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Endocrine > Pituitary and Hypothalamus > Flashcards

Pituitary and Hypothalamus Flashcards

1
Q

What form the andohypothysis?

A

oral ectoderm

Rathke’s pouch

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2
Q

What is the embryonic tissue that form the neurohypophysis?

A

Neuroectoderm

from the hypothalamus

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3
Q

Which arteries to the pit. supply the pars tubercalis, median eminence, and infundibulum?

A

Superior hypophyseal aa.

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4
Q

What area of the pit. does the inferior hypohyseal aa supply>

A

posterior pit (pars nervosa)

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5
Q

Match the following cell types to the hormones.

  1. Somatotropes
  2. Lactotropes
  3. Corticotropes
  4. Gonadotropes
  5. Thyrotropes
A. FSH/LH
B. GH
C. PRL
D. TSH
E. ACTH
A
  1. B
  2. C
  3. E
  4. A
  5. D
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6
Q

Which 4 of the 6 adenohypophysis (AHP) hormons are trophic?

A

ACTH
TSH
FSH
LH

(GH and PRL act directly on target organs)

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7
Q

Which 2 AHP H’s stain as an acidophile?

A

Somatotrope (GH)
Lactotrope (PRL)

(the non-trophic hormones)

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8
Q

What is the stain that is specific for the acidophiles?

A

Orange G

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9
Q

What are the 3 cell types of the AHP that are basophilic and PAS+?

A

Corticotrope (ACTH)
Gonadotrope (FSH and LH)
Thyrotrope (TSH)

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10
Q

Put the following cell types in order from most to least abuntant in the AHP.

ACTH
PRL
FSH/LH
GH
TSH
A

TSH (50%) > PRL = ACTH (15-20%) > FSH/LH (10%) > TSH (5%)

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11
Q

What are the 2 hormones secreted from the NHP?

A

ADH

Oxytocin

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12
Q

What big molecules is cleaved to make ACTH and B-LPH?

A

POMC

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13
Q

What is the hypothalamic hormone that stimulates the somatotropes?

A

GHRH

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14
Q

What is the hormone from the hypothalamus that inhibits the somatotropes and insulin secretion by B cells of the pancreas?

A

Somatostatin

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15
Q

What is the hypothalamic H that inhibits the lactotropes?

A

Dopamine

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16
Q

What is the hypothalamic H that stimulates the corticotropes?

A

CRH

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17
Q

What is the hypothalamic H that stimulates the gonadotropes?

A

GnRH

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18
Q

What is the hypothalamic H that stimulates the thyrotropes?

A

TRH

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19
Q

What is the name of the sytstem that connects the hypothalamus to the AHP?

A

Hypothalamic-hypophysial portal system

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20
Q

What mediates the effect of GH on the tissue, and is synthesized in the liver?

A

IGF-1

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21
Q

What are the 5 actions of GH on proteins?

A 
Proteins --> tissue
AA --> cell membranes
↑ protein synthesis
↑ DNA txn
↓ catabolism of proteins
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22
Q

What is the main action of GH on adipose tissue?

A

GH ↑ the relase of FA’s form fat –> body fluids

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23
Q

So under the whip of GH, what is the main source of energy?

A

Fat

this is why u get skinny during puberty

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24
Q

What is the hormone that GH hates and is willing to put a plentiful bounty on its head?

A

Insulin

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25
Q

What are the 3 main actions of GH on carbohydrate metabolism?

Think anti-insulin, or “glucagon” effects.

A
  1. ↓ glucose uptake into tissues
  2. Increase glucose production by the liver
  3. increase insulin secretion
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26
Q

So yeah, GH puts a lot of glucose and therefore insulin into the blood, but what can GH cause to bitchslap insulin’s effects?

A

Insulin resistance

similar to DMII

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27
Q

What are the molecuels that are made in the liver in repsonse to GH, mediates GH effects, and binds tighter than GH to plasma proteins?

A

Somatomedins (IGF-1)

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28
Q

What happens to GH levels under starvation, hypoglycemia, exercise, excitement, or trauma?

A

it ↑

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29
Q

This is the condition where there are excessively active, acidophilic, GH-producing cells in kids.

A

Gigantism

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30
Q

Which famous person has gigantism?

A

Yo mama

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31
Q

This is the condition from an acidophilic tumor that occurs after adolescence.

A

Acromegaly

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32
Q

Since bones can’t grow taller in acromegaly, what happens to them?

A

They get thicker

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33
Q

Which famous person has acromegaly?

