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128 Cards in this Set
- Front
- Back
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5 stimulatory HThic hormones
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GnRH
CRH TRH PRH (PRL RH) GHRH |
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2 inhibitory HThic factors
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PRL inhibitory factor
GH inhibitory factor |
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PRL inhibitory factor is
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DA
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GH inhibitory factor is
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somatostatin
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adenohypophyseal hormones
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FSH
LH ACTH TSH PRL GH |
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neurohypophyseal hormones
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ADH
OT |
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2 effects of ADH
the more important effect is ___ |
antidiuretic
vasopressor antidiuretic |
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antidiuretic effect of ADH is for responding to ___
vasopressor effect of ADH is for responding to ___ |
dehydration
hemorrhage |
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2 effects of oxytocin
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myometrial contraction (labor)
lactation |
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insufficient ADH causes ___
excess ADH causes ___ the more common disorder is ___ |
DI
SIADH DI |
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2 kinds of DI
the more common is ___ |
nephrogenic
central central |
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central DI is caused by ___ whereas nephrogenic DI is caused by ___. in the former ADH is high/low, in the latter it is high/low.
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insufficient ADH release
ADH insensitivity low high |
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___ is treated by administering exogenous ADH
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central DI
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3 causes of central DI
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trauma
infection tumor |
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3 causes of nephrogenic DI
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renal disease
ADH receptor mutation AQP mutation |
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4 causes of SIADH
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trauma
pain opiates pleuritis |
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treatment for SIADH (2)
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water deprivation
Na+ correction |
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3 kinds of pituitary disease
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adenoma
apoplexy hypopituitarism |
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___ is a tumor-suppressor gene implicated in pituitary adenomas. function of the gene is lost because of ___.
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MEG3
hypermethylation |
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McCune Albright syndrome is caused by ___ in ____ or ___
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constitutive G protein activation
pituitary endocrine target |
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most common pituitary tumor in McCune Albright is ___, which causes ___.
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somatotropinoma
acromegaly |
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silent pituitary tumors are present in ___ of people.
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25%
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most common cell type in pituitary is
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lactotroph
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a pituitary macroadenoma is ___ in size
microadenoma is ___ |
>= 1cm
< 1cm |
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classical visual manifestation of pituitary macroadenoma is
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bitemporal hemianopia
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with the exception of ___, pituitary adenomas have no predilection for race or sex
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corticotropinoma
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corticotropinomas favor ___ in a ratio of ___
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females
4:1 |
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TRH normally causes ___ (2). These effects are blunted in ___ (3)
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TSH release
PRL release hyperprolactinemia hyperthyroidism panhypopituitarism |
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a "paradoxical" effect of TRH may be observed with ___. in this case the effect is ___ (2). this happens because of ____
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Gnomas
elevated Gn elevated GH loss of cell specificity |
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the response to GHRH may be blunted in cases of ___ (3)
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GH deficiency
Cushing's disease hypothyroidism |
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there may be a paradoxical response to GHRH with ___ (3). the effect is ___.
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acromegaly
acute illness chronic renal failure reduced GH |
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hyperglycemia normally causes ___. this effect is blunted in ___ (4).
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reduced GH release
somatotropinoma ectopic GH tumor Cushing's syndrome anorexia |
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there may be a paradoxical response to hyperglycemia in ___.
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acromegaly
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there may be a "paradoxical" response to GnRH in ___. the effect is ___.
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acromegaly
elevated GH |
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the response to CRH may be blunted in ___. the response may be exagerrated in ___.
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Cushing's syndrome
Cushing's disease |
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IPS sampling is ___ and is used for ___.
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inferior petrosal sinus sampling
distinguishing Cushing's disease from ectopic ACTH |
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hypoglycemia causes ___ (3)
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increased ACTH
increased cortisol increased GH |
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the effect of hypoglycemia is blunted in ___ (4)
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Cushing's syndrome
GH deficiency hypothyroidism hyperthyroidism |
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cosyntropin is a ___. its normal effect is ___. its effect is blunted in ___.
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synthetic ACTH analog
elevated cortisol primary addison's disease |
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in new secondary addison's disease, the response to cosyntropin is ___
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positive
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GnRH causes ___ (2). its effect is blunted in ___. there may be a paradoxical effect in ___.
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elevated FSH
elevated LH pituitary hypogonadism primary hypogonadism |
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metyrapone causes ___ at the adrenals, which causes accumulation of ___ (2) and decreased ___.
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inhibition of 11beta hydroxylase
11-deoxycortisol 17-OH progesterone cortisol |
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in normals, metyrapone causes ___ at the pituitary. this effect is blunted in ___ and exagerrated in ___.
