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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
explain the differneces int eh ant and post pit
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
which part of pit is derived from rathke pouch, epithelium, portal system
anterior
how do somatostatin and dopamine act on the pit
somatostatin: inhibits GH and TSH

dopamine: inhibits TSH and prolactin
if dopamine is inhibited what happens? how can this happen
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
what 2 hormones from distant sites act on the hypothalamus adn pit
ACTH and Cortisol from the adrenals

ACTH: blocks ant pit

Cortisol: blocks pit AND hypothalamus
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
most common pituitary hormone excess is caused by what
pit adenoma

most are just solitray lesions, but 3% are associated with MEN
what type of pit adenoma is more likely to be silent a macro or micro
macro
are pit carcinomas common
nope, adenomas are common

adenomas cause over production of hormones
in MEN1 there is an inactivating mutation og what...
MEN1 gene product, menin, it regulates transcription
a macroadenoma is what size?
>1 cm
*no hormones usually
*shows enlarged sella turcica

Sx include BiTemporal hemianopsia, increased intracranial pressure
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
whats the most common pit adenoma? what are the sx
prolactinoma.

sx: amenorrhea, gealctorrhea, loss of libido, infertility
• 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
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
what is a somatotroph adenoma
secretes GH, 2 most common (prolactin is most). GH and IGF are increased

Acidophilic adenoma- the acidophiles make GH
aciophilic cells in the pit secrete what?
GH
what does sugar level have to do with GHRH release
hypoghycemia --> GHRH release
giantism is a result of what
somatotroph pit adenoma- GH secretion.

excess GH in kids makes them grow. all organs are enlarged
acromegaly
excess GH in an adult (somatophroph adenoma)

*big fingers, thyroid, heart, kidney, liver, adrenals enlarge (in giantism ALL organs enlarge)

**
what are some of the downside complications associated with somatotroph adenoma
1. hyperglycemia/DM
2. osteoperosis
3. HTN
4. GONADAL dysfx
*CHF
6. hyperprolactin

**this is why ppl shouldnt take exogenous GH
is adenoma a hyper or hypo fx of the pit
can be either

most common:
1. prolactin increase
2. GH increase
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
acromegaly is assocaited with what phenotypic features
protrude jaw/malocclusion
skin tags (fibroepithelial polyps)
DM
big fingers, toes
forehead prominant
enlarged sella
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
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
what is a corticotroph adenoma
excess cortisol--> cushings DISEASE

basophiles, hyperpigmentation
what is the morph, stain of a corticotroph adenoma
basophiles

recall acidophiles were GH
whats nelsons syndrome
adrenal insuffiency with hyperpigmentation
no adrenals but have pit tumor that makes ACTH
what are the sx of cushings
redistribution of fat- central obesity
stria
mm wasting
easy bruise
hypertension
hyperglycemia
osteoperosis
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
gonadotroph adenomas
large, local sx
hyperfx is rare
thyrotroph adenoma
rare, make THS
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
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
whats panhypopituitarism
ANTERIOR pit deficit
>75% of pit must be destroyed

caused by traumatic brain injury, SAH, tumrors/mass lesion of pit, pit apoplexy
what causes panhypopituitarism
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
what is pituitary apoplexy
its a sudden hemorrhage into the ant pit, common in adenomas. its a HA, diplopia and hypopit

neuro emergency, can cause cardio collapse
what is Sheehan syndrome
ischemic necrosis of the ant pit- cause of panhypopituitarism

seen after preggo
besides sheehan and apoplexy what are some other ways to have an ischemic infarct in the pit
DIC
trauma
shock

leads to panhypopit and even diabetes insipidious
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
what is it called if youhave a baby and then you infarct your pit, what part of pit is gone
sheehan syndrome, only ant pit is affected
ok so can the hypothalamus cause pan hypo pit
you bet

tumors- craniopharyngioma, mets, inflammation- sarcodiosis, tuberculous meningitis
what are the clinical and morph of craniopharyngioma
remnant of rathkes pouch

seen in old and young

suprasellar

solid or cyst

can produce hypo or hyper pit fx
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
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
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
whats central diabetes insipidious
ADH deficit,

get thirsty and pee lots, low specific gravity
whats hand schiller christian disease
triad of diabetes insipid
calvarial defects
exopthalmos

due to eosinophilic granuloma cell infiltrates
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
if you have SIADH caused by sm cell CA of lungs what is the Na level
hyponatremia

**hypernatremia with diabetes insipidious
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
whats a pituitary dwarf
proportinate!!!

tx with GH before the plates close
what dwarf has short limbs and cauliflower ears
diastrophic dwarf
AR
deafness
whats Pyknodysostosis
Autosomal recessive
Generalized developmental disorder
Proportionate dwarfism
Increased density and fragility of bone
Absent distal end of clavicle
Short digits
Small face
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
what is the AD disease in which there is a defect in the fibroblastic Growth receptor 3
achondroplasia

AD dwarfism, normal trunk , large head, short limbs