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CEP > WEEK 5 > Flashcards

WEEK 5 Flashcards

1
Q

What hormones does the anterior lobe of the pituitary gland produce and secrete?

A 
Adrenocorticotropic Hormone (ACTH)
Thyroid Stimulating Hormone (TSH)
Growth Hormone (GH)
Follicle Stimulating/Luteinising (Gonadotropic) Hormones (FSH/LH)
Prolactin
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2
Q

What hormones are stored and secreted into the bloodstream from the posterior lobe of the pituitary gland?

A

ADH (anti-diuretic hormone)/Vasopressin

Oxytocin

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3
Q

Where are the hormones stored and secreted into the bloodstream via the posterior lobe of the pituitary gland produced?

A

Supraoptic and Paraventricular nuclei in the hypothalamus

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4
Q

How is hypothalamus activity regulated?

A

Hormone-mediated signals (negative feedback) and neural inputs

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5
Q

Other than endocrine function, what other functions of the hypothalamus are there?

A

Homeostatic processes such as maintenance of body temperature, thirst and food intake

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6
Q

What is the process of hormone secretion into the bloodstream via the anterior lobe of the pituitary gland?

A

Neurosecretory cells produce hypothalamic-releasing and hypothalamic-inhibiting hormones which are secreted into the hypophyseal portal vessels which travel through the tuberoinfundibular tract (to ant. lobe), causing stimulation or inhibition of hormone production and secretion from the anterior lobe into the bloodstream

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7
Q

What is the process of hormone secretion into the bloodstream via the posterior lobe of the pituitary gland?

A

Supraoptic and paraventricular nuclei in the hypothalamus produce ADH and oxytocin, these hormones move down axons to axon endings in the hypothalamo-hypophyseal tract and are stored in the posterior lobe until secretion from the axon endings into the bloodstream

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8
Q

What is the name of the stalk that connects the hypothalamus and pituitary gland?

A

Infundibulum

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9
Q

Which hormones regulate Growth Hormone production and secretion from the PG?

A

Growth Hormone Releasing Hormone (GHRH)

Somatostatin - INHIBITS

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10
Q

Which hormone regulates FSH/LH production and secretion from the PG?

A

Gonadotropin Releasing Hormone (GnRH)

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11
Q

Which hormone regulates ACTH production and secretion from the PG?

A

Corticotropin Releasing Hormone (CRH)

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12
Q

Which hormone regulates TSH production and secretion from the PG?

A

Thyrotropin Releasing Hormone (TRH)

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13
Q

Which hormone regulates Prolactin production and secretion from the PG?

A

Dopamine - INHIBITS

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14
Q

Describe Growth Hormone (GH)

A

Hormone released throughout life
Pulsatile (peaks and troughs)
Stimulated by hypoglycaemia, exercise and sleep, Suppressed by hyperglycaemia
Effects are mediated by IGF-1 (insulin-like growth factor)
Release stimulated by GHRH, inhibited by somatostatin

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15
Q

What are the effects of GH?

A 
Linear growth in children
Acquisition of bone mass
Stimulates: Protein synthesis, Lipolysis, Glucose metabolism
Regulates body composition
Physiological well-being
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16
Q

Describe Follicle Stimulating Hormone (FSH)/Luteinising Hormone (LH)

A

Release stimulated by GnRH which increases in production at around 8y/o
FSH and LH trigger testosterone production in testes and oestrogen production in ovaries

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17
Q

What are the effects of FSH/LH?

A 
Testosterone production:
Male secondary sex characteristics
Spermatogenesis
Oestrogen production:
Female secondary sex characteristics
Folliculogenesis
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18
Q

Describe Prolactin

A

Essential for lactation
Levels dramatically increase in pregnancy and breast-feeding
inhibits gonadal activity through central suppression of GnRH (decreasing FSH/LH)
Inhibited by dopamine

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19
Q

Describe the hypothalamic-pituitary-adrenal axis

A

CRH secreted from hypothalamus, ACTH secreted from anterior pituitary gland, cortisol secreted from adrenal glands

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20
Q

What are the effects of cortisol?

