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CEP > Piuitary Gland > Flashcards

Piuitary Gland Flashcards

1
Q

What is hypothalamus pituitary system

A

Hypothalamus secretes hormones which stimulate the PG

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2
Q

Hormones secreted by anterior pituitary

A

ACTH
LH FSH
prolactin
TSH
GH

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3
Q

Hormones secreted from posterior pituitary

A

Oxytocin
Vasopressin (ADH)

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4
Q

Where is pituitary situated

A

Base of brain
Sella turcica

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5
Q

How is hypothalamus secretion regulated

A

Via hormone mediated signals (negative feedback)
Via neural inputs (ACh)

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6
Q

Which nuclei regulate endocrine functions

A

Paraventricular
Supraoptic
Ventromedial

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7
Q

Hypothalamus’ non endocrine functions

A

Regulation of body temp
Thirst
Food intake
Blood pressure

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8
Q

How is pituitary gland connected to hypothalamus

A

Infundibulum stalk

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9
Q

Which hypothalamus hormones relate to anterior pituitary gland hormones

A

GHRH - GH
GnRH - LH/FSH
CRH - ACTH
TRH - TSH
TRH + GnRH - prolactin

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10
Q

What is GH stimulated by

A

Hypoglycaemia
Exercise
Sleep

Supported by hyperglycaemia

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11
Q

How are the effects of GH mediated

A

IGF-1

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12
Q

What is the pattern of GH secretion

A

Released through out life
Pulsatile
Peaks when asleep

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13
Q

Function of GH

A

Linear growth in children
Acquisition of bone mass
Stimulate:
- Protein synthesis
- Lipolysis
- Glucose metabolism
Regulation of body composition
Psychological well-being

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14
Q

What happens to secretion of gonadotropins during puberty

A

Sensitising of hypothalamus and PG to negative feedback of gonadotropins decrease
So increase production of testosterone and oestrogen
Allows development of secondary sex characteristics

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15
Q

What does testosterone release cause

A

Spermatogenesis
Male secondary sec characteristics

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16
Q

What does oestrogen release cause

A

Folliculogenesis
Female sex secondary characteristics

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17
Q

Function of prolactin

A

Essential for lactation
Level increase pregnancy and breast feeding
Inhibits gonadal activity by suppressing GnRH
Can cause disease in excess

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18
Q

Function of ACTH

A

Promotes secretion of cortisol

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19
Q

Secretion pattern of ACTH

A

Pulsatile
High in morning
Drops throughout day
When sleeping cortisol undetectable

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20
Q

Where is ADH synthesised

A

In supraoptic and paraventricular nuclei of hypothalamus

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21
Q

What kind of hormone is ADH

A

Peptide hormone

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22
Q

How is ADH transmitted to posterior pituitary gland

A

Migrate via axons of the supraopticohypophyseal tract into posterior lobe

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23
Q

Function of ADH

A

Primary physiological determinant of the rate of free water excretion
Augments the water permeability of luminal membranes of cortical and medullary collecting tubules
Via V2 receptor (kidney)
Retains water and decreases water excretion

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24
Q

What are the major stimuli for increased secretion of ADH

A

Hyperosmolality - thick blood
Effective circulating volume depletion

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25
Q

Function of oxytocin

A

Stimulates contraction of smooth muscle of breast and uterus
Under positive feedback
More contraction = more oxytocin
Roles in: milk ejection reflex and birth

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26
Q

What is synthetic oxytocin used for your

A

Inducing labour

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27
Q

Main effects of parasellar (located around sella turcica) lesions

A

Neurological
Visual
Hypopituitarism

28
Q

Most common pituitary lesion

A

Pituitary adenoma

29
Q

How visual defects are caused

A

Pressure on optic nerve/ optic chiasm

30
Q

Neurological/ visual effects due to pituitary lesion

A

Headaches
Brain damage
Cranial nerve damage - III, IV, V, VI (in cavernous sinuses)
CFS leak

31
Q

How can peripheral visual fields be compromised due to pituitary lesion

A

Impinges on medial nerves
Medial nerves cross over at optic chiasm
So pressure on optic chiasm causes temporary loss of peripheral vision

32
Q

Major causes of hypopituitarism

A

Pituitary tumours
Radiotherapy
Pituitary infatction (apoplexy) - death of area of PG
Infiltration of PG
Trauma
Isolated hypothalamic releasing hormone deficiency

33
Q

Manifestations of GH deficiency

A

Children: poor growth
Adults: increases abdominal fat, decreases lean body mass
Impaired lipid profile
Decreases muscle strength and exercise capacity
Impaired cardiac function
Decreases bone mineral density
Impaired psychological well being

34
Q

How to diagnose GH deficiency

A

Tests:
ITT - insulin tolerance test. Make patient hypoglycaemic. Stimulates GH. Record GH levels.
Glucagon
GHRH + Arginine
Measure IGF-1

35
Q

What is IGF-1

A

Mediates the secretion of GH

36
Q

Treatment for GH deficiency

A

Hormone replacement:
Recombinant human GH
Injection at night- mimics physiology. GH high at night.

