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58 Cards in this Set
- Front
- Back
where is the pit found
what is the ant pit made from what is the post pit made from |
sella turcica in the sphenoid
Ant Pit: adenophyophysis rathkes pouch epithelial derivation, portal system Post Pit: neurohypothysis hypothalamis stalk neurotissue oxytocin and ADH |
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explain the differneces int eh ant and post pit
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ant pit is epithelial derived from rethekes pouch, its associated with the portal system. secreted more hormones
post pit is neuro tissue adn secretes only ADH and oxytocin |
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which part of pit is derived from rathke pouch, epithelium, portal system
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anterior
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how do somatostatin and dopamine act on the pit
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somatostatin: inhibits GH and TSH
dopamine: inhibits TSH and prolactin |
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if dopamine is inhibited what happens? how can this happen
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dopamine inhibits prolactin, if dop is not there then there is hyperprolactinemia
**dopamine can be blocked by the "stalk effect" if there is a compression of the stalk dopamine cant get to pit to block prolactin |
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what 2 hormones from distant sites act on the hypothalamus adn pit
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ACTH and Cortisol from the adrenals
ACTH: blocks ant pit Cortisol: blocks pit AND hypothalamus |
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A new mother calls her obstetrician to say that she is having trouble breast feeding. She is unable to produce enough milk to sate her baby
even though her breasts are aching with stored milk. Which medication can be prescribed to aid in milk letdown? a) ADH; b) HCG c) oxytocin; d) somatostatin e) somatomedans |
**oxytocin from post pit
**keep in mind hormones from the post pit (oxytocin ADH) are made in hypothalamus and stored in pit |
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most common pituitary hormone excess is caused by what
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pit adenoma
most are just solitray lesions, but 3% are associated with MEN |
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what type of pit adenoma is more likely to be silent a macro or micro
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macro
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are pit carcinomas common
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nope, adenomas are common
adenomas cause over production of hormones |
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in MEN1 there is an inactivating mutation og what...
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MEN1 gene product, menin, it regulates transcription
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a macroadenoma is what size?
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>1 cm
*no hormones usually *shows enlarged sella turcica Sx include BiTemporal hemianopsia, increased intracranial pressure |
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A 55 y/o male presents with decreasing vision
over the last few months. He sees “spots” in his temporal fields and his optometrist discovered that he had some visual field defects. • He is occasionally tired but denies decreased libido or beard growth. He denies polyuria or polydipsia. • An MRI shows a 3 x 2 cm pituitary tumor what is the deal? what lab tests do you order? |
>1 cm, macroadenoma, super common to have visual field defects and no hormonal changes
LABS: TSH, Free T4, cortisol, testosterone, prolactin **THE PROLACTIN IS WHOPPING, its a prolactinoma, not common in a macro tx w/bromocriptine |
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whats the most common pit adenoma? what are the sx
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prolactinoma.
sx: amenorrhea, gealctorrhea, loss of libido, infertility |
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• A 20 y/o female c/o bilateral galactorrhea for for 1 yr. with oligomenorrrhea. She has had mildly blurred vision for 2 months; there is no diplopia. She has never been pregnant.
• Visual confrontation testing was normal. • Visual fields showed minimal bitemporal defect. Serum prolactin was 49 ng/mL (1.4‐15). MRI revealed and 8mm microadenoma with no extrasellar extension. |
prolactinoma- super common pit adenoma. treat with a domanime agonist (recall dopamine inhibits prolactin) like bromocriptine
temporal defects common in macro >1cm |
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A 38 y/o female was found to have a goiter
(enlarged thyroid) at age 28; she was placed on levothyroxine; goiter believed to be nontoxic. Over the past year she has noticed an increase in shoe size from 6 1/2 to 8 and a weight increase from 125 to 160#. • Menstruation stopped 1 year ago. A ring had to be cut from her finger. She c/o of persistent numbness and tingling in her hands, especially at night as well as an increase in acne and excessive snoring at night. • Physical examination revealed a large but not obese woman 64 in. tall, 165#. There was diffuse thyromegaly. Physical exam, continued. Her face demonstrated thickening of the nasolabial folds and prominence of suprorbital ridge. Features were strikingly more coarse when compared with a photograph from 10 years earlier. Hands and feet had a flabby, “rubbery” consistency. |
acromegaly- increased GH
*prominant face, big fingers, IGF increased |
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what is a somatotroph adenoma
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secretes GH, 2 most common (prolactin is most). GH and IGF are increased
Acidophilic adenoma- the acidophiles make GH |
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aciophilic cells in the pit secrete what?
