Pit gland disorders

Question 1

What does the anterior pit gland secrete?

Answer 1

thyroid stim hor. ACTH, 4 more

Question 2

What does the posterior pit gland secrete

Answer 2

Antidiuretic (vasopressin) hormone, oxytocin

Question 3

How are cortisol and aldosterone?

Answer 3

ACTH stims release of cortisol and aldosterone from the adrenal cortex

Question 4

What lab is used to dx adrenocorticoid dysfunction

Answer 4

ACTH levels

Question 5

What does the adrenal medulla do?

Answer 5

Secrete EPI and NOR when SNS stim, triggering fight or flight response

Question 6

What does the cortex stimulate in response to ACTH?

Answer 6

Steroids;
cortisol, aldosterone (mineralocorticoids), sex steroids (androgens)
“sugar, salt, and sex”

Question 7

Cushing’s

Answer 7

Hypercortisolism - ACTH stims the cortex which stims the hypo to stim the cortex release excess cortisol (neg feedback)

Question 8

Primary hyperfxn

Answer 8

dysfxn adrenal cortex releases excess cortisol (actual gland dysfxn); Cushing SYNDROME

Question 9

Secondary hyperfxn

Answer 9

dysfxn with anterior pituitary gland makes lots ACTH which makes excess cortisol; Cushing DISEASE

Question 10

What can long dose EXOGENOUS steroids cause?

Answer 10

Cushing syndrome (prednisone, dexamethasone)
- most common cause

Question 11

When might patients with Cushing need extra ACTH?

Answer 11

before surgery bc they can’t respond to natural triggers

Question 12

Are endogenous steroids stored on hand?

Answer 12

NO - must be created

Question 13

Cortisol functions

Answer 13

• raises blood sugar (opposes) insulin
• protects against stress
• b/d pro and fat - inc chol and BP
• suppresses immune and inflam responses

Question 14

Does ACTH rise during a “normal” stress response in someone with Cushing’s?

Answer 14

NO - can lead to pit atrophy

Question 15

Cushing’s CM

Answer 15

• glucose intolerance, hyperG
• HTN, capillary friability (ecchymoses)
• muscle waste, weakness, thin skin, osteoporosis, bone pain from inc pro b/d
• redistribute fat to ab, shoulders, face from fat b/d
• dec wound heal, inc risk infx
• mood swings, insomnia from CNS excite
• hirsutism
• gynecomastia
• moon face
• buffalo hump
• wide abdomen and thin extremities

Question 16

Cushing tx

Answer 16

Depend on cause; taper drug PRN, surgery or radiation for tumor, drugs

Question 17

Aminoglutethimide MOA

Answer 17

blocks synth of all adrenal steroids

Question 18

Aminoglutethimide SE and NC

Answer 18

• Drowsy, nausea, anorexia, rash
• not use longer than 3M
• does not affect underlying disease process

Question 19

ketoconazole MOA

Answer 19

Antifungal drug that inhibits glucocorticoid synthesis

Question 20

When is ketoconazole given?

Answer 20

Adjunct therapy to surg or radiation for Cushing

Question 21

ketoconazole SE and NC

Answer 21

• severe kuver damage
• don’t take with alc or other drugs that harm liver
• NO PREG (fetal thyroid damage)

Question 22

Addison disease

Answer 22

Disease of adrenal cortex that causes hyposec of all adrenocortical hor

Question 23

Addison cause

Answer 23

idiopathic, autoimmune, or other

Question 24

Addison disease patho

Answer 24

ADrenal gland destroyed so cortex not functioning, cortisol not produced, lack of negative feedback so ant pit increases ACTH and melanocyte stim hor to inc cortisol but doesn’t work so just have high ACTH

Question 25

When is Addison often dx

Answer 25

Far into diesase process

Question 26

Addison early CM

Answer 26

Anorexia, wt loss, weakness, malaise, apathy, electrolyte imbalances, skin hyperpigmentation

Question 27

Addison later CM

Answer 27

Hypoaldosteronism (hypotension, dec CO, vasular tone, and blood vol)
- get salt craving and dec NA, inc K, dehydration
Hypocortisolism
- hypogly, weak and fatigue, high ACTH, hyperpig

Question 28

Addison pharm

Answer 28

• needs to be LIFELONG
• all need glucocorticoid (pred, dexa)
• some need mineralcorticoid (fludro)
• often get Hydrocortisone bc has gluc and mineral properties
• often PO

Question 29

Addisons pharm

Answer 29

• dosing should mimic natural release (all bed or mix morn and bed)
• TAPER bc can cause Addisonian crisis
• dose need to inc during stress or can be fatal (infx, surg, trauma)
• always need emergency supply (oral and IJ)
• wear medic alert bracelet

Question 30

3x3 rule

Answer 30

For Addisons, take 3x normal dose for 3 days during high stress

Question 31

Severe Cushing Syndrome

Answer 31

• emergency
• rapid mass of random inc cortisol at any time or 24h free floating cortisol 4x UL
• assoc w/ onset sepsis, opportunistic infx, HTN, HF
• severe hypokalemia

Question 32

Addisonian crisis aka acute adrenal insufficiency

Answer 32

• sudden inc stress with chronic disease or sudden inc corticosteroid drug therapy
• body crash - medical emergency
• lack stress hor

Question 33

Pheochromocytoma

Answer 33

Rare tumor of the medulla that releases excess catecholamine in response to SNS stim
- often benign “oma”

Question 34

Pheochromocytoma risk factors

Answer 34

often young, middle aged adult

Question 35

Pheochromocytoma CM

Answer 35

HTN, HA, diaphoresis, tachy
- episodes with stress and exercise

Question 36

Big risk of Pheochromocytoma

Answer 36

STROKE

Question 37

Tx for Pheochromocytoma

Answer 37

• relaxation, low stress
• surgery is best
• alpha 1 blockers that cause HTN
• alpha blockers until surg or for inoperable tumors or preop to dec HTN

Question 38

Phenoxybenzamine HCl class, indications, and MOA

Answer 38

• alpha 1 adrenergic blocker
• pheochromocytoma
• Long-lasting, irreversible blockage of alpha-adrenergic receptors—vasodilation

Question 39

Phenoxybenzamine HCl SE and NC

Answer 39

• Dec BP, orthostatic hypotension, reflex tachycardia, nasal congestion, sexual SE in men
• given until surg or for inoperable tumor or preop to dec HTN