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GINME > Week 8: Pituitary > Flashcards

Week 8: Pituitary Flashcards

1
Q

Identify the anatomy of pituitary

A

hangs down via pituitary stalk from hypothalamus

anterior portion resembles acinar endocrine tissue like the pancreas

posterior pituitary has neurons like the brain

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2
Q

Identify blood supply of the pituitary

A
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3
Q

The most vascular gland in the body g for g

A

Pituitary gland

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4
Q

Describe the feedback regulation of the anterior pituitary

A
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5
Q

Question

A

Pituitary gland

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6
Q

Endocrine rhythms

A
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7
Q

List of anterior pituitary hormones

6 listed

A
  • ACTH
  • Growth Hormone
  • TSH
  • LH
  • FSH
  • Prolactin
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8
Q

List of posterior pituitary hormones

2 listed

A
  • Anti-diuretic hormone (Vasopressin)
  • Oxytocin
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9
Q

Antidiuretic hormone structure and location

A

12 AA peptide released from neurosecretory elements in the posterior pituitary

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10
Q

Antidiuretic hormone AKA

A

ADH

or

vasopressin

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11
Q

ADH AKA

A

Antidiuretic hormone

or

Vasopressin

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12
Q

Stimulation of pituitary secretion of ADH

8 listed

A
  • Plasma osmolality (hypothalamic osmo-receptors)
  • Blood volume (Atrial & large vessel baroreceptors)
  • Nausea
  • Nicotine
  • Morphine
  • Angiotensin
  • Hypoxia
  • Hypercapnia
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13
Q

ADH MOA

A

Acts to stimulate free-water reabsorption in the distal renal tubules and collecting ducts through a cAMP-mediated mechanism thus inhibiting water diuresis

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14
Q

Vasopressin AKA

A

ADH

or

Anti-diuretic hormone

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15
Q

Source of ADH

A

produced by the Supra-optic nuclei of the hypothalamus

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16
Q

ADH functions

A

In the kidney

  • decreases medullary flow
  • increases water permeability in the distal tubules and collecting ducts (V2 receptors)
  • Increases Na+, Cl-, K+ reabsorption
  • Suppresses Renin secretion

In the Vasculature

  • stimulates constriction of vascular smooth muscle (V1 receptors)
  • increased blood pressure
  • Increased SVR

Other actions

  • Decreased hepatic gluconeogenesis
  • Increased ACTH release (V3 receptors)
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17
Q

Describe the physiology of ADH secretion

A
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18
Q

What is polyuria?

A

Urine output > 3L/day in adults

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19
Q

What causes polyuria?

A

Not counting glucose-induced osmotic diuresis in uncontrolled DM there are 3 main causes

  • Primary polydipsia
  • Central Diabetes Insipidus
  • Nephrogenic Diabetes Insipidus
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20
Q

What is Primary polydipsia?

A
  • It is characterized by an increase in oral water intake
  • This disorder is most often seen in middle-aged women and in patients with psychiatric illnesses including those taking a phenothiazine, which can lead to the sensation of a dry mouth
  • Primary polydipsia can also be induced by hypothalamic lesions that directly affect the thirst center
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21
Q

Common drug that can cause Primary Polydipsia?

A

phenothiazine

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22
Q

What is Central DI?

A
  • Associated with the deficient secretion of antidiuretic hormone (ADH)
  • This condition is most often idiopathic or can be induced by trauma, pituitary surgery or hypoxic or ischemic encephalopathy
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23
Q

What is nephrogenic DI?

A

Characterized by normal ADH secretion but varying degrees of renal resistance to its water-retaining effect

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24
Q

Describe an approach to DI

A
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25
Q

First Aid approach to SIADH

A
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26
Q

Describe the relationship of plasma osmolality to ADH

A
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27
Q

Describe the relationship of urine osmolality to ADH levels

A
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28
Q

Describe hydration status and Plasma ADH and plasma osmolality

A
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29
Q

what is the most common type of polyuria?

