Final Exam - Endocrine Problems part 2 (Unit 12): Disorders of the Anterior Pituitary Gland

Question 1

What is Acromegaly ?

Answer 1

Excess secretion of Growth hormone (GH)

Question 2

What is Acromegaly usually caused by ?

Answer 2

benign pituitary tumor (adenoma)

Question 3

What does Acromegaly cause in adults ?

Answer 3

thickening of bones and soft tissues

Question 4

What does Acromegaly cause in children ?

Answer 4

gigantism

Question 5

What are Clinical Manifestations of Acromegaly ?

Answer 5

• Slow onset
• Enlargement of the hands/feet (hands and feet continue to grow into adulthood)
• Facial changes
• Tongue enlargement
• Sleep apnea
• Hypertrophy of the vocal cords (causes deeper voice)
• Skin leathery
• Proximal muscle weakness

Question 6

Pt’s with Acromegaly have an increased risk for what ?

Answer 6

• Diabetes

- Cardiovascular disease

Question 7

Why does having Acromegaly increase the risk for Diabetes ?

Answer 7

GH antagonizes the action of insulin, leading to hyperglycemia and possible DM

Question 8

Why does having Acromegaly increase the risk for cardiovascular disease ?

Answer 8

GH mobilizes fats, leading to atherosclerosis

Question 9

If GH levels do not fall, there is a diagnosis of what ?

Answer 9

Acromegaly

Question 10

What is the Tx of choice for Acromegaly ?

Answer 10

Surgery

Question 11

What is the medical term for the type of surgery used to Tx Acromegaly ?

Answer 11

Hypophysectomy

Question 12

What is a Hypophysectomy ?

Answer 12

Removal of the entire pituitary gland

Question 13

Hypophysectomy surgery leads to permanent loss of what ?

Answer 13

ALL pituitary hormones

Question 14

Because of Hypophysectomy leads to permanent loss of all pituitary hormones, the pt. will need what ?

Answer 14

Hormone replacement throughout life

Question 15

When performing surgery (Hypophysectomy) for Acromegaly, what approach do they use to access the anterior pituitary ?

Answer 15

Transsphenoidal Approach

Question 16

Where is the incision made when using a Transsphenoidal approach for a Hypophysectomy surgery ?

Answer 16

Incision is made in the upper inner aspect of the lip, through the gums

Question 17

Where should the HOB be placed for a post-op Hypophysectomy pt ?

Answer 17

Elevate HOB at 30 degrees AT ALL TIMES

Question 18

Why do we want the HOB elevated to 30 degrees at all times for post-op Hypophysectomy pt’s?

Answer 18

• To avoid pressure on the area

- Decrease headache, a frequent post-op complication

Question 19

What should we monitor in pt’s who are post-op from a Hypophysectomy ?

Answer 19

Neuro status (LOC, vision, etc)

Question 20

What do we want pt’s to avoid post-op from a Hypophysectomy ?

Answer 20

Avoid vigorous coughing or straining to prevent CSF leak

Question 21

To avoid straining in post-op Hypophysectomy pt’s, what might we put them on ?

Answer 21

Stool softners

Question 22

What should you do with any clear nasal drainage from your pt who is post-op from a Hypophysectomy ?

Answer 22

Send to the lab to be tested for glucose

>30 mg/dL indicates CSF leak

Question 23

What happens if a post-op Hypophysectomy pt has a CSF leak ?

Answer 23

It will usually resolve in 72hrs on its own. If not, need antibiotics

Question 24

What should you avoid Post-op Hypophysectomy pt’s from doing ?

Answer 24

AVOID brushing teeth for 10 days

due to surgical incision of lip/gum

Question 25

Post-op Hypophysectomy pt’s can develop what ? due to surgery ?

Answer 25

Diabetes Insipidious (DI)

• GET HOURLY URINE OUTPUT (to rule out DI)

Question 26

What is Hypopituitarism ?

Answer 26

A rare disorder that involves a decrease in one or more pituitary hormones

(EX: ACTH (adrenocorticotropic hormone), TSH, FSH, LH, ADH)

Question 27

What is the most common cause of Hypopituitarism ?

Answer 27

Pituitary tumor

But can also be from: infection, destruction of pituitary gland from trauma, radiation, or surgery

Question 28

What is the Tx for Hypopituitarism ?

Answer 28

Surgical removal of the tumor or radiation

• Lifelong hormone replacement