CHAPTER 20- PITUITARY.txt

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scottmreis
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CHAPTER 20- PITUITARY.txt
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2012-01-07 18:09:23
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  1. Hypothalamus:
    • 1) Releases the following into the median eminance:
    • 1- TRH
    • 2- CRH
    • 3-GnRH
    • 4- GHRH
    • 5- Dopamine

    2) passes through the neurohypophysis on way to adenohypophysis
  2. Dopamine:
    inhibits prolactin secretion
  3. Posterior pituitary
    • 1) neurohypophysis
    • 2) ADH-
    • 1- supraoptic nucleus
    • 2- regulated by osmolar receptors in hypothalamus

    • 3) Oxytocin
    • 1- paraventricular nuclei in hypothalamus
  4. What cell bodies does neurohypophysis contain ?
    neurohypophysis doesn't contain cell bodies
  5. Anterior pituitary
    • 1) 80% of gland, adenohypophysis
    • 2) Releases:
    • 1- ACTH
    • 2- TSH
    • 3- GH
    • 4- LH
    • 5- FSH
    • 6- Prolactin
  6. What is the blood supply to the anterior pituitary?
    the anterior pituitary doesn't have its own blood supply, it passes through the neurohypophysis first
  7. Bitemporal hemianopia
    pituitary mass compressing optic nerve (CNII) at chiasm
  8. Nonfunctioning tumors:
    • 1) almost always macroadenomas
    • 2) present with mass effect and decreased ACTH, TSH, GH, LH, FSH
    • 3) Tx: transsphenoid resection
  9. Contraindications to transsphenoid approaches:
    • 1) suprasellar extension
    • 2) massive lateral extension
    • 3) dumbbell-shaped tumor
  10. Which tumors respond to bromocriptine
    TSH and FSH/LH secreting tumors may respond to bromocriptine
  11. Prolactinoma
    • 1) most common pituitary adenoma
    • 2) mostly microadenomas
    • 3) most patients do not need surgery. Prolactin is usually >150 in these patients
    • 4) Symptoms:
    • 1- galactorrhea
    • 2- irregular menses
    • 3- decreased libido
    • 4- infertility
    • 5- decreased vision
    • 5) Tx: bromocriptine for most, or trassphenoidal resection for failure of medical management
    • 1) Macroadenomas-
    • 1- resection with hemorrhage
    • 2- visual loss
    • 3- wants pregnancy
    • 4- CSF leak
    • 2) Microadenomas- resection if bromocriptine unsafe or ineffective (is OK in pregnancy)
  12. Acromegaly
    • 1) growth hormone
    • 2) Symptoms:
    • 1- HTN
    • 2- DM
    • 3- gigantism
    • 3) GH >10 in 90%; usually macroadenomas
    • 4) Preoperative octreotide may be helpful (inhibits release of GH)
    • 5) can be life threatening secondary to cardiac symptoms (valve dysfunction, cardiomyopathy)
    • 6) higher remission rate for microadenomas
    • 7) Dx:
    • 1- elevated IGF-1
    • 2- Growth hormone >5-10
    • 8) Tx:
    • 1- trassphenoidal resection
    • 2- XRT and bromocriptine can be used for primary or secondary therapy
  13. Sheehan's syndrome
    • 1) postpartum trouble lactating- usually first sign
    • 2) can also have:
    • 1- amenorrhea
    • 2- adrenal insufficiency
    • 3- hypothyroidism
    • 3) due to pituitary ischemia following hemorrhage and hypotensive episode
  14. Craniopharyngioma
    • 1) calcified cyst, remnant of rathke's pouch
    • 2) Most frequently presents with
    • 1- endocrine abnormalities
    • 2- visual disturbances
    • 3- headache
    • 4- hydrocephalus
    • 3) Tx:
    • 1- surgery
    • 2- XRT
    • 4) Diabetes insipidus is a frequent complication postoperatively
  15. Bilateral pituitary masses
    1) check axis; if ok, probably metastases
  16. Nelson's syndrome
    • 1) occurs after bilateral adrenalectomy
    • 2) increased CRH causes pituitary enlargment, resulting in amenorrhea, visual problems (bitemporal hemianopia)
    • 3) Also get hyperpigmentation from beta-MSH (melanocyte-stimulating hormone), a peptide byproduct of ACTH
    • 4) Tx: steroids
  17. Waterhouse-Friderichsen syndrome
    • 1) adrenal gland hemorrhage that occurs after meningococcal sepsis infection
    • 2) can lead to adrenal insufficiency

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