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F1:CEP20/21 > Pituitary gland and disorders > Flashcards

Pituitary gland and disorders Flashcards

1
Q

Where does the pituitary sit?

A

In the mid cranial fossa in the sella turcica of the sphenoid bone

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2
Q

What is the pituitary gland directly attached to? How does this happen through what membrane does this happen?

A

Pituitary is connected. hypothalamus via the infundibulum which pierces through the diaphragma sellae into the sella turcia

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3
Q

What axis does the pituitary form?

A

Hypothamo-pituitary axis

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4
Q

What is the anterior pituitary also known as

A

The adenohypophysis

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5
Q

What does the adenohypophysis comprise of?

A

Pars distalis
Pars intermediate
and the pars tuberalis that wraps around the pituitary stalk

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6
Q

What is the pars distalis?

A

contains glandular endothelial cells that produce anterior pituitary hormones as well as a rich fenestrated capillary network supported by fibroblasts and reticular fibres

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7
Q

What does the neruohypophysis or posterior pituitary comprise of?

A

Infundibular stalk and infundibular process that forms the posterior lobe

Is an extension of the hypothalamus therefore is neural tissue

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8
Q

What does the posterior pituitary contain?

What hormones does it produce?

A

Axons of neurones that originate in the supraoptic (mainly AVP) nuclei and the paraventricular (mainly oxytocin) nuclei of the hypothalamus
axons pass down the supraopticohypophyseal tract into capillary bed where they secrete oxytocin and vasopressin (ADH) via neruosecretion

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9
Q

Chromaphils are the secretory cells in the anterior pituitary what are the subtypes

A

Acidophils pink staining

basophils more blue staining

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10
Q

What cells are the acidophils in the anterior pituitary?

What is their histological apperance?

A

Somatotrophs
very large nuclei most numerous cell in the anterior pituitary produce and secrete GH which is packed in many vehicles in the cytosol

Lacto-mommotropic cells produce prolactin

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11
Q

What are the basophils that are present in the anterior pituitary?

A

Gonadatropic cells
produce LH and FSH
large cells with large nuclei

Corticotropic cells
produce ACTH
sparser secretory granules vesicles located on periphery

Thyrotropic cells
produce TSH
smaller granule contain vesicles located on the periphery

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12
Q

What are the two main blood vessels that bring blood to the pituitary gland?
Where do they stem form?
What part of the pituitary do they supply

A

Superior hypophyseal arteries stem from internal carotid artery bring blood to the median eminence of the hypothalamus and the infundibular stalk

Inferior hypophyseal artery that supplies the posterior pituitary

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13
Q

What is significant about the superior hypophyseal artery?

A

Blood supply to median eminence of the hypothalamus capillaries then region into blood sinusoids down into the pars distalis then branches to form an extensive capillary network

This is known as the hypothalamicHypophyseal portal system and allows hormones produced by the pituitary to reach the anterior pituitary without entering systemic circulation

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14
Q

What is the venous drainage of the pituitary gland

A

The hypophyseal vein

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15
Q

What is significant about the pituitary glands location?

A

Superior is the optic chiasm
surrounded laterally anteriorly and posteriorly by the cavernous sinus
and surrounded inferiorly by the sphenoid sinus

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16
Q

What is significant about the cavernous sinus and the pituitary gland

A

Contains cranial nerves III, IV, VI and V1 and V2 in order from superior to inferior
as well as the internal carotid artery

as such there is a lot to avoid when carrying out pituitary surgery

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17
Q

What are tropic hormones

A

hormones that target other endocrine tissues

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18
Q

What are the tropic hormones produced by the pituitary?

A

FSH
LH
ACTH
TSH

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19
Q

What are the other non-tropic hormones produced by the anterior pituitary

A

Prolactin

Growth hormone

20
Q

What stimulates growth hormone secretion?

A

GHRH growth hormone releasing hormone produce by the hypothalamus

Also stimulated by sleep hypoglycaemia and exercise

21
Q

What is the function of GH, and how does it carry out this role?

A

Cell division
protein synthesis
glucose metabolism
bone growth

It does this indirectly through the production of insulin growth factor one (IGF-1) in the liver which then triggers the mitogenic and metabolic effects of the GH

22
Q

What inhibits GH

A

high GH levels and high IGF-1
hyperglycaemia
somatostatin

23
Q

What does GH deficiency result in

A

Stunted growth and delayed development results in dwarfism in children
decreases muscle strength and exercise capacity
decreases bone mineral density

24
Q

How is GH deficiency diagnosed? What test do you do?

