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Endo: Sem 2 > Pituitary Gland and It's Disorders > Flashcards

Pituitary Gland and It's Disorders Flashcards

1
Q

Two lobes of pituitary

A

anterior and posterior

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2
Q

what do magnocellular neurones do?

A

project down from hypothalamus and release hormones directly in the blood: oxytocin and vasopressin

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3
Q

what do parvicellular neurones project into?

A

they release hormones into median eminence which flows into portal vessels and then into anterioir pituitary to stimulate endocrine tissues to produce hormones

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4
Q

what is a portal vessel?

A

vessel that goes from a capillary bed to a capillary bed

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5
Q

is there a direct connection between hypothalamus and anterior pituitary?

A

no

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6
Q

where is the pituitary gland?

A

below brain in the sella turcica

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7
Q

what forms the pituitary stalk?

A

notochordal projection connecting the gland to the brain

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8
Q

what is underneath the sella turcica?

A

sphenoid sinus

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9
Q

what is above the pituitary?

A

optic chiasm, internal carotid arterides

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10
Q

what are two pituitary cell types?

A
  • acidic (orange G)

- basic (aldehyde fuscin)

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11
Q

Hormones released by anterior pituitary?

A
  • ACTH
  • TSH
  • GH
  • LH/FSH
  • Prolactin
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12
Q

hormones released by posterior pituitary?

A
  • ADH

- Oxytocin

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13
Q

what is the endocrine system organised into?

A

layers

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14
Q

what are the layers of the endocrine system?

A
  • Primary: end organ
  • Secondary: pituitary
  • Tertiary: hypothalamus
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15
Q

describe the endocrine system

A

slow and long

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16
Q

what does the hypothalamus do?

A

takes input of our senses and higher centres and integrates them. releases hormones in response

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17
Q

what is function of pituitary?

A

amplify signals of the hypothalamus

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18
Q

three considerations when dealing with pituitary lesions?

A

1) Hormone hypersecretion
2) hormone deficiency status,
3) Space occupying lesion

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19
Q

what is hormone deficiency status?

A

tumour can squish normal pituitary surrounding it leading to decreased hormone release from those parts

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20
Q

what is space occupying lesion?

A

as tumour grows more can effect nearby structures = headaches, visual loss

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21
Q

what can tumours of the anterior pituitary cause?

A

syndromes of hormone excess

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22
Q

what is Acromegaly?

A

excess GH (gigantism)

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23
Q

what is Cushings disease?

A

excess ACTH

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24
Q

what is secondary thryotoxicosis?

A

excess TSH

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25
Q

what is non-functioning pituitary tumour?

A

excess LH/FSH

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26
Q

what is prolactinoma?

A

excess PRL

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27
Q

what does GH do?

A

causes release of IGF-1 from liver which causes linear growth on the bones.

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28
Q

how do we grow?

A

lipids metabolised and protein synthesised for energy

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29
Q

systemic effects of excess GH?

A
  • acral enlargement
  • increased skin thickness
  • increased sweating
  • skin tags
  • changed appearance
  • visceral enlargement
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30
Q

metabolic changes of excess GH?

A
  • impaired fasting glucose
  • impaired glucose tolerance
  • diabetes mellitus
  • insulin resistance
  • increased TAG
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31
Q

other consequences of excess GH?

A
  • cardiomyopathy
  • hypertension
  • bowel polyps
  • colon cancer
  • female looks masculine
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32
Q

what are the actions of cortisol?

A
  • increased plasma glucose levels
  • increased lipolysis
  • proteins catabolised
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33
Q

how do plasma glucose levels increase?

A
  • increased gluconeogenesis
  • decreased glucose utilisation
  • increased glycogenesis
  • increased glycogen storage
  • Na+/H20 rentention
  • anti-inflammatory
  • increased gastric acid production
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34
Q

why does lipolysis increase?

A

to give more energy

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35
Q

what does protein catabolises do?

A

release AA

36
Q

what does Na+/H20 retention do?

A

maintains BP

37
Q

what are the effects of cushings syndrome?

A
  • changes in protein and fat metabolism
  • change in sex hormones
  • salt and water retention
38
Q

what is the effect of change in protein and fat metabolism?

A
  • change in body shape
  • central obesity
  • moon face
  • buffalo hump
  • diabetes
39
Q

what is the effect of change in sex hormones?

A
  • excess hair growth
  • irregular periods
  • problems conceiving
  • impotence
40
Q

what is the effect of salt and water retention?

A

high BP and fluid retention

41
Q

how is release of prolactin different to other pituitary hormones?

A

stimulus for the production is external to the body, relies on mechanical stimulation of the breast

42
Q

what happens with nipple is mechanical stimulated?

A

neural signal sent to the brain inhibiting dopamine

43
Q

what happens when dopamine production is switched off?

A

instant surge in prolactin production allowing milk to enter breast for baby

44
Q

how is the milk production terminated?

