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AS - N935 Advanced Patho II > Endocrine - Pituitary > Flashcards

Endocrine - Pituitary Flashcards

1
Q

Endocrine Glands

A

Secrete hormones DIRECTLY into surrounding extracellular fluid

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2
Q

Exocrine Glands

A

Products are discharged via ducts

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3
Q

What mediates the endocrine system?

A

HORMONES

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4
Q

What are hormones?

A

Chemical messengers that transport information from initial cells to target cells

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5
Q

Hormone Secretion Regulation

A
  • Neural control
  • Biorhythms
  • Feedback mechanisms
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6
Q

Hormone Neural Control

A

Suppress or stimulate hormone secretion
Stimuli include pain, smell, touch, stress, sight, taste
Catecholamines, ADH, & cortisol are hormones under neural control

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7
Q

Hormone Biorhythms

A

Genetically encoded or acquired biorhythms
Intrinsic hormonal oscillations - circadian, weekly, or seasonal
Potential to vary w/ life stages

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8
Q

Hormone Feedback Mechanisms

A

Negative or positive

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9
Q

Anterior Pituitary

A 
Adenohypophysis
80% pituitary
Secretes 6 hormones 
- Growth hormone
- Adrenocorticotropic ACTH
- Thyroid-stimulating TSH
- Follicle-stimulating FSH
- Luteinizing hormone
- Prolactin
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10
Q

TSH

A

Thyrotropin-releasing hormone TRH → TSH

Target site = thyroid glands

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11
Q

ACTH

A

Corticotropin-releasing hormone CRH → ACTH
Target site = adrenal cortex zona fasiculata & reticularis
CORTISOL

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12
Q

FSH/LH

A

Gonadotropin-releasing hormone → FSH/LH
Target site = gonads (testes/ovaries)
Estrogen, progesterone, testosterone

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13
Q

Prolactin

A

Anterior pituitary hormone
Prolactin releasing & inhibitory hormone/factor
Lactotroph
Target site = breasts

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14
Q

Growth Hormone

A

Anterior pituitary hormone
Growth hormone releasing & inhibitory hormone/factor
Somatotroph
Target site = all tissues

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15
Q

Primary Pituitary Disorder

A

Defect to the peripheral endocrine gland (target organ)

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16
Q

Secondary Pituitary Disorder

A 
Pituitary defect
(ex: tumor)
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17
Q

Tertiary Pituitary Disorder

A

Hypothalamus defect (not common)

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18
Q

Panhypopituitarism

A

Generalized pituitary hypofunction

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19
Q

Panhypopituitarism Causes

A 
Non-functioning tumors compress & destroy normal pituitary tissue
Hypophysectomy
Postpartum shock
Irradiation
Trauma
Infiltrative disorders
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20
Q

Anterior Pituitary Hyposecretion

Treatment

A

Surgical tumor removal

Hormone replacement therapy - thyroid hormone, glucocorticoids, vasopressin

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21
Q

Anterior Pituitary Hypersecretion

A

Usually caused by benign adenomas
Prolactin → amenorrhea, infertility, ↓libido, impotence
ACTH → Cushing’s disease
Growth hormone → promotes growth all tissues capable to grow
Tumors that secrete thyrotropin or gonadotropin are rare

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22
Q

Growth Hormone Normal Secretion

A

Secretion increases during stress, hypoglycemia, exercise, & deep sleep
Stimulate insulin-like growth factor type 1 (IGF-1) production that mediates GH effects
Skeletal muscle, heart, skin, & visceral organ undergo hypertrophy & hyperplasia d/t GH & IGF-1

23
Q

Growth Hormone Hypersecretion

A

Usually caused by GH secreting pituitary adenoma

24
Q

Gigantism

A

GH hypersecretion prior to puberty or before growth plates closure
8-9’ tall

25
Q

Acromegaly

A

GH hypersecretion in adults after growth plates closed (adolescence)
Sustained GH hypersecretion → tissue growth

26
Q

Acromegaly S/S

A 
Skeletal & soft tissue overgrowth
Large mandible & tongue → potential difficult intubation
Tissue hypertrophy around vocal cords
Visceromegaly
Osteoarthritis
Glucose intolerance
Skeletal muscle weakness
Extrasellar tumor excision
27
Q

Acromegaly Comorbidities

A

HTN, cardiomyopathy, & ischemic heart disease
Diabetes
Osteoarthritis & skeletal muscle weakness/fatigue
↑lung volumes & sleep apnea
Organ enlargement - liver, spleen, kidneys, heart

28
Q

Acromegaly Treatment

A

Restore normal GH levels
Preferred initial treatment - microsurgical tumor removal w/ gland preservation
Small tumors transsphenoid approach
Large tumors intracranial approach
Irradiation and/or suppressant drug therapy as adjunct to shrink tumor for non-surgical candidates

29
Q

Acromegaly Anesthetic Considerations

A

Difficult mask/airway
Sleep apnea
Postop respiratory obstruction or failure
Systemic HTN, ischemic heart disease, arrhythmias
Monitor blood glucose
Stress-level glucocorticoid therapy & thyroid replacement

30
Q

Pituitary Surgery

Preop Evaluation

A

Check electrolytes, hormone levels, & glucose
Imaging to assess tumor extent
EKG to assess LV hypertrophy or arrhythmias
Consider echo w/ cardiac dysfunction patients
Optimize cardiac function prior to surgery
Check collateral wrist circulation prior to A-line insertion (potential ulnar flow impede d/t carpal tunnel ligament hypertrophy)

