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Piuitary Gland Flashcards

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1
Q

What is hypothalamus pituitary system

A

Hypothalamus secretes hormones which stimulate the PG

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2
Q

Hormones secreted by anterior pituitary

A

ACTH
LH FSH
prolactin
TSH
GH

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3
Q

Hormones secreted from posterior pituitary

A

Oxytocin
Vasopressin (ADH)

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4
Q

Where is pituitary situated

A

Base of brain
Sella turcica

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5
Q

How is hypothalamus secretion regulated

A

Via hormone mediated signals (negative feedback)
Via neural inputs (ACh)

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6
Q

Which nuclei regulate endocrine functions

A

Paraventricular
Supraoptic
Ventromedial

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7
Q

Hypothalamus’ non endocrine functions

A

Regulation of body temp
Thirst
Food intake
Blood pressure

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8
Q

How is pituitary gland connected to hypothalamus

A

Infundibulum stalk

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9
Q

Which hypothalamus hormones relate to anterior pituitary gland hormones

A

GHRH - GH
GnRH - LH/FSH
CRH - ACTH
TRH - TSH
TRH + GnRH - prolactin

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10
Q

What is GH stimulated by

A

Hypoglycaemia
Exercise
Sleep

Supported by hyperglycaemia

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11
Q

How are the effects of GH mediated

A

IGF-1

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12
Q

What is the pattern of GH secretion

A

Released through out life
Pulsatile
Peaks when asleep

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13
Q

Function of GH

A

Linear growth in children
Acquisition of bone mass
Stimulate:
- Protein synthesis
- Lipolysis
- Glucose metabolism
Regulation of body composition
Psychological well-being

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14
Q

What happens to secretion of gonadotropins during puberty

A

Sensitising of hypothalamus and PG to negative feedback of gonadotropins decrease
So increase production of testosterone and oestrogen
Allows development of secondary sex characteristics

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15
Q

What does testosterone release cause

A

Spermatogenesis
Male secondary sec characteristics

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16
Q

What does oestrogen release cause

A

Folliculogenesis
Female sex secondary characteristics

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17
Q

Function of prolactin

A

Essential for lactation
Level increase pregnancy and breast feeding
Inhibits gonadal activity by suppressing GnRH
Can cause disease in excess

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18
Q

Function of ACTH

A

Promotes secretion of cortisol

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19
Q

Secretion pattern of ACTH

A

Pulsatile
High in morning
Drops throughout day
When sleeping cortisol undetectable

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20
Q

Where is ADH synthesised

A

In supraoptic and paraventricular nuclei of hypothalamus

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21
Q

What kind of hormone is ADH

A

Peptide hormone

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22
Q

How is ADH transmitted to posterior pituitary gland

A

Migrate via axons of the supraopticohypophyseal tract into posterior lobe

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23
Q

Function of ADH

A

Primary physiological determinant of the rate of free water excretion
Augments the water permeability of luminal membranes of cortical and medullary collecting tubules
Via V2 receptor (kidney)
Retains water and decreases water excretion

