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21 Cards in this Set

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Embryologic origin of the pituitary

Remnant can give rise to what mass?
Downgrowth of the diencephalon gives rise to the posterior pituitary and rathke's pouch (up from roof of developing mouth) gives rise to anterior pituitary

Craniopharyngioma- bitemporal hemianopsia
Prolactin secretion- stimulated by? Inhibited by?
TRH & VIP, just tonically inhibited by dopamine (at D2 receptors)
First indicator of pituitary function (measured first)?
Prolactin
Growth hormone- stimulated by? Inhibited by?
GHRH (produced by hypothalamus)
Inhibited by SRIF=somatostatin (also hypothal)
What is the role of CRH?
Produced by hypothalamus, acts at the corticotrophs in the anterior pituitary and stimulates ACTH production.
What does GH do?
Goes to liver & stimulates production of insulin like growth factor 1 (thru JAK/STAT pathway) --> bone growth. Binds receptors & stimulates MAPK/ERK pathway--> proliferation of chondrocytes.
Result of a CRH test in a person with Cushing's disease? Ectopic ACTH?
CD- pituitary tumor makes tons of ACTH (has CRH receptor)

Ectopic ACTH production- seen in some lung masses, CRH dose will not change as much.
Therapy for Kallman syndrome?

For GH adenoma?

For thyroid cancer?
GnRH

Somatostatin

hrTSH (long T1/2)
Congenital hormone deficiency- what gene is mutated? Deficiency in what?
PROP-1

PRL, GH, TSH

ACTH, LH, FSH levels ARE FINE!
Androgen insensitivity syndrome. What is happening?
Genotypically XY, phenotypically XX

Cells make testosterone but cannot bind receptors (therefore it is aromatized to estrogen) --> female sex characteristics They have masses (undescended testes)
Causes of hyperprolactinemia?
ESTROGEN- Pregnancy, oral contraceptives

Hypothyroidism, medications (neuroleptics, TCAs, cocaine)
Most commonly elevated hormone in a pituitary adenoma?
Prolactin
Describe prolactinomas in males. Females
Males- macroadenoma, mass effect,
SUPER HIGH prolactin levels

Females- microadenoma, oligomenorrhea/amenorrhea, galactorrhea, elevated prolactin levels (not as high as males)
Treatment of prolactinomas
Dopamine agonists (since DA inhibits prolactin release)- cabergoline, bromocriptine. Decrease tumor size by 80%, restore visual field

Macro- meds FOR LIFE
Micro- may be able to discontinue meds
Non-functional adenoma
Mass effect, incidentaloma

May have normal FSH, LH (or producing inactive FSH/LH)
What is the result of a glucose tolerance test in a person with acromegaly?
They have a harder time suppressing a glucose load. GH is gluconeogenic and the glucose levels remain elevated for a longer time.
Long term effects of acromegaly

Treatment
Cardiac probs (CHF), malignancy (colon & breast CA)

Gamma knife radiation, somatostatin analog (decrease GH), pegvisomant (GH analog/antagonist)
Pituitary apoplexy

What causes it?
Sheehan's syndrome- infarct of pituitary after pregnancy

Pituitary grows during pregnancy (outgrows pituitary blood supply)
Mom notices failure to lactate, hypotension, fatigue, arthritis
What is empty sella syndrome
Dura covering sella turcica is incompetant, sella becomes filled with CSF
Main symptoms of pituitary apoplexy

Endocrine deficiencies following apoplexy
Headache, visual disturbance, ocular palsies

GH deficiency, hypogonadism, acute adrenal insufficiency
Which hormones are produced in lateral pituitary?

Which hormones are produced in central pituitary?
GH, PRL

ACTH, TSH