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[LECT] CC 2 - Finals > [M6 GROUP 1] Hypothalamic and Pituitary Function > Flashcards

[M6 GROUP 1] Hypothalamic and Pituitary Function Flashcards

1
Q

PITUITARY is aka

A

master gland

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2
Q

aka “master gland”

A

PITUITARY

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3
Q

PITUITARY is derived from both ___ and ___ which means to “____”

A

Latin,
Greek,
spit mucus

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4
Q

It secrete hormones that regulate the other endocrine glands

A

PITUITARY

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5
Q

PITUITARY also referred as “___”, from Greek meaning “____”

A

hypophysis,
undergrowth

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6
Q

hypophysis means

A

undergrowth

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7
Q

Reflection of dura

A

Diaphragma sella

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8
Q

It separates superior portion of the pituitary from the hypothalamus

A

Diaphragma sella

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9
Q

Diaphragma sella is Penetrated by ____

A

infundibulum

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10
Q

Connects adenohypophysis to the median eminence and
hypothalamus

A

Infundibulum

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11
Q

Infundibulum connects ____ to the median ___ and
_____

A

adenohypophysis;
eminence;
hypothalamus

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12
Q

WHAT ARE THE 4 FEATURES THAT DISTINGUISH THE FUNCTION OF PITUITARY

A
  1. Feedback loops
  2. Pulsatile secretions
  3. Diurnal rhythms
  4. Environmental or external modification of its performance
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13
Q

What are the three distinct parts of the pituitary:

A

Anterior pituitary
Intermediate lobe
Posterior pituitary

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14
Q

Anterior pituitary is aka

A

adenohypophysis

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15
Q

Anterior pituitary or adenohypophysis receives ____ of the ____ and ____ via the _____

A

80-90%;
blood supply;
hypothalamic factors;
hypothalamic–hypophyseal portal system

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16
Q

Receives 80-90% of the blood supply and hypothalamic factors via
the hypothalamic–hypophyseal portal system

A

Anterior pituitary or adenohypophysis

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17
Q

Intermediate lobe is aka

A

pars intermedalis

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18
Q

Poorly developed in humans and has little functional capacity

A

Intermediate lobe or pars intermedalis

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19
Q

Posterior pituitary is aka

A

neurohypophysis

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20
Q

Posterior pituitary or neurohypophysis is Responsible for storage and release of ___ and ___

A

oxytocin
vasopressin

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21
Q

Responsible for storage and release of oxytocin and vasopressin

A

Posterior pituitary or neurohypophysis

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22
Q

Posterior pituitary or neurohypophysis is Connected to the ___ and ____ hypothalamic nuclei

A

supraoptic;
paraventricular

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23
Q

Connected to the supraoptic and paraventricular hypothalamic nuclei

A

Posterior pituitary or neurohypophysis

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24
Q

What are the different Anterior Pituitary Cell Types

A

Lactotrophs
Somatotrophs
Thyrotrophs
Corticotrophs
Gonadotrophs
Follicle-stimulating hormone

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25
Q

prolactin-secreting cells

A

Lactotrophs

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26
Q

growth hormone [GH]-secreting cells

A

Somatotrophs

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27
Q

(thyroid-stimulating hormone [TSH]-secreting cells

A

Thyrotrophs

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28
Q

adrenocorticotropin hormone [ACTH]-secreting cells

A

Corticotrophs

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29
Q

luteinizing hormone

A

Gonadotrophs

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30
Q

[FSH]-secreting cells

A

Follicle-stimulating hormone

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31
Q

WHAT ARE THE FUNCTIONAL ASPECTS OF THE HYPOTHALAMIC-HYPOPHYSEAL UNIT

A

Endocrine Feedback Loop
Pulsatility
Cyclic nature of Hormone Secretion

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32
Q

An example of Endocrine Feedback Loop

A

Hypothalamic-Pituitary-Thyroidal Axis

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33
Q

Can be partially inhibited by adrenal steroids and cytokines

A

Hypothalamic-Pituitary-Thyroidal Axis

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34
Q

Hypothalamic-Pituitary-Thyroidal Axis Can be partially inhibited by ____ and ___

A

adrenal steroids
cytokines

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35
Q

TRH means

A

Thyrotropin-releasing hormone

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36
Q

Thyrotropin-releasing hormone is produced by

A

hypothalamus

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37
Q

It is a Hypophysiotropic hormone

A

Thyrotropin-releasing hormone (TRH)

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38
Q

Directs the thyrotrophs

A

Thyrotropin-releasing hormone (TRH)

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39
Q

TSH-producing cells

A

thyrotrophs

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40
Q

Thyrotropin-releasing hormone (TRH) secretes?

