Exam 3, Day 1 Lecture Flashcards
An anesthetic technique allowing for ________ and _____ is desirable in transsphenoidal surgical approach.
smooth intubation and extubation rapid neurological assessment
ACTH controls secretion of adrenal cortex hormones which affect _____, _____ and ____ metabolism
carbohydrates, protein, and lipid metabolism
The name of the portal system involved at the hypothalamus and pituitary glands.
hypothalamo-hypophyseal portal system ….. or hypophyseal portal system
6 Factors known to increase GH secretion
- Starvation 2. Hypoglycemia or low fatty acids 3. Exercise 4. Excitement 5. Trauma 6. the 1st 2 hours of deep sleep
Components of bone matrix (2)
protein and minerals
Prolactin-secreting macroadenomas respond frequently to medication such as (3)
bromocriptine cabergoline pergolide (damages heart valves)
Post GH theapy, IGF-1 level are checked after ____ month(s)
one
Acquired Causes of Hypopituitarism (5)
Cranial irradiation Lymphocytic hypophysitis Infiltrative disorders Pituitary Apoplexy Empty Sella Syndrome
The symptoms of pituitary apoplexy may occur immediately or may develop over ___ days
1 - 2 days
Secretion of adenohypophyseal hormones is controlled by _______ which are secreted from the hypothalamus and traveling through the hypophyseal portal veins to the capillaries of the anterior pituitary.
hypothalamic releasing and hypothalamic inhibiting hormones.
This i referred to as the master gland.
Anterior pituitary gland
The growth promoting action of GH requires both ____ and ____.
insulin and carbohydrates
The anterior pituitary is glandular develops from _____ of pharyngeal epithelium
Rathke’s pouch
This blood vessel is located in the cavernous sinus
internal carotid artery
This is located superior to the pituitary stalk.
Optic chiasm
This is a channel for venous blood anterior to the sphenoid bone
carvernous sinuses.
Some cases of dwarfism are due to panhypopituitarism. This condition is specifically called ___.
pituitary dwarfism.
Mass effect: Lateral extension may compress CN 3,4,6, V1,V2 leading to ___.
Diplopia
True or False: Hormone resistance may be due to mutation at the receptor site.
True
A cartilage at both ends of the bone which is the site for new bone deposition.
Epiphyseal plate
This condition has an excessive growth and height significantly above average due to an excess of growth hormone during childhood, BEFORE the epiphyseal plates have closed.
Gigantism
4 Causes of panhypopituitarism
Congenital Tumors (adenoma, craniopharyngioma) TBI Thrombosis of pituitary vessel
What occurs when chondrocytes are converted to osteogenic cells?
bone deposition
Safest approach in surgically removing tumors of the pituitary gland.
transsphenoidal via nasal cavity
Type of intubation which should be considered for patients with acromegaly
fiberoptic-guided intubation. (Endotracheal intubation may present a challenge)
The most common cause of hyper secretion of anterior pituitary.
hyperfunctioning pituitary adenoma
What is the indirect effect of GH?
GH causes the liver to make at least 4 insulin-like growth factors (IGF-1 is the most important)
The hypothalamic-pituitary portal plexus allows transmission of _____ without significant systemic dilution. Consequently, pituitary cells are exposed to sharp spikes of releasing factors and in turn release their hormones as discrete pulses.
hypothalamic peptide pulses
Nerves associated with proximity to the pituitary gland. (5)
CN 3,4,6: for extrinsic eye movement Opthalmic nerve V1 Maxillary nerve V2
The axon terminals of the dorsal medial, ventral medial, and infundibular nuclei terminates at _____.
median eminence of the infundibulum.
The 3 most common hypersecreting pituitary tumors are those that produce
Prolactin (most common), ACTH, GH
6 Clinical presentation of Pituitary Apoplexy
Nausea, vomiting Vertigo Meningismus Variable onset of severe headache +/- visual defects +/- altered consciousness
The major blood source of anterior Pituitary gland.
Hypothalamic-pituitary portal plexus.
These cells (2) increase protein deposition in the bone matrix
Chondrocytes: cartilage-making cells Osteocytes: bone-making cells
Other name for posterior pituitary gland
Neurohypohysis
Inflammation of the hypophysis due to influx of lymphocytes
Lymphocytic hypophysitis
Achondroplasia is directly related to mutations in _____ and is unrelated to pituitary disorder.
Fibroblast growth factor receptor 3 (FGFR3)
This medication is used to treat acromegaly. It is a GH receptor antagonist (GHIH)
Pegvisomant (somavert)
This results when the pituitary gland produces excess growth hormone AFTER epiphyseal plate closure at puberty.
Acromegaly
This is referred to as the bone formation within the cartilage model.