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elevated ACTH
Cushing's syndrome Cushing's disease |
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___ (2) are the preferred modalities for imaging the pituitary
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CT
MRI |
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dexamethasone is a ___. it normally causes ___ at the pituitary.
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synthetic glucocorticoid
suppression of ACTH release |
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___ is better at visualizing bony or calcified structures
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CT
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___ is the modality of choice for imaging pituitary, because ___ (2)
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MRI
no need for contrast no irradiation |
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T1 weighted MRI highlights ___
T2 weighted MRI highlights ___ |
fat
water |
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the main risk in pituitary surgery is ___.
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damage to sphenoidal sinus
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___ often require surgery, with the exception of ___, which respond well to medication, specifically ___ (2).
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macroadenomas
macroprolactinomas ergot alkaloids DA derivatives |
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the cure rate by surgery alone for microadenomas is ___ and for macroadenomas is ___.
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90%
15-37% |
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macroadenomas often require ___ and ___ in addition to surgery
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radiation
medication |
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drawbacks of irradiation for macroadenomas are ___ (2). these effects are improved when using ___.
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delayed effect
high incidence of panhypopituitarism gamma knife |
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PRL is homologous to ___. both lactotrophs and ___ are triggered by ___ and act on target cells via ___.
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GH
somatotrophs Gs JAK-STAT |
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positive regulators of PRL (5)
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PRH
TRH GnRH Estrogens VIP |
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inhibitory regulator of PRL
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DA aka PRL inhibitory factor
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during labor, E2 ___s milk secretion, causing ___.
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inhibits
congestion of breasts |
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after birth there is a drop in ___ (2) which causes ___, allowing ___.
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P & E2
release of E2 inhibition breast feeding |
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breast feeding ___ PRL release
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increases
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pituitary causes of hyperprolactinemia (3)
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prolactinoma
pseudoprolactinoma hypothyroidism |
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T/F: hyperprolactinemia is rare
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false
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effects of hyperprolactinemia on men (3)
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reduced testosterone
reduced spermatogenesis impotence |
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effects of hyperprolactinemia on women (4)
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galactorrhea
reduced menstrual cycle duration amenorrhea anovulation |
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drugs which can cause hyperprolactinemia (7)
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DA blockers
methyldopa reserpine cocaine isoniazid verapamil tricyclic antidepressants |
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the treatment for hyper-PRLemia is ___. the first generation drug is ___, second is ___ and 3rd is ___.
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DA agonists
bromocriptine quinagolide cabergoline |
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bromocriptine may cause ___ (2)
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IHD
hypertension |
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quinagolide may cause ___ (2)
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nephrotoxicity
hepatotoxicity |
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cabergoline may cause ___ (2)
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IHD
hypertension |
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metabolic effects of GH (4)
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increased protein synthesis
increased lipolysis increased glycogenolysis increased gluconeogenesis |
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GH acts on directly on ____ and ___. Its indirect effects are mediated by ___ released by ___.
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liver
adipose tissue IGF-1 liver |
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IGF-1 acts on ___ and ___.
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bone
muscle |
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neurogenic GH secretagogues (5)
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non-REM deep sleep
stress adrenergic agonists DA ACh |
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neurogenic GH anti-secretagogues (4)
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REM sleep
emotional deprivation adrenergic antagonists ACh antagonists |
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metabolic GH secretagogues (5)
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hypoglycemia
hypolipidemia uremia cirrhosis DM |
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metabolic GH anti-secretagogues (3)
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obesity
hyperglycemia high FA level |
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hormonal GH secretagogues (5)
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GHRH
estrogen glucagon ADH low IGF-1 |
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hormonal GH anti-secretagogues (4)
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somatostatin
high IGF-1 hypothyroidism GCs |
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IGF-1 causes ___ at pituitary and ___ at HTh
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inhibition of GH
stimulation of somatostatin |
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GH causes ___ at pituitary and ___ at HTh
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inhibition of GH
inhibition of GHRH |
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ghrelin causes ___ at HTh
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stimulation of GHRH
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if a pituitary tumor damages the pituitary stalk, ___ can result from ___. this is called a ___
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hyperprolactinemia
loss of DA inhibition pseudoprolactinoma |
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pituitary tumors can cause deficiecy of (3)
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GC
sex steroids thyroid hormone |
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hyperhidrosis is ___. it is associated with ___.
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excessive sweating
acromegaly |
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___ (2) are neoplasms associated with acromegaly. ___ are possible markers for the latter.
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colonic polyps
colonic adenocarcinoma skin tags |
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thyroid problem associated with acromegaly is ___. it typically manifests as ___.
