OnlineMedEd: Endocrine - "Anterior Pituitary" Flashcards

1
Q

Why does the posterior pituitary not fit into the H-P-X axis?

A

The posterior pituitary is a continuation of the hypothalamus, so it does not require an intermediary hormone from the hypothalamus.

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2
Q

Review the anterior pituitary hormones from most-to-least necessary.

A
  • ACTH
  • TSH
  • GH
  • FSH/LH
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3
Q

List the hypothalamic hormones, their pituitary counterparts, their target organs, and the final hormone.

A
  • CRH -> ACTH -> adrenal glands -> cortisol
  • TRH -> TSH -> thyroid gland -> T4
  • GHRH -> GH -> liver -> IGF1
  • GRH -> FHS/LH -> gonads -> testosterone/estrogen
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4
Q

Describe the presentations of prolactinomas in men and women.

A
  • Women: secondary amenorrhea, galactorrhea; microadenomas because caught early
  • Men: decreased libido, bitemporal hemianopsia; macroadenomas caught late
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5
Q

How should you work up suspected prolactinoma?

A
  • First, review medications for dopamine antagonists
  • Second, check a TSH and prolactin level. (Dustyn says to do these as separate steps, but I think in real life you do both at once.)
  • Third, do an MRI for tumor if prolactin levels high
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6
Q

True or false: prolactinomas are not usually treated surgically.

A

True

Cabergoline is the mainstay treatment. Bromocriptine can also be used but has a worse side effect profile.

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7
Q

____________-thyroidism can cause prolactinemia.

A

Hypo

TRH stimulates the release of prolactin. Hypothyroidism causes increased TRH release.

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8
Q

Describe the different presentations of acromegaly based on age.

A
  • Kids: gigantism

* Adults: growth of hands, feet, face, visceral organs, and diabetes (because GH stimulates glucose production)

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9
Q

_____________ usually causes death in those with acromegaly.

A

Diastolic heart failure (because of heart growth)

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10
Q

To work up acromegaly, start with ___________.

A

IGF-1 levels

If this is elevated, do a glucose suppression test.

If the glucose suppression is also positive, then do an MRI.

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11
Q

List the two treatments for acromegaly.

A
  • Surgery

* Octreotide

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12
Q

What vital sign abnormalities will you see in hypocortisolism?

A
  • Hypotension

* Tachycardia

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13
Q

The three groups of causes of acute hypopituitarism are _______________.

A

infection, infarction, and iatrogenic

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14
Q

Apoplexy is usually caused by ____________.

A

a tumor that causes an infarction

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15
Q

In cases of chronic hypopituitarism, the body diverts pituitary resources to _____________.

A

ACTH and TSH (at the expense of GH, FSH, and LH)

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16
Q

Those with chronic hypopituitarism usually complain of ______________.

A

decreased libido, amenorrhea, or fatigue (because the body tries to preserve ACTH)

17
Q

Explain how the insulin stimulation test can diagnose hypopituitarism.

A

If you give insulin, the body responds by raising the blood sugar with GH and cortisol. If the person cannot make these they will become hypoglycemic with low doses of insulin.

18
Q

What is empty sella syndrome?

A

A normal anatomic variant in which the pituitary is above the sella (where it normally would be), discovered incidentally

19
Q

What are some causes of chronic hypopituitarism?

A
  • Autoimmune disease
  • Infiltrative disease (sarcoidosis, amyloidosis)
  • Slow growing tumors