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24
Q

What are the major stimuli for increased secretion of ADH

A

Hyperosmolality - thick blood
Effective circulating volume depletion

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25
Function of oxytocin
Stimulates contraction of smooth muscle of breast and uterus Under positive feedback More contraction = more oxytocin Roles in: milk ejection reflex and birth
26
What is synthetic oxytocin used for your
Inducing labour
27
Main effects of parasellar (located around sella turcica) lesions
Neurological Visual Hypopituitarism
28
Most common pituitary lesion
Pituitary adenoma
29
How visual defects are caused
Pressure on optic nerve/ optic chiasm
30
Neurological/ visual effects due to pituitary lesion
Headaches Brain damage Cranial nerve damage - III, IV, V, VI (in cavernous sinuses) CFS leak
31
How can peripheral visual fields be compromised due to pituitary lesion
Impinges on medial nerves Medial nerves cross over at optic chiasm So pressure on optic chiasm causes temporary loss of peripheral vision
32
Major causes of hypopituitarism
Pituitary tumours Radiotherapy Pituitary infatction (apoplexy) - death of area of PG Infiltration of PG Trauma Isolated hypothalamic releasing hormone deficiency
33
Manifestations of GH deficiency
Children: poor growth Adults: increases abdominal fat, decreases lean body mass Impaired lipid profile Decreases muscle strength and exercise capacity Impaired cardiac function Decreases bone mineral density Impaired psychological well being
34
How to diagnose GH deficiency
Tests: ITT - insulin tolerance test. Make patient hypoglycaemic. Stimulates GH. Record GH levels. Glucagon GHRH + Arginine Measure IGF-1
35
What is IGF-1
Mediates the secretion of GH
36
Treatment for GH deficiency
Hormone replacement: Recombinant human GH Injection at night- mimics physiology. GH high at night.
37
Manifestations of FSH/ LH deficiency in men
Men: decrease libido, infertility, loss secondary sex features, decrease muscle mass, decrease mood and wellbeing, osteoporosis and anaemia
38
Manifestations of FSH/ LH deficiency in children
Children: delayed puberty
39
Manifestations of FSH/ LH deficiency in women
Decrease libido, menstrual disorders, infertility, dyspareunia (painful intercourse), osteoporosis, premature atherosclerosis (narrowing arteries)
40
How FSH/ LH deficiency is diagnosed
Females: FSH LH oestradiol (menstrual history) Males: FSH LH and morning (afternoon not representative) testosterone
41
Treatment for FSH LH deficiency
Hormone replacement Oestrogen and progesterone Testosterone
42
Manifestations of ACTH deficiency
Fatigue Weakness Nausea/ vomiting Anorexia Weight loss Hypoglycaemia - corticosteroids are insulin antagonist Hypotension Anaemia
43
Diagnosis of ACTH deficiency
9.00am serum cortisol and ACTH levels Dynamic tests: Short synathen test - synthetic ACTH test see if cortisol is secreted Insulin tolerance test - cause hypoglycaemia. Stress induces cortisol. Glucagon test
44
ACTH deficiency treatment
Replace what is missing (steroids) No need for aldosterone replacement - not regulated via ACTH/ HPA
45
Manifestations of TSH deficiency
Fatigue Weakness Cold intolerance Bradycardia Weight gain Puffiness Pale + dry skin Constipation
46
Diagnosis of TSH deficiency
Serum TSH Serum T3 Serum T4 levels
47
Treatment for TSH deficiency
Hormone replacement (levothyoxine)
48
What is central diabetes insipidus
Deficient secretion of ADH
49
Causes of ADH deficiency
1. Idiopathic (autoimmune destruction) 2. Familial Mutations 3. Tumours 4. Neurosurgery or trauma 5. Infiltrative disorders 6. Infections 7. Hypoxia encephalopathy or severe ischaemia
50
Manifestations of ADH deficiency
Water not retained in kidneys so more urine passed Polyuria (output >3L/ day and 2L/day for children) Polydipsia Nocturia
51
Major causes of Polyuria in common clinical practice
Osmotic diuresis: Diabetes mellitus Renal failure Primary polydipsia Diabetes insipidus
52
Diagnosis of ADH deficiency
Measure Urine output Osmolalities (plasma, urine) Blood electrolytes Glucose Urea Creatinine Kidney function Water deprivation test - derive patient of fluid In normal patient urine would be low
53
Treatment of ADH deficiency
ADH analogues
54
Two types of pituitary adenomas
1. Pressurises optic pathway 2. Benign that hypersecretes hormones
55
What does hypersecretion of GH cause
Acromegaly
56
How to diagnose acromegaly
Oral glucose test- hyperglycaemia suppresses GH IGF-1 - marker of GH secretion Pituitary imaging - identify where GH secreting tumour is
57
Treatment of acromegaly
Pituitary surgery Medical treatment - dopamine agonists - somatostatin analogues - GH receptor antagonists Radiotherapy - radiate tumour
58
What is a prolactinoma
Benign tumour secreted excess prolactin
59
Manifestations of prolactinoma
Hypogonadism - prolactin inhibits GnRH Galactorrhoea - breast discharge Mass effects
60
Diagnosis of prolactinoma
Exclude other causes of prolactin Pituitary imagining
61
Treatment of prolactinoma
1. Medical treatment Dopamine agonists 2. Surgery 3. Radiotherapy
62
Diagnosis of Cushing’s syndrome
ACTH dependant - cushings disease: pituitary adenomas - ectopic tumours ACTH Independent - adrenal disease Latrogenic: Exogenous steroids
63
Diagnosis of Cushing’s syndrome
24hr Urinary free cortisol Midnight serum/ salivary cortisol - levels should be undetectable Low dose dexamethasone suppression test
64
Diagnosis of cushings disease
9.00am ACTH - if ACTH dependant then ACTH will be elevated High dose dexamethasone suppression test CRH test Imaging (pituitary, ectopic so may be lungs)
65
Management of cushings
Pituitary surgery Radiotherapy Drugs Bilateral adrenalectomy
66
What hormones does the placenta produce
Oestrogen Progesterone

CEP (12 decks)

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