38 Questions
What is the primary goal of early diagnosis in patients with sellar masses?
To prevent optic atrophy
What is included in the initial hormonal evaluation for a pituitary incidentaloma?
Basal prolactin, IGF-I, 24-h UFC, and FSH
What is the purpose of a 24-h urinary free cortisol (UFC) test in the evaluation of a sellar mass?
To evaluate for cortisol excess
What is the primary purpose of visual field assessment using perimetry techniques in patients with sellar masses?
To monitor for vision loss
What is not included in the initial laboratory investigation of a sellar mass?
Thyroid-stimulating hormone (TSH) levels
What type of MRI is shown in the figure?
T1-weighted with gadolinium
What is a possible cause of growth hormone resistance?
Pathology of GH receptors
What is the typical height of an adult male with hypopituitarism?
Less than 130 cm
At what age can growth retardation be observed in a child with hypopituitarism?
3-4 years
What is the characteristic of body proportions in a person with hypopituitarism?
Normal body proportions
What is a potential complication of hypopituitarism?
Hypothyroidism
Why may puberty not appear in a person with hypopituitarism?
Due to lack of gonadotropic hormones
What is the typical characteristic of mental development in a person with hypopituitarism?
Normal mental development
What is the term for the discrepancy between a person's passport age and biological age in hypopituitarism?
Biological age delay
What is the name of the disease caused by an ACTH-producing adenoma?
Cushing's disease
Which part of the pituitary gland is derived from neural tissue?
Neurohypophysis
What is the primary function of the pituitary gland?
To produce hormones that regulate other endocrine glands
What is the term for the axis that includes the hypothalamus, pituitary gland, and other endocrine glands?
Hypothalamic-pituitary-organ axis
What is the term for the condition characterized by excessive thirst and urination?
Diabetes insipidus
What is the term for the condition characterized by low sodium levels and excessive secretion of antidiuretic hormone?
SIADH
What is the origin of the adenohypophysis?
Rathke's pouch
What is the approximate weight of the pituitary gland?
0.5-1 gram
What is pituitary apoplexy associated with?
Diabetes, hypertension, and sickle cell anemia
What is the most common presentation of pituitary apoplexy?
Severe headache with signs of meningeal irritation
What is the 'pituitary ring sign' seen on MRI?
A hypointense center and a ring of gadolinium enhancement
What is the difference between empty sella and pituitary apoplexy?
Empty sella is an incidental MRI finding, while pituitary apoplexy is a life-threatening condition
What is the consequence of severe pituitary apoplexy?
All of the above
What is the characteristic of the surrounding rim of pituitary tissue in empty sella?
It is fully functional
What is the development of hypopituitarism in empty sella?
It develops insidiously
What is the characteristic MRI finding in pituitary apoplexy?
A hypointense center and a ring of gadolinium enhancement
What is the characteristic of patients with isolated GH deficiency?
Normal pituitary function and normal reproductive capacity
What is the effect of acquired hypothalamic or pituitary somatotrope damage in adult GH deficiency?
Body composition changes
What is the characteristic of Karl Kosiczky, who was diagnosed with pituitary dwarfism?
Stopped growing at the age of 4
What is the feature of adult GH deficiency?
Impaired quality of life
What is the change in body composition seen in adult GH deficiency?
Increased body fat mass
What is the characteristic of central fat deposition in adult GH deficiency?
Increased waist-to-hip ratio
What is the effect of adult GH deficiency on cardiovascular health?
Increased cardiovascular risk factors
What is the characteristic of patients with isolated GH deficiency in terms of puberty?
Normal puberty
Study Notes
Pituitary Gland
- The pituitary gland is around 1 centimeter in diameter and weighs 0.5 to 1 gram.
- It has two parts: the adenohypophysis and the neurohypophysis.
- The name "pituitary" comes from the belief that it channeled mucus to the nose from Rathke's pouch.
- The neurohypophysis develops from neural tissue and is an outgrowth from the hypothalamus.
Hypothalamic-Pituitary Axis
- The pituitary gland is often referred to as the "master gland" because it controls other endocrine glands.
- Hypothalamic hormones regulate anterior pituitary trophic hormones, which in turn determine target gland secretion.
Pituitary Disorders
- Diabetes insipidus is a disorder of the neurohypophysis.
- Hypodipsic hypernatremia is a disorder of the neurohypophysis.
- SIADH (Syndrome of Inappropriate Antidiuretic Hormone) is a disorder of the neurohypophysis.
Pituitary Apoplexy
- Pituitary apoplexy is an endocrine emergency that may result in severe hypoglycemia, hypotension, shock, CNS hemorrhage, and death.
- It may occur spontaneously in a preexisting adenoma, postpartum (Sheehan's syndrome), or in association with diabetes, hypertension, sickle cell anemia, or acute shock.
- Symptoms include severe headache with signs of meningeal irritation, bilateral visual changes, ophthalmoplegia, and cardiovascular collapse.
Empty Sella
- Empty sella is often an incidental MRI finding and may have normal pituitary function.
- Hypopituitarism may develop insidiously.
Evaluation of Sellar Masses
- Ophthalmologic evaluation includes visual field assessment using perimetry techniques.
- Laboratory investigation includes initial hormonal evaluation for a pituitary incidentaloma, including basal prolactin, insulin-like growth factor I, 24-h urinary free cortisol, and FSH and LH levels.
Growth Hormone Deficiency
- Growth hormone deficiency can be congenital or acquired.
- Clinical manifestations include short stature, growth retardation, delayed puberty, and normal mental development.
- In adults, growth hormone deficiency can present with impaired quality of life, body composition changes, reduced exercise capacity, and cardiovascular risk factors.
This quiz covers various disorders related to the pituitary gland, including diabetes insipidus, hypodipsic hypernatremia, and SIADH. It also touches on Cushing's disease and TSH-secreting adenoma.
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