20 Pituitary

Question 1

Hypothalamus releases:

Answer 1

TRH, CRH, GnRH, GHRH, dopamine
Released into the median eminence
Passes through neurohypophylsis on way to adenohypophysis

Question 2

Dopamine

Answer 2

Inhibits prolactin secretion

Question 3

Posterior pituitary

Answer 3

Neurohypophysis
ADH, oxytocin
Does not contain cell bodies

Question 4

ADH

Answer 4

Supraoptic nuclei

Regulated by osmolar receptors in hypothalamus

Question 5

Oxytocin

Answer 5

Paraventricular nuclei in hypothalamus

Question 6

Anterior pituitary

Answer 6

Adenohypophysis
Releases ACTH, TSH, GH, LH, FSH and prolactin
Does not have its own direct blood supply - passes through neurohypophysis (portal venous sustem)

Question 7

Bi-temporal hemianopia

Answer 7

Pituitary mass compressing optic nerve at chiasm

Question 8

Non-functional tumors

Answer 8

Macroadenoma
Mass effects and decreased ACTH, TSH, GH, LH, FSH
Tx: Transsphenoidal resection

Question 9

Contraindications to transsphenoidal approaches

Answer 9

Suprasellar extension
Massive lateral extension
Dumbbell-shaped tumor

Question 10

Medical treatment for pituitary tumors?

Answer 10

Bromocriptine (dopamine agonist)

Question 11

Prolactinoma

Answer 11

Microadenoma
Requires >150 for symptoms
Sx: galactorrhea, irregular menses, decreased libido, infertility
Tx: bromocriptine, cabergoline, surgery for failure of medical managment

Question 12

What is the most common pituitary adenoma?

Answer 12

Prolactinoma

Question 13

Prolactinoma in pregnancy - medical treatment?

Answer 13

Bromocriptine

Question 14

When do you resect macro prolactinoma?

Answer 14

Hemorrhage
Visual loss
Wants pregnancy
CSF leak

Question 15

Acromegaly

Answer 15

Excess GH
Sx: HTN, DM, gigantism, cardiac symptoms
Dx: elevated IGF-1, GH >10
Tx: Octreotide or transshenoidal resection XRT and bromocriptine

Question 16

Sheehan’s syndrome

Answer 16

Post-partum trouble lactating
Sx: amenhorrhea, adrenal insufficiency, hypothyroidism
Due to intrapartum pituitary ischemia
Tx: hormone replacement

Question 17

Craniopharyngioma

Answer 17

Benign calcified cyst, remnants of rathke’s ouch, grows along pituitary stalk to suprasellar location
Sx: endocrine abnormalities, visual disturbances, HA, hydrocephalus
Tx: Surgical resection

Question 18

Post-op complication of craniopharyngioma resection?

Answer 18

Diabetes insipidus

Question 19

Bilateral pituitary masses - workup?

Answer 19

Check pituitary axis hormones.

If okay - probably mets

Question 20

Syndrome that occurs after bilateral adrenalectomy?

Answer 20

Nelson’s syndrome
Increased CRH cause pituitary enlargement - amenhorrhea and bi-temporal hemianopia
Also increased B-MSH - hyperpigmentation
Tx: Steroids

Question 21

Adrenal insufficiency secondary to hemorrhage?

Answer 21

Waterhouse-Frederichsen syndrome

Associated with meningococcal sepsis