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Case 11: Male Reproductive System > Pituitary Disease > Flashcards

Pituitary Disease Flashcards

1
Q

What is the 4 axis of endocrine system

A

Hypothalamus-pituitary-adrenal
GH
Hypothalamus-pituitary-thyroid
Hypothalamus-pituitary-gonadal

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2
Q

Why is negative feedback important

A

Maintain equilibrium

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3
Q

What is primary hyperfunction

A

Increased target hormone at target cells & inhibit at pituitary & hypothalamus

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4
Q

What is primary hypofunction

A

Stimulate at pituitary & hypothalamus due to low concentration

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5
Q

What 5 factors affects secretion

A

Negative feedback
Pulsatile secretion
Effects of stress (increases GH, cortisol & prolactin)
Effects of intense exercise (suppress gonadal axis)
Effects development (GH = length & age)

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6
Q

How to assess for hypofunction

A

Stimulation test

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7
Q

How to assess for hyperfunction

A

Suppression test

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8
Q

How does the hypothalamus-pituitary-adrenal axis flow

A

Corticotropin releasing hormone stimulate pituitary to release adenocorticotropic hormone that stimulate adrenal glands to secrete cortisol
Affects all tissue by inflammation & increase blood glucose

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9
Q

How does the GH axis flow

A

GH releasing hormone acts on pituitary to secrete GH acting on muscles, liver & bone for growth

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10
Q

How does the hypothalamus-pituitary-thyroid axis flow

A

Thyrotropin releasing hormone acts on pituitary to secrete thyroid stimulating hormone to stimulate thyroid to produce thyroid hormone to increase cells metabolism & prolactin

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11
Q

What inhibits prolactin

A

Dopamine

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12
Q

What 2 things stimulates prolactin

A

Stress & TRH

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13
Q

How does the hypothalamus-pituitary-gonadal axis flow

A

Gonadotropin releasing hormone acts on pituitary to secrete LH & FSH & act on gonads to produce gametes & sex hormones

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14
Q

What sequence does hypopituitarism deficiency occur

A

GH, FSH & LH
ACTH
TSH

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15
Q

What is hypopituitarism

A

Decreased production of one or more pituitary hormone resulting from hypothalamic or pituitary disease

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16
Q

What is panhypopituitarism

A

All hormones are deficient

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17
Q

What is spared with hypopituitarism

A

Posterior pituitary

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18
Q

What is the clinical findings in hypopituitarism in adults & children

A

Children: growth failure
Adults: reproductive dysfunction

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19
Q

What is 4 causes of hypopituitarism

A

Congenital: hypoplasia of pituitary or chromosome 22 detection syndrome
Acquired: tumour, surgery, radiation, trauma

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20
Q

When is growth hormone secreted the most

A

Pulsatile hormone so increased secretion at night & decrease w/ age

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21
Q

What is the 2 major actions of GH

A
  1. Metabolic: antagonist insulin action causing hyperglycemia & promote lipolysis in fasting state
  2. Stimulate production of insulin like growth factor: anabolic action by inhibiting protein breakdown & stimulate muscle & bone growth
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22
Q

What 6 factors stimulate GH

A

Hypoglycemia
Amino acids
Fasting
Exercise
Sleep
Adrenergic stimulant clonidine

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23
Q

What 2 factors inhibit GH

A

Somatostatin
Hyperglycemia

24
Q

What is the clinical presentation of GH deficiency in children, neonates & adults

A

Children: short stature
Neonate: hypoglycemia
Adults: decreased muscle mass & increase adipose

25
What test should be performed to diagnose growth hormone deficiency
Decreased IGF-1 Failure of GH increase w/ stimulation test (fasting, exercise, clonidine, insulin induce hypoglycemia)
26
What is 5 causes of GH deficiency
Congenital Tumour Trauma Idiopathic Receptor defects
27
What is clinical features of GH excess in children & adults
Children: gigantism Adults: acromegaly
28
What is the cause for excess GH
GH or GHRH producing tumour
29
How to diagnose GH excess
Failure to suppress GH w/ oral glucose load
30
What is the function of prolactin
Initiates & sustains lactation during pregnancy
31
What is a cause of low prolactin
Pituitary damage like Sheehan syndrome
32
What is 5 causes of high prolactin
Prolactin producing tumor Stalk effect Dopamine antagonist Stress Primary hypothyroidism
33
What is 2 clinical features of elevated prolactin
Galactorrhoea Amenorrhea
34
What is another name for ADH
Vasopressin
35
Where is ADH produced
In hypothalamus & stored in posterior pituitary
36
What is the function of ADH
Secreted when there is an increase in osmolality to decrease in blood volume to reabsorb water
37
What is ADH main target
Kidneys to change water permeability at collecting ducts
38
What is ADH deficiency called
Diabetes insipidus
39
What is 4 clinical features of diabetes insipidus
Polydipsia Polyuria Dehydration Severe hypernatraemia
40
What is the osmolality to the urine & serum in diabetes insipidus
Urine has decreased osmolarity & serum has increased osmolality due to water excretion
41
What is the two types of diabetes insipidus
Central due to deficiency in ADH Nephrogenic due to nephrogenic resistance to ADH
42
What is 4 causes of central diabetes insipidus
Genetic, trauma, inflammation or vascular condition
43
What is 3 causes of nephrogenic diabetes insipidus
Genetic, drugs & renal pathologies
44
How is diabetes insipidus diagnosed
Water deprivation test w/ serial urine collections & ADH is administered once osmolality of urine plateaus
45
What is the results & diagnosis of water deprivation test
Normal: 700-800 DI: plateau at 200-300 Central: increased osmolality after injection of ADH Nephrogenic: no change after ADH injection
46
What is SIADH
Syndrome of inappropriate ADH Failure of low plasma osmolality to suppress ADH release Fluid retention stimulates RAAS maintaining normal water balance but Na is lost
47
What is osmolality of the urine & serum in SIADH
Hyponatraemia & low osmolality serum High urine osmolality
48
What is 4 causes of SIADH
Tumor Trauma Drugs Infection
49
Where is human chorionic gonadotropin secreted from
Placenta
50
When is HCG secreted
At pregnancy At very high levels with pregnancy related tumour
51
How does HCG & TSH cross react
Same a-subunits
52
What happens when TSH & HCG cross react
Increased HCG cross react w/ TSH receptor in thyroid leading to increased secretion of thyroxine/T4 & inhibits TSH production (- feedback) HCG peaks at 12 weeks & once HCG decrease TSH will increase
53
How does HCG & LH cross react
Same a-subunit
54
What is HCG & LH cross reaction used for
To test for testosterone deficiency If HCG is administered & testosterone should normally increase
55
How is the different subunits differentiated in the labs
In lab looks for a & b subunits

Case 11: Male Reproductive System (9 decks)

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