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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
Q

What test should be performed to diagnose growth hormone deficiency

A

Decreased IGF-1
Failure of GH increase w/ stimulation test (fasting, exercise, clonidine, insulin induce hypoglycemia)

26
Q

What is 5 causes of GH deficiency

A

Congenital
Tumour
Trauma
Idiopathic
Receptor defects

27
Q

What is clinical features of GH excess in children & adults

A

Children: gigantism
Adults: acromegaly

28
Q

What is the cause for excess GH

A

GH or GHRH producing tumour

29
Q

How to diagnose GH excess

A

Failure to suppress GH w/ oral glucose load

30
Q

What is the function of prolactin

A

Initiates & sustains lactation during pregnancy

31
Q

What is a cause of low prolactin

A

Pituitary damage like Sheehan syndrome

32
Q

What is 5 causes of high prolactin

A

Prolactin producing tumor
Stalk effect
Dopamine antagonist
Stress
Primary hypothyroidism

33
Q

What is 2 clinical features of elevated prolactin

A

Galactorrhoea
Amenorrhea

34
Q

What is another name for ADH

A

Vasopressin

35
Q

Where is ADH produced

A

In hypothalamus & stored in posterior pituitary

36
Q

What is the function of ADH

A

Secreted when there is an increase in osmolality to decrease in blood volume to reabsorb water

37
Q

What is ADH main target

A

Kidneys to change water permeability at collecting ducts

38
Q

What is ADH deficiency called

A

Diabetes insipidus

39
Q

What is 4 clinical features of diabetes insipidus

A

Polydipsia
Polyuria
Dehydration
Severe hypernatraemia

40
Q

What is the osmolality to the urine & serum in diabetes insipidus

A

Urine has decreased osmolarity & serum has increased osmolality due to water excretion

41
Q

What is the two types of diabetes insipidus

A

Central due to deficiency in ADH
Nephrogenic due to nephrogenic resistance to ADH

42
Q

What is 4 causes of central diabetes insipidus

A

Genetic, trauma, inflammation or vascular condition

43
Q

What is 3 causes of nephrogenic diabetes insipidus

A

Genetic, drugs & renal pathologies

44
Q

How is diabetes insipidus diagnosed

A

Water deprivation test w/ serial urine collections & ADH is administered once osmolality of urine plateaus

45
Q

What is the results & diagnosis of water deprivation test

A

Normal: 700-800
DI: plateau at 200-300
Central: increased osmolality after injection of ADH
Nephrogenic: no change after ADH injection

46
Q

What is SIADH

A

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
Q

What is osmolality of the urine & serum in SIADH

A

Hyponatraemia & low osmolality serum
High urine osmolality

48
Q

What is 4 causes of SIADH

A

Tumor
Trauma
Drugs
Infection

49
Q

Where is human chorionic gonadotropin secreted from

A

Placenta

50
Q

When is HCG secreted

A

At pregnancy
At very high levels with pregnancy related tumour

51
Q

How does HCG & TSH cross react

A

Same a-subunits

52
Q

What happens when TSH & HCG cross react

A

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
Q

How does HCG & LH cross react

A

Same a-subunit

54
Q

What is HCG & LH cross reaction used for

A

To test for testosterone deficiency
If HCG is administered & testosterone should normally increase

55
Q

How is the different subunits differentiated in the labs

A

In lab looks for a & b subunits

Case 11: Male Reproductive System (9 decks)

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