A

DM

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30
Q

Lab findings on presentation of primary polydipsia

A
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31
Q

Water deprivation test results primary polydipsia

A
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32
Q

Desmospressin administration results in primary polydipsia

A
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33
Q

CDI AKA

A

Central diabetes insipidus

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34
Q

CDI Lab findings on presentation

A
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35
Q

Water deprivation tests in CDI

A
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36
Q

Desmopressin administration results in CDI

A
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37
Q

NDI AKA

A

Nephrogenic Diabetes Insipidus

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38
Q

Lab findings on presentation of NDI

A
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39
Q

Water deprivation test results of NDI

A
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40
Q

Desmopressin administration results of NDI

A
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41
Q

Clinical features of SIADH

A
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42
Q

Diagnostics of SIADH

A
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43
Q

SIADH AKA

A

Syndrome of inappropriate ADH Secretion

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44
Q

SIADH Characterized by

A
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45
Q

SIADH Etiologies

A
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46
Q

Treatment of SIADH

A
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47
Q

Oxytocin actions

A
  • uterine contraction
  • mammry gland enhancing milk ejection
  • Men enhanced ejaculation
  • Men and women enhanced orgasm
  • inflammation
  • enhanced wound healing
  • feelings of generosity
  • trust
  • mothering instincts
  • sexual arousal
  • romantic attachment
  • pair bonding
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48
Q

Oxytocin deficiencies

A
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49
Q

The anterior pituitary hormones and their stimuli

A
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50
Q

TSH stimulus

A

TRH from hypothalmus

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51
Q

TSH inhibition from the hypothalamus

A

Somatostatin

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52
Q

Prolactin inhibition from the hypothalamus

A

Dopamine

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53
Q

GH Stimulus from the hypothalamus

A

GNRH

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54
Q

TRH stimulates what in the posterior pituitary?

A

TSH secretion

&

Prolactin secretion

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55
Q

Prolactin Stimuli from the hypothalamus

A

TRH

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56
Q

LH Stimuli from the hypothalamus

A

GnRH

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57
Q

FSH Stimuli from the hypothalamus

A

GnRH

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58
Q

ACTH Stimuli from the hypothalamus

A

CRH

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59
Q

GnRH action on posterior pituitary

A

stimulates

LH

&

FSH

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60
Q

CRH action on posterior pituitary

A

Stimulates

ACTH

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61
Q

Dopamine actions on posterior pituitary

A

Inhibits

  • Prolactin
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62
Q

GHRH actions on posterior pituitary

A

Stimulates

  • GH
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63
Q

Somatostatin actions on posterior pituitary

A

Inhibits

  • TSH
  • GH
64
Q

TRH actions on posterior pituitary

A

Stimulates

  • TSH
65
Q

Cell types that produce GH

A

Somatotrophs

66
Q

Cell types that produce prolactin

A

Lactotrophs

67
Q

Cell types that produce GH & Prolactin

A

Somatomammotrophs

69
Q

Cell types that produce ACTH

A

Corticotrophs

70
Q

Cell types that produce LH & FSH

A

Gonadotrophs

71
Q

Cell types that produce TSH

A

Thyrotrophs

72
Q

Somatorophs secrete

73
Q

Lactotrophs secrete

74
Q

Samatomammotrophs secrete

A

GH

Prolactin

75
Q

Corticotrophs secrete

76
Q

Gonadotrophs secrete

77
Q

Thyrotrophs secrete

78
Q

Somatotrophs under H&E

A

Acidophilic (pink)

79
Q

Lactotrophs under H&E

A

Acidophilic (pink)

80
Q

Somatomammotroph under H&E

A

Acidophilic (pink)

81
Q

Corticotrophs under H&E

A

Basophilic (blue)

82
Q

Gonadotrophs under H&E

A

Basophilic (Blue)

83
Q

Thyrotrophs under H&E

A

Basophilic (blue)

