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Hypothalamus-Pituitary-Organ axis, Ant. pituitary/ Adenohypophysis/ pars…

- - - - Post. Pituitary/
        Neurohypophysis/
        par nervosa
        
        Vasopresson/ADH
        (Stimuli: Plasma osmosis, Hypovolemia)
        
        Principle cell of CD
        
        insert Aquaporin channel at CD
        
        Disease
        
        HypoADH
        
        Central DI
        
        P§: no release ADH from Hypothalamus
        
        1 more item...
        
        Peripheral DI
        
        P§: ADH receptor resistance
        
        1 more item...
        
        HyperADH
        
        Paraneoplastic syndrome of small cell lung CA
        
        Oxytocin
        (Stimuli: somatic sensory)
        
        Uterine contract
        
        during labor
        
        Smooth muscle contract at peri-alveoli
        by Suckling
        
        Milk letdown
        
        Social bond
  - - - GHRH
        
        Somatotroph
        
        GH
        
        Liver Secrete IGF-1
        
        IGF-1
        
        Bone growth
        
        Muscle growth
        
        Insulin resistant
        
        Lypolysis
        
        Glycogenolysis/Gluconeogenesis
        
        Disease
        
        Acromegaly in Adult
        (close epiphyseal plate)
        
        Deep voice
        
        Large hand & foot
        
        Aging face
        
        Gigantism in Child
        (open epiphyseal plate)
      - Pulsatile GnRH
        
        Gonadotroph
        
        LH, FSH
        
        Sertoli cell/ Follicular cell stimulation
      - CRH
        
        Corticotroph
        
        ACTH
        
        Zona fasciculata
        
        Cortisol
        
        ‘BIG FIB’
        
        6 more items...
      - TRH
        
        Thyrotroph
        
        TSH
        
        Follicular cell in Thyroid
        
        1) Na+ I- cotransport
        2) Oxidation (by TPO)
        3) Organization (I2 + TG by TPO)
        4) Coupling (by TPO)
        
        T3/T4
        ;Mostly bound form
        
        2 more items...
        
        Thyroglobulin(TG) is tumor marker
        
        Thyroid adenoma/CA ;mostly cold nodule
      - Dopamine
        
        Lactotroph
        
        Prolactin
        
        Hypothalamus GnRH
        
        Alveoli at breast synthesis milk
        
        Milk production
        
        Disease
        
        Prolactinoma
        
        P§:Mass effect
        
        Hypopituitarism
        
        Headache
        
        Bilateral hemianopia
        (Compress Optic chiasm)
        
        P§: Excess Prolactin hormones
        
        Amenorrhea
        
        Milk letdown
        
        Tx: Dopamine agonist = bromocriptine
      - Continue GnRH
- - - - P§: Rathke’s pouch tumor
        
        Histo: Machine oil like
        
        P§: Mass effect
    - - Silent Mass effect
    - - P§: Postpartum bleeding or DIC -> Ischemic pituitary
    - - P§: Sudden rupture hemorrhage pituitary
        (precipitated factor: pituitary adenoma)
        
        Mass effect
        
        Diplopia (CN III palsy)
        
        Bilateral hemianopia (compress optic chiasm)
        
        Abrupt severe headache
- - - - Small vessel: Retinopathy(micro aneurysm), KW nodule in Glomerulosclerosis, Gluacoma
    - - Large vessel: CAD, MI, AAA
  - - - Sorbital accumulate & Osmotic damage
        
        Cataract & Neuropathy
- - - - Thyroglossal duct
        (Move with tongue or swollen)
        around Hyoid bone
- - - - Sup. laryngeal n.
  - - - Recurrent laryngeal n.
- - - - (+)Ca2+ & (+)PO4
- - - - (+)PTH
- - - - PTU, Propranolol(Beta blocker), Prednisolone(Costicosteroid)
    - - MOA: Wolff-Chaikoff effect(inh. TPO)
- - - - Activate ENaC & N+K+ ATPase
  - - - Hyperaldosterone
        
        Conn’s syndrome
        (Primary adenoma)
        
        Lab: HT, HypoK+, Metabolic alkalosis, Low renin
        
        Renal stenosis, HF, Nephrotic
        
        Lab: High Renin
      - Cushing syndrome
        (HyperCortisol)
        
        Cushing disease
        
        (+)ACTH
        
        Paraneoplastic syndrome
        (small cell lung CA)
        
        (+)ACTH
        
        Exogenous corticosteroids
        
        (-)ACTH
        
        Dx test = Dexamethasone suppression test
        To distinguish Ectopic ACTH(-) & Piuitary disease(+)
    - - Adrenocortical infficiency
        
        Waterhouse-Friderichsem syndrome by DIC of N. meningitidis
      - Addison’s disease
        (primary)
        
        (-)Cortisol
        
        (+)ACTH
        
        Mucosal pigmentation
        
        Hypotension
        
        Serum HypoNa+, HyperK+
- - - - Associated NF-1
      - P§: Hyperproduction of NE, EP in relapse & remit
        
        Episodic Hypertension & palpitation
      - Dx: high VMA (Vamillylmandelic acid) in urine
        & high Metanephrine in blood
    - - Dx: high VMA & Homovanillic acid in urine
      - P§: N-myc oncogene
      - SS: Raccoon eyes by Metastasis in skull
      - DDx: Neuroblastoma(Abdominal distent, Irregular mass) VS Wlim tumor(Smooth mass, Unilateral)
- - - - Pineal gland
        
        Release Melatonin
        by Pinealocyte
        
        Deep sleep
- - - - Dilating Afferent arteriole
    - - Block Aldosterone receptor
    - - Inh. Renin release
- - - - ATP sensitive K+ channel close
        
        Depolarize
        
        Ca2+ influx
        
        Degranulation insulin