A

remove baby from nipple = positive feedback

45
Q

what drugs interfere with dopamine and PRL secretion?

A

OCP (oral contraceptive pill), HRT, antemetics, antipsychotics

46
Q

features of PRL excess?

A
  • infertility
  • oligoamenorrhoea
  • amenorrhoea
  • reduced libido
  • impotence
47
Q

what is oligoamenorrhoea?

A

reduced periods

48
Q

what is amenorrhoea?

A

no periods

49
Q

treatment of PRL excess?

A

dopamine agonists (e.g. bromocriptine and cabergoline)

50
Q

what do non functioning pituitary tumours cause?

A

headaches and visual defects due to space occupation

51
Q

treatment for non-functioning pituitary tumours?

A

surgery or radiotherapy

52
Q

how does the visual field defect occur?

A

first visual loss on the sides, due to compression where the fibres cross

53
Q

how does loss of pituitary function occur with an expanding tumour?

A

there is a set order in which you lose the pituitary hormones and it is based on their biological importance

54
Q

what is the order in which the hormones go?

A

1) FSH/LH as sex/repro is least priority
2) GH as growth unimportant
3) TSH as metabolic rate is important
4) ACTH as stress response needed for survival

55
Q

what happens to prolactin when hormones are all going?

A

prolactin levels rise due to compression of pituitary stalk so dopamine cant reach lactotrophs so wont be inhibited

56
Q

how are pituitary adenomas treated?

A
  • surgery to remove the tumour (unless prolactinoma as this responds to drug therapy)
  • if tumour too big = radiotherapy but its slow
  • drugs to block hormone production/release
57
Q

causes of pituitary failure?

A
  • tumour
  • trauma
  • infection
  • inflammation
  • latrogenic
58
Q

what is hypopituitarism?

A

deficiency of hormones due to hypopituitarism

59
Q

reduced thyroid?

A
  • bradycardia
  • weight gain
  • cold intolerance
  • hypothermia
  • constipation
60
Q

reduced sex steroids?

A
  • oligomenorrhoea
  • reduced libido
  • hot flushes
  • reduced body hair
61
Q

reduced cortisol?

A
  • tiredness
  • weakness
  • anorexia
  • postural hypotension
  • myalgia
62
Q

reduced GH?

A
  • tired

- central weight gain

63
Q

treatment for hypopituitarism

A
  • thyroid = thyroxine
  • sex steroids = testosterone and oestrogen
  • reduced cortisol = hydrocortisone
  • reduced GH = GH
64
Q

what does ADH do?

A

stops you peeing and vasoconstricts blood vessels

65
Q

what stimulates ADH release?

A
  • lack of water in blood causing increase in plasma osmolality
  • decreased BP
  • reduced PaO2 and increased PaCO2
66
Q

what senses change in osmolality?

A

osmoreceptors in hypothalamus

67
Q

what senses decreased BP?

A

baroreceptors

68
Q

what will ADH do?

A

open aquaporins in the collecting ducts increasing permeability for water. there is increased reabsorption of water into blood and vasoconstriction

69
Q

syndrome of inappropriate ADH

A

SIAH

70
Q

what is SIAH caused by?

A

injury or infection, or lung cancer and other metabolic causes

71
Q

Diagnosis of SIAH

A
  • decreased plasma Na+
  • decreased plasma osmolality
  • increased urine osmolality
  • increased urine Na+
72
Q

what is underproduction of ADH?

A

diabetes insipidus

73
Q

what does diabetes mean?

A

peeing a lot.
sweet = mellitus
watery = insipidus

74
Q

what could cause underproduction of ADH?

A
  • cranial cause in lack of production

- brain can make it but the kidney is damaged so receptor isnt working

75
Q

what is polyruia?

A

peeing a lot

76
Q

what is polydipsia?

A

drinking a lot of water

77
Q

difference between someone dehydrated and someone with diabetes insipidus?

A

DI cannot reabsorb water and produce conc urine as urine osmolality is similar to plasma

78
Q

what is the water deprivation test?

A

testing if someone has diabetes inspidus. keep someone dehydrated, change in weight = water loss

79
Q

how does water deprivation test happen?

A

weight patient, work out 3% of body weight and wait until they lose that or wait 8 hours. Check volume and conc of urine and plasma

80
Q

what is a normal result for water deprivation test?

A

plasma conc should be normal and urine concentrated

81
Q

what result suggests DI in water deprivation test?

A

plasma osmolality increases and urine remains dilute

82
Q

if it goes away with DDAVP (desmopressin) what does this mean?

A

cranial cause. If no response = kidney problem

83
Q

what considerations are made of pituitary tumours?

A
  • tumour hormone production
  • effects on normal pituitary function
  • effects on surrounding structures
84
Q

treatment of pituitary tumours

A
  • surgery
  • radiotherapy
  • medical therapy
85
Q

how is pituitary failure treated?

A

hormone replacement

Endo: Sem 2 (11 decks)

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