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ABSITE (EVAN) > Chapter 20: Pituitary > Flashcards

Chapter 20: Pituitary Flashcards

1
Q

Releases TRH, CRH, GnRH, GHRH, and dopamine into median eminence; passes through neurohypophysis on way to adenohypophysis

A

Hypothalamus

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2
Q

Inhibits prolactin secretion

A

Dopamine

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3
Q

Neurohypophysis

A

Posterior pituitary

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4
Q

Supraoptic nuclei, regulated by osmolar receptors in hypothalamus

A

ADH

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5
Q

Paraventricular nuclei in hypothalamus

A

Oxytocin

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6
Q

Does not contain cell bodies

A

Neurohypophysis

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7
Q

80% of pituitary gland

A

Anterior pituitary (adenohypophysis)

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8
Q

What does the anterior pituitary release?

A

ADH, TSH, GH, LH, FSH, PROLACTIN

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9
Q

Blood supply of anterior pituitary

A

Does not have its own direct blood supply; passes through neurohypophysis 1st (portal venous system)

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10
Q

Pituitary mass compressing optic nerve (CNII) at chiasm

A

Bi-temporal hemianopia

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11
Q

Almost always macro adenomas; present with mass effect and decreased ACTH, TSH, GH, LH, FSH. Tx: transsphenoidal resection

A

Nonfunctional tumors

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12
Q

Tx: nonfunctional pituitary tumors

A

Transsphenoidal resection

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13
Q

Contraindications to transsphenoidal approaches

A

Suprasellar extension, massive lateral extension, dumbbell-shaped tumor

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14
Q

Most pituitary tumors respond to…

A

Bromocriptine (dopamine agonist)

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15
Q
  • MC pituitary adenoma

- Mostly microadenomas

A

Prolactinoma

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16
Q

Tx: prolactinoma

A
  • Most patients do not need surgery
17
Q

When do symptoms occur with prolactinoma?

A

Prolactin is usually > 150 for symptoms to occur

18
Q

Galactorrhea, irregular menses, decreased libido, infertility

A

Prolactinoma

19
Q

Tx: prolactinoma

A

Bromocriptine (safe in pregnancy) or cabergoline (both are dopamine agonists) for most or transsphenoidal resection for failure of medical management

20
Q

When do you resect macroadenomas in prolactinoma?

A

Resection with hemorrhage, visual loss, wants pregnancy, CSF leak

21
Q

HTN, DM, gigantism; can be life-threatening secondary to cardiac symptoms (valve dysfunction, cardiomyopathy)
- Usually macroadenomas

A

Acromegaly (growth hormone)

22
Q

Dx: Acromegaly

A

Elevated IGF-1 (best test), growth hormone > 10 in 90%

23
Q

Tx: acromegaly

A

Octreotide or transphenoidal resection; XRT and bromocriptine can be used as secondary therapies

24
Q
  • Post partum trouble lactating (usually 1st sign)

- Can also have amenorrhea, adrenal insufficiency, and hypothyroidism

A

Sheehan’s syndrome

25
Q

What causes Sheehan’s syndrome?

A

Due to pituitary ischemia following hemorrhage and hypotensive episode during childbirth

26
Q

Tx: Sheehan’s syndrome

A

Hormone replacement

27
Q

Benign calcified cyst, remnants of Rathke’s pouch; grows along pituitary stalk to suprasellar location

A

Craniopharyngioma

28
Q

Most frequently presents with endocrine abnormalities, visual disturbances, headache, hypocephalus

A

Craniopharyngioma

29
Q

Tx: craniopharyngioma

A

Surgery to resect cyst

30
Q

Frequent complication s/p craniopharyngioma

A

Diabetes insipidus

31
Q

What to look for in bilateral pituitary masses?

A

Check pituitary axis hormones; if OK, probably metastases

32
Q
  • Occurs after bilateral adrenalectomy resulting in amenorrhea and visual problems (bi temporal hemianopia)
  • Hyperpigmentation
A

Nelson’s syndrome

Tx: steroids

33
Q

Why amenorrhea and visual problems in Nelson’s syndrome?

A

Bilateral adrenalectomy -> increased CRH causes pituitary enlargement resulting in amenorrhea and visual problems (bitemporal hemianopia)

34
Q

Why hyperpgimentation in Nelson’s syndrome?

A

Bilateral adrenelecotmy -> beta-MSH, a peptide byproduct of ACTH

35
Q

Adrenal gland hemorrhage that occurs after meningococcal sepsis infection, can lead to adrenal insufficiency

A

Waterhouse-Friderichsen syndrome

ABSITE (EVAN) (35 decks)

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