A

Thyroid Stimulating Hormone (TSH)

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41
Q

stimulates several steps in the thyroid that are critical in the production and release of thyroid hormone (thyroxine)

A

Thyroid Stimulating Hormone

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42
Q

The one that suppress TRH and TSH production

A

Thyroxine

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43
Q

feedback of thyroxine at the level of the
pituitary

A

Short feedback loop

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44
Q

Short feedback loop is the feedback of thyroxine at the level of the
___

A

pituitary

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45
Q

feedback at the level of the hypothalamus

A

Long feedback loop

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46
Q

Feedback between the pituitary and
hypothalamus (when present)

A

Ultrashort feedback loop

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47
Q

Regulated by neural modulation

A

Pulsatility

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48
Q

Pulsatility is Regulated by ____

A

neural modulation

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49
Q

→ Specific for each hypothalamic-pituitary-end-organ unit

A

Pulsatility

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50
Q

Median interpulse interval for LH

A

Pulsatility

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51
Q

Pulsatility:

Normal Male: ___

A

55 minutes

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52
Q

Pulsatility:

Average LH peak duration: _____

A

40 minutes

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53
Q

Regulatory hypothalamic hormone

A

Gonadotropin-Releasing Hormone (GnRH)

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54
Q

Its pulse frequency has profound effects on LH secretion profiles

A

Gonadotropin-Releasing Hormone (GnRH)

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55
Q

Gonadotropin-Releasing Hormone (GnRH)

Increased: reduces ___

A

gonadotrope secretory response

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56
Q

Gonadotropin-Releasing Hormone (GnRH)

Decreased: increases the ____

A

amplitude of the subsequent LH pulse

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57
Q

Regulated by nervous system through external signals

A

Cyclic nature of Hormone Secretion

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58
Q

It means “time giver”

A

“Zeitgeber”

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59
Q

Process of entertaining or synchronizing theses external cues
into the function of internal biologic clocks

A

“Zeitgeber”

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60
Q

“Zeitgeber”

A

Cyclic nature of Hormone Secretion

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61
Q

Cyclic nature of Hormone Secretion is Typified by ___ or ___ secretion

A

ACTH;
TSH

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62
Q

Cyclic nature of Hormone Secretion:

Typified by ACTH or TSH secretion
o Lowest: _____
o Peak: _____

A

11:00 pm and 3:00 am

6:00 am to 9:00 am

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63
Q

Nocturnal Levels of TSH is ____ the ____ levels

A

twice
daytime

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64
Q

Nocturnal Levels of TSH is Increased due to increased ___

A

pulse amplitude

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65
Q

Actions of Hypothalamic hormones:

● TRH stimulates secretion of ___ and ____
● GnRH stimulates ____ and ___
● Somatostatin (SS) inhibits ___ and ___ release
● Vasopressin (ADH) stimulate ___ secretion

A

TSH ; prolactin
LH ; FSH
GH ; TSH
ACTH

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66
Q

What are the Actions of Hypothalamic hormones:

A

● TRH stimulates secretion of TSH and prolactin
● GnRH stimulates LH and FSH
● Somatostatin (SS) inhibits GH and TSH release
● Vasopressin (ADH) stimulate ACTH secretion

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67
Q

What are the different Hypophysiotropic hormones

A

TRH
GnRH
CRH
GHRH
Somatostatin
Dopamine

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68
Q

HYPOPHYSIOTROPIC HORMONES:

What is the structure of TRH

A

3 amino acids

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69
Q

HYPOPHYSIOTROPIC HORMONES:

What is the action of TRH

A

Release TSH and prolactin

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70
Q

HYPOPHYSIOTROPIC HORMONES:

What is the structure of GnRH

A

10 amino acids

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71
Q

HYPOPHYSIOTROPIC HORMONES:

What is the action of GnRH

A

Releases LH and FSH

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72
Q

HYPOPHYSIOTROPIC HORMONES:

What is the structure of CRH

A

41 a.a

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73
Q

HYPOPHYSIOTROPIC HORMONES:

What is the action of CRH

A

releases ACTH

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74
Q

HYPOPHYSIOTROPIC HORMONES:

What is the structure of GHRH

A

44 a.a

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75
Q

HYPOPHYSIOTROPIC HORMONES:

What is the action of GHRH

A

releases growth hormone

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76
Q

HYPOPHYSIOTROPIC HORMONES:

What is the structure of somatostatin

A

14 and 28 a.a

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77
Q

HYPOPHYSIOTROPIC HORMONES:

What is the action of somatostatin

A

Inhibits GH and TSH release (additional effects on gut and pancreatic function

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78
Q

HYPOPHYSIOTROPIC HORMONES:

What is the structure of dopamine

A

1 a.a

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79
Q

HYPOPHYSIOTROPIC HORMONES:

What is the action of dopamine

A

inhibits prolactin release

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80
Q

prolactin inhibitory factor

A

dopamine

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81
Q

ANTERIOR PITUITARY HORMONES is characterized as (2)

A

Direct effectors
Tropic

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82
Q

classification of anterior pituitary hormone that act directly on peripheral tissues

A

Direct effectors

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83
Q

Example of Direct effectors

A

GH

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84
Q

Example of Direct effectors

A

GH

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85
Q

classification of anterior pituitary hormone that is specific for another endocrine gland

A

Tropic

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86
Q

WHAT ARE THE DIFF TROPIC HORMONES

A

LH
FSH
TSH
ACTH

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87
Q

Tropic hormone that directs testosterone production from men and women

A

LH

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88
Q

LH – directs ___ production from:
✓ Men: ___
✓ Women: ___

A

testosterone;
Leydig cells;
Ovulation

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89
Q

FSH is responsible for:
✓ Men: ____
✓ Women: ___

A

Spermatogenesis;
Ovarian recruitment and Ovulation

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90
Q

TROPIC HORMONES that directs thyroid hormone production

A

TSH

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91
Q

TROPIC HORMONES that regulates adrenal steroidogenesis

A

ACTH

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92
Q

What are the diff anterior pituitary hormone

A

LH
FSH
TSH
ACTH
GH
PRL

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93
Q

What is/are the anterior pituitary hormone that targets the gonad (tropic) gland

A

LH
FSH

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94
Q

anterior pituitary hormone with dimeric glycoprotein structure

A

LH
FSH
TSH

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95
Q

What is/are the anterior pituitary hormone that targets THYROID (TROPIC) GLAND

A

TSH

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96
Q

What is/are the anterior pituitary hormone that targets adrenal (tropic) gland

A

ACTH

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97
Q

What is/are the anterior pituitary hormone that targets Multiple (direct effector) gland

A

GH

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98
Q

What is/are the anterior pituitary hormone that targets breast (direct effector) gland

A

Prolactin

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99
Q

anterior pituitary hormone with SINGLE PEPTIDE DERIVED FROM POMC structure

A

ACTH

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100
Q

anterior pituitary hormone with SINGLE PEPTIDE

A

GH
PRL

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101
Q

LH

Feedback hormone: ____

A

Sex steroids

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102
Q

FSH

Feedback hormone: ____

A

Inhibin

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103
Q

TSH

Feedback hormone: ____

A

Thyroid hormones

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104
Q

ACTH

Feedback hormone: ____

A

cortisol

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105
Q

GH

Feedback hormone: ____

A

IGF-1

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106
Q

PRL

Feedback hormone: ____

A

Unknown

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107
Q

____ of people harbor clinically silent ___

A

20%
pituitary adenomas

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108
Q

____ of ___ individuals have ____ observed under ___

A

10% - 30%;
normal;
pituitary tumors;
MRI examinations

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109
Q

____ of the lesions removed from carefully selected patients who have undergone ____ surgery are ____

A

91%;
transsphenoidal ;
pituitary tumors

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110
Q

Most common Pituitary tumor

A

prolactin secreting pituitary tumors

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111
Q

Have an MIB-1 proliferative
index greater than 3%

A

Atypical Pituitary Tumors

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112
Q

monoclonal antibody used to detect Ki-67

A

MIB-1

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113
Q
  • a marker of cell proliferation
A

Ki-67

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114
Q

Excessive p53 immunoreactivity

A

Atypical Pituitary Tumors

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115
Q

Atypical Pituitary Tumors has Excessive ____

A

p53 immunoreactivity

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116
Q

Increased mitotic activity

A

Atypical Pituitary Tumors

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117
Q

Macroadenomas

A

Atypical Pituitary Tumors

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118
Q

Show invasion into surrounding structures like the cavernous sinuses

A

Atypical Pituitary Tumors

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119
Q

● Seen during puberty and pregnancy

A

PHYSIOLOGIC ENLARGEMEN (OF PITUITARY TUMORS)

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120
Q

PHYSIOLOGIC ENLARGEMEN (OF PITUITARY TUMORS) IS SEEN DURING ___ AND ___ DUE TO ____

A

puberty;
pregnancy;
lactotroph hyperplasia

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121
Q

seen in long standing primary thyroidal failure

A

Thyrotroph and lactotroph hyperplasia

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122
Q

Gonadal failure

A

Gonadotroph hyperplasia

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123
Q

GROWTH HORMONE IS AKA

A

Somatotropin

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124
Q

Structurally related to prolactin and human placental lactogen

A

GROWTH HORMONE

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125
Q

GROWTH HORMONE IS Structurally related to ___ and ___

A

prolactin;
human placental lactogen

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126
Q

GROWTH HORMONE is produced by the ___ specifically the ___
(____)