A

Regulates glucose levels
Increases body fat
Helps body defence against infection
Helps body respond to stress

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21
Q

What change to the adrenal glands is seen due to ACTH excess?

A

Hyperplasia

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22
Q

What change to the adrenal glands is seen due to ACTH deficiency?

A

Atrophy

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23
Q

What is the effect of TSH?

A

Secretion of T3 and T4 hormones from the thyroid gland

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24
Q

What negative feedback is received in the hypothalamic–pituitary–thyroid axis?

A

Secretion of TRH is inhibited by T3

Secretion of TSH is inhibited by T3 and T4

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25
Q

Describe ADH/Vasopressin

A

Polypeptide synthesised in supraoptic and paraventricular nuclei of the hypothalamus
Primary determinant of the rate of free water excretion

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26
Q

Describe the process of ADH/Vasopressin on the rate of free water excretion

A

Hormone augments water permeability of the luminal membranes of cortical and medullary collecting tubules via opening of aquaporins (H20 channels), resulting in reabsorption of water into the blood

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27
Q

What are the major stimuli for ADH secretion?

A

Hyperosmolarity and effective circulating volume depletion

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28
Q

Describe the negative feedback loop of osmoregulation in response to increased plasma osmolarity/decreased effective circulating volume

A

1) Increased thirst, increased water intake, increased water retention, decreased plasma osmolarity and increased effective circulating volume, decreased thirst
2) increased ADH secretion, decreased water excretion, increased water retention, decreased plasma osmolarity and increased effective circulating volume, decreased ADH secretion

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29
Q

What is Oxytocin and what are it’s effects

A

Hormone under positive feedback
Stimulates contraction of smooth muscle of the breast and uterus-has role in milk ejection reflex and parturition (birth)->synthetic oxytocin can be given to induce labour

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30
Q

What do the main manifestations of pituitary disease relate to?

A

Mass effects from (para)sellar lesions

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31
Q

What are the 3 types of mass effects that result from pituitary disease?

A

Neurological
Visual
Hypopituitarism

32
Q

What are the mass effects relating to neurological and visual changes?

A 
Headaches
Hypothalamic damage, brain damage
III, IV, V, VI nerve damage
Optic (II) nerve damage
CSF leak
33
Q

What are the main causes of hypopituitarism?

A

Pituitary/Parapituitary tumours
Radiotherapy
Pituitary infarction (apoplexy), Sheehan’s syndrome
Infiltration of the pituitary
Trauma
Isolated hypothalamic releasing hormone deficiency

34
Q

What is the main manifestation of GH deficiency in children?

A

Poor growth

35
Q

What are the manifestations of GH deficiency in adults?

A

increased abdominal fat, decreased lean body mass
impaired lipid profile
decreased muscle strength and exercise quality
impaired cardiac function
decreased bone mineral density
impaired psychological well-being

36
Q

How would you diagnose GH deficiency?

A

GH stimulation tests (Insulin tolerance test, Glucagon, GHRH + arginine)
IGF-1 test

37
Q

What is the treatment for GH deficiency?

A

Hormone replacement mimicking physiology-injections at night

38
Q

What is the main manifestation of FSH/LH deficiency in children?

A

Delayed puberty

39
Q

What are the manifestations of FSH/LH deficiency in men?

A

Decreased libido, impotence, infertility, decreased secondary sex features
Decreased muscle mass and strength, decreased mood and well-being, osteoporosis and anaemia

40
Q

What are the manifestations of FSH/LH deficiency in women?

A

Decreased libido, menstrual disorders, infertility, dyspareunia, osteoporosis, premature atherosclerosis

41
Q

How would you diagnose FSH/LH deficiency in men?

A

Measure FSH/LH levels and morning testosterone (increased levels in morning)

42
Q

How would you diagnose FSH/LH deficiency in women?

A

Measure FSH/LH levels and check oestradiol levels + menstrual history

43
Q

What is the treatment for FSH/LH deficiency?

A

Hormone replacement-testosterone/oestrogen

44
Q

What is the result of hypopituitarism?

A

Pituitary hormone deficiency

45
Q

What are the manifestations of ACTH deficiency?

A

Fatigue, weakness, nausea/vomiting, anorexia, weight loss, hypoglycaemia, hypotension, anaemia

46
Q

How would you diagnose ACTH deficiency?