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GH
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what does sugar level have to do with GHRH release
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hypoghycemia --> GHRH release
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giantism is a result of what
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somatotroph pit adenoma- GH secretion.
excess GH in kids makes them grow. all organs are enlarged |
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acromegaly
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excess GH in an adult (somatophroph adenoma)
*big fingers, thyroid, heart, kidney, liver, adrenals enlarge (in giantism ALL organs enlarge) ** |
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what are some of the downside complications associated with somatotroph adenoma
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1. hyperglycemia/DM
2. osteoperosis 3. HTN 4. GONADAL dysfx *CHF 6. hyperprolactin **this is why ppl shouldnt take exogenous GH |
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is adenoma a hyper or hypo fx of the pit
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can be either
most common: 1. prolactin increase 2. GH increase |
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A 43 y/o woman presented with type 2 diabetes
mellitus. HbA1c was 12% (normal <6%) and glucose levels had been above 400mg/dl for 3 months despite therapy with insulin. • The patient’s jaw protruded with teeth that had become wide‐spaced. The patient’s daughter stated that her mother’s appearance started to change shortly after diabetes was diagnosed 3 years earlier. Her hands were large with sweaty palms; feet showed soft tissue thickening of the soles. • She had no visual symptoms or headache. • GH 55ng/mL (0‐5) Insulin‐like growth factor‐1 >1000 (90‐360) • MRI showed a macroadenoma eroding the wall of the sella turcica. • Patient refused surgery, was treated with octreotide and cabergoline; died in 6m of CHF |
its a GH secreting tumor- somatotroph
all of the excess GH --> DM and hyperglycemia |
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acromegaly is assocaited with what phenotypic features
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protrude jaw/malocclusion
skin tags (fibroepithelial polyps) DM big fingers, toes forehead prominant enlarged sella |
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A 36 y/o woman presents to the physician with
amenorrhea. She reports an increase in her ring and shoe sizes over the past year, increased sweating and increased fatigue. PE is remarkable for BP of 150/90 mmHg and coarse facial features with mild macroglossia. Should she refuse surgery, which of the following medications is most appropriate pharmacotherapy |
ita a GH secreting tumor- GH is inhibited by somatostatin
tx with somatostatin |
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A 45 y/o man comes to his primary care
physician complaining of back pain. On questioning, the patient indicates a recent history of polyuria, polydipsia, hypertension and weight gain. X‐ray of the spine shows an L4‐5 compression fracture. Which of the following is most likely to be elevated in this patient not the normal DM- compression fracture means we might be having a GH secreting adenoma A) Cortisol B) Glucagon C) Growth hormone D) Insulin E) Thyroxine |
GH
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what is a corticotroph adenoma
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excess cortisol--> cushings DISEASE
basophiles, hyperpigmentation |
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what is the morph, stain of a corticotroph adenoma
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basophiles
recall acidophiles were GH |
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whats nelsons syndrome
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adrenal insuffiency with hyperpigmentation
no adrenals but have pit tumor that makes ACTH |
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what are the sx of cushings
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redistribution of fat- central obesity
stria mm wasting easy bruise hypertension hyperglycemia osteoperosis |
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This 37 year old woman presented with a 9 kg
weight gain over 2 years, new hypertension, secondary amenorrhea, hirsutism, emotional lability and central distribution of fat. • Serum cortisol and ACTH were increased. • An MRI showed an intrasellular microadenoma. • Transsphenoidal surgery was performed second picture is 6 months later. • Dx? |
Dx- corticotroph adenoma of the pit
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gonadotroph adenomas
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large, local sx
hyperfx is rare |
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thyrotroph adenoma
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rare, make THS
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What are the frequency and consequences of
nonfunctioning adenomas and of carcinoma |
non fx adnoma are about 25% of pit tumors
Carcinoma- rare, non fx |
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A 42 y/o male in previously good health presented
to his physician for evaluation of headache and “problems seeing.” Headaches developed over 1 year, were worse while reclining. Aspirin and acetominophen provided relief for six months but were ineffective during the past 6 months. He had developed “blind spots” involving his lateral fields of vision, particularly on the right side. Physical exam showed blurring of the optic discs. An asymmetrical, bitemperal visual field deficit was present, involving the right visual field more than the left. CT and MRI scans revealed a large midline mass with erosion of the sella turcica. The mass extended into the suprasellar space and into the right cavernous sinus. Lab: Prolactin 90 ng/ml (normal <14). A biopsy was taken followed by neurosurgical excision. The mass was resected as completely as possible. It obliterated the lateral walls of the sella turcica, compressed the optic chiasm and extended into the cavernous sinuses. There was a monomorphous population of cells |
sounds liek a pit CA, macroadenoma. cimpression of optic chiasm
prolactinoma |
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whats panhypopituitarism
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ANTERIOR pit deficit
>75% of pit must be destroyed caused by traumatic brain injury, SAH, tumrors/mass lesion of pit, pit apoplexy |
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what causes panhypopituitarism
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1. traumatic brain injury
