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Endocrine II DF > Pituitary Guerin > Flashcards

Pituitary Guerin Flashcards

1
Q

anterior pituitary cell types

A

somatotrophs

mammosomatotrophs

lactotrophs

corticotrophs

thyrotrophs

gonadotrophs

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2
Q

somatotrophs secrete

A

GH

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3
Q

mammosomatotrophs secrete

A

prolactin and GH

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4
Q

lactrotrophs secrete

A

prolacting

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5
Q

corticotrophs secrete

A

ACTH and POMC, and melanocyte stimulating hormone (MSH)

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6
Q

thyrotrophs secrete

A

TSH

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7
Q

gonadotrophs secrete

A

FSH and LH

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8
Q

local mass effect pituitary

A

radiographic abnormalities of sella turcica

compression of optic nerves and chiasm–> visual fiedl abnormalities
-lateral (temporal) visual fields

signs and symptoms of elevated intracranial pressure
-HA, nausea, vomitin

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9
Q

pituitrary adenoma, if really big can cause

A

hypopituitarism

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10
Q

pituitary adenoma peak age and size

A

35-60 y/o

if above 1 cm then macroadenoma if below 1 cm then microadenoma

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11
Q

atypical adenomas

A

more likely to behave aggressively

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12
Q

Gross typical pituitary adenoma

A
  • soft and well circumscribed
  • when small, confined to sella turcica
  • as expand, they erode sella turcica and anterior clinoid processes

larger ones extend superiorly and often compress the optic chiasm and adjcaent structures like cranial nerves

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13
Q

pituitary adenoma histology

A

uniform, polygonal cells in sheets or cords

  • reticulin is sparse
  • mitotic activity is usually sparse
  • cytoplasm may be acidophilic, basophilic, or chromophobic
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14
Q

atypical adenomas

A

elevated mitotic activity
nuclear p53 expression from TP53 mutations
more likely to behave aggressively, including invasion and recurrence

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15
Q

GNAS mutation in what

A

pituitary adenomas: except for GTL (gonadotrophs, lactotrophs, thyrotrophs)

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16
Q

galactorrhea and amenorrhea in females, sexual dysfunction, infertility

A

lactotroph adenoma

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17
Q

gigantism (children)

acromegaly (adults)

A

somatotroph adenoma

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18
Q

combined features of gH and prolcating excess

A

mammosomatotroph adenoma

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19
Q

cushing syndrome, nelson syndrome

A

corticotrohp adenoma

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20
Q

hyperthyroidism

A

thryotroph

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21
Q

hypogonadism, mass effects, and hypopituitarism

A

gonadotroph

22
Q

other causes of hyperprolactinemia

-physiologic/normal

A

physiologic/normal

  • pregancy
  • nipple stimulation during suckling
  • response to stress
23
Q

other causes of hyperprolactinemia

-pathologic

A

lactotroph hyperplasia occurs when there is loss of dopamine mediated inhibition of prolactin

  • damage of dopaminergic neurons of hypothal
  • damage of pituitary stalk from head trauma
  • drugs that block dopamine receptors on lactoroph cells
  • any mass in suprasellar compartment may interfeere with inhibitory effect of hypothalamus on prolactin secretion
  • renal failure
  • hypothyroidism
24
Q

treament for lactotroph adenoma

A

bromocriptine

surgery

25
Q

somatoroph adenomas secrete GH which stimulates

A

hepatic secretion of IGF-1

26
Q

acromegaly

A

after closure of epiphyses

  • growth in skin and soft tissue
  • viscera- thyroid, heart, liver, adrenals
  • bones of face, hands, feet
  • increased bone density
27
Q

other findings with excess GH

A 
gonadal dysfunction
DM
generalized muscle weakness
hypertension
arthritis
CHF
increased risk of GI cancer
28
Q

diagnosis of excess GH

A

elevated GH and IGF-1
failure to suppress GH production in respons to an oral load of glucose
-very sensitive test for acromegaly

29
Q

treatment for somatotroph adenoma

A
  • surgery to remove
  • somatostatin analogs (inhibit pituitary GH secretion)
  • GH receptor antagnoist
30
Q

corticotroph adenomas

A

secrete ACTH–> adrenal hypersecretion of cortisol–>hypercortisolism (cushing syndrome)

