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Pathophys II > Endocrine Pituitary Gland > Flashcards

Endocrine Pituitary Gland Flashcards

1
Q

Endocrine glands

A

secrete hormones directly into the surrounding ECF

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2
Q

Exocrine glands

A

products are discharged through ducts

ex. salivary, sweat glands

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3
Q

What are the important endocrine glands?

A 
pituitary gland
thyroid gland
parathyroid glands
pancreas
adrenal glands
ovaries & testes
placenta
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4
Q

The mediators of the endocrine system are

A

*hormones

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5
Q

Hormones are _________ that transport information (a message) from one set of cells (endocrine cells) to another (target cells)

A

chemical messengers***

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6
Q

____________ is the primary event that initiates a response to a hormone

A

binding to a target cell receptor

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7
Q

The hormone receptor has high

A

specificity and affinity for the correct hormone

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8
Q

The location of the receptor directs the

A

hormone to the correct target organ or target cell

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9
Q

Some hormones, such as ________, have wide spread target sites while others, such as _______, act on one target issue

A

insulin; TSH

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10
Q

The synthesis and secretion of hormones by endocrine glands are regulated by:

A

neural control
biorhythms
feedback mechanisms

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11
Q

Describe neural control

A

can suppress or stimulate hormone secretion
stimuli include pain, smell, touch, stress, sight, & taste
hormones under neural control include catecholamines, ADH, cortisol

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12
Q

Describe biorhythms

A

genetically encoded or acquired biorhythms
the intrinsic hormonal oscillations may be circadian, weekly, or seasonal
they may vary with stages of life

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13
Q

Feedback mechanisms include

A

negative feedback

positive feedback

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14
Q

The regulatory pathway of tropic hormones includes

A

hypothalamus–> pituitary gland–> target gland

the target gland hormone provides feedback to the pituitary gland and the hypothalamus

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15
Q

The anterior pituitary secretes these hormones

A 
growth hormone
adrenocorticotropic hormone
thyroid-stimulating hormone
follicle-stimulating hormone
Luteinizing hormone
prolactin
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16
Q

The blood supply to the pituitary is via the

A

superior and inferior hypophyseal arteries

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17
Q

The pituitary collects and integrates information from almost everywhere in the body

A

& uses this information to control the secretion of vital pituitary hormones

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18
Q

Pituitary hormone secretion is regulated by

A

feedback control from peripheral target organ hormones or other target products

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19
Q

The pituitary and hypothalamus have virtually no

A

blood brain barrier; this allows feedback products to have a potent effect on them

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20
Q

The pituitary located at the base of the brain and has two distinct portions:

A

the anterior lobe (adenohyophysis) and the posterior lobe (neurohypophysis)

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21
Q

Describe the anterior pituitary target cell type, the anterior pituitary hormone, the hormone target site, and the primary peripheral feedback hormone for thyrotropin-releasing hormone.

A

Anterior pituitary target cell type: Thyrotroph
Anterior pituitary hormone: Thyroid-stimulating hormone (TSH)
Hormone target site: thyroid glands
Primary peripheral feedback hormone: Triiodothyronine

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22
Q

Describe the the anterior pituitary target cell type, the anterior pituitary hormone, the hormone target site, and the primary peripheral feedback hormone for corticotropin-releasing hormone.

A

anterior pituitary target cell type: corticotroph
anterior pituitary hormone: adrenocorticotropic hormone
hormone target site: zona fasciculata & zona reticularis of adrenal cortex
primary peripheral feedback hormone: cortisol

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23
Q

Describe the the anterior pituitary target cell type, the anterior pituitary hormone, the hormone target site, and the primary peripheral feedback hormone for gonadotropin-releasing hormone.

A

anterior pituitary target cell type: gonadotroph
anterior pituitary hormone: follicle stimulating hormone luteinizing hormone
hormone target site: gonads (testes, ovaries)
primary peripheral feedback hormone: estrogen, progesterone, testosterone

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24
Q

Describe the the anterior pituitary target cell type, the anterior pituitary hormone, the hormone target site, and the primary peripheral feedback hormone for prolactin-releasing factor.

