Session 8 Flashcards

1
Q

Where is the pituitary gland located?

A

Beneath the hypothalamus in a socket of bone called the sell turcica

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2
Q

What is the name given to the socket of bone where the pituitary gland sits?

A

Sella turcica

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3
Q

Where is the pituitary gland located in relation to the hypothalamus?

A

Below the hypothalamus

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4
Q

The hypothalamus and pituitary gland form a functional unit that serves as a link between…

A

The endocrine and nervous systems

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5
Q

The pituitary gland consists of how many parts? Name them

A

2 parts

Anterior pituitary gland
Posterior pituitary gland

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6
Q

Describe the embryological origins of the…

I) anterior pituitary
II) posterior pituitary

A

Arises from evagination of oral ectoderm

Arises from neuroectoderm

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7
Q

What is oral ectoderm?

A

Primitive gut tissue (ap arises from this)

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8
Q

What is neuroectoderm?

A

Primitive brain tissue (pp arises from this)

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9
Q

Which parts of the pituitary gland are physically connected to the hypothalamus?

A

Posterior Pituitary Gland

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10
Q

The hypothalamus drops down through the ________________ to form the posterior pituitary

A

Infundibulum

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11
Q

What is the colloquial name for the infundibulum?

A

Pituitary stalk

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12
Q

Where is oxytoxin and ADH produced?

A

By neurosecretory cells in the supraoptic and paraventricular nuclei of the hypothalamus

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13
Q

Oxytocin and ADH are produced by neurosecretory cells of which parts of the hypothalamus?

A

Supraoptic and paraventricular nuclei

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14
Q

Oxytocin and ADH produced in the supraoptic/paraventricular nuclei of the hypothalamus are transported down nerve cell axons to the…

A

Posterior pituitary

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15
Q

How is oxytocin/ADH transported from the hypothalamus to the posterior pituitary?

A

Down nerve cell axons

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16
Q

Where is oxytocin and ADH…

I) produced
II) stored
III) released into the general circulation

A

Hypothalamus - supraoptic/paraventricular nuclei

Posterior pituitary

Posterior pituitary

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17
Q

The ADH and oxytocin released form the posterior pituitary act on…

A

Distant targets

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18
Q

Hormones synthesised in hypothalamus are transported down axons and stored in the…

…before being released into the hypophyseal portal system

A

Median eminence

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19
Q

Hormones for stimulation of the anterior pituitary are synthesised in the ______________, stored in the ___________ __________ and then released into the…

A

Hypothalamus

Median eminence

Hypophyseal portal system

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20
Q

What is the function of the hormones released from the hypothalamus for action on the anterior pituitary?

What name is given to this type of cell/hormonal communication?

A

They stimulate/inhibit target endocrine cells in the anterior pituitary

Neurocrine function

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21
Q

Describe the endocrine function of the anterior pituitary

A

Endocrine cells in the anterior pituitary secrete a variety of hormones into the bloodstream that act on distant sites

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22
Q

Does the anterior pituitary have autocrine/paracrine functions?

A

Yes - hormones released from the anterior pituitary effect neighbouring cells

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23
Q

Hormones are produced by __________ cells in the hypothalamus

A

Nerve

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24
Q

Hormones secreted exclusively into the hypophyseal portal system affect _____________ cells within the _____________ ___________

A

Endocrine

Anterior pituitary

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25
Q

Which hormones are produced in the hypothalamus for release from the posterior pituitary?

A

Oxytocin

ADH

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26
Q

What is the function of oxytocin? Where is it released?

A

Milk let down and uterus contractions during birth

Posterior pituitary

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27
Q

What is the function of ADH? Where is it released?

A

Regulation of body water volume

Posterior pituitary

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28
Q

The tropic hormones of the hypothalamus have direct effects on the release of other anterior pituitary hormones. What is meant by the term tropic?

A

Affects the release of other hormones in the target tissue (anterior pituitary)

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29
Q

How many tropic hormones are produced in the hypothalamus for effect on the anterior pituitary?

