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A 28-year-old woman presents to her GP complaining of cessation of her menstrual periods for the past six months and milky discharge from both breasts, which started spontaneously. She is not pregnant and denies any recent changes in medication. Physical examination is unremarkable.

1. Based on her presenting symptoms, which anterior pituitary hormone is most likely to be elevated?

2. What are the possible physiological causes of elevated levels of this hormone in a non-pregnant, non-breastfeeding woman?

3. What is the primary mechanism by which the hypothalamus regulates the secretion of this hormone?

A. Which of the following investigations would be the most appropriate initial step in evaluating this patient's condition?

a) Measurement of serum LH and FSH levels

b) Measurement of serum TSH and free T4 levels

c) Measurement of serum prolactin level

d) Pelvic ultrasound

B. If this patient is found to have significantly elevated prolactin levels and a pituitary microadenoma on MRI, the most likely diagnosis is ...:

a) Hypothyroidism

b) Prolactinoma

c) Empty sella syndrome

d) Acromegaly

C. Prolactin exerts its effects on the mammary glands via ...:

a) Binding to G protein-coupled receptors and activating cAMP

b) Binding to tyrosine kinase receptors and activating the JAK-STAT pathway

c) Acting through second messenger systems involving IP3 and DAG

d) Directly influencing gene transcription

I. True or False: Dopamine from the hypothalamus primarily inhibits prolactin secretion

II. True or False: Elevated TRH levels can stimulate prolactin release

III. True or False: Prolactin is a glycoprotein hormone

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A 55-year-old man reports a gradual onset of decreased libido and erectile dysfunction over the past year. He also mentions occasional headaches. Physical examination reveals no significant abnormalities, and his secondary sexual characteristics appear normal for his age.

1. Elevated levels of which anterior pituitary hormone could contribute to decreased libido and erectile dysfunction in men?

2. What are the potential effects of a pituitary tumour on surrounding structures that could explain his headaches?

3. How does hyperprolactinemia typically affect the hypothalamic-pituitary-gonadal axis in men?

A. If investigations reveal hyperprolactinemia in this patient, which of the following would be the most likely cause?

a) Primary hypogonadism

b) Prolactinoma

c) Hyperthyroidism

d) Adrenal insufficiency

B. Treatment of a prolactin-secreting adenoma in this patient with a dopamine agonist like cabergoline would primarily aim to

a) Increase testosterone production directly

b) Inhibit prolactin synthesis and secretion

c) Stimulate LH and FSH release

d) Block estrogen production

C. A large pituitary adenoma in this patient could potentially lead to hypopituitarism by ...:

a) Stimulating the secretion of all anterior pituitary hormones excessively

b) Compressing the normal pituitary tissue and impairing hormone production c) Increasing the sensitivity of target organs to pituitary hormones

d) Blocking the action of hypothalamic releasing hormones

I. True or False: Hyperprolactinemia in men can lead to decreased testosterone synthesis

II. True or False: Prolactinomas are more common in men than in women.

III. True or False: Visual field defects can occur due to the upward extension of a pituitary macroadenoma compressing the optic chiasm

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An 8-year-old boy is brought to the clinic by his parents due to significantly below-average height for his age and a slow growth rate over the past few years. His development has otherwise been normal.

1. Which anterior pituitary hormone is crucial for linear growth during childhood?

2. Name two hypothalamic hormones that regulate the secretion of this growth-promoting hormone.

3. What are some potential causes of growth hormone deficiency in a child

A. Deficiency of growth hormone in this child could result from

a) Excessive production of somatostatin

b) Primary hypothyroidism

c) A pituitary adenoma compressing somatotrophs

d) Excessive production of growth hormone-releasing hormone

B. Growth hormone primarily mediates its effects on growth through.

a) Direct stimulation of bone growth

b) Stimulation of insulin-like growth factor 1 (IGF-1) production

c) Increased secretion of thyroid hormones

d) Increased production of adrenal androgens

C. Somatotrophs, the cells that produce growth hormone, are classified histologically as

a) Basophils

b) Chromophobes

c) Acidophils

d) Gonadotropes

I. True or False: Growth hormone acts through second-messenger systems involving cAMP

II. True or False: The hypothalamus predominantly stimulates GH secretion through somatostatin

III. True or False: Isolated growth hormone deficiency is always due to a pituitary disorder

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A 45-year-old woman reports increasing fatigue, cold intolerance, weight gain, and dry skin over the past several months. She also mentions irregular menstrual periods.

1. These symptoms are suggestive of deficiency in which target gland hormone?

2. A deficiency in which anterior pituitary hormone could lead to these symptoms?

3. Name the hypothalamic hormone that stimulates the secretion of this anterior pituitary hormone.

A. The anterior pituitary cell type responsible for producing the hormone involved in this case is

a) Corticotroph

b) Gonadotrope

c) Somatotrope

d) Thyrotrope

B. Thyroid-stimulating hormone (TSH) is a

a) Peptide hormone

b) Steroid hormone

c) Glycoprotein hormone

d) Amine hormone

C. TSH binds to receptors on thyroid follicular cells, leading to

a) Decreased iodide uptake by the thyroid gland

b) Inhibition of thyroid hormone synthesis c) Increased production and secretion of thyroid hormones

d) Atrophy of the thyroid gland

I. True or False: TSH secretion is stimulated by thyroxine (T4) and triiodothyronine (T3)

II. True or False: TSH acts through a second messenger system involving cAMP

III. True or False: Somatostatin stimulates the release of TSH

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A 50-year-old man presents with progressive darkening of his skin, particularly in sun-exposed areas and skin creases. He also reports increasing fatigue, weakness, and occasional dizziness, especially on standing. Blood pressure is low.

1. The hyperpigmentation in this case is suggestive of elevated levels of which hormone family?

2. Deficiency of which anterior pituitary hormone could lead to the symptoms of fatigue, weakness, and hypotension?

3. Name the hypothalamic hormone that stimulates the secretion of this crucial anterior pituitary hormone.

A. The anterior pituitary cell type responsible for producing ACTH is

a) Thyrotrope

b) Somatotrope

c) Corticotrope

d) Lactotrope

B. ACTH is derived from the precursor molecule

a) Thyroglobulin

b) Insulin-like growth factor 1 (IGF-1)

c) Proopiomelanocortin (POMC)

d) Gonadotropin-releasing hormone (GnRH)

C. ACTH primarily targets the

a) Thyroid gland

b) Gonads

c) Adrenal gland

d) Liver

I. True or False: ACTH secretion shows a diurnal pattern with a peak in the late evening

II. True or False: Cortisol exerts a positive feedback on ACTH secretion

III. True or False: ACTH acts through a second messenger system involving cAMP