A

anterior pituitary target cell type: lactotroph
anterior pituitary hormone: prolactin
Hormone target site: breasts
primary peripheral feedback hormone: none

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25
Q

Describe the anterior pituitary target cell type for prolactin-inhibitory factor

A

lactotroph

there is no peripheral feedback hormone

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26
Q

Describe the the anterior pituitary target cell type, the anterior pituitary hormone, the hormone target site, and the primary peripheral feedback hormone for growth-hormone releasing hormone

A

anterior pituitary target cell type: somatroph
anterior pituitary hormone: growth hormone
hormone target site: all tissues
primary peripheral feedback hormone: growth hormone, insulin, growth factor-1

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27
Q

Describe the the anterior pituitary target cell type, the anterior pituitary hormone, the hormone target site, and the primary peripheral feedback hormone for growth hormone inhibitory factor (somatostatin).

A

anterior pituitary target cell type- somatroph
anterior pituitary hormone: growth hormone
hormone target site: all tissues
primary peripheral feedback hormone: growth hormone, insulin, growth factor 1

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28
Q

Pituitary disorders can be

A

primary disorder
secondary disorder
tertiary disorder

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29
Q

Describe what a primary pituitary disorder involves

A

defect to the peripheral endocrine gland

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30
Q

Describe a secondary pituitary disorder.

A

defect to the pituitary

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31
Q

Describe a tertiary disorder.

A

defect to the hypothalamus

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32
Q

Anterior pituitary hyposecretion is known as

A

panhypopituitarism- generalized pituitary hypofunction

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33
Q

Causes of anterior pituitary hyposecretion include:

A 
nonfunctioning tumors compress and destroy normal pituitary tissue
hypophysectomy
postpartum shock
irradiation
trauma
infiltrative disorders
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34
Q

Surgical removal of a tumor of the pituitary gland may require

A

thyroid hormone
glucocorticoids
vasopressin

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35
Q

Surgical removal of the tumor or the pituitary gland can be done to

A

decompress or remove the tumor

to control bleeding

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36
Q

Anterior pituitary hypersecretion is usually caused by

A

genign adenomas

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37
Q

The three most common tumors of the anterior pituitary produce

A

prolactin–> amenorrhea, infertility/decreased libido, impotence
ACTH–> Cushing’s disease
GH–> promotes growth of all tissues capable of growing
tumors that secrete thyrotropin or gonadotropin are very rare

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38
Q

Growth hormone secretion increases during

A

stress, hypoglycemia, exercise, and deep sleep

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39
Q

Growth hormone exerts its effects on

A

almost every part of the body

40
Q

Pulsatile fluctuations of growth hormone releasing hormone and growth hormone inhibiting hormone regulate

A

synthesis throughout the day

41
Q

A major target for growth hormone is

A

the liver- GH stimulates production of insulin-like growth factor type 1 (IGF-1) which mediates many of the effects of GH

42
Q

_______________ undergo hypertrophy and hyperplasia due to GH and IGF-1

A

skeletal muscle, heart, skin, and visceral organs

43
Q

Growth hormone hypersecretion is usually caused by a

A

growth hormone secreting pituitary adenoma

44
Q

Growth hormone hypersecretion is known as _____ in adults

A

acromegaly

acromegaly is the sustained hypersecretion of GH after adolescence

45
Q

Gigantism is the

A

hypersecretion of GH prior to puberty (before closure of the growth plates- may reach 8 to 9 feet tall)

46
Q

Common features of acromegaly include

A

skeletal overgrowth, soft tissue overgrowth, visceromegaly, osteoarthritis, glucose intolerance, skeletal muscle weakness, extrasellar tumor extension, peripheral neuropathy, challenging intubations

47
Q

Comorbidities of acromegaly include

A

hypertension, cardiomyopathy, ischemic heart disease, diabetes, osteoarthritis, skeletal muscle weakness/fatigue, increased lung volumes, sleep apnea (d/t all of the airway changes), increased liver, spleen, kidneys, & heart

48
Q

Treatment for acromegaly includes

A

restore normal GH levels
preferred initial treatment is microsurgical removal of the tumor with preservation of the gland
for small tumors, a transsphenoidal approach- going through sinus cavities
for large tumors an intracranial approach
irradiation and/or suppressant drug therapy are adjunctive treatments or for non surgical candidates

49
Q

Anesthetic considerations for the surgery patients with acromegaly include:

A

airway management
sleep apnea >60%
postoperative respiratory obstruction or failure
systemic hypertension, ischemic heart disease, and arrhythmias
skeletal muscle weakness
hyperglycemia
entrapment neuropathies
if adrenal or thyroid axis impairment- may need stress-level glucocorticoid therapy & thyroid replacement

50
Q

Describe the airway management concerns for the patient with acromegaly.

