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N935 Advanced Pathophysiology > endocrine pituitary gland > Flashcards

endocrine pituitary gland Flashcards

1
Q

endocrine glands secrete

A

hormones directly into the surrounding ECF

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2
Q

exocrine glands secrete

A

products through ducts

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3
Q

examples of exocrine glands

A

salivary and sweat glands

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4
Q

examples of endocrine glands

A

pituitary, thyroid, parathyroid, pancreas, adrenal, ovaries, testes, placenta

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5
Q

endocrine glands control

A

growth, behavior, metabolism, reproduction

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6
Q

hormones are

A

chemical messengers that transport info from one set of cells to another (endocrine cells to target cells)

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7
Q

binding to a target cell receptor is the primary event that initiates

A

a response to a hormone

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8
Q

the hormone receptor has high

A

specificity and affinity for the correct hormone

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9
Q

the synthesis and secretion of hormones by endocrine glands are regulated by

A

neural control, biorhythms, and feedback mechanisms

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10
Q

neural control of hormone secretion

A

can suppress or stimulate secretion

stimuli: pain, smell, touch, stress, sight, taste

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11
Q

hormones under neural control include

A

catecholamines, ADH, cortisol

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12
Q

biorhythms are

A

genetically encoded or acquired

can be circadian, weekly, or seasonal and vary with stages of life

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13
Q

pituitary function

A

collects and integrates information from almost everywhere in body and uses it to control the secretion of hormones

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14
Q

the pituitary and hypothalamus don’t have a

A

blood brain barrier to allow for feedback products to have a potent effect on them

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15
Q

the anterior lobe of the pituitary

A

adenohypophysis

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16
Q

the posterior lobe of the pituitary

A

neurohypophysis

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17
Q

blood supply to the pituitary is via

A

the superior and inferior hypophyseal arteries

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18
Q

the anterior pituitary secretes which hormones

A

6 hormones:

growth hormone, adrenocorticotropic, thyroid stimulating, follicle stimulating hormone, luteinizing hormone, prolactin

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19
Q

Thyrotropin releasing hormone pathway

A

released by hypothalamus to anterior pituitary that will release thyroid stimulating hormone to the thyroid glands

primary peripheral feedback hormone: triiodothyronine

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20
Q

Corticotropin releasing hormone pathway

A

released by hypothalamus to anterior pituitary to release adrenocorticotropic hormone (ACTH) to adrenal cortex

primary feedback: cortisol

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21
Q

gonadotropin releasing hormone pathway

A

released from hypothalamus to anterior pituitary to release follicle stimulating and luteinizing hormones to the gonads

primary feedback: estrogen, progesterone, testosterone

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22
Q

what are the hormones of the anterior pituitary that can be releasing or inhibiting

A

prolactin, growth hormone

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23
Q

primary pituitary disorder

A

defect to the peripheral endocrine gland (target gland)

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24
Q

secondary pituitary disorder

A

defect to the pituitary gland (ex. tumor)

