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Year 2 > Pituitary hormone regulation + presentation of pituitary disease > Flashcards

Pituitary hormone regulation + presentation of pituitary disease Flashcards

1
Q

What part of the pituitary glands has an arterial blood supply

A

The posterior pituitary glands

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2
Q

What thyroid controlled hormone is released by the hypothalamus

A

TRH

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3
Q

What does TRH stimulate in the pituitary glands

A

TSH

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4
Q

How does TSH effect the thyroid

A

Causes release of T4 and T3

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5
Q

Describe the pituitary gonadal axis

A
  1. GnRH secreted by hypothalamus
  2. GnRH down anterior pituitary via hypophyseal portal system
  3. GnRH stimulates anterior pituitary glands to secrete LH and FSH
  4. FSH and LH in females causes production of oestrogen and inhibin + regulates menstrual cycle
  5. LH in men causes testosterone production and FSH causes spermatogenesis
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6
Q

Describe the hypothalamic-pituitary-adrenal axis

A
  1. CRH and Vasopressin produced in nerve terminals of the medial eminence
  2. CRH moves down pituitary stalk and vasopressin is transported down axon to the posterior pituitary glands
  3. CRH and vasopressin stimulate secretion of stored ACTH.
  4. ACTH transported to adrenal gland
  5. Stimulates synthesis of corticosteroids such as cortisol and aldosterone
  6. Cortisol binds to miner corticoids receptors
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7
Q

Describe the negative feedback mechanism in the HPA axis

A
  1. Cortisol inhibits hypothalamus and pituitary glands - reduces levels of CRH and vasopressin
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8
Q

Describe the GH/IGF-I axis

A
  1. GnRH stimulates the pituitary
  2. Somatostatin inhibits pituitary
  3. Liver produces IGF-I
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9
Q

Role of IGF-I in GH/IGF-I axis

A

Inhibits hypothalamus

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10
Q

5 common diseases of the pituitary gland

A
  1. Benign pituitary adenoma
  2. Craniopharyngioma
  3. Trauma
  4. Apoplexy
  5. Sarcoid
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11
Q

What is pituitary apoplexy

A

Bleeding into or impaired blood supply of the pituitary gland - tumours

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12
Q

Why does pituitary glands cause bitemporal hemianopsia

A

Temporal vision crosses over at the optic chasm. Pituitary gland tumours can compress the optic chiasm leading to temporal vision being lost.

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13
Q

What are the three important presentations of a pituitary disease

A
  1. Pressure one local structures
  2. Pressure on normal pituitary function (hypo/hyperpituitarism)
  3. How tumour is affecting levels in the body of other hormones (prolactinoma, Acromegaly and Cushing’s disease)
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14
Q

Why would a pituitary tumour cause headaches

A

Pituitary gland can place pressure on the dura mater

Pituitary gland could lead to hydrocephaly

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15
Q

How would lateral extension of a pituitary gland effect an individual

A

Cranial nerves will be squished

Temporal lobe epilepsy

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16
Q

What is an epilepsy

A

Sensory disturbances in the brain

17
Q

How would downward extension of the pituitary tumour effect an individual

A

Lead to cerebrospinal fluid rhinorrhoea (breaks through CSF space)

18
Q

What is cerebrospinal fluid rhinorrhoea

A

Drainage of CSF through the nose

19
Q

What is a microadneoma

A

A tumour less than 10mm in diameter

20
Q

Symptoms of prolactinoma

A 
Hyperprolactinemia 
Vision problems (as gland causes bitemporal hemaniopsa) 
Loss of libido
Galactorrhea
Amenorrhea
21
Q

How does an excess of prolactinoma effect males

A

Erectile dysfunction

22
Q

What is a macro adenoma

A

Greater than 10mm diameter

23
Q

In what sex is prolactinoma more common

A

Women

24
Q

How is prolactinoma treated

A

Dopamine agonist (Cabergoline and Bromocriptine)

25
Q

How is Cushing’s syndrome caused

A

Excess of cortisol

26
Q

Pathophysiology of cushion’s syndrome

A
  1. Adenoma of pituitary gland causes excess production of ACTH in response to excess CRH
  2. ACTH levels stay high as tumour is unresponsive to negative feedback
  3. ACTH causes excess cortisol to be produced
27
Q

How does excess cortisol cause the symptoms associated with cushing’s syndrome

A
  1. Central obesity (in the stomach not in legs and arms)
  2. Osteoporosis
  3. Muscle and bone weakness
  4. Diabetes
  5. Hypertension
  6. Hyperpigmentation
  7. CVD
28
Q

In summary, what three questions do we ask a patient we suspect has a pituitary tumour

A
  1. Is it pressing the optic chimes
  2. Are they hypopituitary
  3. Do they have a functioning tumour

Year 2 (155 decks)

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