84
Q

Anterior pituitary cell types & their products & appearance under H&E

85
Q

Peptide hormone families

A
  • Somatomamotropins
  • Corticotropins
  • Glycoprotein hormones
86
Q

List of Somatotropins

3 listed

A

GH

Prolactin

Placental Lactogen (non-pituitary)

87
Q

List of Corticotropins

4 listed

A
  • ACTH (and all cleavage products)
  • MSH
  • Lipotropin (LPH)
  • β-Endorphin
88
Q

List of glycoprotein hormones

4 listed

A
  • LH
  • FSH
  • TSH
  • β-hCG (nonpituitary)
89
Q

ACTH AKA

A

Adrenocorticotropin

90
Q

Adrenocorticotropin AKA

91
Q

ACTH structure

A

39 AA peptide

92
Q

ACTH MOA

93
Q

Describe the synthesis of ACTH

94
Q

ACTH synthesis and other hormones

95
Q

Characteristics of Adrenal insufficiency

9 listed

96
Q

How to Dx ACTH deficiency

97
Q

Gold-standard test to diagnose ACTH Deficiency

A

Insulin hypoglycemia

*This test can be dangerous in the elderly or those with myocardial ischemia*

98
Q

2 Questions

99
Q

2 Questions

100
Q

GH AKA

A

Growth Hormone

101
Q

What is GH?

A

An anabolic hormone with multiple tissue effects

102
Q

GH MOA

A

Many of the actions of GH are mediated through IGF-1

103
Q

GH deficiency

A

causes dwarfism in children and mild muscle wasting syndrome in adults

104
Q

GH excess

A

Causes gigantism in children and acromegaly in adults

105
Q

Describe the regulation of GH

A

Regulation occurs through feedback inhibition of GH by IGF-1 and feedback stimulation of somatostatin by IGF-1

106
Q

Growth Hormone actions

A

Liver

  • (IGF-1)
  • Somatostatin

(Results in increased glucose production)

Bone

  • Linear growth

Adipose tissue

  • Lipolysis

Muscle

  • Insulin antagonism
107
Q

GH targets and effects in the Liver

A

IGF-1 & Somatostatin

Results in increased glucose production

108
Q

GH targets and effects in bone

A

Results in linear growth

109
Q

GH targets and effects in adipose tissue

110
Q

GH targets and effects in muscle

A

Insulin antagonism

111
Q

What increases GH Secretion

7 listed

A
  • GHRH
  • Sleep
  • Exercise
  • Stress
  • Hypoglycemia
  • Estrogen
  • Starvation/Anorexia
112
Q

What decreases GH Secretion

A
  • Somatostatin
  • GH
  • Hyperglycemia
  • Fatty Acidemia
  • Obesity
  • Thyroid dysfunction
113
Q

Prolactin functions

A

Acts on breast tissue to stimulate milk production after parturition

114
Q

Prolactin regulation

A

Is under tonic inhibitory control by

  • hypothalamic dopamine

Prolactin secretion is stimulated by

  • nipple stimulation
  • Suckling
  • Exercise
  • dopamine antagonist drugs
115
Q

Prolactin excess

A

can cause hypogonadotropic (pituitary) hypogonadism resulting in amenorrhea in women and sexual dysfunction in men

116
Q

Describe regulation of prolactin

117
Q

Question

118
Q

What are the glycoprotein hormones and how are they specified?

A

LH

FSH

TSH

hCG

The β-subunits confer specificity

119
Q

Thyrotropin MOA

A

Stimulates production of thyroid hormone in the thyroid gland through cAMP generation

TSH binding stimulates iodine transport and protein synthesis in the cell as well as cell proliferation

121
Q

TSH AKA

A

Thyrotropin of thyroid-stimulating hormone

122
Q

TSH regulation

A

TSH secretion is stimulated by TRH

Negative feedback regulation occurs mainly through T3 which is the active form of thyroid hormone

123
Q

What are the Gonadotropins?

