391.2 📚 國考版醫垫國考 / PGY OSCE

391.2.0.1 📌 Cram Sheet

391.2.0.1.1 🔥 高 yield 15
  1. 5 现胞 5 軞: GH, PRL, ACTH, TSH, LH/FSH
  2. Anterior pituitary = Rathke pouch (oral ectoderm)
  3. Posterior pituitary = neuroectoderm
  4. Portal venous carries hypothalamic releasing hormones
  5. PRL default secrete, dopamine 抑制
  6. Stalk effect → PRL mild ↑ (< 100, often < 200)
  7. Prolactinoma → cabergoline 1st line
  8. Acromegaly screen: IGF-1 + OGTT GH 䞍 suppress < 1
  9. Cushing’s screen: low-dose dex / late-night salivary cortisol / 24-h urine
  10. High-dose dex 區分 Cushing’s disease vs ectopic
  11. TSH first-line thyroid screen but central 看 free T4
  12. GnRH pulsatile, continuous → suppress
  13. TRH stim: TSH + PRL ↑
  14. Bitemporal hemianopsia = chiasm compression by macroadenoma
  15. Sheehan syndrome: post-partum hemorrhage → panhypopituitarism
391.2.0.1.2 🔢 必背
項目 æ•žå­—
Microadenoma < 10 mm
Macroadenoma ≥ 10 mm
OGTT GH suppress < 1 ng/mL
Low-dose dex suppress < 1.8 ÎŒg/dL
Late-night salivary cortisol > 0.15 abnormal
24-h urine cortisol > 50 ÎŒg/d abnormal
Prolactinoma cutoff > 200 highly suspicious

391.2.0.2 ⭐ 高 yield

391.2.0.2.1 现胞 % + 賀爟蒙
现胞 % Hormone
Somatotrophs 50 GH
Lactotrophs 15-20 PRL
Corticotrophs 15-20 ACTH
Thyrotrophs 5 TSH
Gonadotrophs 10-15 LH/FSH
391.2.0.2.2 賀爟蒙 Receptor
Hormone Receptor
GH JAK/STAT
PRL JAK/STAT
ACTH GPCR Gαs
TSH GPCR Gαs
LH/FSH GPCR Gαs
391.2.0.2.3 Hypothalamic Hormones Targets
Releasing Target Effect
TRH TSH + PRL ↑ both
CRH ACTH ↑
GnRH (pulsatile) LH/FSH ↑
GHRH GH ↑
Somatostatin GH (+ TSH) ↓
Dopamine PRL ↓ inhibitor
391.2.0.2.4 Hyperprolactinemia 原因
  • 生理: 劊嚠/哺乳/sleep/stress/sex
  • Prolactinoma
  • Stalk effect (PRL < 100)
  • 藥: metoclopramide, antipsychotic, methyldopa, opioid, SSRI
  • Hypothyroidism (TRH ↑)
  • Renal failure
  • Cirrhosis
  • Macroprolactinemia (false high)
391.2.0.2.5 Pituitary Mass Effect
  • Bitemporal hemianopsia (chiasm)
  • CN III/IV/V1/V2/VI palsy (cavernous sinus)
  • Headache
  • Hypopituitarism (stalk)
  • CSF rhinorrhea (rare)
391.2.0.2.6 Common Pituitary Tumors %
Tumor %
Prolactinoma 40-50%
Nonfunctioning 25-30%
GH-secreting (acromegaly) 10-15%
ACTH-secreting (Cushing’s disease) 5-10%
TSH-secreting < 1%
Gonadotroph (mostly nonfunctional) varies

391.2.0.3 🎯 自我檢枬

  1. 5 现胞? → Somato/lacto/cortico/thyro/gonado
  2. PRL default? → Secreted, dopamine inhibits
  3. Stalk effect PRL? → < 100 (often < 200)
  4. Prolactinoma 1st line? → Cabergoline
  5. Acromegaly suppress test? → OGTT GH < 1
  6. Cushing’s screen 3? → 1 mg dex / salivary / 24-h urine
  7. Bitemporal hemianopsia cause? → Chiasm compression
  8. TRH stimulates? → TSH + PRL
  9. Dopamine inhibits? → PRL
  10. Pulsatile GnRH? → Stimulates LH/FSH; continuous → suppresses
  11. Hook effect? → Extreme PRL → false low → dilute
  12. Sheehan? → Post-partum hemorrhage → panhypopituitarism
  13. Macroprolactinemia? → PRL-IgG complex, false high, asymptomatic
  14. ACTH source POMC? → ACTH/MSH/β-endorphin
  15. α-subunit shared by? → TSH/LH/FSH/hCG

⚠ AI 草皿。