback system.
27
Q

Pharmacological agents that Inhibit pituitary prolactin release

A
  • Bromocriptine: synthetic DA receptor agonist
  • -Indications:
  • Hyperprolactinemia
  • Acromegaly
  • Parkinson’s disease
  • Diabetes mellitus type 2
  • Non-pregnancy related amenorrhea-galactorrhea syndrome
  • Use of bromocriptine to suppress lactation in postpartum women is not recommended.
  • the area postrema in the medulla, which stimulates nausea and lies outside the blood–brain barrier, possesses dopamine receptors
28
Q

agents that Inhibit pituitary prolactin release

A

PBS 602 Pathophysiology (13 decks)

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