Endochondral ossification (Bone growth)
Hypothalamic releasing and inhibiting hormones travel through the _____ to the capillaries of the Anterior pituitary gland.
hypophyseal portal veins
This is a branch of the cavernous part of the internal carotid artery
Inferior hypophyseal artery
True or False: In empty sella syndrome, hypopituitarism may develop insidiously.
True
Cranial nerves that move the eyeballs.
CN 3 (oculomotor) ,4 (Trochlear),6 (Abducens)
Top 4 tissues where Growth Hormone receptor is significantly expressed.
- B lymphoblasts 2. Adipocyte 3. Liver 4. Prostate
This are glial-like cells supporting the function of the neurons the projects down to the neurohypophysis. They don’t secrete hormones.
Pituicytes
This is a sequence of chemical reactions that constructs or synthesizes molecules from smaller units, usually requiring input of energy (ATP) in the process.
Anabolism
Bone elongation continues until a person reaches their full adult height, but bones can become ______.
thicker throughout life due to GH.
True or False: Empty sella syndrome is often an incidental MRI Finding
true
Main symptom if any of the CN are accidentally damaged from pituitary surgery.
double vision
Pituitary masses may undergo clinically silent infarction with development of a partial or totally empty sella by ______ filling the dural herniation.
CSF
This is a decreased secretion of all pituitary hormones.
panhypopituitarism
Symptomatic patients who have suboptimal response to medical therapy benefit from ____.
microsurgical removal of the tumor.
Test peroformed prior to radial arterial catherter insertion.
Allen’s test
Part of pituitary gland which contains cells that make hormones.
Anterior pituitary (Adenohypophysis, glandular part)
How many skeletal muscles attached to each eyeballs
6 (4 rectus muscles, 2 obliques muscles)
Incidence of Pituitary tumor
17 - 22% or 1 in 5 people
The highest concentration of any hypothalamic inhibiting and releasing hormones will be at which vein?
Primary plexus of the hypothalamic-hypophyseal portal system or at the hypophyseal portal veins. (they both have the same concentrations)
The neurosecretory cell’s axon terminal for anterior pituitary gland is located in the ____.
hypothalamus.
GH promotes growth via ____, _____, and _____.
protein anabolism, mitosis, and differentiation
The main hormone for production of gamete (sex cells).
Luteinizing Hormone
This gland develops from an evangination of the hypothalamus.
Neurohypohysis
This syndrome is associated with postpartum shock causing hyposecretion of anterior pituitary gland.
Sheehan’s Syndrome
Meningeal irritation with symptoms suggesting meningitis.
Meningismus
Mass effect: Inferior extension may lead to ____.
CSF rhinorrhea.
When does Epiphyseal plate closure occurs?
Puberty
The most important function of GH is ___.
Increased DNA transcription into mRNA
Growth hormone therapy is indicated when evoked GH level is ____.
< 3 micrograms/ L
Acromegaly progression characteristics (5)
Cardiomyopathy Hypertension Accelerated atherosclerosis Coarse facial features Overgrowth of internal organs Limited exercise tolerance
This is noticeably absent from the list of effects of panhypopituitarism onset in adulthood
GH deficiency.
When does growth hormone level starts decreasing?
after puberty
True or False: Rarely, functional pituitary adenomas may arise within the rim of pituitary tissue, and these are not always visible on MRI.
True
Two hormones needed for nursing successfully.
oxytocin and prolactin
Mass effect: Superior extension may compromise ____.
optic pathways leading to impaired visual acuity and visual field defects. May also produce hypothalamic syndrome (disturbed sleep,thirst, satiety, temperature regulation)
This occur with venous occlusions where blood can collect in infarcted zones.
Red infarct
Name 2 gonadotropins. They target the testes and ovaries.
FSH and LH
Medications used in evoked GH test (2)
Arginine GH-releasing hormone
True or False: Panhypopituitarism is more common than just a single hormone hypo secretion.
true
This hormone is responsible for mammary development and milk production.
Prolactin
The most common type of dwarfism is due to ___.
achondroplasia
This tests measures the ability of the pituitary gland to release GH after administration of a medication.
Evoked GH
Adeno means relating to a ____.
gland
This is a branch of the cerebral part of the internal carotid artery
Superior hypophyseal artery
One way that bone grows is by replacing the _____ with bone. (type of bone formation)
hyaline cartilage model
The decrease in glucose reuptake in skeletal muscle and adipose tissue is a result from _____.
GH-induced insulin resistance (similar to type 2 DM)
Pituitary glands are encased by ____. It is a depression in the sphenoid bone.
Sella turcica
The main effect of Growth hormone is __.
promotion of protein anabolism
Other name of IGF-1
Somatomedin C
Hormones of the supraoptic and paraventricular nuclei are released at the ____.
Pars nervosa
This is a neurosurgical emergency caused by hemorrhagic infarction of a pituitary adenoma or tumor.
Pituitary apoplexy