  • usually microadenomas
  • adenomas are PAS positive (PAS the weed in CA)
    • carbs in POMC, the ACTH precursor molecule
  • variable immunoreactivity for POMC and its derivatives, like ACTH and B-endorphin
31
Q

cushing disease

A

when excessive production of ACTH by the pituitary called this

32
Q

nelson syndrome

A

pt with preexisting corticotroph microadenoma

  • occurs after surgical removal of adrenal glands for treatment of cushings syndrome
  • loss of inhibiotor effect of adrenal corticosteroids
    • large destructive pituitary adenoma with mass effect
  • hyperpigmentation bc of ACTH precursor molecule on melanocyte
33
Q

symptoms gonadotroph adenomas

A

most have mass effect

  • impaired vision, HA, diplopia, pituitary apoplexy
  • can get deficiency in LH = decreased energy and libido in men and amenorrhea in premenopausal women
34
Q

nonfunctionaing pituitary adenoma can also cause what

A

can compress residual anterior pituitary causing hypopituitarism

  • either slowly from enlargment
  • abruptly from acute intratumoral hemorrhage (pituitary apoplexy)
35
Q

pituitary carcinoma

A

rare
defined by metastases
most are functional and most commnly secrete prolacting and ACTH

36
Q

if you have hypopituitarism and posterior pituitary dysfunction =

A

diabetes insipidus = hypothalamic origin

37
Q

causes of hypopituitarism

A

tumors and other mass lesions

traumatic brain injury and subarachnoid hemorrhage

pituitary surgery or radiation

pituitary apoplexy (hemorrhage into pituitary gland, often occurin in pituitary adenoma, can cause death)

iscehmic necrosis of pituitary and sheehan syndrome

38
Q

sheehan syndrome effects

A

anterior pituitary

posterior pituitary receives blood directly from arterial branches so less susceptible to injury

39
Q

rathke cleft cyst can cause

A

hypopituitarism

40
Q

hypothalamic lesions causing hypopituitarism

A

can also diminsh secretion of ADH–>DI

tumors: benign (craniopharyngioma) or maligant (metastases to the hypothalamus)

41
Q

inflammatory disorders and infections causing hypopituitarism

A

sarcoidosis or tuberculous meningitis

42
Q

primary empty sella

A

arachnoid mater and CSF herniate into sella and compress pituitary

seen in obese women with history of multiple pregnancies

pts have visual field defects, sometimes with hyperprolactinemia bc of interruption of inhibitory hypothalamic inputs

43
Q

hypopituitarism GH deficiency

A

children can dvelop growth failure

44
Q

hypopituitarism gonadotropin deficiency

A

amenorrhea and infertility in women

decreased libido, impotence, and loss of pubic and axillary hair in men

45
Q

most frequent causes of SIADH

A

secretion of ADH by malignant neoplasms (particularly SCC of the lung)

drugs that increase ADH secretion

CNS disorders like infections and trauma

46
Q

clinical manifestations of SIADH

A

hyponatremia, cerebral edema, and reultant neurologic dysfunction

47
Q

most common suprasellar tumors and cause what

A

gliomas

craniopharyngiomas

cause hypo or hyper function of AP, DI or combinations

48
Q

craniopharyngioma arise from what
age distribution
presentation
prognosis

A

remnants of rathkes pouch

bimodal age

  • 1st peak is 5-15 yrs
  • 2nd peak is at 65 and older

headaches and visual distrubances

children can have growth retardation due to pituitary hypofunction and GH deficiency

good prognosis

49
Q

craniopharyngioma morphology

A

size is 3-4 cm in diameter
typically cystic, sometimes multiloculated (can be encapsulated)
often encroach on optic chiasm and CNs
can bulge into floor of third ventricle and base of brain

50
Q

adamantinomatous craniopharyngioma

age
morphology
what rxn

A

children

calcified
nests of cords of stratified squamous epithelium with peripheral palisading and compact, lamerllar keratin
cyst formation: cholesterol-rich, thick brown-yellow fluid that is compared to “machine oil”

firbosis and chronic inflammation

extend little fingers of epithelium into adjacent brain–>brisk glial rxn

51
Q

papillary craniopharyngioma

age
morphology

A

adults

rarely calcified
both solid sheets and papillae lined by well diff squamous epithelium
-no peripheral palisading
-usually lack keratin, calcification, and cysts

Endocrine II DF (7 decks)

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