A

pituitary gland;
somatotrophs;
pituitary cells

127
Q

Produced by the pituitary gland specifically the somatotrophs
(pituitary cells)

A

GROWTH HORMONE

128
Q

Release of this hormone is stimulated by the growth hormone-releasing hormone (GHRH)

A

GROWTH HORMONE

129
Q

GROWTH HORMONE Release is stimulated by the ____

A

growth hormone-releasing hormone
(GHRH)

130
Q

enteric hormone that plays an important role in nutrient sensing, appetite, and in glucose regulation leading to stimulation of GH secretion

A

Ghrelin

131
Q

This hormone is secreted in pulses

A

GH

132
Q

GH is secreted in ___

A

pulses

133
Q

GROWTH HORMONE:

Between pulses, level of GH may be ____ leading to clinical evaluation of ____ based on a ____, ____

A

undetectable;
GH deficiency;
single;
challenging measurement

134
Q

Other modifiers of Growth hormone secretion that STIMULATES GH Secretion

A

Sleep
Exercise
Physiologic stress
Amino acids
Hypoglycemia
Sex steroids
α-Agonists
β-Blockers

135
Q

Other modifiers of Growth hormone secretion that INHIBITS GH Secretion

A

Glucose loading
β-Agonists
α-Blockers
Emotional/psychogenic stress
Nutritional deficiencies
Insulin deficiency
Thyroxine deficiency

136
Q

EXAMPLE of amino acids used to STIMULATE GH secretions

A

Arginine

137
Q

EXAMPLE of α-Agonists used to STIMULATE GH secretions

A

norepinephrine

138
Q

EXAMPLE of β-blockers used to STIMULATE GH secretions

A

propranolol

139
Q

EXAMPLE of β-Agonists used to INHIBIT GH secretions

A

epinephrine

140
Q

EXAMPLE of α-Blockers used to INHIBIT GH secretions

A

phentolamine

141
Q

Amphibolic hormone

A

GH

142
Q

GH is ____ hormone

A

Amphibolic hormone

143
Q

anabolic effects of the action of GH (Amphibolic hormone)

Reflected by enhanced ____ in
tissues which is translated into ___ and
phosphate retention

A

protein synthesis;
positive nitrogen balance;
phosphate retention

144
Q

ACTIONS OF GH:

Major effect is permitting the effective ___ of an individual from ___ to ____ (without experiencing a ___ of _____)

A

transition ;
fed state ;
fasting state ;
shortage ;
substrates

145
Q

Major effect is permitting the effective transition of an individual from fed state to fasting state

A

ACTIONS OF GH

146
Q

ACTIONS OF GH

Directly ___ the effect of ___ on ___

A

antagonizes ;
insulin ;
glucose metabolism

147
Q

Directly antagonizes the effect of insulin on glucose metabolism

A

ACTIONS OF GH

148
Q

ACTIONS OF GH:

Promotes ___

A

hepatic gluconeogenesis

149
Q

Promotes hepatic gluconeogenesis

A

ACTIONS OF GH

150
Q

ACTIONS OF GH:

Stimulates ___

A

lipolysis

151
Q

Indirect effects of ___ is mediated by ____ (former name) that is
now known as ____

A

GH ;
somatomedins ;
Insulin-like Growth Factor (IGF)

152
Q

What are the Indirect effects of GH

A

→ Hypoglycemia
→ Hyperinsulinemia
→ Stimulation of IGF-1 production
→ Inhibition of neoplastic cell proliferation
→ Higher rates of colorectal cancer risk

153
Q

Indirect effects of GH that amplifies GH levels

A

Stimulation of IGF-1 production

154
Q

___ and ___ levels are measured through ____. Elevated levels
of these two are consistent with sustained ___

A

IGF-I ;
IGFBP-3 ;
assays ;
excess of GH

155
Q

Increased IGF-I is associated with ___

A

Hepatoma

156
Q

Low IGF-I is associated with ___ (3)

A

✓ Poorly controlled diabetes
✓ Malnutrition
✓ Chronic illnesses

157
Q

Individuals with active acromegaly shows ___ levels of IGFBP-3

A

ABNORMAL

158
Q

Abnormal levels of IGFBP-3 is seen in individuals with __

A

active acromegaly

159
Q

Definitive testing for determination of autonomous production of GH

A

Oral glucose loading

160
Q

Oral glucose loading is Performed after ____

A

overnight fasting

161
Q

Performed after overnight fasting

A

Oral glucose loading

162
Q

In Oral glucose loading, Px is given ___

A

100g oral glucose load

163
Q

GH is measured at time zero, 60, and 120 minutes after glucose ingestion

A

Oral glucose loading

164
Q

In Oral glucose loading, GH is then measured at time ___, ___, and ___ ___ after ____

