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Endocrinology Y2 > Hyposecretion of Anterior Pituitary Hormones > Flashcards

Hyposecretion of Anterior Pituitary Hormones Flashcards

(73 cards)

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1
Q

Name the 5 hormones secreted by the adenohypophysis

A

Gonadotrophin (LH and FSH), somatrophin (GH), prolactin, thyrothrophin (TSH) and corticotrophins (ACTH)

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2
Q

Where is a primary endocrine disease situated, give an example of a site

A

In the endocrine gland (e.g. thyroid gland)

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3
Q

Where is a secondary endocrine disease situated

A

In the pituitary

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4
Q

Where is a tertiary endocrine disease site

A

Hypothalamus

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5
Q

What is panhypopituitarism?

A

Insufficient excretion of all adenohypophysial hormones

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6
Q

Which level of hypopituitarism is most common and least (primary/secondary/tertiary)

A

Primary is most, tertiary is least

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7
Q

How common is congenital panhypopituitarism

A

Rare

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8
Q

What mutation causes congenital panhypopituitarism

A

PROP1

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9
Q

What is PROP1

A

Transcription factor that allows the development of the pituitary gland to take place

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10
Q

Which hormone does a congenital PROP1 mutation always affect?

A

Growth hormone

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11
Q

What is he presentation of congenital hypopituitarism (2)

A

Short stature and a hypoplastic pituitary on an MRI

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12
Q

What things cause hypopituitarism (9)

A 
Congenital
Tumours
chemotherapy radiation
infection
traumatic brain injury
Infiltrative disease
Inflammation
Pituitary apoplexy
Peri-partum infarction
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13
Q

What are hypothalamic tumours known as

A

Craniopharyngiomas

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14
Q

What are pituitary tumours known as

A

Adenomas

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15
Q

What type of cancer tends to metastasise to the pituitary

A

Breast

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16
Q

What else is similar to a tumour that can compress the pituitary

A

Cysts

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17
Q

Which secretion/hormone is most and least resistant to damage via radiotherapy

A

Most is GH least is TSH

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18
Q

Which microorganism can infect and cause pituitary pathology

A

Meningitis

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19
Q

What is an example of an infiltrative disease? Which part of the physiology of the pituitary is used