A

Jaws from James Bond

His only line in all the movies is in Moonraker right before he dies and he says “Well, here’s to us.”

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34
Q

When should u use recombinant GH as a treatment?

A

Hyposecretion of GH

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35
Q

What is the treamtent for the hypersecretion of GH?

A

Removal of tumor

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36
Q

What are the glial cells called in the posterior pituitary called?

A

Pituicytes

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37
Q

Which nucleus makes ADH? Oxytocin?

A

ADH- Supraoptic nucleus

OTX- Paraventricular nucleus

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38
Q

What is the stimulus for ADH release from the hypothalamus?

A

↑ osmolarity of extracellular fluid

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39
Q

What does ADH do to the collecting duct?

A

inserts Aq into luminal membrane –> water reabsorption

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40
Q

What does ADH also do to blood vessels?

A

Vasoconstriction

remember the other name of ADH is “vasopressin”

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41
Q

What stimulates the hypothalamus to produce OTX to contract the uterus?

A

Stimulation of the cervix

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42
Q

What stimulates the paraventricular and supraoptic nuclei in the hypothalamus to release OTX, which causes myoepithelial cells around the mammary glands to contract, and thus milk flows?

A

Suckling of the nipple

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43
Q

So in essence, what are the 2 main actions of OTX?

A

Uterine contraction

Milk exporation

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44
Q

What are the 2 forms of pituitary adenomas?

A

Functional (hormone-producing)

Nonfunctional (silent)

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45
Q

What are the visual problems with a nonfunctional pituitary adenoma?

A

Bitemporal hemianopsia due to compression of the optic chiasm

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46
Q

What are the Sx of a prolactinoma in women?

A

Galactorrhea

Amenorrhea

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47
Q

What are the Sx of prolactinoma in men?

A

↓ libido

Headaches

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48
Q

True or False: prolactinomas are the most common type of pituitary adenoma.

A

True!

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49
Q

What are the 2 dopamine agonists in the treatment of a prolactinoma?

A

bromocriptine or cabergoline

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50
Q

What is the treatment for large prolactinomas?

A

CUT IT OUT

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51
Q

What happens to GH levels in a GH adenoma if you give glucose?

A

They don’t change

normally they’d ↓

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52
Q

What is the somatostatin analogue that supresses GH release in the treament of GH adenomas?

A

Octreotide

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53
Q

What is the syndrome called from ACTH adneomas?

A

Cushings

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54
Q

How much of the pituitary parenchyma must u lose to show Sx in hypopituitiarism?

A

> 65%

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55
Q

What is a common cause of hypopituitarism in adults? Kids?

A

Adults- adenomas

KIds- craniopharyngiomas

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56
Q

This is a pregnancy-related infarction of the pituitary gland, where there is blood loss during parturition.

A

Sheehan syndrome

57
Q

What are the 3 major Sx to Sheehan syndrome?

A

Poor lactation
Loss of pubic hair
Fatigue

58
Q

This is the cause of hypopituitarism where there is a congenital defect in the sella, where there is herniation of the arachnoid and CSF into sells –> destroys pit.

A

Empty sella syndrome

59
Q

This is the condition where there is an ADH deficiency due to hypothalamic or NHP pathology.

A

Central diabetes insipidus (DI)

60
Q

What are the urine, salt, and osmolarity changes in central DI?

A

Polyuria/polydipsia
Hypernatremia
Low urine osm and specific gravity

61
Q

What is the result of water deprivation tests in central DI?

A

They FAIL to increase urine osmolality

62
Q

What is the DOC for central DI?

A

Desmopressin (ADH analog)

63
Q

This is the condition where there is impaired renal response to ADH, usually from inherited mutations or drugs.

A

Nephrogenic DI

64
Q

What are the 2 common drugs to cause nephrogenic DI?

A

Li

Demeclocycline

65
Q

True or False: in nephrogenic DI, there is adequate response to Demopressin like there is in central DI.

A

FALSE

Central DI has a response and nephrogenic DI has no response. Remember in central, you can’t MAKE ADH, and the kidneys are fine, so replacement therapy is good. In nephrogenic, the ADH levels in the blood are fine but the kidney can’t respond to it, so it doesnt matter if u inject more ADH because the kidney will be like “yes, i still suck”

66
Q

This is the condition where there is retenton of free water, leading to hyponatremia, low serum osmolality, mental status changes, and seizures.

A

SIADH

67
Q

In addition to trauma, infection, and drugs like cyclophosphamide, what is the important cause of SIADH?