A

zero ;
60 ;
120 ;
minutes ;
glucose ingestion

165
Q

Result of Oral glucose loading;

Undetectable GH = ___

A

Normal

166
Q

Result of Oral glucose loading;

Detectable GH = ___

A

Acromegaly

167
Q

Insulin-like Growth Factor (IGF) TESTING:

Gold standard: ___

A

: Insulin-induced hypoglycemia

168
Q

Most widely used for testing GH

A

Combination infusions of GHRH and L-arginine or infusion of L-arginine coupled with oral L-DOPA

169
Q

: Most widely used for testing GH

Combination infusions of ____ and ____ or ___ of L-arginine
coupled with oral ____

A

GHRH ;
L-arginine ;
infusion ;
L-DOPA

170
Q

What is the GH levels of patient who is not GH deficient

A

> 3-5 ng/mL

171
Q

Results from pathologic or autonomous GH excess and pituitary tumor

A

ACROMEGALY

172
Q

ACROMEGALY

Results from pathologic or autonomous _________and _________

A

GH excess
pituitary tumor

173
Q

tumors causing acromegaly are results of the ectopic production of _________

A

GHRH (Growth Hormone-Releasing Hormone)

174
Q

Diseases Associated with Acromegaly

A

Gigantism

175
Q

Patient with GH-producing tumors may develops

A

Gigantism

176
Q

FEATURES OF GIGANTISM

✓ progressive enlargement of the ____________
✓ growth of ________, including the _______ and bones of the ____
✓ significant gaps between their _____
✓ overgrowth of the _____________ or the ______ can produce a debilitating form of ________.

A

hands and feet
facial bones, mandible, skull.
teeth
ends of long bones, spine, arthritis

177
Q

Enumerate the clinical features of gigantism

A

● Overt Diabetes or glucose intolerance
● Hypertension
● Accelerated atherosclerosis
● Proximal muscle weakness, resulting from acquired myopathy
● Sleep apnea is common
● Organomegaly, especially thyromegaly, is common.
● Hyperthyroidism

178
Q

Symptoms of Acromegaly

A

● Excessive sweating or heat intolerance

179
Q

SYMPTOMS OF ACROMEGALY

If left untreated, acromegaly increases risk of the following:

A

✓ heart disease, resulting from the combination of hypertension
✓ coronary artery disease
✓ diabetes/insulin resistance
✓ risk of developing cancer

180
Q

DIAGNOSIS

T/F: however, some patients with acromegaly have normal random levels of GH.

A

True

181
Q

DIAGNOSIS

● patients with normal, random levels of GH, elevated levels of ____

A

IGF-I

182
Q

Definitive test for acromegaly

A

nonsuppressibility of GH to glucose loading

183
Q

TREATMENT ACROMEGALY

A

Transsphenoidal adenomectomy
External beam or focused irradiation

184
Q

THREE DIFFERENT CLASSES OF GH SUPPRESSION AGENTS

A

SS analogs
dopaminergic agonists
GH receptor antagonists

185
Q

Example of SS analogs

A

octreotide and lanreotide

186
Q

Example of dopaminergic agonists

A

cabergoline and bromocriptine

187
Q

Example of GH receptor antagonist

A

pegvisomant

188
Q

GH deficiency occurs in

A

both children and adults.

189
Q

GH DEFECIENCY

In ______, it may be familial or due to tumors, such as _____________.

A

children
craniopharyngiomas

190
Q

GH DEFECIENCY

In _______, it is a result of structural or functional abnormalities of the _______.

A

adults
pituitary

191
Q

GENETIC DEFECT

A (recessive/dominant) mutation in the _____ gene that causes a failure of GH secretion

A

recessive
GHRH

192
Q

In genetic defect, there is a loss of ______

A

GH gene itself

193
Q

GENETIC DEFECTS

Mutations that cause GH ______

A

insensitivity

194
Q

GENETIC DEFECTS

structural lesions of the ______ or _______ may also cause GH deficiency and may be associated with other _____________________________.

A

pituitary
hypothalamus
anterior pituitary hormone deficiencies

195
Q

An ___________ has been described in patients who have complete or even partial failure of the anterior pituitary.

A

adult GH deficiency syndrome

196
Q

An adult GH deficiency syndrome has been described in patients who have complete or even partial failure of the _________

A

anterior pituitary.