A

6

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30
Q

Name the 6 tropic hormones produced in the hypothalamus for effect on the anterior pituitary

A
TRH - thyrotropin releasing hormone 
PIH - prolactin release-inhibiting hormone 
CRH - corticotropin releasing hormone
GnRH - gonadotropin releasing hormone 
GHRH - growth hormone releasing hormone
GHIH - growth hormone inhibiting hormone
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31
Q

Somatostatin is also known as…

A

Growth hormone inhibiting hormone

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32
Q

Dopamine is also known as…

A

Prolactin release-inhibiting hormone

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33
Q

Which 6 hormones are released from the anterior pituitary?

A
TSH - thyroid stimulating hormone 
FSH - follicle stimulating hormone 
GH - growth hormone 
ACTH - adrenocorticotropic hormone 
PL - prolactin 
LSH - luteinising hormone
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34
Q

What is the function of TSH?

A

Secretion of thyroid hormone from thyroid gland

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35
Q

What is the function of adrenocorticotropic hormone (ACTH)?

A

Secretion of hormones from adrenal cortex (cortisol)

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36
Q

What is the function of luteinising hormone?

A

Ovulation and secretion of sex hormones

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37
Q

What is the function of follicle stimulating hormone?

A

Development of eggs and sperm

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38
Q

What is the function of prolactin?

A

Mammary gland development and milk secretion

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39
Q

What is the function of growth hormone?

A

Growth and energy metabolism

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40
Q

Growth hormone stimulates…

A

IGFs

Insulin-like Growth Factors

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41
Q

TRH released from the hypothalamus activates which hormone in the anterior pituitary?

What does this hormone released from the anterior pituitary act on?

A

TSH

Thyroid gland

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42
Q

Which hormone from the hypothalamus results in the release of ACTH from the anterior pituitary?

ACTH released from the anterior pituitary acts on…

A

CRH

Adrenal cortex

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43
Q

Which hormones affect the release of prolactin from the anterior pituitary? What effect does each have?

Prolactin acts on which gland?

A

PIH (inhibit)
TRH (stimulatory)

Mammary gland

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44
Q

What hormones in the anterior pituitary does GnRH act on?

What parts of the body do these hormones released from the anterior pituitary act on?

A

LH

FSH

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45
Q

The pathways by which hypothalamic and anterior pituitary hormones are produced is often regulated by…

A

Negative feedback

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46
Q

What is apoptosis?

A

Programmed cell death - cell death by shrinkage

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47
Q

What is necrosis?

A

Cell death by damage

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48
Q

What is atrophy?

A

Decrease in cell number/size

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49
Q

What is hyperplasia?

A

Increase in cell number

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50
Q

What is hypertrophy?

A

Increase in cell size

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51
Q

What is the most important endocrine regulator of postnatal growth?

A

Growth hormone

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52
Q

State 4 factors that influence growth…

A

Genetics
Environment
Nutrition
Hormones

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53
Q

Where is growth hormone produced?

A

In the anterior pituitary

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54
Q

What hormone stimulates the release of growth hormone?

What hormone inhibits the release of growth hormone?

A

GHRH

GHIH

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55
Q

What type of hormone is growth hormone?

A

PEPTIDE HORMONE - protein hormone consisting of a single peptide

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56
Q

The growth-promoting effects of growth hormone are mainly excreted indirectly via…

A

Insulin-like growth factors

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57
Q

In response to growth hormone, cells of the liver and skeletal muscle produce/secrete…

A

Insulin-like growth factors

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58
Q

What role does growth hormone and the IGFs they act via have during childhood and teenage years?

A

It is essential for NORMAL growth

GH —> Long bone development
IGFs —> Bone + Cartilage growth

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59
Q

What role does GH and IGFs play in adults?

A

Helps maintain muscle/bone mass and promotes healing and tissue repair

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60
Q

What role does GH specifically have in children?

A

Involved in long bone development

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61
Q

What role do IGFs as a result of GH specifically have in children?

A

Involved in both bone + cartilage growth

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62
Q

Control of GH secretion is principally via the…

A

Hypothalamus and secretion of GHRH/GHIH

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63
Q

What role does the CNS play in the control of GH secretion?

A

Regulates GH secretion via inputs into the hypothalamus affecting GHRH/GHIH levels

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64
Q

Name two things that can result in increased GH secretion?

A

Onset of deep sleep
Stress
Exercise
Fasting

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65
Q

Name two things that can result in a decrease in GH secretion

A

Obesity

R.E.M. Sleep

66
Q

GH secretion is regulated by long loop and short loop negative feedback.

