Endocrinde disease (Pituitary gland)

Question 1

1. What are 8 major glands of the endocrine system?

Answer 1

i. Pancreas
ii. Pituitary
iii. Thyroid
iv. Parathyroid
v. Adrenal
vi. Thymus
vii. Ovary
viii. Testes

Question 2

2. What are 3 things that can happen to the peripheral tissues with hyposecretion of hormones?

Answer 2

i. Agenesis
ii. Destruction
iii. Atrophy
* these all lead to hypofunction of tissues

Question 3

3. What are 2 things that can happen to the peripheral tissues with hypersecretion of hormones?

Answer 3

i. Tumor
ii. Hyperplasia
* these all lead to hyperfunction of tissues

Question 4

4. What is the “Master Gland?” Where is this located?

Answer 4

Pituitary Gland
* composed of anterior lobe and posterior lobe
* Posterior lobe is composed of modified glial cells and axonal processes
extending from hypothalamic neurons.

Located in Sella Turcica

Question 5

5. How is Pituitary Gland regulated?

Answer 5

It is connected to Hypothalamus via stalk, which releases factors controlling the release of trophic hormones by Pituitary Gland.

Question 6

6. What is the embryologic origin of anterior lobe? What about posterior lobe?

Answer 6

i. Anterior lobe : Rathke’s Pouch

ii. Posterior lobe : Neuroectoderm

Question 7

7. Of the different types of cells that are found in Pituitary gland, what is the most frequent or common cell type?

Answer 7

Somatotroph : (50%) : Growth Hormone

Others include:
Corticotroph		:	(15-20%)	:	Corticotropin (ACTH)
Lactotroph		:	(10-20%)	:	Prolactin (PRL)
Gonadotroph		:	(10%)		:	LH and FSH
Thyrotroph		:	(5%)		:	Thyrotropin (TSH)

Question 8

8. What kind of cells comprise of Posterior lobe of pituitary gland?

Answer 8

Modified glial cells and axonal processes extending from hypothalamic neurons.

Question 9

9. Oxytocin and ADH is produced by what structure in Posterior Pituitary Gland?

Answer 9

Hypothalamic neurons

Question 10

10. What is a condition is almost always associated with hyperfunction of Anterior Pituitary Gland (hyperpituitarism)?

Answer 10

Pituitary Adenoma

* May produce symptoms by hormone production or by local mass effect

Question 11

11. What are symptoms of hyperfunction of anterior pituitary gland?

Answer 11

i. Compression of optic nerve (leads to visual disturbances)

ii. Increased intracranial pressure (e.g., Headache, Nausea, Vomiting)

Question 12

12. What kind of physiologic features are associated with individual with Acromegaly?

Answer 12

i. Large fingers
ii. Prognathic mandible
iii. Spacing in dentition
iv. Hypertension
v. Congestive heart failure
* With growth hormone adenomas, when epiphyses close affect the physical characteristics associated with the cancer.

Question 13

13. What happens with decreased secretion of Oxytocin by Posterior lobe of pituitary gland?

Answer 13

No significant clinical abnormalities

Question 14

14. What are diseases or symptoms that are associated with the following hormones? ACTH, GH, Prolactin and GH, Prolactin, TSH, and FSH and LH.

Answer 14

i. ACTH and POMC derived : i. Cushing Syndrome
ii. Nelson Syndrome

ii. GH : i. Gigantism (Children)
ii. Acromegaly (Adults)

iii. Prolactin : i. Galactorrhea (spontaneous flow of milk)
ii. Amenorrhea (absence of menstruation)
iii. Sexual Dysfunction
iv. Infertility

iv. Prolactin and GH : i. Both Prolactin and GH symptoms
v. TSH : i. Hyperthyroidism

vi. FSH, LH : i. Hypogonadism
ii. Mass effects and hypopituitarism

Question 15

15. What are 2 clinical manifestations associated with decreased ADH secretion?

Answer 15

i. Functions in kidneys to promote resorption of free water

ii. Diabetes insipidus (have excessive thirst and excretion of very diluted urine)

Question 16

16. What is the treatment approach for hypersecretion of Growth Hormones?

Answer 16

Surgical removal of adenoma

Question 17

17. What are the clinical features of Gigantism? How would you treat it?

Answer 17

i. Generalized increase in body size
ii. Disproportionately long arm and legs
* Surgically remove the adenoma

Question 18

18. What are the clinical features or symptoms associated with Acromegaly?

Answer 18

i. Enlarged bones of the hands, feet and face
ii. Prognathism (includes diastema)
iii. Hypertension
iv. Congestive heart failure
* This is also due to adenoma
* These symptoms occur after the epiphyseal plates have closed or after bones
have matured.

Question 19

19. What is the prognosis for patients with Acromegaly?

Answer 19

Guarded
* because of clinical features or symptoms such as hypertension and congestive
heart failure

Question 20

20. What are two potential causes of Pituitary Dwarfism?

Answer 20

i. Failure of pituitary gland to produce Growth Hormone
ii. Lack of tissue response to Growth Hormone
* this results in small stature, small jaw and teeth. This is opposite of Acromegaly

Question 21

21. How would you treat Pituitary Dwarfism?

Answer 21

Hormone Replacement Therapy

* This has good prognosis assuming that hormone replacement therapy works

Question 22

22. What are 4 potential causes of hypopituitarism?

Answer 22

i. Ablation of pituitary by surgeon or radiation
ii. Ischemic necrosis, most commonly form Sheehan’s Syndrome (post-partum infarction)
iii. Destruction by adjacent tumor
iv. Non-functional pituitary adenoma
* A I D Non-functional pituitary adenoma

Question 23

23. What are 5 clinical manifestations associated with hypopituitarism?

Answer 23

i. Pituitary Dwarfism (Growth Hormone)
ii. Amenorrhea and Infertility in women (Gonadotropin)
iii. No post-partum lactation (Prolactin)
iv. Hypothyroidism (TSH)
v. Hypoadrenalism (ACTH)