Normal pituitary function and disease

Question 1

How is the anterior pituitary connected to the hypothalamus

Answer 1

Vasular connections

Question 2

How is the posterior pituitary connected to the hypothalamus

Answer 2

Neural connections

Question 3

What would be the consequence of damage to the pituitary stalk

Answer 3

Releasing factors from the hypothalamus can’t reach the pituitary to stimulate release of stuff from pituitary

Question 4

What is the pituitary stalk

Answer 4

Connects the hypothalamus to the pituitary

Question 5

What is hypo secretion of the pituitary normally due to

Answer 5

Trauma/surgery, genetic disease, tumour

Question 6

What is hyper secretion of the pituitary most likely due to

Answer 6

Tumour

Question 7

What is the most common cause of pituitary disease

Answer 7

Pituitary tumours. MOStly benign (adenoma)

Question 8

How can pituitary tumours affect the pituitary gland

Answer 8

Over production of a pituitary hormone

Inadequate production of other remaining hormones

Local effects on anatomically related structures (visual disturbances, headaches)

Question 9

What is prolactinoma

Answer 9

tumour of pituitary gland that makes the tumour secrete more prolactin

Question 10

What is a consequence of prolactinoma

Answer 10

HYperprlactinaemia

Question 11

What are the consequence s of GH- secreting pituitary tumours

Answer 11

Acromegaly (increase in bone size)

Gigantism in children

Question 12

What is the consequence of an ACTH secreting pituitary tumour

Answer 12

Cushing’s disease

Question 13

What are the consequences of non-secreting pituitary hormones

Answer 13

Mechanical symptoms such as headaches and hypopituitarism

Question 14

When are stimulation tests done

Answer 14

IF you suspect hypo secretion

Question 15

When are suppression tests done

Answer 15

If you suspect hyper secretion

Question 16

What is a test done to see if there is secondary hypothyroidism

Answer 16

TRH stimulation test

Question 17

What is the TRH stimulation test and what results would you expect in a normal response

Answer 17

TRH given

Increase in TSH and an increase in T3/T4

Question 18

What would you expect in a TRH stimulation test with secondary hypothyroidism

Answer 18

Low T3/4 and TSH due to deficient TSH release from anterior pituitary

Question 19

In a TRH test, what does a failure to stimulate TSH/T4 suggest

Answer 19

Deficiency of TSH

Question 20

What suppression test is used to measure acromegaly

Answer 20

Oral glucose tolerance test- high plasma glucose usually suppresses GH release

failure to lower GH secretion suggests a GH tumour

Question 21

What does a failure to suppress indicate

Answer 21

autonomous secretion (

Question 22

What is a normal response in the oral glucose tolerance test when testing for acromegaly and therefore what is an abnormal response

Answer 22

There is an increase in plasma concentration of glucose and a decrease in growth hormone

-Autonomous secretion of GH from tumour cells which are independent of normal control process. Lack of suppression with high glucose

Question 23

What is the difference between a macroadenoma and micro adenoma

Answer 23

Macroadenoma >10mm

microadenoma <10mm

Question 24

What is a potential side effect of using surgery or radiotherapy to manage pituitary disease

Answer 24

Hypopituitarism and damage to optic pathways

Question 25

What is the preferred method treatment for most pituitary tumours (and types)

Answer 25

surgery - craniotomy (through the skull above the eye - Trans-sphenoidal-through the nose

Question 26

Causes of hyperprolactinaemia

Answer 26

Prolactinoma (prolactin secreting tumour) Damage to pituitary stalk and loss of inhibitory influence of hypothalamic dopamine

Question 27

Symptoms of hyperprolactinaemia

Answer 27

Loss of fertility/libido, galactorrhea (milky discharge from breast tissue) gynaecomastia (proliferation of breast tissue)

Question 28

What is the role of prolactin

Answer 28

Stimulates mammary glands to produce milk Promotes growth and development of breasts

Question 29

How does prolactin cause reduction in reproductive function

Answer 29

It decreases GnRH release Which in turn decreases LH and FSH release And in turn that decreases sex hormones

Question 30

What drug is used to treat a hyperprolactinaemia and how does it work

Answer 30

Dopamine receptor agonists Inhibit prolactin secretion and shrunk tumour (surgery/radiotherapy considered with tumours resistant to drug therapy)

Question 31

What is the most common cause of acromegaly

Answer 31

GH secreting tumour

Question 32

What is acromegaly

Answer 32

Bone density increases. Coarsening of facial features and enlarged hands and feet

Question 33

Symptoms of acromegaly

Answer 33

Headaches, vision disturbance, sleep apnoea, general tiredness Hypertension, cardiomegaly Glucose intolerance (diabetes) Irregular or loss of periods Impotence in males

Question 34

How can dentists detect acromegaly early

Answer 34

As lower jaw enlarges, gaps appear between teeth

Question 35

Treatment for acromegaly

Answer 35

Surgical removal of tumour, radiotherapy in some

Question 36

Drug therapy for acromegaly

Answer 36

Somatostatin (inhibit GH release) If somatostatin is not effective, use bromocriptine (dopamine receptor agonist)

Question 37

What causes Cushing's syndrome

Answer 37

Excessive glucocorticoid activity ACTH-secreting anterior pituitary tumour

Question 38

Treatment of cushings syndrome

Answer 38

Surgical removal

Question 39

What is pan-hypopituitarism

Answer 39

Deficiency of all pituitary hormones

Question 40

What can cause damage pituitary stalk

Answer 40

Severe head trauma

Question 41

What can GH deficiency lead to

Answer 41

Stunted growth in childhood

Question 42

What can TSH deficiency lead to

Answer 42

secondary hypothyroidism

Question 43

What can ACTH deficiency lead to

Answer 43

Secondary adrenal insufficiency

Question 44

What can ADH deficiency lead to

Answer 44

Diabetes insipidis

Question 45

What can a Ganadotropin (LH/FSH) deficiency lead to in a young and adult patient -And treatment

Answer 45

Young- lack of sexual development (delayed puberty) adult- infertility Hormone therapy