What is long loop negative feedback mediated by?
What is short loop negative feedback mediated by?

A

IGFs

GH

67
Q

Name 3 effects that IGF has on the control of GF release

A

Negative feedback via long loop

Inhibits release of GHRH
Stimulates release of GHIH
Inhibits release of GH from anterior pituitary

68
Q

The short loop in the negative feedback control of GH secretion is mediated by ____ itself via stimulation of ______ release

A

GH

GHIH

69
Q

What can growth hormone deficiency result in?

A

Pituitary dwarfism in childhood

70
Q

What is the usual treatment for growth hormone deficiency?

A

GH therapy

71
Q

What are three signs of growth hormone deficiency?

A

Height below 3rd percentile on standard growth charts

Growth rate slower than expected for age

Delayed or no sexual development during teen years

72
Q

Growth hormone in excess in adults results in…

A

Acromegaly

73
Q

Growth hormone in excess in children results in…

A

Gigantism

74
Q

Growth hormone in excess in children (leading to gigantism) is commonly caused by…

A

Pituitary adenoma

75
Q

What does acromegaly mean?

A

Large extremities - e.g. Hands, feet, lower jaw etc.

76
Q

What IGFs are found in mammals?

A

IGF2

IGF1

77
Q

IGF2 is mainly involved in…

A

Fetal growth

78
Q

What is the major growth factor in adults?

A

IGF1

79
Q

What modulates the availability of IGFs?

A

Binding proteins

80
Q

By which mechanism do IGFs act?

A

Autocrine
Paracrine
Endocrine

81
Q

IGF acts on which receptors?

A

IGF receptors

82
Q

IGF binds to IGF receptors modulating… (4)

A

Hyperplasia
Hypertrophy
Increase rate of protein synthesis
Increase rate of lipolysis in adipose

83
Q

How does GH exert its effect on cells?

A

Bind to GH receptors which activate Janus kinases (JAKs), resulting in transcription factor activation and IGF production

84
Q

Binding of GH to GH receptors results in…

A

Activation of Janus kinases (JAKs), transcription factor activation and IGF production

85
Q

Apart from growth hormone, state three other hormones that can influence growth?

A

Insulin
Thyroid hormones
Androgens
Glucocorticoids (cortisol)

86
Q

Are pituitary tumours benign or malignant?

A

Benign

87
Q

Name two ways a pituitary tumour may present…

A

Due to…

Mass effect of tumour on local structures

Abnormality in pituitary function

88
Q

Benign pituitary tumours can present due to the mass effect of the tumour on local structures. State two symptoms that may result from this

A

Headache

Visual loss

89
Q

Benign pituitary tumours can present due to abnormalities in pituitary function. What sorts of symptoms may be seen?

A

Symptoms of hypo- or hypersecretion of the pituitary gland

90
Q

Which hormones of the anterior pituitary gland are under ‘positive control’?

Which hormones of the anterior pituitary gland are under ‘negative’ control?

A
GH (small inhibitory effect by GHIH)
ACTH
LH
FSH
TSH

Prolactin

91
Q

What effect will a tumour blocking the passage of hormones from the hypothalamus have on the levels of the hormones in the anterior pituitary?

A

Reduction in the ‘positive control’ hormones (GH, TSH, ACTH, FSH, LH)

Increase in the ‘negative control’ hormone (prolactin)

HYPOPITUITARISM

92
Q

In a tumour affecting the pituitary gland, state the order in which the ‘positive control’ hormones are lost…

A

GH

LH & FSH

TSH & ACTH

93
Q

What effect can growth hormone deficiency seen in a tumour affecting the pituitary gland result in, in adults and children?

A

Short stature in children (pituitary dwarfism)

Reduced quality of life in adults

94
Q

What effect can gonadotropin deficiency (LH & FSH) seen in a tumour affecting the pituitary gland result in, in adults and children?

A

Delayed puberty in children

Loss of secondary sexual characteristics in adults

Loss of periods in women

95
Q

What effect can TSH deficiency as a result of a tumour affecting the pituitary gland result in?

A

Low thyroid hormone - weight gain, tiredness, slow pulse

96
Q

What effect can ACTH deficiency as a result of a tumour affecting the pituitary gland result in?