197
Q

Symptoms of Adult GH Deficiency Syndrome

✓ __________
✓ _________
✓ _________
✓ _____________________
✓ Frequent concomitants of adult GH deficiency are __________ and alterations in _________
✓ ___________ with the advent of recombinant ________

A

✓ social withdrawal
✓ fatigue
✓ loss of motivation
✓ diminished feeling of wellbeing
✓ Osteoporosis, body composition
✓ GH replacement therapy, human GH

198
Q

Considered a stress hormone

A

Prolactin

199
Q

Prolactin is considered as a _____

A

stress hormone

200
Q

● Has vital functions in relation to reproduction

A

Prolactin

201
Q

Prolactin has has vital functions in relation to _______

A

reproduction

202
Q

Classified as a direct effector hormone

A

Prolactin

203
Q

Prolactin is classified as a ___________

A

direct effector hormone

204
Q

the physiologic effect of prolactin is ________

A

lactation

205
Q

● tonic inhibition is its major mode of hypothalamic regulation

A

Prolactin

206
Q

PROLACTIN

● _________is its major mode of hypothalamic regulation

A

tonic inhibition

207
Q

inhibits prolactin

A

Dopamine

208
Q

Pituitary tumor directly secreting prolactin

A

Prolactinoma

209
Q

Most common type of functional pituitary tumor

A

Prolactinoma

210
Q

PROLACTINOMA

Clinical presentation depends on the ________ of the patient and the ________

A

age and gender
size of the tumor

211
Q

HYPERPROLACTINEMIA CAUSES

A

● Medications (dopaminergic antagonist)
● Disruption of the pituitary stalk
● Increased Thyrotropin-releasing Hormone
● Pathologic stimulation of neural sucking reflex
● Primary thyroidal failure
● Renal failure
● Polycystic ovary syndrome
● Pregnancy
● Exercise and seizures

212
Q

MANAGEMENT OF PROLACTINOMA

Therapeutic goals

A
  1. Decreasing tumor mass
  2. Restoration of normal gonadal function and fertility
  3. Osteoporosis prevention
  4. Preservation of normal anterior and posterior pituitary function
213
Q

MANAGEMENT OF PROLACTINOMA

Therapeutic Options

A
  1. Simple observation
  2. Surgery
  3. Radiotherapy
  4. Medical management with dopamine agonists
214
Q

FACTORS TO CONSIDER FOR PROLACTINOMA MANAGEMENT:

A
  1. Tumor size
  2. Preferences of the patien
215
Q

TUMOR SIZE

A

Macroadenomas
Microadenomas

216
Q

Macroadenomas size

A

> 10 mm

217
Q

Microadenomas size

A

<10 mm

218
Q

Among the tumor sizes, which is LESS likely to be cured?

A

Macroadenomas

219
Q

most commonly used therapy for microprolactinomas

A

Dopamine agonists

220
Q

● cause tumor shrinkage in >90% of patients

A

DOPAMINE RECEPTOR AGONISTS:

221
Q

DOPAMINE RECEPTOR AGONISTS:

● cause tumor shrinkage in ____ of patients

A

> 90%

222
Q

DOPAMINE RECEPTOR AGONISTS:

also shrink ________________

A

prolactin-secreting macroadenomas

223
Q

T/F: Dopamine receptor agonist is discontinued during pregnancy unless tumor regrowth is detected

A

True

224
Q

Types of Dopamine receptor agonists

A
  1. Bromocriptine mesylate
  2. Cabergoline
225
Q

Example of Bromocriptine mesylate

A

Parlodel

226
Q

Example of Cabergoline

A

Dostinex

227
Q

DOPAMINE RECEPTOR AGONISTS

Has an adverse effects

A

Bromocriptine mesylate

228
Q

What are the adverse effect of Bromocriptine mesylate

A

orthostatic hypotension, dizziness,
nausea, GI problems

229
Q

BROMOCRIPTINE MESYLATE

Remedy for GI adverse effects: __________

A

intravaginal administration

230
Q

DOPAMINE RECEPTOR AGONISTS

Fewer adverse effects

A

Cabergoline (Dostinex)

231
Q

DOPAMINE RECEPTOR AGONISTS

Administered weekly due to its longer duration of action

A

Cabergoline (Dostinex)

232
Q

Cabergoline (Dostinex) is linked to

A

valvular heart disease development

233
Q

Cabergoline (Dostinex) is linked to valvular heart disease development - due to its ability to interact with _________________________________________________

A

5-hydroxytryptamine (5-HT)2B serotonergic receptor

234
Q

NOT a primary mode of prolactinoma management

A

NEUROSURGERY

235
Q

● Indications for neurosurgical intervention:

A
  1. Pituitary tumor apoplexy (hemorrhage)
  2. Acute visual loss due to macroadenoma
  3. Cystic prolactinoma
  4. Intolerance to medical therapy
  5. Tumor resistance to dopaminergic agonists
236
Q

Surgical cure rates are (directly/inversely) proportional to ______ and degree of ________

A

INVERSELY

tumor size
prolactin elevation.

