Step I Pituitary apoplexy

[ChessMaster3000]

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Hey folks,

UW spoiler here. qid 220

UW makes a distinction btw pituitary apoplexy that occurs from a pituitary adenoma hemorrhaging into itself and Sheehan's syndrome that results in ischemic hemorrhagic necrosis. According to many, Sheehan's is a form of apoplexy, but UW does not consider them to be the same. And thus a postpartum patient with amenorrhea is the result of ischemic hemorrhagic necrosis, NOT apoplexy.

Is this a little ridiculous, or is it just me? I guess given answer choice "ischemic necrosis" I should have picked that, but still.

 

[acciddropping]

Hey folks,

UW spoiler here. qid 220

UW makes a distinction btw pituitary apoplexy that occurs from a pituitary adenoma hemorrhaging into itself and Sheehan's syndrome that results in ischemic hemorrhagic necrosis. According to many, Sheehan's is a form of apoplexy, but UW does not consider them to be the same. And thus a postpartum patient with amenorrhea is the result of ischemic hemorrhagic necrosis, NOT apoplexy.

Is this a little ridiculous, or is it just me? I guess given answer choice "ischemic necrosis" I should have picked that, but still.

- I was confused at first too. I think it's safe to go with these conditions
a) Drop dead from heart failure and has had tunnel vision plus mental changes ( Apoplexy - hemorrage of the pre-existing adenoma)
b) Sheehan is for a new mother who can't mense or breastfeed postpartanly. (not serious - it's ischemic infarct because growing lactotrophs during estrogen surge during pregnancy cannot be kept up by blood supply to the anterior pituitary)

 

[ChessMaster3000]

- I was confused at first too. I think it's safe to go with these conditions
a) Drop dead from heart failure and has had tunnel vision plus mental changes ( Apoplexy - hemorrage of the pre-existing adenoma)
b) Sheehan is for a new mother who can't mense or breastfeed postpartanly. (not serious - it's ischemic infarct because growing lactotrophs during estrogen surge during pregnancy cannot be kept up by blood supply to the anterior pituitary)

so in their mind apoplexy denotes a much more serious insult on the pituitary?

 

[acciddropping]

Yeah, think of apoplexy as pan-hypoptiuary and has siginifcant effects on heart (think of the improtance of cortisol and thyroid H functions on heart and if you don't have them, you can't run your heart.... cortisol maintains BP by expressing alpha 1 on arterioles and TH expresses beta1 on heart.

 

[ChessMaster3000]

Yeah, think of apoplexy as pan-hypoptiuary and has siginifcant effects on heart (think of the improtance of cortisol and thyroid H functions on heart and if you don't have them, you can't run your heart.... cortisol maintains BP by expressing alpha 1 on arterioles and TH expresses beta1 on heart.

do you mean TH expresses adrenergic-responsive b1 receptors on the heart? I was trying to find this online and couldnt come up with anything. do you remember where you read that? the only thing I could find were thyroid hormone's own b1 receptors which are expressed in the brain, which we surely dont need to know about

 

[acciddropping]

FA page 295 "increase b1 receptors in heart = increase CO, HR, SV, contractibility"
- that's why it's good to give them beta blocker like propanaolol to hyperthyrod pts.. also beta blocker decreases t4 to t3 conversion so it's a win win.

 

[ChessMaster3000]

FA page 295 "increase b1 receptors in heart = increase CO, HR, SV, contractibility"
- that's why it's good to give them beta blocker like propanaolol to hyperthyrod pts.. also beta blocker decreases t4 to t3 conversion so it's a win win.

nice! i read that before and kind of went, "oh yeah I got that" but it was only when you wrote it out of context that I realized it hadn't sunk in. thanks again.