124
Q

LH Functions

A
  • LH stimulates the production of testosterone by testicular Leydig cells in the male
  • Promotes ovulation and supports the corpus luteum function in the ovary
125
Q

FSH functions

A
  • stimulates spermatogenesis in the testicle
  • promotes follicular development in the ovary
127
Q

LH regulation

A

LH secretion is inhibited by

  • Testosterone and estrogen in males
  • inhibited and stimulated by estrogen in females
128
Q

FSH regulation

A

FSH is inhibited by the gonadal hormone Inhibin

129
Q

Gross causes of hypopituitarism

A
  • Tumors
  • Sheehan’s Syndrome
  • Vascular
  • Infection
  • Infiltrative
  • Trauma
  • Post-hypophysectomy
  • Pituitary irradiation
  • Idiopathic
130
Q

Tumors that can cause hypopituitarism

3 listed

A
  • Pituitary adenomas
  • Suprasellar (craniopharyngioma)
  • Metastatic
131
Q

Vascular causes of hypopituitarism

A
  • Cerebral aneurysms
  • Cavernous sinus thrombosis
132
Q

Infectious causes of hypopituitarism

4 listed

A
  • TB
  • Fungal
  • Syphilis
  • Meningitis
133
Q

Infiltrative causes of hypopituitarism

A
  • Amyloidosis
  • Hemochromatosis
  • Granulomatous disease
134
Q

Symptoms of hypopituitarism

6 main groups

A

Symptoms from

  • ADH
  • ACTH
  • TSH
  • LH/FSH
  • Prolactin
  • GH
135
Q

ADH Symptoms of hypopituitarism

A
  • Polyuria
  • Polydipsia
136
Q

ACTH Symptoms of hypopituitarism

A
  • Hypotension
  • hypoglycemia
  • weakness
  • dehydration
  • nausea
  • weight loss
137
Q

TSH Symptoms of hypopituitarism

7 listed

A
  • Hypothermia
  • Fatigue
  • Weight gain
  • Cold-intolerance
  • Dry-skin
  • Constipation
  • Hypercholesterolemia
138
Q

LH/FSH Symptoms of hypopituitarism

4 listed

A
  • Impotence
  • amenorrhea
  • infertility
  • osteoporosis
139
Q

Prolactin Symptoms of hypopituitarism

A

inability to lactate

140
Q

GH Symptoms of hypopituitarism

A
  • subtle malaise
  • weakness in adults
141
Q

Tx of panhypopituitarism

142
Q

Pituitary hormones essential for life

A
  • Thyroid hormone through (TSH)
  • Cortisol through (ACTH)
  • ADH
143
Q

Pituitary hormones that increase the quality of life

A
  • Testosterone through LH and FSH
  • Estrogen Through LH and FSH
  • GH
144
Q

Describe pituitary adenomas

A

Solitary hormone-producing tumors (adenomas) cause disease by producing a state of hormone excess and patients present with symptoms referable to hormone excess

Non-hormone producing tumors cause disease by compressing vital structures (the optic chiasm, carotid arteries) and patients present with symptoms referable to mass effect (headache), vision loss, and/or pituitary insufficiency

145
Q

Pituitary adenomas classifications

A

Classified according to size

Microadenomas < 1 cm

Macroadenomas > 1 cm

146
Q

Pituitary adenomas in order of frequency

A
  1. Prolactin
  2. Non-secretory
  3. GH
  4. ACTH
  5. TSH
  6. LH/FSH
  7. Unknown
147
Q

Cushing’s Disease

148
Q

Glucocorticoid Excess

A

Cushing’s Disease

149
Q

Acromegaly

150
Q

Gigantism

151
Q

Acromegaly

152
Q

Tx of pituitary adenomas

153
Q

Pituitary pharmacology

154
Q

Question

155
Q

50% of GH-secreting pituitary adenomas co-secrete?

GINME (63 decks)

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