Hypothalamus and pituitary lecture

Question 1

What is the coordinating center of the endocrine system

Answer 1

hypothalamus

Question 2

Where is the pituitary gland

Answer 2

sella tursica in the sphenoid bone

Question 3

another name for anterior pituitary

Answer 3

adenohypophysis

Question 4

what is the anterior pituitary

Answer 4

highly vascularized
regulates thyroid, adrenal, mammary glands
regulated GH, gonads, melanocytes

Question 5

adrenal glands- major

Answer 5

thyroid, adrenals, gonads

Question 6

anterior pituitary cell types

Answer 6

somatotrops (30-40%) most abundant, secretes GH
Croticotropes (20%) secretes ACTH
Thyrotropes (5%) secretes TSH
Gonadotropes (5%) secretes LH and FSH
Lactrotropes (5%) secretes prolactin

Question 7

The posterior pituitary is aka

Answer 7

neurohypophysis
produces adh and oxytocin

Question 8

where is blood supplied from when it goes to the hypothalamus, AP, and PP

Answer 8

hypothalamus- superior hypophyseal artery
AP- long portal vessels
PP- inferior hypophyseal artery

Question 9

names and function of the nuclei in the hypothalamus

Answer 9

paraventricular- oxytocin (pitocin)
supraoptic nucleus- ADH

Question 10

what is the master gland

Answer 10

pituitary gland

Question 11

anterior pituitary secretes:

Answer 11

FLAT PG
fsh
lh
acth
thyroid/ tsh
prolactin
gh

Question 12

stimulus for adh release- what is activated?

Answer 12

high plasma osmolarity >290 activate
osmoreceptor in hypothalamus
decreased ecf volume
increased na, low bp, at2, nicotine, pain, ppv,

Question 13

DI

Answer 13

adh deficiency
neurogenic (common) or nephrogenic

Question 14

what can cause nephrogenic di

Answer 14

ckd
lithium toxicity
hypercalcemia
hypokalemia
drugs (tubulointerstitial disease)
genetics

Question 15

anesthesia and hypernatremia

Answer 15

increased mac
decreased ecf requires lower iv doses
postpone if over 150
lethargy, hyperreflexia, restlessness

Question 16

siadh

Answer 16

water
adh overload
restrict fluids, demeclocycline

Question 17

anesthesia and hyponatremia (stop level, mac, symptoms, tx)

Answer 17

cancel if below 130
<130 decrease in mac
agitation, confusion, somnolence
3% saline, lasix

Question 18

risk factors for central pontine myelinolysis

Answer 18

sodium >120 for 48 hours
aggressive iv fluid therapy with 3%
development of hypernatremia during treatment
monitor q1h

Question 19

where is oxytocin secreted from

Answer 19

paraventricular nucleus of posterior pituitary

Question 20

what is the action of oxytocin

Answer 20

contract uterus during labor- used after labor to stop blood loss after birth
contract lactating breast

Question 21

risks of oxytocin

Answer 21

fetal distress due to hyperstimulation
uterine tetany
maternal water intoxication
rapid infusion can cause htn, tachy, nv, seizures

Question 22

how do pituitary tumors present

Answer 22

eye issues
bitemporal hemianopsia

Question 23

excess GH presentation

Answer 23

acromegaly, difficult mask and intubation

Question 24

excess tsh presentation

Answer 24

hyperthyroid, tachy, weight loss

Question 25

acth excess presentaiton

Answer 25

cushings, difficult airway and access

Question 26

treatment for panhypopituitarism

Answer 26

cortisol
t4
ddavp

Question 27

pituitary surgery approach

Answer 27

most done with transphenoidal approach
some may require craniotomy

Question 28

risks (and tx) of pituitary surgery

Answer 28

di
suspect with urine spec gravity <1.005
treat with ddavp 2mcg iv or sq and volume

Question 29

anesthetic considerations for pituitary surgery

Answer 29

normotensive and normocapneic
hypocapnea will lower icp
deep extubate
oral rae

Question 30

acromegaly presentation

Answer 30

large tongue, large epiglottis, enlarged mandible, distorted anatomy
subglottic narrowing, vocal cord enlargement
downszie ett
osa, htn, cmp, lvh common
skeletal overgrowth
glucose intolerance
entrapment nueropathys

Question 31

most common cause of di

Answer 31

pituitary surgery
but also
tbi
sah

Question 32

ddavp dose for di

Answer 32

sc- 0.5-2mcg bid
nasal- 5-40 mcg qd

Question 33

treatment for siadh

Answer 33

fluid restriction
3%
demeclocycline

Question 34

most common cause of siadh

Answer 34

tbi - most
small cell lung carcinoma
carbamazepine

Question 35

another name for growth hormone

Answer 35

somatotropin

Question 36

main cause of acromegaly

Answer 36

pituitary adenoma

Question 37

acromegaly vs gigantism

Answer 37

acromegaly- after adolescence
gigantism- before puberty

Question 38

t3 vs t4

Answer 38

t3- more potent, shorter half life, less protein bound
t4- prohormone, less potent, more concentrations in the blood

Question 39

half life of t3 and t4

Answer 39

t3- 1 day
t4- 7 days

Question 40

acromegaly considerations

Answer 40

distorted facial features- difficult mask ventilation
Large tongue, teeth, epiglottis- difficult laryngoscopy
subglottic narrow and vocal cord enlargement- use smaller tube
turbinate enlargements- risk of epistaxis, avoid nasal intubation if possible
osa common
htn, cad, rhythm disturbance
glucose intolerance
sm weakness
entrapment neuropathy- ulnar

Question 41

what do patients with hyperparathyroid present with often?

Answer 41

increased PTH and hypophosphatemia

Question 42

clinical feature of primary hyperparathyroidism

Answer 42

shortened qt from hypercalemia
pathological fx from bone resportion

Question 43

hypocalcemia can cause

Answer 43

laryngospams
myocardial depression