Pituitary Pathology and Puberty

Question 1

Which part of the trilaminar disc is the APG derived from? Where is the PPG derived from?

Answer 1

APG: Ectoderm
PPG: Floor of the third ventricles

Question 2

What are the seven hormones that the APG produce?

Answer 2

FSH
LH
ACTH
Growth Hormone
TSH
MelanOcyte Releasing
Prolactin

Question 3

What hormones does the PPG secrete and where are they synthesised?

Answer 3

H: ADH and Oxytocin
S: Para-ventricular and supra-optic nuclei

Question 4

What are the functions of the 2 PPG hormones?

Answer 4

1) ADH: Water retention and release

2) O: a) Milk Secretion b) Uterine Contraction

Question 5

What are the 3 main problems of a pituitary tumour?

Answer 5

1) Pressure on local structures e.g. Optic Chiasm
2) Hypo-pituitary
3) Functioning Tumour

Question 6

What are the 2 causes and 5 signs of a prolactinoma and treatment?

Answer 6

a) Pituitary Adenoma b) Anti-dopaminergic drugs
1) Infertility 2) Galactorrhoea 3) Amenorrhoea 4) Loss of Libido 5) Visual field defects and headaches from local tumour effect
T: Dopaminergic Agonist

Question 7

How is GH secreted from the anterior pituitary?

Answer 7

Pulsatile fashion –> Increased release during sleep

Question 8

What are the main local effects of a pituitary adenoma?

Answer 8

1) Headaches
2) Visual field defects
3) CSF rhinorrhoea
4) CN palsy and temporal lobe epilepsy

Question 9

What is puberty and what are the first tell-tale signs in M/F?

Answer 9

Morphological, physiological and behavioural changes of gonads infantile – > Adult
M: First-ejaculation (Night based)
F: Menarche

Question 10

What hormones are responsible for Female growth and development?

Answer 10

Pub/Ax Hair: Ovarian and Adrenal androgens

Genitalia/Breasts: Ovarian androgens

Question 11

What are the roles of testicular androgens in Male Development?

Answer 11

1) Development of external genitalia
2) Growth of pubic and axillary hair
3) Voice deepening

Question 12

What is the name of the scale used to measure physical development based on external sex characteristics?

Answer 12

Tanner Scale

Question 13

What is Thelarche and what are the 3 main stages?

Answer 13

Process of breast development (3 years, controlled by oestrogen)

1) Ductal Proliferation
2) Adipose Deposition
3) Areola and Nipple Enlargement

Question 14

What is adrenarche and what are the 2 main signs of it?

Answer 14

Maturation of adrenal gland –> Zona Reticularis cells
Pre-pubertal adrenal androgen production
1) Body Odour 2) Mild Acne

Question 15

What is pubarche?

Answer 15

Growth of pubic hair

Question 16

What is precocious puberty and what is the treatment for it?

Answer 16

Onset of sexual characteristics before 8/9

T: GnRH super agonist to suppress pulsatility of GnRH secretion.

Question 17

What is delayed puberty, most likely male cause, and 3 main consequences?

Answer 17

Delayed: Absence of characteristics by 14y/o and 16y/o
Male: Constitutional family delay –> Late menarche or delayed paternal growth spurt
1) Psychological problems
2) Reduced bone mass
3) Reproduction defects

Question 18

What are the main functional causes of delayed puberty?

Answer 18

1. Anorexia.
2. Bulimia.
3. Over exercising.
4. CKD.
5. Drugs.
6. Stress.
7. Sickle cell Disease

Question 19

What tests would you run to check for delayed puberty?

Answer 19

1. FBC - red cell count especially.
2. U+E.
3. LH/FSH measurements.
4. TFT’s.
5. Karyotyping for Turners.

Question 20

What is adrenarche?

Answer 20

Development of the adrenal gland, with specialised cells forming the zona reticularis

Question 21

What is a primary cause of hypogonadism?

Answer 21

Klinefelter’s Syndrome (Additional X chromosome)

Question 22

How do hypogonadism and hypopituitarism affect testosterone and FSH/LH levels?

Answer 22

HG: Testosterone low FH/LSH high
HP: FSH/LH will be low, Testosterone low

Question 23

How does androgen deficiency affect males?

Answer 23

1) Loss of libido
2) High pitched voice
3) Loss of facial, axillary, limb and pubic hair
4) Poorly developed scrotum and penis
5) Loss of erection

Question 24

How is hypogonadism treated?

Answer 24

Injection of testosterone

Question 25

What is hypergonadotropic hypogonadism?

Answer 25

Primary gonadal failure!

- Testes or ovarian failure.

Question 26

What are 2 examples of hypogonadotropic hypogonadism?

Answer 26

1) Klinefelter’s Syndrome (47XXY)

2) Turner’s Syndrome (45X)

Question 27

What is hypogonadotropic hypogonadism?

Answer 27

Secondary gonadal failure!

- Hypopituitary or problems with the hypothalamus.

Question 28

What is hypogonadotropic hypogonadism?

Answer 28

Kallman’s Syndrome

Question 29

What is Turner syndrome and the symptoms found within it?

Answer 29

45(X) - One X Chromosome

1. Short stature.
2. Delayed puberty.
3. CV and renal malformations.
4. Recurrent otitis media.

Question 30

What is Klinefelter’s syndrome and what are the symptoms within it?

Answer 30

47(XXY) - One extra X Chromosome

1. Azoospermia.
2. Gynaecomastia (enlargement of male breast tissue).
3. Increased risk of breast cancer.
4. Testicular size <5ml.

Question 31

What is Kallman’s Syndrome?

Answer 31

Congenital deficiency of GnRH

Question 32

What causes acromegaly?

Answer 32

Benign pituitary adenoma which produces excess growth hormone

Question 33

What are the main symptoms of acromegaly?

Answer 33

1. Change in appearance.
2. Increase in size of hands and feet.
3. Excessive sweating.
4. Headache.
5. Tiredness.
6. Weight gain.
7. Amenorrhoea.
8. Deep voice.
9. Goitre.

Question 34

Give 4 signs of Craniopharyngioma.

Answer 34

1. Raised ICP.
2. Vision affected.
3. Growth failure.
4. Puberty affected.

Question 35

Give 4 local effects of pituitary adenoma.

Answer 35

1. Headaches.
2. Visual field defects - bitemporal hemianopia.
3. Cn palsy and temporal lobe epilepsy.
4. CSF rhinorrhoea.

Question 36

What suprasellar neoplasm results from benign cysts and calcification of Rathke’s pouch?

Answer 36

Craniopharyngioma.