A

enlarged tongue, lips, nasal turbinates, & epiglottis, overgrowth of the mandible, vocal cord dysfunction
lead to upper airway obstruction, difficult mask fit, impaired visualization of cords, subglottic narrowing, dyspnea/hoarseness–> larynx involved

51
Q

Preoperative preparation for the patient with pituitary surgery includes

A

thorough H&P concentrate on symptoms associated with acromegaly
labs should include glucose, electrolytes, and hormone levels
images should be done to determine the extent of the tumor invasion
EKG- look for signs of left ventricular hypertrophy and arrhythmias
consider an echo if the patient has cardiac dysfunction
optimized cardiac function
check collateral circulation at the wrist prior to a-line insertion–> hypertrophy of carpal tunnel ligament may impede ulnar artery flow

52
Q

Anesthetic considerations for the transsphenoidal approach include

A

head of bed is elevated 15 degrees
a-line is usually inserted
a lumbar drain may be placed
consider monitoring for venous air emboli
usually not significant blood loss
use of submucosal injection of epinephrine containing solutions or use of topical vasoconstrictors may result in hypertension
the anesthetic technique chose should allow for muscle relaxation, smooth extubation and rapid neurlogoical assessment

53
Q

For the transphenoidal approach intraoperative hypotension may be due to

A

inadequate cortisol secretion- replace with hydrocortisone 50 to 100 mg IV

54
Q

For the transsphenoidal approach, blood loss is

A

usually minimal, there is the potential for large amounts of blood loss if a large cavernous sinus is inadvertently entered

55
Q

With the transsphenoidal approach, a venous air embolism is possible if

A

large tumor invading a large sinus and/or steep head up position

56
Q

Surgical complications of transsphenoidal approach include

A

cranial nerve damage, epistaxis, hyponatremia, cerebral spinal fluid leaks
diabetes insipidus

57
Q

Diabetes insipidus can occur

A

intra or postoperatively because of surgical trauma to the posterior pituitary- the trauma is reversible
results in insufficient ADH

58
Q

Diagnosis of diabetes insipidus is through

A

measuring serum electrolytes, hyperosmolar plasma, and urine osmolariy

59
Q

Treatment of diabetes insipidus involves

A

monitor urine output and electrolytes- can give DDAVP, restrict Na intake

60
Q

The posterior pituitary secretes

A

antidiuretic hormone (ADH or arginine vasopressin) and oxytocin

61
Q

ADH controls

A

renal water excretion and reabsorption and is a major regulator of serum osmolarity

62
Q

Oxytocin powerfully stimulates

A

uterine contractions, stimulates myoepithelia cells of the breast for milk ejection during lactation, is used for inducing labor and decreasing postpartum bleeding

63
Q

The posterior pituitary antidiuretic hormone has three types of vasopressin receptors:

A

V1- mediates vasoconstriction
V2- mediates water reabsorption in the renal collecting ducts
V3- found in the CNS and stimulate modulation of corticotrophin secretion

64
Q

Stimuli for ADH release include

A 
increased plasma sodium
increased serum osmolality
decreased blood volume
smoking (nicotine)
pain
stress
nausea
vasovagal reaction
angiotensin II
positive pressure ventilation
65
Q

Types of diabetes insipidus include

A

neurogenic or central- caused by inadequate release of ADH

nephrogenic- renal tubular resistance to ADH

66
Q

Causes of neurogenic diabetes insipidus include

A

head trauma, brain tumors, neurosurgery, infiltrating pituitary lesions

67
Q

Neurogenic diabetes insipidus may be associated with

A

hypokalemia, hyperkalemia, genetic mutations, hypercalcemia, and medication induced nephrotoxicity

68
Q

Inhibitors of ADH action or release include

A

ethanol, demeclocycline, phenytoin, chloropromazine, lithium

69
Q

Symptoms of ADH deficiency include

A

polyuria- Hallmark symptom
inability to produce a concentrated urine
dehydration
hypernatremia
low urine osmolarity- <300 mOsm/L
urine specific gravity <1.010
Urine volume >2 mL/kg/hr
Serum osmolarity >290 mOsm/L and sodium >145 mEq/L
neurological symptoms of hyperreflexia, weakness, lethargy, seizures, and coma

