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F3 E4 Shea > Pituitary 1 > Flashcards

Pituitary 1 Flashcards

1
Q

What 2 hormones are released from the Posterior Pituitary?

A
  • Oxytocin
  • ADH
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2
Q

Where is the pituitary located?

Which cranial nerves?

A

Sits in sella turcica of sphenoid bone

3, 4, 5, 6

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3
Q

Which method of testing is used for majority of tests run on blood?

A

Venipuncture

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4
Q

Describe a 24 hour urine

  • Measurement of what 2 things for Pheochromocytoma?
A
  • Discard the first morning void
  • Collect for next 24 hours (including void at end of 24 hours)
  • Record last voiding time
  • Keep urine cool
  • If ANY urine is lost, discard entire specimen, begin collection again next day
  • Pheo: catecholamines & metabolites
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5
Q

What is being measured?

  • Hormone w/ longer half life
  • NOT bound by proteins
  • Measured directly w random test
A

TSH

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6
Q

What is being measured?

  • Hormones BOUND to proteins (albumin & binding proteins)
A

Free & total fractions

Total T4 and Free T4

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7
Q

When should cortisol be measured and how?

A

Blood, perform first venipuncture between 6 am - 8am

(cortisol is highest in the AM)

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8
Q

What type of test do you use?

  • Hyperfunctioning of gland is suspected
  • Pt w/ excess cortisol
A

Suppression test

  • Dexamethasone suppression test (synthetic glucocorticoid)
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9
Q

Which test do you use?

  • Test for HYPOfunctioning gland
  • Pt w/ low cortisol
A

Stimulation test

  • ACTH stimulation test (tests adrenals response to ACTH)
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10
Q

What is the most abundant pituitary hormone?

A

Growth Hormone (GH)

Somatotrope cells

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11
Q

GH secretion is controlled by what 2 factors?

A
  • Hypothalamic
  • Peripheral
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12
Q

What do GHRH and GHIH do?

A
  • GHRH: stimulates GH secretion
  • GHIH: (somatostatin) inhibits GH secretion
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13
Q

T/F

  • GH secretion is pulsatile and is undetectable between pulses
A

True

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14
Q

When is GH at its peak?

A

Within an hour after the onset of DEEP SLEEP

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15
Q

What is produced in the liver after stimulation of GH?

GH stimulates what type of growth in children?

A
  • IGF-1
  • linear growth
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16
Q

What stimulates growth of epiphyseal plates of long bones?

A

IGF-1

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17
Q

Absence of IGF-1 produces what condition?

A

Dwarfism (Laron type dwarfism)

18
Q

What are the 3 phases of post-natal growth?

A
  • Infantile
  • Childhood
  • Pubertal
19
Q

Which post-natal growth phase?

  • Rapid growth
  • first 2 yrs of life
  • 30-35 cm
A

Infantile phase

20
Q

Which post-natal growth phase?

  • Growth is constant (5-7 cm/yr)
  • Slight slowing later in childhood “prepubertal dip”
A

Childhood

21
Q

Which post-natal growth phase?

  • Growth spurt of 8-14 cm/yr
  • Effects of increasing gonadal steroids/GH secretion
A

Pubertal Phase

22
Q

Velocity falls to what number when approaching final adult height?

A

0

23
Q

Definition of what?

◦Variation of normal

◦2 SDs or more below the mean height for children of that sex and chronologic age

A

Constitutional Short Stature

24
Q

Definition of what?

◦Constitutional short stature in children of short parents

–Child is growing within the parental target range

–Growth curve is consistently at or below the 3-5th percentile

–Growth velocity is typically normal

A

Genetic Short Stature

25
Q

What are 6 pathologic causes of short stature?

A
  • GH deficiency
  • IUGR
  • Infections (rubella, CMV)
  • Maternal drug/alcohol usage
  • Genetic syndromes (Turner’s syndrome, etc.)
  • Chronic systemic disease (cancer, cystic fibrosis, renal insufficiency, GI disease)
  • Psychosocial dwarfism – poor growth associated with emotional and nutritional deprivation
26
Q

What are 3 basic steps to dx short stature

A
  1. H&P
  2. IGF-1 levels
  3. GH stimulation tests (DEEP SLEEP)
27
Q

What are 4 MC reasons a pt might have noticeable dysmorphic features / disproportionate short stature?

A
  1. Chromosomal abnormalities (Trisomy 21/Turners)
  2. Intrauterine infections
  3. Maternal exposures (toxins, ETOH, smoking)
  4. Disproportionate short stature (Skeletal dysplasia or Rickets)
28
Q

What are some “genetic factors” which could lead to short stature? (3)

A
  • Height of relatives
  • Health problems in family
  • Hx of early/late puberty in family members
29
Q

Dx of Short Stature

Does the child have growth failure?

  • Children should grow __ cm / year from age 2 y/o until onset of puberty
  • What 2 structures should be x-rayed to compare bone development to height & chronological age? (bone age vs. chronological age)
A
  • 5cm
  • Hand & wrist
30
Q

A patient’s H&P suggests GH deficiency.

What is the next step in diagnosing short stature?

A

Measure plasma IGF-1 levels

(concentration of IGF-1 reflects concentration of secreted GH)

(IGF is stable during the day w/ serum half life of 12-16 hrs)

31
Q

In what 4 circumstances would IGF-1 levels be lowered, but GH is normal?

A
  • Poor nutrition
  • Hypothyroidism
  • DM
  • Renal Failure
32
Q

Dx of short stature

  • What is “GOLD STANDARD” in dx of GH deficiency and is used when IGF-1 is low?
A

GH stimulation tests (2 types)

33
Q

Which GH stimulation test?

  • Measure serum glucose and serum GH before and 15, 30, 60, 90 and 120 minutes after the injection of insulin
A

Insulin induced hypoglycemia

34
Q

Which GH stimulation test?

  • Measure serum GH at 0, 30, 60, 90 and 120 minutes
A

Arginine

35
Q

What should be corrected before doing any GH stimulation tests??

A

Thyroid deficiency

36
Q

What are 2 hypothalamic causes of GH deficiency?

A

–Idiopathic ↓ GHRH secretion

–Hypothalamic tumors

37
Q

What are pituitary causes of GH deficiency?

A

–Pituitary tumors

–Trauma

–Surgical removal

–Irradiation

–Idiopathic

–Secretion of abnormal GH molecules

38
Q

Psychosocial Dwarfism is due to what?

A

Severe neglect

39
Q

What is a pharm tx option for GH deficiency in children?

A

Humatrope Pen

  • Synthetic GHRH (if pituitary capable of producing GH)
    Depot- 1 - 2 doses/month
  • 3x/week - daily therapy
  • Multiple dose pen devices
  • MC sub-q administration of Somatropin!
40
Q

Growth Hormone Therapy in Children

  • Continue therapy until when?
  • May develop normal GH secretion…
  • Stimulatory effects of which hormones?
  • When should GH be retested?
  • Children w/ what rarely recover GH as an adult?
A
  • Until growth ceases
  • gonadal steroid hormones
  • after completion of growth
  • multiple pituitary hormone deficiencies
41
Q

Summary of Short Stature Management:

  • Get a good H&P!!
  • FOLLOW growth curves!
  • If suspicious for pathologic short stature, follow what 4 steps?
A
  1. Obtain bone age w/ wrist x-ray
  2. IGF-1
  3. Confirm w/ GH stimulation test
  4. Refer to pediatric endocrinologist

F3 E4 Shea (12 decks)

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