Term
| Where does hypothal release its hormones/what path do they take? |
|
Definition
released into median eminence->
-through Neurohypophysis (post pit) to the adenohypophysis (ant pit) |
|
|
Term
| what are the nuclei leading to the post pit? |
|
Definition
surpaoptic and paraventriular nuclei
-axons extend from these (in hypothal) to post pit
-no cell bodies in the post pit itself |
|
|
Term
| Hormones secreted by post pit? |
|
Definition
|
|
Term
| Which nuclei control which post pit hormones? |
|
Definition
supra-optic --> ADH (osmolar regulation from the hypothal)
paraventricular-->Oxytocin |
|
|
Term
Dibetes insipidus
-basic lab/clinical trends? |
|
Definition
-Inc UOP, inc serum Na and serum Osmolality
-dec Urine spec grav (dilute urine)
--->tx with DDAVP and free water |
|
|
Term
|
Definition
| DDAVP and free water (slow Na correction to avoid cerebral edema) |
|
|
Term
SIADH
-basic lab /clinical trends? |
|
Definition
| dec UOP, dec serum Na/osmolality (decreased and concentrated urine) |
|
|
Term
| SIADH initial treatment options? |
|
Definition
1st line = Water restriction
..then diuresis..then hypertonic saline
(if sxs from hypoNa, skip diuresis and go to hypertonic saline) |
|
|
Term
| what are the names of the ADH inhibitors and where do they act? |
|
Definition
-Conivaptan = ADH inhibitor @ V1 and V2
-->aguaresis (water removal without electrolyte loss)
-Demeclocycline = ADH inhib @ collecting ducts |
|
|
Term
| what part of pituitary is largest? |
|
Definition
| Adenohypophysis = anterior = 80% of gland |
|
|
Term
| what are the ant pit hormones? |
|
Definition
FLAT PiG
FSH, LH, ACTH, TSH - PRL, (i), GH |
|
|
Term
| What provides ant pit blood supply? |
|
Definition
has portal system (no direct blood supply)
-blood passes thru post pit first |
|
|
Term
| visual problems 2/2 pit mass = |
|
Definition
bitemporal hemianopsia
-compression of optic nerve (CN 2) at the chiasm |
|
|
Term
Non-functional pituitary tumors
-MC?
-Sx?
-Tx? |
|
Definition
MC = macro-adenomas
Sx = mass effect w/dec FSH/LH/ACTH/TSH, GH
Tx = trans-sphenoidal resection |
|
|
Term
| Contra-indications to trans-sphenoidal tumor resection? |
|
Definition
-supra-cellar (dumbbell shaped) extension
-massive lateral extension |
|
|
Term
| what tumor types can bromocriptine be used to tx? |
|
Definition
| All pituitary endocrine secreting tumors EXCEPT ATCH secreting |
|
|
Term
| what anatomic location is the pituitary in? |
|
Definition
|
|
Term
|
Definition
| Prolactinoma (~micro-adeneoma) |
|
|
Term
|
Definition
usually microadenoma
-amen, galactorrhea, infertility, dec libido, visual problems |
|
|
Term
|
Definition
elevated prolactin (>150)
MRI/visual field testing |
|
|
Term
|
Definition
Most do NOT need surgery
-asympt micro-adenoma ==> follow w/MRI
-symptoms OR macroadenoma ==> bromocriptine > surg > XRT |
|
|
Term
|
Definition
Dopa agonist
-safe with preg
-85% success vs prolactinoma |
|
|
Term
| micro vs macro adenoma cut off? |
|
Definition
|
|
Term
| Indications for surgery vs prolactinoma? |
|
Definition
failed medical mgmt
hemorrhage
visual loss
wants preg
CSF leak |
|
|
Term
|
Definition
| GH stims insulin-like growth factor-1 |
|
|
Term
|
Definition
| GH secreting macro-adenoma (higher remission if micro-adeno) |
