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Endocrine- Clin Med > Hypothalamic and Pituitary Gland Disease > Flashcards

Hypothalamic and Pituitary Gland Disease Flashcards

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1
Q

Hypophysis aka

A

pituitary gland

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2
Q

pituitary gland visualized by

A

MRI scanning

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3
Q

located ABOVE optic chiasm and pituitary gland

A

hypothalamus

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4
Q

located BELOW optic chiasm in sella turcica

A

pituitary gland

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5
Q

pituitary stalk

A

connects pituitary gland to hypothalamus

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6
Q

anterior pituitary lobe aka

A

adenohypophysis

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7
Q

posterior pituitary lobe aka

A

neurohypophysis

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8
Q

why does pituitary adenoma cause visual disturbances

A

lies right below optic chiasm

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9
Q

6 major hormones produces and released from anterior pituitary gland

A

PRL, GH, TSH, FSH, LH, and adrenocorticotropin hormone

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10
Q

innervation of posterior pituitary lobe

A

hypothalamic neurons that run though pituitary stalk innervate the posterior pituitary lobe

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11
Q

ADH and oxytocin produced and released from

A

produced in hypothalamus, transported to posterior pituitary where they are stored and released as needed

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12
Q

Impaired production of ALL OF the pituitary hormones

A

panhypopituitarism

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13
Q

Impaired production of 1 or more of the pituitary hormones

A

hypopituitarism

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14
Q

hypopituitarism acquired of inherited?

A

both

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15
Q

hypopituitarism dx

A

measure hormone levels you are suspicious of that have impaired production. Neuroimaging if appropriate (MRI)

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16
Q

Tx of hypopituitarism

A

hormone replacement therapy

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17
Q

most common type of pituitary adenoma

A

prolactinoma

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18
Q

most common cause of pituitary hormone hypersecretion and hyposecretion syndromes

A

pituitary adenoma

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19
Q

pituitary adenomas classified according to

A

size, function, and cell of origin

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20
Q

types of pituitary adenomas

A

gonadotrophs, throtrophs, corticotroph, lactotroph, somatotroph

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21
Q

if find pituitary micro-incidentaloma

A

Measure PRL if clinical suspicious of hyormonal hypersecretion.

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22
Q

If find pituitary incidentaloma larger than 5-9 mm

A

monitor with MRI

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23
Q

If pituitary macro- incidentaloma

A

RESECT if compressive sx present. Measure hormone levels. If abnormal- tx individual adenoma. If no compressive sx or hornomal alternations- monitor patient closely