A

Ectopic production (like small cell carcinoma of the lung)

68
Q

What are the 2 treatments for SIADH?

A

Free water restriction

Demeclocycline

69
Q

Where are craniopharyngiomas derived from?

A

Rathke’s pouch

70
Q

Which form of craniopharyngiomas have dystrophic calcifications, palisading squamous epithelium, lamellar/wet keratin, and there is a cholesterol-rich, thick brownish-yellow fluid?

A

Adamantinomatous craniopharyngiomas

kids

71
Q

What form of craniopharyngiomas are in adults, and rarely calcifies?

A

Papillary craniopharyngiomas

72
Q

What is the gland between the superior colliculi at the base of the brain, composed of cells with photosensory and neuroendocrine fxns?

A

Pineal gland

73
Q

What is the main product of the pineal gland to regulate the circadian rhythms?

A

Melatonin

74
Q

What are teh 2 forms of pinealomas?

A

Pineoblastomas

Pineocytomas

75
Q

What are the all the hormones involved in the cortisol pathway?

A

CRH from hypothal –> ACTH from AHP –> Cortisol from adrenal

76
Q

What are the all the hormones involved in the GH pathway?

A

Ghrelin and GHRH stimulate AHP to release GH –> GH stimulates liver to make IGF-1

Somatostain inhibits GHRH receptors

77
Q

In growth hormone insensitivity, waht is the 1 pathway that’s enhanced?

A

lack of IGF-1 release from liver –> ↑ GH from AHP

78
Q

In secondary growth hormone insensitivity, waht is the 1 pathway that’s reduced?

A

↓ GH release from AHP

79
Q

In tertiary growth hormone insensitivity, what 2 hormones are reduced?

A

Ghrelin + GHRH

therefore no AHP stimulation

80
Q

What is the drug that is a GHRH analogue, and enhanced basal and pulsatile GH secretion?

A

Tesamorelin

81
Q

Which form of GH insensitivity is Tesamorelin indicated?

A

tertiary insensitivity

82
Q

What are the 2 adult contiditons that are indications for recombinant HGH (somatotropin)?

A

GH deficiency

Panhypopituitarism

83
Q

What are the 4 kid conditions that are indications for recombinant HGH (somatotropin)?

A

Idiopathic short stature
Chronic kidney disease
Turners syndrome
PW syndrome

84
Q

Patients with GH insensitivity (Larson dwarfism) or GH deficiency and Ab’s against GH are indications for the use of which drug?

A

Mecasermin

85
Q

What are the Sx of acromegaly?

A

organomegaly, macroglossia, large facial features, increased hand/feet thickness, hyperhidrosis, fatigue

86
Q

What are the 2 somatostatin analogues?

A

Octreotide

Lanreotide

87
Q

What is the GH analogue that has been modified in a way that one of the sites binds to the GH receptor w/ higher affinity than the native molecule, but the other binding site is inactive.

A

Pegvisomant

88
Q

What is the indication for Pegvisomant?

A

2n3 or 3rd line after SRL therapy has been attempted for somatotroph adenomas

89
Q

What is the prolactin pathway?

A

TRH from hypothal –> PRL from AHP –> lactation

Estrogen stimulates PRL
Dopamine inhibits PRL

90
Q

Why do phenothiazine antipsychotics or metoclopramide elevate prolactin levels?

A

They’re D antagonists

91
Q

How soon does the initiation of breastfeeding cause the release of prolactin?

A

30 mins

92
Q

Since prolactin suppresses estrogen synthesis, which thus ↓ FSH/LH, what is the common problem in ↑ prolactin levles?

A

Infertility w/ oligomenorrhea or amenorrhea

93
Q

What is the synthetic dopamine agonist that inhibits lactotroph cell growth, which is used to treat prolactinomas?

A

Bromocriptine

94
Q

What is another dopamine receptor agonist that i used to treat prolactinomas?

A

Cabergoline

95
Q

What is the main test used in screening for pirmary thyroid disease?

A

Serum TSH

96
Q

What will cause ↑ TSH? ↓ TSH?

A

↑ TSH- primary thyroid problem

↓ TSH- secondary problem (with AHP or hypothal)

97
Q

Which nucleus of the hypothalamus makes CRH?

A

Paraventricular nucleus

98
Q

MSH, Liptropin, B-endotropin, and ACTH are from what big molecule?

A

POMC

99
Q

What drug is a synthetic analogue of ACTH?

