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Chapter 17 Learning Objectives 1. Within what structure are hypothalamic regulating factors released into the portal system? Median eminence 2. Where does the medial forebrain bundle run? Through the lateral hypothalamus 3. What is the embryologic origin of the preoptic area? Where is the rest of the hypothalamus derived from? Telencephalon; POA is the most anterior nucleus Most of the hypothalamus is from the diencephalon 4. Which nuclei produce oxytocin and vasopressin? Which nucleus is the master clock for circadian rhythms? Preoptic area and paraventricular nuclei Suprachiasmatic nucleus [right over the chiasm so it can get some light] 5. What nuclei do do autonomic fibers originate from (although not all autonomics originate in the hypothalamus)? What pathway do they follow? Primarily the paraventricular nucleus, but also dorsomedial nucleus and lateral & posterior hypothalamus [the most superior nuclei] Nuclei=> medial forebrain bundle=> dorsolateral brainstem=> periacqueductal grey=> parasympathetic nuclei in brainstem & IML in spinal cord 6. By what pathways do emotions influence autonomic pathways and the immune system (2)? What rare hypothalamic tumor can cause gelastic epilepsy through this pathway? Amygdala <=> ventral amygdofugal pathway OR stria terminalis <=> hypothalamus Hypothalamic hamartoma 7. Which hypothalamic lesion causes insomnia? Hypersomnia? Anterior lesion=> insomnia [Mr. Burns’ head nodding forward waking him up] Posterior lesion=> sleepy time 8. Which hypothalamic lesion causes anorexia? Hyperphagia? Medial lesion=> anorexia [shrinking happens inward/medially] Lateral lesion=> Fatty McButterpants 9. What lesion causes poikilothermia? Bilateral posterior hypothalamic lesions 10. What is the most common hormone secreted by pituitary adenomas? What are the clinical signs of this type? Prolactin Amenorrhea in women, hypogonadism in men, weight gain, decreased libido, and galactorrhea 11. How should you localize the lesion in Cushing syndrome when high-dose dexamethasone suppresses cortisol? Pituitary sources of ACTH (Cushing disease) are usually suppressed by high dose, whereas nonpituitary ectopic sources are usually not 12. What sign is noticeably absent when patients have a TSH-secreting adenoma instead of Grave’s disease? There will be no exopthalmos when the cause is a TSH adenoma i. It’s caused by the autoimmunity in Grave’s disease 13. What treatment for SIADH can cause central pontine myelinolysis if not properly monitored? Hypertonic saline causes central pontine myelinolysis if the hyponatremia is corrected too rapidly 14. What is the most common cause of panhypopituitarism? Rare, unique cause? Clinical signs? adenoma pituitary apoplexy (spontaneous hemorrhage) sudden headache, meningeal signs, cavernous sinus syndrome, visual loss, unconciousness