A

Secretion of GH naturally pulsative higher at night

Growth hormone stimulation tests given insulin that results in hypoglycaemia should result in an increase in GH secretion
IGF-1 levels also measured

25
What is GH excess? What causes this? What does it cause and what are the symptoms of this disease?
Leads to acromegaly or gigantisism in children Caused by a pituitary adenoma no reduction or natural drops in GH levels ``` Acromegaly: growth of facial skeleton protruded jaw growth of hands and feet issues with fertility and heart thickened skin difficulty sleeping inter dental spacing ```
26
What are the local effects of pituitary adenomas
headaches pressure on the optic chiasm resulting in visual field loss bitemporal hemianopia lateral expansion can lead to compression of cranial nerves in cavernous sinus
27
Treatment of GH excess?
Surgery to remove pituitary adenoma transsphenoidal surgery Radiotherapy somatostatin analogues can be given as long actin preparations
28
LH and FSH What simulates production? What is the role of FSH and LH?
Produced by gonadtropic cells Stimulated to produce LH and FSH by GnRH gonadatropin releasing hormone FSH and LH Peptide hormones with an inactive A subunit and specific B subunit that is activated once cleaved Role in the development of secondary sex characteristics production of sex hormones oestrogen and testosterone
29
What inhibits FSH LH
high GnRH high FSH high LH and various other sex hormones
30
FSH LH deficiency? Effects? Treatment?
Leads to delayed puberty in children and poor development of secondary sex characteristics Leads to decreased fertility and libido in women and osteoporosis leads to decreased libido and infertility in men as well as loss of muscle mass Treatment: FSH and LH replacement therapy
31
FSH LH excess
VERY RARE FSHomas of pituitary will lead to menstural irregularities as well as enlarged testicles Treatment is surgery
32
ACTH what does it stand for?
Adrenocorticotropic hormone
33
What stimulates ACTH release and what is its role?
Stimulated by release of CRH (corticotropin releasing hormone) by the hypothalamus Also stimulated by stress controls cortisol production by the adrenal glands which itself has a key role regulating the production of other steroids produced by the adrenal gland
34
What inhibits ACTH
high ACTH high CRH high levels of many other hormones it results in the production of
35
ACTH excess?
results in Cushings disease central obesity moon face thick skin striae on skin easy bruising osteoporosis
36
Diagnosis Treatment of ACTH excess?
high cortisol leaves loss of diurnal rhythm no significant drop in cortisol level Transsphenoidal surgery to remove pituitary adenoma
37
TSH Stimulation Role Inhibition
Produced by thyrotropic cells Stimulated by TRH Thyrotropin releasing hormone Role in thyroid gland and thyroid home regulation Inhibited by high TSH high thyroid hormone levels
38
TSH excess due to pituitary adenoma
Hyperthyroidism TSH-omas VERY RARE cause Treatment is transsphenoidal surgery
39
TSH defficency
secondary Hypothyroidism
40
Prolactin
Produced by lacto-/ mammotropic cells stimulated by breast feeding and pregnancy allows mammotropic glands to produce milk following childbirth and inhibits gonadal activity through inhibition of GnRH Hypothalamus inhibits PRL release via dopamine
41
Prolactin excess? Cause? Symptoms?
When no pregnant can be caused by drugs (dopamine antagonists) or through pituitary adenomas Galactorrhoea milky nipple discharge and hypogonadism Treatment dopamine agonists to degrease PRL levels and the size of the tumour
42
ADH or vasopressin AVP? | Role?
Produced and released by neurosecretory cells in the posterior pituitary Increases the rate of free water reabsorption in the luminal membrane of kidney through V2 receptors causing integration of aquaporins into luminal membrane of collecting duct Stimulated by hyperosmoregularity of the circulate effective circulating volume
43
``` What is AVP deficiency Causes how is it diagnosed? treatment? ```
Diabetes insipidus ``` Autoimmune destruction of neurosecretory cells tumors trauma infection inheritance ``` have to determine it is not diabetes mellitus measure blood gluc Water deprivation test urine output should decrease in people who are normal will remain the same for ADH deficiency Treatment ADH analogues
44
What is inadequate production of pituitary hormones called? | What is inadequate production of hormones from the anterior pituitary called?
hypopituitarism Panhypopituitarism
45
Give three causes of hypopituitarism
Trauma to the pituitary non functional Pituitary adenomas Pituitary infarction
46
Causes of hyperpituitarism
functional pituitary adenomas hypothalamic disease rare ectopic production of hypothalamic agents

F1:CEP20/21 (12 decks)

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