Hypothalamus/Pit CIS

Question 1

Posterior Pituitary Hormones (2)

Answer 1

1. Oxycontin

2. ADH

Question 2

Anterior Pituitary Hormones (5)

Answer 2

1. GH
2. Prolactin
3. LH/FHS
4. TSH
5. ACTH

Question 3

Common Cause of Sheehan Syndrome

Answer 3

Postpartum Hemorrhage that required a blood transfusion

Question 4

Hemorrhage in Sheehan Syndrome causes ______

Answer 4

Damage to the Anterior Pituitary

Question 5

Increased levels of prolactin during lactation suppress ____

Answer 5

GnRH

Question 6

Prolactin is inhibited by ___

Answer 6

Dopamine

Question 7

Lab Values in Sheehan Syndrome

Answer 7

Overall decrease in anterior pituitary hormones

Question 8

Symptoms in Sheehans (5)

Answer 8

• inability to lactate
• fatigue
• amenorrhea
• weight retention
• Skin and voice changes

Question 9

Blood Supply for the anterior pituitary

Answer 9

Superior Hypophyseal Artery

Question 10

Blood Supply for the Posterior Pituitary

Answer 10

Inferior Hypophseal Artery

Question 11

Pituitary Hormones can result in _____ problems

Answer 11

Vision

Question 12

Why are pregnant women susceptible to Pituitary Infarction?

Answer 12

• they produce increased amounts of estrogen, progesterone and prolactin

Question 13

How does increased prolactin production put pregnant women at risk of developing Sheehan Sydrome?

Answer 13

Hyperplasia of lactotropes –> hyperplasia of pituitary –> increased blood demand/supply –> a hemorrhage during pregnancy can cause ischemic necrosis of the gland

Question 14

Why can the posterior pituitary be spared in Sheehan’s?

Answer 14

Different blood supply from the anterior pituitary

Question 15

Causes of Hyperprolactinemia (2)

Answer 15

• loss of dopamine inhibition

- Hypothyroidism

Question 16

How does hypothyroidism result in hyperprolactinemia?

Answer 16

TRH is a stimulus for prolactin release

Question 17

Case:

• Brain injury
• low levels of LH, FSH, T4, T3, TSH, and Cortisol
• high levels of prolactin

Answer 17

Hypothyroidism dt damage to the pituitary stalk (no Dopamine inhibition on prolactin)

Question 18

In a Prolactinomaof the lactrotropes, _____ hormone levels should be normal while ___ and ___ levels should be low.

Answer 18

• Thyroid hormone

- LH and FSH

Question 19

In hypothyroidism you see very high levels of ____ and ____.

Answer 19

Prolactin and TSH

Question 20

Treatment of a Prolactinoma?

Answer 20

Dopamine agonist

Question 21

Prolactin Inhibits: (4)

Answer 21

-LH, FSH, GnRH, Testosterone

Question 22

Most common Cause of Acromegaly

Answer 22

Somatotroph adenoma of the anterior pituitary

Question 23

How does the body GH effect fat metabolism and blood glucose?

Answer 23

• increases lipolysis

- increases blood glucose levels

Question 24

How does the body compensate for the increased glucose levels caused by increased GH?

Answer 24

pancreas secretes more insulin –> beta cell hypertrophy –> increase in C peptide levels –> death of beta cells (diabetes)

Question 25

High GH levels will cause insulin _____.

Answer 25

insensitivity

Question 26

Why doesn't height increase in Post puberty acromegaly?

Answer 26

the epiphyseal plates have fused

Question 27

Post puberty effects of high levels of GH and IGF1 (6)

Answer 27

- course facial features - insulin resistance - glucose intolerance increase in: - organ size - hand/foot size - tongue size

Question 28

Fat: GH causes increased ____ which results in ____.

Answer 28

- lipolysis | - hyeperlipidemia

Question 29

Protein : GH causes increased ____ which increases ____.

Answer 29

- protein synthesis | - lean body mass

Question 30

Glucose: GH ____ the effects of insulin which can result in _____.

Answer 30

- opposes | - Type II diabetes

Question 31

In cases of stress, ____ release in increased but ____ is inhibited

Answer 31

- GH | - IGF1

Question 32

Causes of GHRH release: (3)

Answer 32

- fasting - stress - hypoglycemia

Question 33

Effects of protein intake on: - GH - IFG1 - Insulin - Protein Synthesis - Growth - Caloric Storage

Answer 33

- GH --> increased - IFG1 --> increased - Insulin --> increased - Protein Synthesis --> increased - Growth --> increased - Caloric Storage --> no change

Question 34

Effects of Carb intake on: - GH - IFG1 - Insulin - Protein Synthesis - Growth - Caloric Storage

Answer 34

- GH --> decreased - IFG1 --> no change - Insulin --> increased - Protein Synthesis --> no change - Growth --> no change - Caloric Storage --> increased

Question 35

Effects of fasting on: - GH - IFG1 - Insulin - Protein Synthesis - Growth - Caloric metabolism

Answer 35

- GH --> increased - IFG1 --> decresed - Insulin --> decreased - Protein Synthesis --> decreased - Growth --> decreased - Caloric metabolism--> increased

Question 36

Causes of GH inhibition (2)

Answer 36

- Under-nutrition | - acute/chronic illness

Question 37

When there is an abundance of a hormone a ____ test is performed

Answer 37

suppression test

Question 38

When there is a deficiency of a hormone, a ____ test is performed

Answer 38

stimulation test

Question 39

Order of diagnostic tests ordered:

Answer 39

1. hormone assays 2. suppression/stimulation test 3. imaging

Question 40

How is a GH supression test performed?

Answer 40

pt is given oral glucose

Question 41

What is octreotide and what is its mechanism of action?

Answer 41

- acromegaly drug | - somatostatin analogue that inhibits the release of GH

Question 42

What is Pegvisomant?

Answer 42

- acromegaly drug | - GH receptor antagonist

Question 43

Diabetogenic effect of GH

Answer 43

- decreased glucose uptake - increased serum glucose - increased lipolysis - increased blood insulin levels

Question 44

Increased protein synthesis and organ growth (via IGF1) resulting from GH

Answer 44

- increased aa uptake - increased DNA/RNA/protein synthesis - increased lean body mass and organ size

Question 45

An increase in organ size dt to GH can result in ______ dt increase in heart size.

Answer 45

Heart failure

Question 46

3 main actions of GH:

Answer 46

1. Diabetogenic effect 2. increased protein synthesis and organ size (dt IGF1) 3. Increased linear growth before puberty