2. SAH 3. mass tumor/lesion 4. pit surgery/radiation 5. pit apoplexy 6. ischemic necrosis- sheehan syndrome (postpartum) 7. rathke cleft cyst 9. empty sella- obese pultiparious women |
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what is pituitary apoplexy
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its a sudden hemorrhage into the ant pit, common in adenomas. its a HA, diplopia and hypopit
neuro emergency, can cause cardio collapse |
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what is Sheehan syndrome
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ischemic necrosis of the ant pit- cause of panhypopituitarism
seen after preggo |
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besides sheehan and apoplexy what are some other ways to have an ischemic infarct in the pit
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DIC
trauma shock leads to panhypopit and even diabetes insipidious |
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55 y/o c/o “worst headache I’ve ever had” for
8 hours. CT interpreted as normal; he is released from the ER. He returned 8 hours later c/o diplopia. Visual testing suggests bitemporal defects. An MRI reveals a 15 mm intrasellar hemorrhagic mass. The patient underwent transphenoidal surgical decompression with restoration of his sight. He requires ACTH, T4, testosterone replacement whats the dx |
pitutary apoplexy- its a sudden hemorrhage into the glans. common in an adenoma. causes the HA, diplopia, hypopit
can cause cardio collapse, this is a neuro emergency |
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what is it called if youhave a baby and then you infarct your pit, what part of pit is gone
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sheehan syndrome, only ant pit is affected
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ok so can the hypothalamus cause pan hypo pit
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you bet
tumors- craniopharyngioma, mets, inflammation- sarcodiosis, tuberculous meningitis |
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what are the clinical and morph of craniopharyngioma
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remnant of rathkes pouch
seen in old and young suprasellar solid or cyst can produce hypo or hyper pit fx |
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A 7 y/o girl is brought to the ED by her
parents because of concerns that she is not growing and not developing appropriately. The parents say that the patient has cold intolerance easy fatigability, and polyuria. PE is notable for short stature and bilateral papilledema. TSH and free T4 are low. MRI shows a multilobated suprasellar mass with ring calcification in the region of the sella turcica If the lesion visualized on MRI represents a primary intracranial neoplasm, what is the most likely diagnosis? A) Craniopharyngioma B) Prolactinoma C) Thyrotropinoma |
craniopharyngioma- the ringed calcifications is the give away
seen in old and young can be a hypo or hyper fx |
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what is the clinical of pan hypo pitutarism
kids and adults |
loose the gonadotrophs first: kids loose sexual maturation. adults have loss of libido
GH deficit- in kids they are dwarfs, in adults insulin insensitivity, hypoglycemia, mm weakness TSH- hypothyroidism ACTH- adrenal failure- addisons w/o hyperpigmentation |
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A 37 y/o female has a history of extreme
thirst and polyuria of 3 mon. duration. She drinks at least 10‐15 large glasses of water, and several cans of soda during a 2‐3 hour period. She urinates at least 4‐5 times per hour. She keeps a glass of water at bedside and urinates 4 times or more a night. Medical history is significant only for endometriosis treated by hysterectomy |
diabeted insipidious, no ADH to conc the urine.
can be a post pit problem or a nephrogenic problem |
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whats central diabetes insipidious
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ADH deficit,
get thirsty and pee lots, low specific gravity |
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whats hand schiller christian disease
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triad of diabetes insipid
calvarial defects exopthalmos due to eosinophilic granuloma cell infiltrates |
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siadh labs
cause |
inappropriate ADH, lots of ADH, opposite of diabetes insipidipous
its hyponatremia and hemodilution, cerebral edema. usually caused by paraneoplastic SSC of the lung |
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if you have SIADH caused by sm cell CA of lungs what is the Na level
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hyponatremia
**hypernatremia with diabetes insipidious |
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A 66 y/o man with history of chronic cough,
dyspnea and a history of 50 pack years of cigarette smoking comes to the clinic after noticing some blood in his sputum. He reports that he feels lethargic and has lost 18kg (40#) over the past 3 mon. w/o changes in diet or exercise. Labs show a serum Na+ level of 120 mEq/dL (136‐143) He suffers a seizure while awaiting further tests Which of the following is most likely to elevated in this patient A) ACTH B) ADH C) Parathyroid hormone D) Renin |
hyponatremia, seen in SIADH, assume this smoker has small cell lung CA
ADH is high |
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whats a pituitary dwarf
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proportinate!!!
tx with GH before the plates close |
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what dwarf has short limbs and cauliflower ears
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diastrophic dwarf
AR deafness |
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whats Pyknodysostosis
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Autosomal recessive
Generalized developmental disorder Proportionate dwarfism Increased density and fragility of bone Absent distal end of clavicle Short digits Small face |
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A 6 y/o girl is brought to the doctor because
she is not growing proportionately and her parents wonder if some treatment is available. Both parents are short with similar proportions as the child: normal head and trunk size but short arms and legs. Which of the following is the most likely defect A) Deficiency of growth hormone B) ADH receptor deficiency C) Fibroblast growth factor receptor 3 D) Insulin receptor E) LDL receptor |
Achrondroplasia- AD, fibroblast GF receptor 3 deficit
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what is the AD disease in which there is a defect in the fibroblastic Growth receptor 3
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achondroplasia
AD dwarfism, normal trunk , large head, short limbs |