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CEP > Pituitary > Flashcards

Pituitary Flashcards

1
Q

What is the final common pathway by which signals from multiple signals can reach the anterior pituitary?

A

Hypothalamus

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2
Q

What is the hypothalamus regulated by?

A
  • Hormone mediated signals (negative feedback)
  • Neural inputs
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3
Q

What non-endocrine functions is the hypothalamus also involved in?

A
  • Temperature regulation
  • Food intake
  • Thirst
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4
Q

6 hormones released by hypothalamus affecting anterior pituitary

A
  • Growth hormone releasing hormone (GHRH)
  • Somatostatin (inhibitory)
  • Gonadotropin releasing hormone (GnRH)
  • Corticotropin releasing hormone (CRH)
  • Thyrotropin releasing hormone (TRH)
  • Dopamine (inhibitory)
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5
Q

What hormone(s) does GHRH trigger release of?

A

Growth hormone (GH)

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6
Q

What hormone(s) does somatostatin inhibit release of?

A

Growth hormone (GH)

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7
Q

What hormone(s) does GnRH trigger release of?

A
  • Follicle stimulating hormone (FSH)
  • Luteinising hormone (LH)
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8
Q

What hormone(s) does CRH trigger release of?

A

Adrenocorticotrophic hormone (ACTH)

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9
Q

What hormone(s) does TRH trigger release of?

A

Thyroid stimulating hormone (TSH)

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10
Q

What hormone(s) does dopamine inhibit release of?

A

Prolactin

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11
Q

What factor(s) is growth hormone stimulated by?

A
  • Hypoglycaemia
  • Exercise
  • Sleep
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12
Q

What factor(s) is/are growth hormone suppressed by?

A

Hyperglycaemia

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13
Q

Effects of GH

A
  • Linear growth in children
  • Acquisition of bone mass
  • Stimulates protein synthesis, lipolysis, glucose metabolism
  • Regulation of body composition
  • Psychological wellbeing
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14
Q

Primary effects of FSH and LH

A
  • Testosterone production in testes
  • Estrogen production in ovaries
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15
Q

Secondary effects of FSH and LH (males)

A
  • Penis and scrotum growth
  • Facial hair growth
  • Larynx elongates (lowers voice)
  • Shoulders broaden
  • Body, armpit and pubic hair growth
  • Musculature increases body-wide
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16
Q

Secondary effects of FSH and LH (females)

A
  • Breasts develop and mature
  • Hips broaden
  • Pubic hair grows
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17
Q

What is prolactin essential for?

A

Lactation

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18
Q

When do levels of prolactin increase?

A

Pregnancy and breast feeding

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19
Q

How does prolactin inhibit gonadal activity?

A

Central suppression of GnRH (thus decreased FSH/LH levels)

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20
Q

Effects of ADH

A
  • Primary physiological determinant of the rate of free water excretion
  • Augments the water permeability of the luminal membranes of cortical and medulla collecting tubes
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21
Q

Major stimuli for ADH secretion

A
  • Hyperosmality (high solute conc. in blood)
  • Effective circulating volume depletion
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22
Q

What does oxytocin stimulate?

A

Contraction of smooth muscle of breast and uterus

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23
Q

What does oxytocin have roles in?

A
  • Milk ejection reflex
  • Parturition (birth)
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24
Q

Major causes of hypopituitarism

A
  • Pituitary/parapituitary tumours
  • Radiotherapy
  • Pituitary infarction (apoplexy)
  • Infiltration of the pituitary
  • Trauma
  • Isolated hypothalamic releasing hormone deficiency
25
Q

Manifestations of GH deficiency

A
  • Children
    > Poor growth
  • Adults
    > Increased abdominal fat
    > Decreased lean body mass
    > Impaired lipid profile
    > Decreased muscle strength and exercise capacity
    > Impaired cardiac function
    > Decreased bone mineral density
    > Impaired psychological wellbeing
26
Q

How is GH deficiency diagnosed?

A

GH stimulation tests

27
Q

How is GH deficiency treated?

A

Hormone replacement

28
Q

Manifestations of FSH/LH deficiency

A
  • Children
    > Delayed puberty
  • Men
    > Decreased libido
    > Infertility
    > Decreased secondary sex features
    > Decreased muscle mass and strength
    > Decreased mood and wellbeing
    > Osteoporosis
    > Anaemia
  • Women
    > Decreased libido
    > Menstrual disorders
    > Infertility
    > Dyspareunia
    > Osteoporosis
    > Premature atherosclerosis
29
Q

How is FSH/LH deficiency diagnosed?