A

9am serum cortisol and ACTH levels

47
Q

What are three dynamic tests for ACTH deficiency diagnosis?

A

Short synacthen test
Insulin tolerance test
Glucagon test

48
Q

What is the treatment for ACTH deficiency?

A

Hormone replacement (Corticosteroids)-approximate diurnal rhythm

49
Q

What are the manifestations of TSH deficiency?

A

(similar to hypothyroidism)

Fatigue, weakness, cold tolerance, bradycardia, inability to lose or gain weight, puffiness, pale/dry skin, constipation

50
Q

How would you diagnose TSH deficiency?

A

Measure TSH, fT3 and fT4 levels

51
Q

What is the treatment for TSH deficiency?

A

Hormone replacement (levothyroxine)

52
Q

What is the cause of Central Diabetes Insipidus?

A

Deficient ADH secretion

53
Q

What are the different causes of ADH secretion deficiency->Central Diabetes Insipidus?

A 
Idiopathic (autoimmune destruction of hormone secreting cells)
Familial
Tumours
Neurosurgery/Trauma
Infiltrative disorders
Infections
Hypoxic encephalopathy/severe ischaemia
54
Q

What are the manifestations of ADH deficiency?

A

Polyuria (excessive urination)
Polydipsia (excessive thirst)
Nocturia (waking up at night to urinate)

55
Q

What are the major causes of polyuria?

A

Diabetes Mellitus and renal failure (osmotic diuresis-urine not diluted clear due to presence of unwanted substances)
Primary polydipsia
Diabetes insipidus

56
Q

How would you diagnose ADH deficiency?

A

Measure urine output, osmolalities (plasma, urine), blood electrolytes/glucose/urea/creatinine
Water deprivation test

57
Q

What is the treatment for ADH deficiency?

A

ADH analogues

58
Q

What are Functioning Pituitary Adenomas?

A

Benign tumours which hypersecrete one or more hormones

59
Q

What is GH hypersecretion acromegaly?

A

Hypersecretion of GH by pituitary adenoma, GH constantly secreted (no troughs)

60
Q

What are some of the vast manifestations of acromegaly?

A

Large hands and feet
Prognathism (protruding jaw)
Weight gain
Goitre

61
Q

How would you diagnose GH hypersecretion acromegaly?

A

Oral glucose tolerance test
IGF-1 test
Pituitary imaging

62
Q

What is the treatment for GH hypersecretion acromegaly?

A

Pituitary surgery
Medical treatment (GH receptor antagonists, dopamine agonists, somatostatin analogues)
Radiotherapy

63
Q

What are the general types of many causes of high prolactin?

A

Physiological
Drugs
Pathological

64
Q

What is a Prolactinoma?

A

A benign tumour secreting large amounts of prolactin

65
Q

What are the manifestations of a prolactinoma?

A

Hypogonadism
Galactorrhoea (milky nipple discharge)
Mass effects

66
Q

How would you diagnose a prolactinoma?

A

Exclude other causes of high prolactin

Pituitary imaging

67
Q

What is the treatment for a prolactinoma?

A

Medical treatment (dopamine agonists)
Surgery-transsphenoidal
Radiotherapy

68
Q

What is a TSHoma (thyrotropinoma)?

A

A pituitary tumour causing hypersecretion of TSH

69
Q

What are the manifestations of a TSHoma?

A 
Thyrotoxicosis
Mass effects (tachycardia, arrhythmia, increased body temp.)
70
Q

What is the treatment for a TSHoma?

A

Surgery
Medications
Radiotherapy

71
Q

What is an FSHoma?

A

A pituitary tumour causing hypersecretion of FSH

72
Q

What are the manifestations of an FSHoma in men?

A

Testicular enlargement
Infertility
Mass effects

73
Q

What are the manifestations of an FSHoma in women?

A

Menstrual irregularities
Ovarian hyperstimulation
Mass effects

74
Q

How would you diagnose a TSH/FSHoma?

A

Hormonal tests

Pituitary imaging

75
Q

What is the treatment for an FSHoma?

A

Surgery

Radiotherapy

CEP (9 decks)

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