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25
tertiary pituitary disorder
defect to the hypothalamus (not common)
26
anterior pituitary HYPOsecretion causes
nonfunctioning tumors, hypophysectomy, postpartum shock, irradiation, trauma, infiltrative disorders (sarcoidosis)
27
signs and symptoms with anterior pit HYPOsecretion
visual changes (optic nerve near pit and can be compressed), papilloedema, increased ICP
28
anterior pituitary HYPERsecretion caused by
caused by benign adenomas usually
29
3 most common hormones that are secreted with anterior pit HYPERsecretion
prolactin, ACTH, and GH
30
growth hormone increases during
during stress, hypoglycemia, exercise, and deep sleep
31
major target for GH is the
liver, stimulates production of insulin like growth factor type 1 which mediates many of the effects of GH
32
GH hypersecretion
caused by growth hormone secreting pituitary adenoma in adults - acromegaly gigantism
33
acromegaly
sustained hypersecretion of GH after adolescence
34
gigantism
hypersecretion of GH prior to puberty (before closure of growth plates)
35
common features of acromegaly
``` skeletal and soft tissue overgrowth visceromegaly osteoarthritis glucose intolerance skeletal muscle weakness extrasellar tumor extension peripheral neuropathy ```
36
comorbities with acromegaly
HTN, cardiomyopathy, ischemic heart disease, diabetes, osteoarthritis, skeletal muscle weakness, increased lung volumes, sleep apnea, increased liver, spleen, kidneys, heart
37
acromegaly treatment
``` restore normal GH levels microsurgical removal of the tumor with preservation of the gland transsphenoidal approach - small intracranial approach - large irradiation supressant drug therapy ```
38
airway management considerations for acromegaly
enlarged tongue, lips, epiglottis, nasal turbinates, overgrowth of mandible, vocal cord dysfunction/narrowing prone to upper airway obstruction, difficult mask, impaired visualization of cords, subglottic narrowing, dyspnea/hoarseness
39
aline considerations for acromegaly
check collateral circulation because there may be hypertrophy of the carpal tunnel ligament which can impede ulnar artery flow
40
transsphenoidal approach considerations for acromegaly
``` HOB 15 degrees aline lumbar drain maybe monitor for VAE treat intraop HoTN with hydrocortisone 50-100 mg IV minimal blood loss ```
41
venous air embolism s/s
drop in etco2 bradycardia/heart block millwheel heart sound (heard with precordial or doppler)
42
complications with transsphenoidal approach
cranial nerve damage, epistaxis, hyponatremia, cerebral spinal fluid leak, DI
43
diabetes insipidus results in
insufficient ADH
44
diabetes insipidus diagnosis and treatment
diagnosis: low urine osmolarity, high serum osmolarity, hypernatremia treat: monitor urine and electrolytes, DDAVP, restrict Na+ intake, fluid replacement
45
patient education getting transsphenoidal
there will be packing in their nose and they will need to breathe through their mouth when they wake up from surgery
46
posterior pituitary secretes
ADH and oxytocin
47
ADH controls
renal water excretion and reabsorption and is a major regulator of serum osmolarity
48
Oxytocin stimulates
uterine contractions, breast milk ejection, induce labor, decrease postpartum bleeding
49
posterior pituitary hormones synthesis/pathway
So, oxytocin and ADH are synthesized in the hypothalamus and travel via neurons on the hypothalamic-hypophyseal tract to the posterior pituitary where they are stored in axon terminals, they then are released into the blood when hypothalamic neurons fire
50
3 types of vasopressin receptors
v1 - mediates vasoconstriction v2 - mediates water reabsorption in the renal collecting ducts v3 - found in CNS and stimulate modulation of corticotrophin secretion
51
what stimulates ADH release
increased plasma sodium, increased serum osmolality, decreased blood volume, smoking, pain, stress, nausea, vasovagal reaction, angII, PPV
52
neurogenic or central DI caused by
caused by inadequate release of ADH from head trauma, brain tumors, neurosurgery, infiltrating pituitary lesions
53
nephrogenic DI caused by
renal tubular resistance to ADH
54
nephrogenic DI may be associated with
hypokalemia, hyperkalemia, genetic mutations, hypercalcemia, medication induced nephrotoxicity
55
inhibitors of ADH action or release
ethanol, demeclocyline, phenytoin, chlorpromazine, lithium
56
symptoms of ADH deficiency
polyuria (hallmark sign), dilute urine, dehydration, hypernatremia, low urine osmolarity <300, urine specific gravity <1.010, urine volume >2mL/kg/hr, serum osmolarity >290, sodium >145 hyperreflexia, weakness, lethargy, seizures, coma
57
major mechanism for controlling DI in awake patients
thirst
58
mild DI or incomplete DI treatment
meds that augment or release ADH or increase receptor sensitivity carbamazepine, clofibrate
59
severe DI or complete DI treatment (plasma osmolarity >290)
DDAVP 1-2 mcg IV/SQ q12 hours or 5-40 mcg intranasal spray BID aqueous vasopressin 5-10 units IM/SQ q8-12 hours
60
DDAVP
selective V2 agonist DOA: 8-12 hours less vasopressor activity dose: 5-40 mcg/kg nasally, 0.5-2 mcg/day BID SQ increases vwb factor (give 30 minutes prior to surgery)
61
perioperative administration of vasopressin is not necessary for incomplete DI because
the stress of surgery increases ADH secretion
62
ADH can cause ____ due to ___ and caution is necessary in patients with CAD
hypertension; arterial vasoconstriction
63
if plasma osmolarity rises above 290 what should be administered
D5W (free water)
64
hypersecretion of ADH can lead to
SIADH (syndrome of inappropriate ADH)
65
SIADH
disorder characterized by high circulating levels of ADH relative to plasma osmolarity and serum sodium concentration
66
ADH secretion causes the kidneys to ___ in SIADH
continue to reabsorb water
67
the urine is ___ relative to plasma and urine output is ___ in SIADH
hypertonic; low
68
SIADH vs DI
SIADH - serum osmolarity, sodium, and urine volume are low, urine osmolarity is hypertonic, treat with fluid restriction and hypertonic saline DI - serum osmolarity, sodium, and urine volume are high, urine osmolarity is hypotonic, treat with DDAVP or vasopressin
69
clinical features of SIADH
``` water intoxication dilutional hyponatremia brain edema (lethargy, HA, nausea, confusion, seizures, coma) ```
70
severity of symptoms of dilutional hyponatremia is related to
the degree of hyponatremia and the rate of decrease in serum sodium
71
what procedure can cause dilutional hyponatremia?
TURP
72
causes of inappropriate secretion of ADH
hypothyroidism, pulmonary infection, lung carcinoma*, head trauma, intracranial tumors, pituitary surgery, meds (carbamazepine, TCAs, chlorpropamide, cyclophosphamide, oxytocin, nicotine, clofibrate)
73
neoplasms, especially small cell carcinomas of the lung are a common cause of
SIADH
74
mild SIADH with no symptoms of hyponatremia treatment
water restriction of 800-`1000mL/day of NS
75
SIADH with acute,severe hyponatremia (plasma sodium <115-120) or acute neurological symptoms treatment
IV hypertonic saline w/ or w/o loop diuretic
76
what can happen if rapidly increase sodium levels
central pontine demyelination syndrome = acute loss of brain water and neurological damage
77
plasma concentration of sodium must be replaced slow at a rate not to exceed
1-2 mEq/L or 6-12 mEq/L in 24 hours
78
what is something we can easily prevent in patients with SIADH perioperatively
prevent nausea!

N935 Advanced Pathophysiology (15 decks)

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