A

Low cortisol - tiredness, dizziness, low BP and low sodium

97
Q

Small tumours in the pituitary gland can result in overactivity in parts of the pituitary gland and excess of hormones being produced.

What hormones are most commonly seen in increased levels in these cases?

A

Prolactin
GH
ACTH

98
Q

A stimulation test is used for suspected…

A

Hormone deficiency

99
Q

A suppression test is used for suspected…

A

Hormone excess

100
Q

How is ACTH deficiency tested for? (2)

A

Direct stimulation of adrenals by ACTH

Insulin stress test (hypoglycaemia)

101
Q

How is ACTH excess tested for?

A

Suppress ACTH with steroids

102
Q

How is GH deficiency tested for?

A

Insulin stress test (hypoglycaemia)

103
Q

How is GH excess tested for?

A

Suppress GH with glucose load

104
Q

What is tested for in the blood to check for pituitary disease of the thyroid axis?

A

Free T4

TSH

105
Q

What is tested for in the blood to test for pituitary disease of the gonadal axis?

A

LH
FSH

Men - testosterone
Women - oestradiol

106
Q

What is tested for in the blood to test for pituitary disease of the prolactin axis?

A

Serum prolactin

107
Q

What is tested for in the blood to test for pituitary disease of the HPA axis?

A

0900 cortisol levels

108
Q

What is tested for in the blood to test for pituitary disease of the GH axis?

A

GH

IGF1

109
Q

What is a prolactinoma?

A

Benign prolactin secreting pituitary tumour

110
Q

What is described as a ‘macro-adenoma’ with regards to a prolactinoma?

A

> 1 cm in size

111
Q

What is described as a ‘micro-adenoma’ with regards to a prolactinoma?

A

< 1 cm in size

112
Q

The larger the size of a prolactinoma, the higher the…

A

Prolactin

113
Q

What is the treatment for a prolactinoma?

A

Treatment with tablets - dopamine agonist

114
Q

Does the treatment for a prolactinoma change depending on the size of the tumour?

A

No - doesn’t change.

Dopamine agonist tablets for treatment

115
Q

What tablets are used for the treatment of a prolactinoma?

A

Dopamine agonist tablets

116
Q

Is surgery required for the treatment of a prolactinoma?

A

No - tablets are the treatment for this

117
Q

It is important to check prolactin levels before contemplating surgery for a pituitary tumour as treatment is with tablets.

What is the normal range for serum prolactin?

A

50-400

118
Q

State three symptoms of hyperprolactinaemia in women

A

Menstrual disturbance
Fertility problems
Galactorrhoea

119
Q

Hyperprolactinaemia can cause fertility problems as prolactin directly inhibits…

A

Luteinising hormone

120
Q

What is galactorrhoea?

A

Milky discharge in the nipples outside pregnancy

121
Q

Are larger prolactinoma usually seen in men or women?

A

Men

122
Q

The symptoms of hyperprolactinaemia in men are associated with the symptoms of…

A

Low testosterone (due to prolactin inhibition of LH)

123
Q

The symptoms of low testosterone are often…

A

Non-specific

124
Q

Give an example of mass symptom that may be seen in a male with hyperprolactinaemia

A

Visual loss

125
Q

Do symptoms of hyperprolactinaemia present later in men or women? Why?

A

Present later in men

No periods in males

126
Q

When will a high prolactin level be treated with surgery?

A

When levels are below 5000 (with a pituitary mass on MRI)

127
Q

Why is a pituitary mass on MRI with prolactin BELOW 5000 treated by surgery?

A

High prolactin is due to disinhibition of prolactin by blocking of the pituitary stalk rather than active secretion of prolactin

128
Q

When will a high prolactin level be treated with medication?

A

When prolactin levels are ABOVE 5000

High prolactin is due to active prolactin secretion (prolactinoma)

129
Q

What happens in a non-functioning pituitary adenoma?

A

There is no secretion of biologically active hormones

130
Q

The clinical features of a non-functioning pituitary adenoma are either as a result of…

A

Mass effect OR low pituitary hormones

131
Q

Dopamine agonists used in the treatment of a prolactinoma stimulate which receptors?