31
Q

Transsphenoid Approach

A 
Elevate HOB 15° 
A-line
Lumbar drain
VAE risk
Submucosal epi injections to vasoconstrict → HTN
Intraop hypotension d/t inadequate cortisol secretion
Muscle relaxation & smooth extubation
Neurological exam postop
32
Q

Transsphenoid Approach Complications

A 
Cranial nerve damage
Epistaxis
Hyponatremia
CSF leak
Diabetes insipidus
33
Q

Posterior Pituitary

A

Neurohypophysis
20% pituitary
Secretes ADH (vasopressin) & oxytocin (Pitocin)

34
Q

ADH

A

Antidiuretic hormone or vasopressin
Controls renal water reabsorption
Regulates serum osmolarity

35
Q

Oxytocin

A

Stimulates uterine contractions
Breast myoepithelia cells - milk ejection during lactation
Induces labor & decreases postpartum bleeding

36
Q

Vasopressin Receptors

A

V1 - mediates vasopressin (refractory hypotension)
V2 - mediates water reabsorption in renal collecting ducts (DDAVP target site)
V3 - located in CNS & stimulates corticotrophin secretion modulation

37
Q

Stimuli to release ADH:

A 
↑plasma Na+
↑serum osmolality
↓blood volume
Smoking (nicotine)
Pain or stress
Nausea
Vasovagal reaction
ANG II
PPV
38
Q

Diabetes Insipidus

A

Cause: surgical trauma to posterior pituitary
Reversible
Insufficient ADH
↑UOP ↓urine osmolarity & specific gravity ↑serum electrolytes
Hypernatremia

39
Q

DI Types

A

Neurogenic or central caused by inadequate ADH release

Nephrogenic - renal tubular resistance to ADH

40
Q

Neurogenic DI Causes

A

Head trauma
Brain tumors
Neurosurgery
Infiltrating pituitary lesions

41
Q

Nephrogenic DI

A

Associated w/

  • Hypo/hyperkalemia
  • Genetic mutations
  • Hypercalcemia
  • Medication induced nephrotoxicity
42
Q

ADH Deficiency S/S

A

Polyuria >2mL/kg/hr
Dilute unconcentrated urine
Dehydration
Hypernatremia Na+ >145mEq/L
↑serum plasma osmolarity >290mOsm/L
↓urine osmolarity <300mOsm/L & specific gravity <1.01
Neurological hyperreflexia, weakness, lethargy, seizures, & coma

43
Q

Significant/Complete DI

A

Plasma osmolarity >290mOsm/L

44
Q

DI Treatment

A 
Monitor UOP & electrolytes
DDAVP or vasopressin
Restrict Na+ intact
Adequate fluid replacement
UO 1:1
45
Q

DDAVP

A 
Desmopressin ↑factor VIII
Selective V2 agonist
Admin 30-90min before surgery
DOA 8-12 hours
Less V1 (vasopressor) activity
Enhanced antidiuretic properties
Nasal 5-40mcg/day
SQ 0.5-2mcg/day BID
46
Q

Posterior Pituitary Preop Assess

A

Assess plasma electrolytes, renal function, & plasma osmolarity
Dehydration → sensitive to general anesthesia hypotensive effects
Replace intravascular volume w/ isotonic fluids over 24-48hrs

47
Q

ADH Deficiency Preop Treatment

A

Surgery stress increases ADH secretion
Complete DI pre-treat w/ DDAVP 1-2mcg IV Q12H
Vasopressin 5-10 units IM/SQ Q8-12H
Caution w/ CAD patients → HTN d/t arterial vasoconstriction
Measure UOP, plasma osmolarity, & serum Na+
Admin isotonic fluids

48
Q

SIADH

A

Syndrome inappropriate antidiuretic hormone
↑ADH ↑renal H2O reabsorption despite hyponatremia & plasma hypotonicity
Intracellular & extracellular fluid expansion
Hemodilution & weight gain
UOP hypertonic/concentrated related to plasma

49
Q

SIADH Causes

A 
Hypothyroidism
Pulmonary infection
Small cell lung carcinoma
Head trauma
Intracranial tumors
Pituitary surgery
Medications
50
Q

SIADH S/S

A 
Water intoxication
↓serum osmolarity <270mOsm/L
Dilutional hyponatremia <130mOsm/L
↓UOP
Hypertonic/concentrated urine
Neurological cerebral edema → lethargy, headache, nausea, confusion, seizures, & coma
51
Q

SIADH Treatment

A

Mild - fluid restriction 800-1,000mL/day NS
Consider hypertonic saline (symptomatic patients or serum Na+ <115-120mEq/L) w/ or w/o loop diuretic
Monitor serum Na+ Q2H

52
Q

Sodium Replacement

A

SLOWLY
1-2mEq/L/hr or 6-12mEq/L/day
Prevent acute loss brain H2O
Central pontine demyelination syndrome → permanent neurological damage

53
Q

SIADH Anesthetic Considerations

A

Isotonic solution w/ fluid restriction
CVP to help monitor fluid status & guide replacement therapy
Closely monitor UOP, urine osmolarity, plasma osmolarity, & serum Na+ concentration
Prevent nausea → triggers ADH release

AS - N935 Advanced Patho II (20 decks)

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