A

Cosyntropin

100
Q

What will be the result of Cosyntropin treatment in primary adrenal insufficiency?

A

No increase in plasma cortisol.

101
Q

What will be the result of Cosyntropin treatment in new onset adrenal insufficiency?

A

↑ plasma cortisol

102
Q

What will be the result of Cosyntropin treatment in long standing adrenal insufficiency?

A

Blunted cortisol response b/c of progressive adrenal cortical atrophy

103
Q

What is the mechanism and indication for Tolvaptin?

A

V2 antagonist of ADH

for heart failure

104
Q

Conivaptan is used for euvolemic and hypervolemic hyponatremia because it has what mechansism of action?

A

Mixed V1a and V2 antagonist

105
Q

What are the 2 drugs for the treatment of pts with nephrogenic DI?

A

Amiloride (K-sparing) or hydrochlorothiazide

106
Q

What 2 smooth muscles are contracted by OXT?

A

Boob

Uterus

107
Q

Pituitary tumors or surgery and radiotherapy can cause what condition?

A

Hypopituitarism

108
Q

What happens to tesosterone or estradiol levels in the gonadotrophin axis in hypopituitarism?

A

they ↓

109
Q

Which H is ↓ in the Dx of central hypothyroidism?

A

T4

110
Q

What is the test u can do to stimulate GH secretion?

A

Insulin-induced hypoglycemia

111
Q

What is the hormone replaced in ACTH deficiency?

A

Glucocorticoid replacement

112
Q

What is the DOC for TSH deficiency?

A

Levothyroxine sodium

113
Q

What are the 2 components of the “pill”?

A

Estrogen + progesterone

114
Q

What is the H replacement for gonadotrophin deficiency in males?

A

Testosterone

115
Q

What is the difference between microadenomas vs macroadenomas?

A

Mico are < 1cm

Macro are > 1 cm

116
Q

What are the hypothalamic syndrome signs from a pituitary tumor?

A

disturbed thirst, satiety, sleep and temperature regulation

117
Q

Which CN’s can be compressed in a pituitary tumor? Sx?

A

III, IV, VI –> diplopia + strabismus

118
Q

Pituitary tumors can cause CSF draining from which orifice?

A

Nose

CSF rhinorrhea

119
Q

What is the surgery for removal of most pit tumors?

A

Transsphenoidal surgery

120
Q

Pregnancy, postpartum state, stress, and functional disorders can cause what syndrome?

A

Hyperprolactinemia

121
Q

Neuroleptic agents, antidepressants, cimetidine, verapamil, opates, and marijuana can cause what syndrome?

A

Hyperprolactinemia

all interfere with Dopamine

122
Q

Which 2 organ failures can cause hyperprolactinemia from ↓ metabolism of the H?

A

Kidney and Liver

123
Q

What are the 3 indications for medical treatment of a prolactinoma?

A

Infertility, hypogonadism, galactorrhea

124
Q

What is the test for acromegaly?

A

Serum IGF-1

125
Q

Why does a random serum level of GH not helpful in the Dx of acromegaly?

A

because of the pulsatile secretion of GH

126
Q

What is teh treatment of choice for GH secreting tumors?

A

CUT IT OUT

127
Q

This is the clinical syndrome produced by sudden hemorrhage or infection of the pituitary gland.

A

Pituitary apoplexy

128
Q

What are teh 2 electrolyte abnormalities that can cause DI?

A

hyperCa

hypoK

129
Q

What is the plasma osmolality in pts with DI?

A

> 295 mOsm/kg

130
Q

What is the plasma osmolality in pts with psychogenic polydipsia?

A

< 280 mOsm/kg

131
Q

What is the urinary concentration of Na in SIADH?

A

> 20 mEq/L

132
Q

What are the serum levels of creatinine and uric acid in SIADH?

A

normal creatinine and ↓ serum uric acid

133
Q

Which condition causes ↑ creatinine and uric acid?

A

Subclinical hypovolemia

134
Q

Waht is the physical diagnostic sign that is absent despite an expanded extracellular fluid volume in SIADH?

A

Edema

135
Q

Lethargy, malaise, N/V, and confusion are signs of what problem?

A

Hyponatremia

136
Q

What is the DOC for chronic SIADH?

A

Demeclocycline

137
Q

What is administered IV in acute neuro sequelae are present in SIADH?

A

hypertonic saline

138
Q

However, what is the main problem with rapid correction of hyponatremia?

A

Central pontine myelinolysis

Endocrine (4 decks)

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