A

Sarcoidosis, pituitary stalk

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20
Q

What is a pituitary apoplexy

A

Damage from bleeding

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21
Q

What is peri-partum infarction known as

A

Sheehans syndrome

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22
Q

What are the three types of hypopituitarism

A

Simmonds disease (normal hypopituitarism)
Sheehans syndrome
Pituitary apoplexy

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23
Q

What is an FSH/LH deficiency known as

A

Secondary hypogonadism

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24
Q

What is an ACTH deficiency known as

A

Secondary hypoadrenalism

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25
What is a TSH deficiency known as
Secondary hypothyroidism
26
What symptoms are associated with secondary hypogonadism
Reduced libido, secondary amenorrhoea, erectile dysfunction
27
What symptoms are associated secondary hypoadrenalism
Fatigue
28
What symptoms are associated with secondary hypothyroidism
Fatigue (everything slows down)
29
What is panhypopituitarism also known as
Simmonds disease
30
What is simmonds disease more commonly known as
panhypopituitarism
31
Who can be affected by sheehans syndrome
Only women
32
Explain sheehans syndrome. Give cause + effect for three sciencey words at end
Lactotroph hyperplasia occurs during pregnancy making the pituitary bigger. Post-partum hypotension (e.g. due to post-partum haemorrhage) means the pituitary is severely deoxygenated due restricted blood flow bc the increased size is compressing the stalk. Pituitary infarction -> ischaemia -> necrosis
33
Where are all the blood vessels that oxygenate the pituitary found
Travelling down the stalk
34
Where is sheehans syndrome less common
In developed countries due to improves obstetrics
35
What are the symptoms of sheehans syndrome, and explain the symptoms regarding weight
Tiredness, anorexia, weight loss(lack ACTH outweighs the hypothyroidism), failure of lactation, failure of menses resuming
36
Which parts of the pituitary are affected by sheehans syndrome
Only the adenohypophysis, neurohypophysis is usually completely unaffected
37
What are the differences netween sheehans syndrome and a pituitary apoplexy
Pituitary apoplexy is not specific to women and presentation is rapid
38
What can cause pituitary apoplexy
Pituitary adenomas infarcting or intra-pituitary haemorrhage
39
What can precipitate a pituitary apoplexy
Anti-coagulants
40
What is the first rapid presentation of a pituitary apoplexy
Headache
41
Explain how a pituitary apoplexy can cause bitemporal hemianopia
Pituitary sits just below the optic chiasm, expansion can compress the optic chiasm causing bitemporal hemianopia
42
Explain how a pituitary apoplexy can cause ptosis, mention nerve and area
Expansion of the pituitary can cause compression of CNIII
43
What is ptosis
Droopy eyelid
44
Explain how a pituitary apoplexy can cause diplopia, mention the area and the nerves compressed
pituitary apoplexy can cause the pituitary to interfere with structures in the cavernous sinus such as CNIV and CNV
45
Are basal plasma levels of adenohypophysial hormones a useful indicator of hypopituitarism and why
No because the hormones released are pulsatile (LH, FSH, GH ACTH) and T4 has a half life of 6 days
46
What are stimulated dynamic pituitary function tests and what do you administer for each hormone
Administering a releasing hormone to stimulate release and then measuring levels Insulin stimulates GH and ACTH release via lowering blood glucose TRH stimulates TSH GnRH stimulates LH and FSH
47
What radiological method would you use to diagnose panhypopituitarism
MRI
48
What technique is used to treat hypopituitarism
Hormone replacement therapy
49
When testing for suspected ACTH deficiency, which hormone do you test for and why
Cortisol because ACTH has a low plasma half-life
50
Replacement and check for deficienct ACTH
Hydrocortisone and check for serum cortisol
51
Replacement and check for deficient TSH
Thyroxine and check for serum T4
52
Replacement and check for deficient LH/FSH In women
Eostrogen plus progestogen, check for symptoms improvement and withdrawal bleeds
53
Replacement and check for deficient LH/FSH in men
Testosterone and check for symptom improvement and serum testosterone
54
Replacement and check for deficient GH
GH and check IGF1/use a growth chart in children
55
What are the consequences of prolactin deficiency in each gender
Men not that deep, women will be unable to breastfeed due to prolactin being critical for milk ejection
56
What has to be administered with oestrogen to women for secondary hypogonadism
Progestogen
57
What can happen to the female uterus if progestogen is not administered with oestrogen
Endometrial hyperplasia
58
What is given for men who have secondary hypogonadism, route of administration and how often
Testosterone injection every three months
59
What are 7 causes of short stature
Endocrine disorders, genetic causes, emotional deprivation, systemic disease, malnutrition, malabsorption, skeletal dysplasia
60
Where is the problem with Prader-Willi syndrome? What is affected? What’s it associated with? How to treat?
Hypothalamus, lack of GHRH, associated with obesity and learning difficulties, treatment with GH
61
Lack of which hormone causes pituitary dwarfism? When and how does this present? What are the causes?
GH, from childhood, pituitary won’t develop fully due to damage/genetic mutations
62
Achondroplasia is caused by a mutation in which protein?
Fibroblast growth factor 3 receptor (FGF3)
63
What is achondroplasia? How does it present?
Abnormality in growth plate chondrocytes, presents as short arms and legs but normal trunk
64
What is a chondrocyte
Cartilage cells
65
What is Laron dwarfism? How can it be treated?
Problems with the GH receptors on the liver, treated with IGF1
66
Why are random GH tests shit
Because GH release is pulsatile
67
Name the GH provocation tests (4)
Insulin, GHRH, glucagon and exercise
68
How does the insulin GH provocation test work
Insulin induces hypoglycaemia which stimulates the release of GH
69
What do you administer with the GHRH in the provocation test
Arginine
70
How does the glucagon provocation test work
Glucagon makes you feel ill, the stress of vomiting then induces glucagon release
71
In what population is the exercise provocation test useful for
Small children
72
What are the consequences of GH deficiency in adults
``` Reduces lean mass Increased adiposity Reduced muscle strength&bulk Decreased HDL and increased LDL Impaired psychological well-being ```
73
What are the risks of GH therapy (2)
Increased risk of cancer (but no evidence for this), and treatment costs £42k for an adult for all their life

Endocrinology Y2 (18 decks)

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