237
Q

Reserved for high surgical risk patients with locally aggressive macroadenomas and intolerance to dopamine agonists

A

RADIOTHERAPY

238
Q

Radiotherapy is reserved for high surgical risk patients with locally aggressive _________ and intolerance to __________

A

macroadenomas
dopamine agonists

239
Q

condition with unknown cause

A

Idiopathic

240
Q
  • inappropriate lactation
A

Galactorrhea

241
Q

Lactation occurring in women with normal prolactin levels

A

IDIOPATHIC GALACTORRHEA

242
Q

Seen in women who have been pregnant several times and has no pathologic implication,

A

IDIOPATHIC GALACTORRHEA

243
Q

T/F: Idiopathic galactorrhea may be a manifestation of a localized increased sensitivity to prolactin in breast tissue.

A

True

244
Q

A diagnosis of exclusion

A

IDIOPATHIC GALACTORRHEA

245
Q

Failure of either the pituitary gland or the hypothalamus

A

Hypopituitarism

246
Q

● Loss of anterior pituitary function

A

Hypopituitarism

247
Q

HYPOPITUITARISM

Loss of ___________

A

anterior pituitary function

248
Q

HYPOPITUITARISM

Complete loss of function: ______

A

panhypopituitarism

249
Q

HYPOPITUITARISM

Single loss of a pituitary hormone:

A

monotropic hormone deficiency

250
Q

HYPOPITUITARISM

Immediate detectable lost hormones:

A

tropic hormones

251
Q

Example of tropic hormones lost in Hypopituitarism

A

ACTH
TSH
LH,
FSH

252
Q

HYPOPITUITARISM

Delayed unnoticeable lost hormones:

A

direct effectors (GH and prolactin)

253
Q

HYPOPITUITARISM LABORATORY DIAGNOSIS

(Primary/Secondary) failure is accompanied by dramatic (decrease/increase) in circulating levels of the corresponding _________

A

Primary
increases
pituitary tropic hormone

254
Q

HYPOPITUITARISM LABORATORY DIAGNOSIS

___________ is associated with low or normal levels of ________

A

Secondary failure
tropic hormones

255
Q

HYPOPITUITARISM LABORATORY DIAGNOSIS

T/F: Only tropic hormone is measured.

A

FALSE; Both tropic and target hormone levels should be measured

256
Q

Most common cause of hypopituitarism

A

Pituitary tumors

257
Q

Infections in Hypopituitarism

A

fungal infections
tuberculosis
syphilis

258
Q

infiltrative disease in Hypopituitarism

A

hemochromatosis
sarcoidosis, or
histiocytosis

259
Q

Immunologic (hypopituitarism)

A

lymphocytic hypophysitis

260
Q

Familial (hypopituitarism)

A

Kallmann’s syndrome; rare

261
Q

TREATMENT OF PANHYPOPITUITARISM:

A

● Replacement therapy
● Thyroxine, glucocorticoids, and gender-specific sex steroids
● Pulsatile GnRH infusions:
● Gonadotropin preparations:

262
Q

TREATMENT OF PANHYPOPITUITARISM:

for patients with Kallmann’s syndrome

A

Pulsatile GnRH infusions

263
Q

TREATMENT OF PANHYPOPITUITARISM:

for patients with gonadotropin deficiency

A

Gonadotropin preparations

264
Q

POSTERIOR PITUITARY HORMONES a.k.a

A

NEUROHYPOPHYSIS

265
Q

Extension of the forebrain

A

POSTERIOR PITUITARY HORMONES / NEUROHYPOPHYSIS

266
Q

POSTERIOR PITUITARY HORMONES / NEUROHYPOPHYSIS is extension of the _____

A

forebrain

267
Q

Serves as storage for two homologous nonapeptides

A

POSTERIOR PITUITARY HORMONES / NEUROHYPOPHYSIS

268
Q

What are the two homologous nonapeptides stored in Posterior pituitary hormones/Neurohhypophysis

A

ADH & Oxytocin

269
Q

Both have an autocrine or a paracrine function

A

ADH & OXYTOCIN

270
Q

ADH & OXYTOCIN

Both have an ________ or a _______ function

A

autocrine
paracrine

271
Q

Originate primarily in the paraventricular nuclei of the hypothalamus

A

Oxytocin

272
Q

OXYTOCIN

Originate primarily in the ____________ of the hypothalamus

A

paraventricular nuclei

273
Q

Oxytocin plays a major role in

A

lactation
labor
parturition

274
Q

OXYTOCIN

Unique because its secretion responds in a ________________

A

positive feedback mechanism

275
Q

ACTION OF OXYTOCIN

1) contraction of ___________
2) contraction of the ___________

A

myoepithelial cells in the breast
uterus

276
Q

The contraction of myoepithelial cells in the breast causes _________

A

ejection of milk

277
Q

The contraction of uterus induces ________

A

labor

278
Q

A synthetic oxytocin

A

Pitocin

279
Q

● Used in obstetrics to induce labor

A

Pitocin

280
Q

Pitocin is used in obstetrics to ______

A

Induce labor

281
Q

Recent Studies linked Oxytocin to a variety of biosocial behaviors including _________ and ___________

A

maternal nurturing
mother-infant bonding.