A

D2 receptors

132
Q

Give an example of a dopamine agonist used in the treatment of prolactinoma

A

Bromocriptine

133
Q

Dopamine antagonists can cause high…

A

Prolactin

134
Q

What sorts of medications are dopamine antagonists?

A

Anti-sickness

Anti-psychotics

135
Q

What does acromegaly mean? How does it often present?

A

Large extremities

Large hands and feet

136
Q

What causes acromegaly?

A

Excess GH - GH secreting pituitary tumour

137
Q

What causes the excess GH that causes acromegaly?

A

GH-secreting pituitary tumour

138
Q

State 5 long-term complications of untreated acromegaly

A
Premature cardiovascular disease 
Increased risk of colonic tumours 
Increased risk of thyroid cancers
Disfiguring body changes 
Hypertension
Diabetes
139
Q

State three biological tests that can be used to confirm the diagnosis of acromegaly

A

Oral glucose tolerance test (glucose load) - failure to suppress GH —> acromegaly

Elevated IGF1

Elevated mean GH levels

140
Q

What is the treatment for acromegaly?

A

Surgical removal of the tumour

141
Q

If a more complicated GH-secreting pituitary tumour is causing acromegaly what other treatments may be required in addition to surgery?

A

Dopamine agonist
Somatostatin analogues

Pegvisomant

Radiotherapy

142
Q

How do dopamine agonists and somatostatin analogues work as an additional treatment for acromegaly?

A

Reduced GH secretion

143
Q

Describe two methods of radiotherapy that may be carried out as an additional treatment for acromegaly

A

External beam

Gamma knife

144
Q

Compare external beam and gamma knife radiotherapy

A

External beam - multiple short bursts over several weeks

Gamma knife - high concentration over single time

145
Q

Too much ACTH for example due to an ACTH-secreting tumour can lead to ______________ disease

A

Cushing’s

146
Q

Cushing’s disease is caused by too much cortisol due to too much ______ being released from the pituitary gland

A

ACTH

147
Q

Compare Cushing’s disease and Cushing’s syndrome

A

Cushing’s disease is caused by a pituitary tumour

Cushing’s syndrome is caused by something else

148
Q

Give an example of something the may cause Cushing’s SYDROME

A

Adrenal tumour

149
Q

Describe the classical change in appearance that is seen in Cushing’s disease

A
Round pink face with round abdomen 
Skinny and weak arms/legs
Thin skin and easy bruising 
Red stretch marks (striae) on abdomen
High blood pressure 
Diabetes 
Osteoporosis
150
Q

What is diabetes insipidus?

A

Production of large quantities of pale (insipid) urine. Extreme thirst due to fluid loss.

151
Q

Which gland secretes ADH?

A

Posterior pituitary

152
Q

Normally ADH is secreted from the ______________ __________ resulting in decreased urine. ADH binds to ADH receptors on the _______________ membrane of kidney cells and opens __________________ resulting in ______________ reabsorption of water from urine

A

Posterior pituitary

Basolateral

Aquaporins

Increased

153
Q

What causes diabetes insipidus?

A

Not enough ADH is secreted from the posterior pituitary —> not enough water reabsorbed —> large quantities of pale urine produced

154
Q

Name two types of diabetes insipidus

A

Cranial DI

Nephrogenic DI

155
Q

Compare cranial and nephrogenic diabetes insipidus

A

Cranial DI - ADH deficiency

Nephrogenic DI - ADH resistance

156
Q

What usually causes nephrogenic diabetes insipidus?

A

Kidney disease —> resistance to ADH

157
Q

State three consequences of untreated diabetes insipidus

A

Severe dehydration
Very high sodium levels (hypernatraemia)
Coma —> Death

158
Q

What is the usual treatment for diabetes insipidus?

A

Synthetic ADH

159
Q

What is pituitary apoplexy?

A

Sudden vascular event in a pituitary tumour - either a haemorrhage or infarction

160
Q

The ‘sudden vascular event’ seen in pituitary apoplexy is either…

A

Haemorrhage or infarction

161
Q

Describe the typical clinical presentation of pituitary apoplexy (5)

A
Sudden onset headache 
Double vision 
Visual field loss
Cranial nerve palsy 
Hypopituitarism
162
Q

What is the most dangerous consequence of hypopituitarism?

A

Cortisol deficiency