70
Q

______ is the major mechanism for controlling DI in awake patients

A

thirst

71
Q

Medical treatment of DI depends on

A

the degree of ADH deficiency

72
Q

Mild DI or incomplete DI can be treated with

A

medications that augment or release of ADH or increase receptor sensitivity
such as chlorpropamide, carbamazepine, clofibrate

73
Q

Significant DI-complete DI can be treated with

A

ADH preparations such as DDAVP

it is considered to be plasma osmolarity >290 mOsm/L

74
Q

DDAVP is a

A

selective V2 agonist with a duration of action of 8 to 12 hours
can be administered orally, subcutaneously, IV, & nasally

75
Q

DDAVP has less

A

vasopressor activity

enhances antidiuretic properties

76
Q

Preoperative assessment for the patient with DI includes

A

careful assessment of plasma electrolytes, renal function, and plasma osmolarity
dehydration makes these patients very sensitive to the hypotensive effects of general anesthetics
intravascular volume should be replaced with isotonic fluids over 24 to 48 hours

77
Q

Preoperative treatment of diabetes insipidus includes preoperative administration of vasopressin is

A

not necessary for incomplete DI because the stress of surgery increases ADH secretion

78
Q

Complete DI preoperative treatment includes

A

desmopressin
vasopressin
caution is necessary in patients with CAD–> ADH substitutes like ADH cause hypertension due to arterial vasoconstriction

79
Q

Labs to measure for the patient with DI in the intraoperative and immediate postoperative period include

A

plasma osmolarity, urine output, and serum sodium

80
Q

________ fluids should be given during the intraoperative period for patients with ADH deficiency and if the plasma osmolarity rises above 290 mOsm/L, _______ should be administered

A

isotonic fluids

D5W

81
Q

Hypersecretion of ADH is known as

A

syndrome of inappropriate ADH

82
Q

SIADH is a disorder characterized by

A

high circulating levels of ADH relative to plasma osmolarity and serum sodium concentration

83
Q

With SIADH, ADH secretion cause the

A

kidneys to continue to reabsorb water despite the presence of hyponatremia & plasma hypotonicity
expansion of ICF and ECF occurs as well as hemodilution and weight gain

84
Q

In SIADH, urine is

A

hypertonic relative to plasma and urine output is usually low

85
Q

Treatment for SIADH includes

A

fluid restriction

if patient is symptomatic or serum Na is <115-120 mEq/L consider hypertonic saline

86
Q

Clinical features of SIADH include

A

water intoxication, dilutional hyponatremia, & brain edema

87
Q

Brain edema results in

A

lethargy, headache, nausea, mental confusion, seizures, and coma

88
Q

With dilutional hyponatremia, the severity of symptoms is

A

related to the degree of hyponatremia and the rate of decrease in serum sodium

89
Q

Causes of SIADH include

A

hypothyroidism, pulmonary infection, lung carcinoma, head trauma, intracranial tumors, pituitary surgery, and medications

90
Q

The most common cause of SIADH is

A

neoplasms particularly small-cell carcinomas of the lung

91
Q

Preoperative evaluation of the patient with SIADH includes

A

careful volume status evaluation
perioperative fluid management- fluid restriction that involves the use of an isotonic solution
CVP can help with guiding volume replacement
frequent measures of urine output, urine osmolarity, plasma osmolarity, and serum sodium concentration
prevent nausea because it is potent for releasing ADH

92
Q

For mild SIADH with no symptoms of hyponatremia, the treatment is

A

treat with water restriction of 800 to 1000 mL/day of NS

93
Q

SIADH with acute, severe hyponatremia is defined as a plasma sodium concentration of

A

<115-120 mEq/L or acute neurological symptoms may require IV hypertonic saline with or without a loop diuretic

94
Q

Serum sodium should be measured every

A

2 hours during treatment

95
Q

To prevent acute loss of brain water and possible permanent neurological damage

A

known as central pontine demyelination syndrome, plasma concentration of Na must be replaced slowly at a rate not to exceed 1 to 2 mEq/L/hr or 6 to 12 mEq/L in 24 hours

Pathophys II (43 decks)

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