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24
Q

PRL secreting adenoma

A

lactotroph adenoma

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25
GH secreting adenoma
Somatotroph adenoma
26
normal PRL levels in men and women
10-25 micrograms/L in women, 10-20 in men
27
PRL synthesis
by lactotropes and mammosomatotropes in adenohypophysis
28
When is PRL secretion highest?
During REM sleep. also high after exercise, sexual intercourse, meals, and at times of acute stress
29
control of PRL is primarily inhibited with
dopamine
30
30 year old female has history of infertility, oligomenorrhea, galactorrhea. You are suspicious of increased production of what endocrine hormone?
PROLACTIN
31
Action of PRL
Females-induces and maintains lactation, decreases reproductive function, and suppresses sexual drive Males- lowers Testosterone levels, decreases spermatogenesis, decreases libido, and causes reduced fertility
32
physiologic or normal causes of hyperprolactinemia
pregnancy, nipple stimulation, stress
33
pathologic causes of hyperprolactinemia
prolactinomas, decreased dopamine inhibition, hypothyroidism, macroprolactinemia
34
clinical presentation of hyperprolactinemia in postmenopausal women
usually asymptomatic
35
clinical presentation of hyperprolactinemia in males
decreased libido, impotence, infertility, gynecomastia, galactorrhea
36
tx of prolactinomas
dopamine agonists- inhibits PRL secretion and dec size of adenoma
37
what cells secrete GH
somatotroph and mammosomatotroph cells in anterior pituitary lobe
38
most abundant anterior pituitary hormone
Gh
39
highest levels of GH occur
at night (imp to sleep at night so kids can grow!). also during exercise, physical stress, trauma, sepsis
40
effects of GH
stimulates cartilage growth and linear bone growth, increases body mass, impairs glucose tolerance, induces release of IGF
41
Somastostain
growth hormone inhibiting hormone
42
acromegaly
excessive secretion of GH and subsequent release of insulin like growth factor (IGF-1)
43
mean age of acromegaly dx
40-45
44
causes of acromegaly
most common cause - somatotroph. other causes- too much GHRH secretion by hypothalmic tumor, ectopic GHRH secretion by neuroendocrine tumors
45
hyperphosphatemia common in what endocrine disorder
acromegaly
46
Coarse hand and facial featrures, macroglossia. Patient with soft tissue and skin changes, bone and joint changes, colonic neoplasm, diverticula, hyperphosphatemia, hyperinsulinism, hypertriglyceridemia, hypercalciuria. Suspect
acromegaly
47
when the anterior pituitary gland produces excess growth hormone (GH) after epiphyseal plate closure at puberty
acromegaly
48
when the anterior pituitary produces excess GH BEFORE epiphyseal plate closure at puberty
gigantism
49
Dx of acromegaly
GH levels, serum IGF-1
50
tx for acromegaly
somatostain analogs, main goal is to reduce IGF-1 and GH levels. Resect somatotroph if possible. If medical and surgical therapy ineffective, radiation but takes 5-10 years to be effective
51
long term management in acromegaly patient
measure IGF-1 levels every 3-4 months till stable, then every 6 months. other pituitary hormones yearly, MRI yearly. Colonoscopy at baseline, then every 3-4 years after if over 50 bc of risk of colonic neoplasm and diverticula
52
cause of gigantism
d/t hypothalamic GHRH excess in children
53
6 yo child presents with large hands and feet, coarse facial features, excessive sweating. Macrocephaly, moderate obesity, and very tall for age. Suspect
gigantism
54
dx of gigantism
GH suppression test (If GH levels high after OGTT), PRL levels, Thyroid function tests
55
tx of gigantism
surgery, somatostain analog
56
dx of growth hormone deficiency
GH stimulation test, measurement of IGF-1 and IGFBP-3 (only in children), r/o diseases that can cause growth failure
57
How might infants be affected from GH deficiency
prone to hypoglycemia, prolonged jaundice, microphallus, giant cell hepatitis
58
tx of GH deficiency in kids
daily therapy GH via subq injection
59
secretion of ADH/vasopression regulated by
osmoreceptors in hypothalamus
60
central DI
caused by deficient secretion of ADH
61
nephrogenic DI
normal ADH secretion from hypolthalmus, but impaired response- renal resistance
62
sx in DI
polyuria, nocturia, polydipsia, neurologic sx as well
63
tx in DI
desmopressin- decreases urine output (polyuria), nocturia. also low solute diet
64
dx of DI
electrolyte abnormalities, urine osmolality decreased, water restriction test- decreased ADH release and minimal inc in urine osmolality. if desmopressin administered- urine osmolalility will normalize and be increased (after water restriction test)
65
etiology of nephorogenic diabetes insipidus
renal resistance to ADH secretion. possible caused from lithium toxicity, hypercalcemia, hypokalemia, renal disease
66
water restriction test in nephrogenic DI
normal levels of ADH secreted, but minimal or no increase in urine osmolality. Very dilute urine. Give desmopressin- still does not seem to help.
67
tx of nephrogenic DI
correct underlying disorder, decreased dietary solute, diuretics, NSAIDS, desmopressin
68
tx in gestational DI
desmopressin. fluid restriction to less than 1 L/day
69
syndrome characterized by water retention and hyponatremia
SIADH
70
dx of SIADH labs
hyponatremia, urine sodium conce over 40 meq/L, low serum osmolality, elevated urine osmolality
71
max rate of correction in chronic hyponatremia
less than 9 meq/L in 24 hours. if severe, 4-6 meq/L
72
tx of SIADH
fluid restriction, IV saline, sodium, loop diuretics, vasopressin receptor antagonists

Endocrine- Clin Med (10 decks)

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