|
|
Term
|
Definition
| jaw enlargement, HAs, inc soft tissue, HTN, macroglossia, amen, DM, giganticism, visual problems |
|
|
Term
| life-threatening issues with acromegaly? |
|
Definition
| cardiac ==> valve dysfunction, cardiomyopathy |
|
|
Term
|
Definition
-inc IGF-1 level (CANNOT use random GH level )
-oral glucose tolerance test = failed GH supression < 2 ng/mL by 2 hours)
-MRI |
|
|
Term
|
Definition
1st line = surgery if not invading surrounding tissue
-octreotide, bromocriptine (via dec GH production)
-Pegvisomant (GH receptor antagonist)
-XRT |
|
|
Term
| risk of acromegaly without tx? |
|
Definition
3x mortality
pituitary insufficiency
colon CA |
|
|
Term
|
Definition
GH receptor antagonists
-acromegaly tx |
|
|
Term
Sheehan's syndrome
-pphys
-presenting sign? |
|
Definition
-pituitary ischemia after child-birth 2/2 hypovolemia/shock/hem
-->usually only ant pit affected due to portal venous BSupp
--1st sign = failure to lactate (+/- amen, adrenal insuff, hypothy) |
|
|
Term
Craniopharyngioma
def =
sxs |
|
Definition
benign
calcified cyst near ant pit (remnant of Rathke pouch)
-sxs = ha, growth failure, bi-temp hemianiopia, hydroceph, endocrine abn |
|
|
Term
|
Definition
surgery
xrt
--MCCx post -op = Diabetes insipidus |
|
|
Term
pt has bilateral, non-endocrine secreting pit tumors
-dx? |
|
Definition
|
|
Term
Nelson's syndrome
def/pphys |
|
Definition
pituitary enlargement after bilateral adrenalectomy
-2/2 inc CRH, usually from pre-existing adenoma |
|
|
Term
|
Definition
amen, bi-temp hemianopia, hyperpig from MSH, weakness,
-tx with steroids |
|
|
Term
| pphys of hyperpigmentation with some pituitary tumors? |
|
Definition
MSH (melanocyte stimulating hormone)
= peptide byproduct of ACTH |
|
|
Term
Craniopharyngioma
def =
sxs |
|
Definition
benign
calcified cyst near ant pit (remnant of Rathke pouch)
-sxs = ha, growth failure, bi-temp hemianiopia, hydroceph, endocrine abn |
|
|
Term
|
Definition
surgery
xrt
--MCCx post -op = Diabetes insipidus |
|
|
Term
pt has bilateral, non-endocrine secreting pit tumors
-dx? |
|
Definition
|
|
Term
Nelson's syndrome
def/pphys |
|
Definition
pituitary enlargement after bilateral adrenalectomy
-2/2 inc CRH, usually from pre-existing adenoma |
|
|
Term
|
Definition
amen, bi-temp hemianopia, hyperpig from MSH, weakness,
-tx with steroids |
|
|
Term
| pphys of hyperpigmentation with some pituitary tumors? |
|
Definition
MSH (melanocyte stimulating hormone)
= peptide byproduct of ACTH |
|
|
Term
Craniopharyngioma
def =
sxs |
|
Definition
benign
calcified cyst near ant pit (remnant of Rathke pouch)
-sxs = ha, growth failure, bi-temp hemianiopia, hydroceph, endocrine abn |
|
|
Term
|
Definition
surgery
xrt
--MCCx post -op = Diabetes insipidus |
|
|
Term
pt has bilateral, non-endocrine secreting pit tumors
-dx? |
|
Definition
|
|
Term
Nelson's syndrome
def/pphys |
|
Definition
pituitary enlargement after bilateral adrenalectomy
-2/2 inc CRH, usually from pre-existing adenoma |
|
|
Term
|
Definition
amen, bi-temp hemianopia, hyperpig from MSH, weakness,
-tx with steroids |
|
|
Term
| pphys of hyperpigmentation with some pituitary tumors? |
|
Definition
MSH (melanocyte stimulating hormone)
= peptide byproduct of ACTH |
|
|
