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Endocrine- MHD > Pituitary > Flashcards

Pituitary Flashcards

1
Q

What is the relationship between dopamine and prolactin?

A

Dopamine inhibits prolactin synthesis and release from the anterior pituitary

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2
Q

What hormone release from the hypothalamus decreases the release of growth hormone from the anterior pituitary?

A

Somatostatin

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3
Q

List the three cell types found in the adenohypophysis (anterior pituitary)

A

Acidophils - stains red
Basophils- stains blue
Chromophobes- stains clear

All three grow together, and clusters are separated by a reticulin network

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4
Q

List the cell types present in the neurohypophysis

A

The neurohypophysis resembles neural tissue- it has glial cells, nerve fibers, nerve endings, and intra-axonal neurosecretory granules

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5
Q

What is the most common cause of hyperpituitarism?

A

Functional anterior pituitary adenoma

Functional indicates they are actively secreting hormone

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6
Q

Differentiate micro vs macroadenomas

A

microadenoma: <1cm
macroadenoma: >1cm

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7
Q

Which is the most common kind of pituitary adenoma?

A

Lactrotrophs- secretes Prolactin

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8
Q

What is the second and third most common hormones secreted from pituitary adenomas?

A

2- GH

3- ACTH

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9
Q

What are the classic mass effect symptoms caused by pituitary adenomas?

A

Bitemporal hemianopsia (with macroadenoma)

…also headaches

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10
Q

Do functional or non-function adenomas tend to be larger upon presentation?

A

Non-functional, because the only symptoms are caused by mass-effect

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11
Q

MEN 1 includes neoplasms of what three structures?

A

parathyroid, pancreas, and pituitary

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12
Q

Are pituitary adenomas familial or sporadic?

A

95% sporadic

5% familial

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13
Q

What is the role of GNAS1 in many pituitary adenomas?

A

GNAS1 gene mutations –> constitutive activation of Gs protein –> unchecked cellular proliferation (ultimately through cAMP)

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14
Q

How do females present with a prolactinoma?

A

Galactorrhea
Infertility and amenorrhea (prolactin inhibits LH surge)

Women present earlier because they realize they’re no longer menstruating regularly

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15
Q

How do males present with a prolactinoma?

A

Infertility and impotence

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16
Q

Name two drugs that are used to treat prolactinomas

A

Dopamine agonists: bromocriptine and cabergoline

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17
Q

How are macroadenomas of the pituitary treated?

A

Surgical resection

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18
Q

What cell type is responsible for the production of growth hormone?

A

Somatotrophs

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19
Q

Persistent GH stimulation in the liver leads to over-production of what?

A

Insulin-like growth factor 1 (IGF-1)

20
Q

Contrast the effects of a GH producing pituitary adenoma in prepubertal vs post-puberty patients

A

Pre-puberty –> gigantism

Post-puberty–> acromegaly

21
Q

List three ways we diagnose GH adenoas

A

Increased IGF-1 serum levels
Increased GH serum levels
Lack of GH suppression by oral glucose

22
Q

List two treatments for GH adenomas

A

1) surgical resection

2) Somatostatin analogs

23
Q

Name two specific somatostatin analogs

A

Octreotide

Lantreotide

24
Q

Corticotrophs produce which hormone?

A

ACTH

25
Q

What is cushings disease?

A

Hypercortisolism via pituitary adenoma

26
Q

Along with symptoms of hypercortisolism, what other unique skin finding is seen with excess ACTH production?

A

Hyperpigmentation

POMC –> ACTH and melanocyte stimulating hormone

27
Q

What is Nelson syndrome?

A

Removal of adrenal gland in presence of corticotroph adenoma –> rapidly progressing mass (no more feedback from adrenal glands

–> Mass effect and hyperpigmentation, but no excess cortisol

28
Q

List 4 potential causes of hypopituitarism

A

1) Nonfunctional pituitary adenoma
2) Ischemic injury
3) Surgery, radiation
4) Inflammatory conditions

29
Q

What is a pituitary apoplexy?

A

Acute hemorrhage into an adenoma

-If ACTH is eliminated –> lack of cortisol and hypotensive emergency

30
Q

What causes Sheehan syndrome?

A

Post partum necrosis of the anterior pituitary (posterior pituitary has some collateral circulation)

The anterior pituitary is particularly sensitive to ischemic damage, and so is vulnerable following a postpartum hypotensive state

31
Q

What is the initial clinical clue as to Sheehan syndrome?

A

Lack of lactation (due to lack of prolactin)

32
Q

Is Sheehan syndrome dangerous?

A

Yes- there can be a life-threatening lack of secondary adrenal insufficiency

33
Q

What can cause primary empty sella syndrome?

A

Increased CSF pressure causes pituitary atrophy

34
Q

ADH deficiency leads to __________

A

Central diabetes insipidus

35
Q

Excess ADH secretion is called ________–

A

SIADH

36
Q

What is desmopressin?

A

Synthetic ADH analog

37
Q

How does central diabetes insipidus respond to desmopressin?

A

It does respond

38
Q

What is nephrogenic diabetes insipidus?

A

Renal tubules are unresponsive to ADH - does not respond to desmopressin

39
Q

Do patients with central diabetes insipidus have hypo or hypernatremia?

A

HYPERnatremia (they are dehydrated due to free water loss)

40
Q

Do people with SIADH have hypo or hypernatremia?

A

They usually have euvolemic hyponatremia

They dilute out their Na+, but generally are not fluid overloaded

Total body water increases, blood volume remains nearly normal (clinically euvolemic)

41
Q

What is the most common paraneoplastic cause of SIADH?

A

Small cell carcinoma of the lung

42
Q

List a few drugs that can cause SIADH

A

SSRIs, carbamazepine, chlorpromazine, cyclophosphamide

43
Q

What does Rathke’s pouch develop into?

A

The anterior pituitary

44
Q

What are the tumors that can arise from Rathke’s pouch?

A

Craniopharyngioma

45
Q

Where do craniopharyngiomas occur?

A

Suprasellar

46
Q

Are craniopharyngiomas benign or malignant?

A

THey are benign, but tend to recur after resection

47
Q

What is a Rathke cleft cyst? Why are they important?

A

Developmental failure of Rathke’s pouch obliteration

They’re important because their growth may compromise the pituitary gland

Endocrine- MHD (17 decks)

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