A
  • Measure FSH, LH and oestradiol levels and take menstrual history (female)
  • Measure FSH, LH and morning testosterone levels (male)
30
Q

How is FSH/LH deficiency treated?

A

Hormone replacement

31
Q

Manifestations of ACTH deficiency

A
  • Fatigue
  • Weakness
  • Nausea/vomiting
  • Anorexia
  • Weight loss
  • Hypoglycaemia
  • Hypotension
  • Anaemia
32
Q

How is ACTH deficiency diagnosed?

A
  • 9am serum cortisol and ACTH levels
  • Dynamic tests:
    > Short Synacthen test
    > Insulin tolerance test
    > Glucagon test
33
Q

How is ACTH deficiency treated?

A
  • Replace what is missing
  • Approximate natural rhythm
34
Q

Manifestations of TSH deficiency

A
  • Fatigue
  • Weakness
  • Cold intolerance
  • Bradycardia
  • Inability to lose weight
  • Puffiness
  • Pale and dry skin
  • Constipation
35
Q

How is TSH deficiency diagnosed?

A

Measure TSH, fT4 and fT3 levels

36
Q

How is TSH deficiency treated?

A

Hormone replacement

37
Q

What is central diabetes insipidus?

A

Deficient secretion of ADH

38
Q

Causes of central diabetes

A
  • Idiopathic (autoimmune destruction of hormone secreting cells)
  • Tumours
  • Neurosurgery or trauma
  • Infiltrative disorders
  • Infections
  • Hypoxic encephalopathy or severe ischaemia
39
Q

Manifestations of ADH deficiency

A
  • Polyuria of dilute urine
  • Polydipsia
  • Nocturia
40
Q

Major causes of polyuria

A
  • DM
  • Renal failure
  • Primary polydipsia
  • Diabetes insipidus
41
Q

How is ADH deficiency diagnosed?

A
  • Urine output
  • Osmolalities (plasma, urine)
  • Blood electrolytes/glucose/urea/creatinine
  • Water deprivation test
42
Q

How is ADH deficiency treated?

A

ADH analogues

43
Q

What is acromegaly?

A

Hypersecretion of GH

44
Q

How is acromegaly diagnosed?

A
  • Oral glucose tolerance test
  • IGF-I
  • Pituitary imaging
45
Q

How is acromegaly treated?

A
  • Pituitary surgery
  • Dopamine agonists
  • Somatostatin analogues
  • GH receptor antagonists
  • Radiotherapy
46
Q

What is prolactinoma?

A

Non-cancerous tumour of pituitary causing too much prolactin

47
Q

Manifestations of prolactinoma

A
  • Hypogonadism
  • Galactorrhoea
  • Mass effects
48
Q

How is prolactinoma diagnosed?

A
  • Exclude other causes of high prolactin
  • Pituitary imaging
49
Q

How is prolactinoma treated?

A
  • Dopamine agonists
  • Surgery
  • Radiotherapy
50
Q

What is Cushing’s Syndrome?

A

Cortisol hypersecretion

51
Q

How is Cushing’s diagnosed?

A
  • 24h UFC
  • Midnight serum or salivary cortisol levels
  • Overnight or low dose dexamethazone suppression test
52
Q

How is Cushing’s treated?

A
  • Pituitary surgery
  • Radiotherapy
  • Drugs
  • Bilateral adrenalectomy
53
Q

What is a TSHoma/FSHoma?

A

Pituitary tumour causes TSH/FSH hypersecretion

54
Q

Manifestations of TSHoma

A
  • Thyrotoxicosis (hyperthyroidism)
  • Mass effects
55
Q

How is TSHoma diagnosed?

A
  • Hormonal tests by experts
  • Pituitary imaging
56
Q

How is TSHoma treated?

A
  • Surgery
  • Medications
  • Radiotherapy
57
Q

Manifestations of FSHoma

A
  • Menstrual irregularities
  • Ovarian hyperstimulation
  • Testicular enlargement
  • Infertility
  • Mass effects
58
Q

How is FSHoma diagnosed?

A
  • Hormonal tests by experts
  • Pituitary imaging
59
Q

How is FSHoma treated?

A
  • Surgery
  • Radiotherapy

CEP (14 decks)

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