37
Q

Manifestations of FSH/ LH deficiency in men

A

Men: decrease libido, infertility, loss secondary sex features, decrease muscle mass, decrease mood and wellbeing, osteoporosis and anaemia

38
Q

Manifestations of FSH/ LH deficiency in children

A

Children: delayed puberty

39
Q

Manifestations of FSH/ LH deficiency in women

A

Decrease libido, menstrual disorders, infertility, dyspareunia (painful intercourse), osteoporosis, premature atherosclerosis (narrowing arteries)

40
Q

How FSH/ LH deficiency is diagnosed

A

Females: FSH LH oestradiol (menstrual history)
Males: FSH LH and morning (afternoon not representative) testosterone

41
Q

Treatment for FSH LH deficiency

A

Hormone replacement
Oestrogen and progesterone
Testosterone

42
Q

Manifestations of ACTH deficiency

A

Fatigue
Weakness
Nausea/ vomiting
Anorexia
Weight loss
Hypoglycaemia - corticosteroids are insulin antagonist
Hypotension
Anaemia

43
Q

Diagnosis of ACTH deficiency

A

9.00am serum cortisol and ACTH levels
Dynamic tests:
Short synathen test - synthetic ACTH test see if cortisol is secreted
Insulin tolerance test - cause hypoglycaemia. Stress induces cortisol.
Glucagon test

44
Q

ACTH deficiency treatment

A

Replace what is missing (steroids)
No need for aldosterone replacement - not regulated via ACTH/ HPA

45
Q

Manifestations of TSH deficiency

A

Fatigue
Weakness
Cold intolerance
Bradycardia
Weight gain
Puffiness
Pale + dry skin
Constipation

46
Q

Diagnosis of TSH deficiency

A

Serum TSH
Serum T3
Serum T4 levels

47
Q

Treatment for TSH deficiency

A

Hormone replacement (levothyoxine)

48
Q

What is central diabetes insipidus

A

Deficient secretion of ADH

49
Q

Causes of ADH deficiency

A
  1. Idiopathic (autoimmune destruction)
  2. Familial
    Mutations
  3. Tumours
  4. Neurosurgery or trauma
  5. Infiltrative disorders
  6. Infections
  7. Hypoxia encephalopathy or severe ischaemia
50
Q

Manifestations of ADH deficiency

A

Water not retained in kidneys so more urine passed

Polyuria (output >3L/ day and 2L/day for children)
Polydipsia
Nocturia

51
Q

Major causes of Polyuria in common clinical practice

A

Osmotic diuresis:
Diabetes mellitus
Renal failure

Primary polydipsia
Diabetes insipidus

52
Q

Diagnosis of ADH deficiency

A

Measure Urine output
Osmolalities (plasma, urine)
Blood electrolytes
Glucose
Urea
Creatinine
Kidney function

Water deprivation test - derive patient of fluid
In normal patient urine would be low

53
Q

Treatment of ADH deficiency

A

ADH analogues

54
Q

Two types of pituitary adenomas

A
  1. Pressurises optic pathway
  2. Benign that hypersecretes hormones
55
Q

What does hypersecretion of GH cause

A

Acromegaly

56
Q

How to diagnose acromegaly

A

Oral glucose test- hyperglycaemia suppresses GH
IGF-1 - marker of GH secretion
Pituitary imaging - identify where GH secreting tumour is

57
Q

Treatment of acromegaly

A

Pituitary surgery
Medical treatment
- dopamine agonists
- somatostatin analogues
- GH receptor antagonists

Radiotherapy - radiate tumour

58
Q

What is a prolactinoma

A

Benign tumour secreted excess prolactin

59
Q

Manifestations of prolactinoma

A

Hypogonadism - prolactin inhibits GnRH
Galactorrhoea - breast discharge
Mass effects

60
Q

Diagnosis of prolactinoma

A

Exclude other causes of prolactin
Pituitary imagining

61
Q

Treatment of prolactinoma

A
  1. Medical treatment
    Dopamine agonists
  2. Surgery
  3. Radiotherapy
62
Q

Diagnosis of Cushing’s syndrome

A

ACTH dependant
- cushings disease: pituitary adenomas
- ectopic tumours

ACTH Independent
- adrenal disease

Latrogenic: Exogenous steroids

63
Q

Diagnosis of Cushing’s syndrome

A

24hr Urinary free cortisol
Midnight serum/ salivary cortisol - levels should be undetectable
Low dose dexamethasone suppression test

64
Q

Diagnosis of cushings disease

A

9.00am ACTH - if ACTH dependant then ACTH will be elevated
High dose dexamethasone suppression test
CRH test
Imaging (pituitary, ectopic so may be lungs)

65
Q

Management of cushings

A

Pituitary surgery
Radiotherapy
Drugs
Bilateral adrenalectomy

66
Q

What hormones does the placenta produce

A

Oestrogen
Progesterone

CEP (12 decks)

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