282
Q

Oxytocin, also has been shown to have effects on ________________ (5)

A

pituitary
renal
cardiac
metabolic
immune function

283
Q

Synthesized by hypothalamic supraoptic nuclei

A

ADH

284
Q

ADH is synthesized by

A

hypothalamic supraoptic nuclei

285
Q

ADH

Stimulus: (inc/dec) plasma osmolality, (inc/dec) BP and BV

A

inc
dec

286
Q

ADH

Its significant role is to regulate ___________, hence has a central role in ________

A

renal free water excretion
water balance

287
Q

ACTIONS OF ADH

RECEPTORS

A

V2 receptors
V1 receptors

288
Q

increases H20 permeability (aquaporin-2) of cells in
renal collecting tubules and ascending loop of Henle via V2 receptors coupled with adenylate kinase

A

● V2 receptors

289
Q

V2 RECPETORS

increases H20 permeability (______) of cells in
_________ and ascending _______ via V2 receptors coupled with __________

A

aquaporin-2
renal collecting tubules
loop of Henle
adenylate kinase

290
Q

capable of vasoconstriction via V1 receptors coupled
with Phospholipase C

A

V1 Receptors

291
Q

V1 RECEPTORS

capable of _________ via V1 receptors coupled
with ______________

A

vasoconstriction
Phospholipase C

292
Q

● Regulates release of vasopressin from posterior pituitary

A

HYPOTHALAMIC OSMORECEPTORS AND VASCULAR
BARORECEPTORS

293
Q

HYPOTHALAMIC OSMORECEPTORS AND VASCULAR
BARORECEPTORS

● Regulates release of vasopressin from ________

A

posterior pituitary

294
Q

extremely sensitive even to small changes in
plasma osmolality

A

Osmoreceptors

295
Q

OSMORECEPTORS

______________ADH average osmotic threshold

A

284 mOsm/kg

296
Q

T/F: When plasma osmolality increases ADH secretion also increases

A

True

297
Q

When plasma osmolality increases ADH secretion also increases, which in turn (reduces/increases) renal free water clearance, (increasing/lowering) plasma osmolality and returning ________

A

reduces
lowering
homeostasis

298
Q

Vascular Baroreceptors locations

A

left atrium
aortic arch
carotid arteries

299
Q

initiate ADH release in response to decreased BV
or BP – 5% to 10% fall in arterial BP in normal humans

A

→ Vascular Baroreceptors

300
Q

VASCULAR BORORECEPTORS

initiate ADH release in response to (increased/decreased) BV
or BP – ______ fall in arterial BP in normal humans

A

decreased
5% to 10%

301
Q

T/F: Baroreceptor-induced ADH secretion will override the normal osmotic suppression of ADH secretion

A

true

302
Q

PATHOPHYSIOLOGY OF ADH DEFICIENCY

A

● Diabetes Insipidus
● Primary polydipsia

303
Q

characterized by polyuria, and polydipsia

A

● Diabetes Insipidus

304
Q

A typical patient presents with a partial ADH deficiency

A

● Diabetes Insipidus

305
Q

→ Causes of hypothalamic DI:

A

o Apparent autoimmunity to ADH-secreting neurons
o Trauma
o Diseases affecting pituitary stalk function
o Various CNS or pituitary tumors

306
Q

____ of patients will have idiopathic DI

A

30%

307
Q

Diagnosis of DI

Secured diagnosis of DI if inappropriately (low/high) ADH level with (decreased/increased) plasma osmolality

A

low
increased

308
Q

TESTS FOR DIABETES INSIPIDUS

A

✓ Water deprivation Test
✓ Therapeutic Trial of ADH or Synthetic Analog

309
Q

✓ Therapeutic Trial of ADH or Synthetic Analog such as ___________

A

desmopressin (dDAVP)

310
Q

compulsive water consumption, water intoxication

A

Primary polydipsia

311
Q

TREATMENT FOR ADH EXCESS

A
  1. Restricting water intake to small amounts each day for ADH excess
  2. Conivaptan and tolvaptan, ADH V2 receptor antagonists
312
Q

TREATMENT FOR ADH EXCESS

a historical cornerstone of treatment

A
  1. Restricting water intake to small amounts each day for ADH excess
313
Q

TREATMENT OF ADH EXCESS

approved for management of euvolemic hyponatremia due to ADH excess

A

Conivaptan and tolvaptan, ADH V2 receptor antagonists

[LECT] CC 2 - Finals (9 decks)

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