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enlargement
nodular goiter |
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ectopic GH or GHRH may be released by tumors of ___ origin in ___ (3)
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neural crest
GIT pancreas appendix |
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3 categories of acromegaly drugs
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DA receptor agonists
somatostatin analogs GH antagonists |
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2 examples of somatostatin analogs
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octreotide
lanreotide |
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___ is the most useful marker to monitor acromegaly treatment. it is high/low in pregnancy, high/low in obesity, and high/low in starvation.
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IGF-1
high low low |
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in primary addison's ACTH is ___, cortisol is ___, and aldosterone is ___.
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high
low low |
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in secondary addison's ACTH is ____, cortisol is ___, and aldosterone is ___.
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low
low normal |
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primary addison's is typically caused by ___. secondary is typically caused by ___
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autoimmunity against adrenals
iatrogenic |
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hyperpigmentation is characteristic of ___.
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primary addison's
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3 causes of Cushing's syndrome
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Cushing's disease
ectopic ACTH adrenal tumor |
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treatment for Cushing's disease
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transsphenoidal adenomectomy
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treatment for ectopic ACTH
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excision of ectopic source
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in primary hypothyroidism, TSH is ___ and free T4 is ___.
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high
low |
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in secondary hypothyroidism, TSH is ___ and free T4 is ___.
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low
low |
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in tertiary hypothyroidism, TSH is ___ and free T4 is ___.
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low
low |
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in pituitary adenoma, TSH is ___ and free T4 is ___.
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high
high |
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in thyrotoxicosis, TSH is ___ and free T4 is ___.
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low
high |
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primary hypothyroidism is rare/common and is treated with ___
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common
thyroxine |
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secondary hypothyroidism is rare/common and is treated with ___
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rare
thyroxine |
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tertiary hypothyroidism is rare/common and is treated with ___
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rare
thyroxine |
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pituitary adenoma is rare/common and is treated with ___
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rare
surgery |
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thyrotoxicosis is rare/common and is treated with ___ (3)
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common
antithyroid agents radio-iodine surgery |
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in female, inhibin is released by ___ cells and acts on ___ (2). the effect is ___ (3).
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granulosa
HTh pituitary reduced GnRH reduced LH reduced FSH |
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2 effects of FSH in female
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increased ovarian folliculogenesis
increased E2, P secretion |
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in female, LH does ___ before ovulation and ___ (2) after.
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expulsion of egg from follicle
sustains corpus luteum E2, P secretion maintains pregnancy via corpus luteum until placenta is competent |
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4 effects of FSH in male
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stimulate somatic evolution of testes
induce LH receptors on Leydig cells stimulate ABP synthesis in Sertoli cells spermatogenesis |
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effect of LH in males
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increase testosterone synthesis in Leydig cells
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in primary hypgonadism, Gns are ___ and sex hormones are ___. a common cause is ___.
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high
low menopause |
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in hypoGnic hypogonadism, Gns are ___ and sex hormones are ___. congenital hypoGnic hypogonadism is caused by ____, acquired HGH by ___ (2).
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low
low Kallman's syndrome surgery irradiation |
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in hyperGnic hypergonadism, Gns are ___ and sex hormones are ___. it is caused by ___.
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high
high adenoma |
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in hyperGnic hypogonadism, Gns are ___ and sex hormones are ___. in male the cause is ___ and in females, ___.
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high
low Klinefelter's Turner's |
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in contrast to Turner's, in Klinefelter's ___
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patient may be fertile
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in iatrogenic hypergonadism, Gns are ___ and sex hormones are ___. it is caused by ___.
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low
high anabolic steroids |
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9 I's of hypopituitarism
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invasive
infarction infiltrative injury immunologic iatrogenic infectious idiopathic isolated |
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2 examples of invasive hypopituitarism
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tumor
carotid aneurysm |
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2 examples of infarction hypopituitarism
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Sheehan's
pituitary apoplexy |
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4 examples of infiltrative hypopituitarism
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granulomas
sarcoidosis hemochromatosis histiocytosis X |
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3 examples of infectious hypopituitarism
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mycosis
TB syphilis |
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treatment for hypopituitarism
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replacement of all missing hormones
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pituitary apoplexy is
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hemorrhage in sella turcica
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risk factors for pituitary apoplexy
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pitiuitary adenoma
bleeding disorder head trauma Sheehan's |
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T/F: Sheehan's syndrome always has severe manifestation
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false: can be headache
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treatment for Sheehan's
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hormone replacement
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a pseudoprolactinoma is
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a non-secreting tumor which obstructs DA to pituitary, causing hyper-PRL
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