Pituitary Gland

Anterior Pituitary

100

A patient experiences difficulty lactating following a pregnancy which involved a delivery complicated for hemorrhage. What is the cause of her failure to lactate? (Name of syndrome)

What is Sheehan Syndrome?

DAILY DOUBLE: Explain the Pathophysiology of this disease

200

Another PBL patient had low TSH, similar to Claudia. Explain how labs could be used to distinguish between the cause of Claudia's disease and this patient's disease. 

What is high T4/T3 in Graves disease, low T4/T3 in hypopituitarism.

DAILY DOUBLE: Provide the first and last name of the other PBL patient

300

The following genetic syndrome is associated with pituitary tumors similar to what was found in this case

What is MEN1?

DAILY DOUBLE: What is the name and function of the gene mutation in MEN1?

400

Name the 6 anterior pituitary hormones, and indicate which one does not require a stimulation by a releasing hormone

What are ACTH, TSH, GH, FSH, LH, Prolactin

What is prolactin?

500

Draw the Endocrine signaling pathway of that is abnormal in Claudia at diagnosis, and the same pathway following surgical resection.

Drawing of HPA axis, with high ACTH and then low ACTH

Posterior Pituitary

100

This hormone is sometimes called the "love hormone". It is responsible for the release of milk to a lactating baby. It is inhibited by high levels of progesterone and estrogen

What is oxytocin

200

This is a common paraneoplastic syndrome of lung cancer. These patients have low plasma osmolarity and may appear to be fluid overloaded.

What is SIADH

300

This is the other name for the posterior pituitary

neurohypophysis

400

Accidental trauma to the posterior pituitary during removal of an adenoma can cause this syndrome which has patients constantly thirsty

What is Central Diabetes Insipidus 

DAILY DOUBLE: How does a physician determine whether a patient has central or nephrogenic DI?

500

Hormones secreted from the posterior pituitary are made in the following location

What is the hypothalamus?

Surgical Complications

100

Approximately this percentage of microadenomas achieve an initial cure rate 

What is 80-90%? (according to up to date)

200

What is the second line treatment is resection of the tumor fails to achieve remission or a patient experiences reoccurance of disease?

What is pituitary irradiation?

300

What is the approximate cumulative reoccurrence rate over 10 years?

What is 26% (according to uptodate)

400

The following is the most common post surgical complication after pituitary resection, impacting more than 20% of patients, but is rarely permanant

What is diabetes insipidus?

500

Based on her post surgical symptoms, which lobe of Claudia's thyroid is most likely negatively impacted by her surgery?

What is the anterior pituitary?

Psychosocial

100

This is considered a cosmetic advantage to the trans-sphenodial resection of a pituitary adenoma? 

What is no facial scaring?

200

Many women have the following complaint as a result of a pituitary tumor resection or gland removal. However the same condition can in some cases be reversed through the removal of a prolactinoma, without resecting the entire gland. 

What is infertility?

300

If a man were to have the most common type of pituitary adenoma, he might experience this embarrassing growth pattern?

What is gynecomastia?

400

The following hormone needs to be replaced in higher doses in times of stress in a patient who lacks an anterior pituitary gland.

What is cortisol?

500

The following is a symptom of Cushing's disease that a patient is likely to deny if asked. They are likely to blame this symptom on other people, and may become angry that they were even asked about this symptom.

What is irritability/ anger problems.

Adrenal Gland

100

The following receptors in the adrenal cortex are bound by ACTH

What are melanocortin 2 receptors?

200

Cortisol level are typically highest around this time of day? 

What is early morning (sources vary between 6-9am)

300

The following is the name of the syndrome in which a patient grows a large ACTH secreting pituitary adenoma after removal of both adrenal glands

What is Nelson Syndrome?

400

Cortisol is produced in this region of the adrenal gland.

What is the zona fasiculata?

500

The following condition is sometimes considered the "opposite" of Cushing disease. President JFK was diagnosed with this condition. A secondary form of this disease can occur as a result of pituitary resection.

What is Addison's disease?

Fun fact- some people believe that President Kennedy bled out more quickly because he was chronically hypovolemic and hypotensive as a result of low cortisol. This has never been directly proven, but has a basis in physiology.