Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

XIO > Pituitary > Flashcards

Pituitary Flashcards

1
Q

FUNCTIONS OF THE NEPHRON - Responds to ADH by reabsorbing water from the

A

collecting ducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

DISEASES OF THE POSTERIOR PITUITARY- Significant hormone alternation in the posterior pituitary usually related to

A

Significant hormone alternation in the posterior pituitary usually related to abnormal ADH

These pathological states have significant clinical effects on:
The modulation of body fluids and electrolytes
Cognitive function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

SYNDROME OF INAPPROPRIATE ADH: SIADH ETIOLOGY (sia has ADH)

A

SIADH is characterized by ↑ ADH in spite of having normal or low plasma osmolarity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

SIADH: PATHOPHYSIOLOGY - osmolality? (think…too much water)

A

Cardinal features of SIADH are the result of excess water retention
ADH acts on the renal collecting ducts increasing H2O reabsorption
Leads to:
Increased intravascular fluid volume → dilutional hyponatremia
Overall serum hypo-osmolality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

SIADH: CLINICAL MANIFESTATION- main issue is low what?

A

Sx of SIADH are primarily related to hyponatremia
The severity and rapidity of low Na+ determines the extent of Sx:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

SIADH: Criteria for dx - sodium

A

Criteria for dx:
hyponatremia: < 135 mEq/L (normal 135-145)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

SIADH: TREATMENT - what % of sodium solution?

A

Correct underlying cause
Gradual correction of hyponatremia with hypertonic solutions e.g. 3% sodium
Vigilant monitoring of Na levels and mental status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

SIADH: PHARMACOLOGIC TREATMENT - LASIX - when can you give it? - what number exactly

A

LASIX to promote UOP (only if Na >125 since Lasix can cause further Na loss)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

SIADH: NURSING CONSIDERATIONS

A

Seizure precaution
Fluid restriction (minimize thirst with ice cold drinks, sugar free chewing gum, cold water sprays)
Monitor I/O
Daily weight
Monitor electrolytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ADH DEFICIENCY: DIABETES INSIPIDUS - the 3 types

A

DI : Deficiency in ADH or decrease renal response to ADH
3 TYPES:
Central DI, Nephrogenic, Primary DI :

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ADH DEFICIENCY: DIABETES INSIPIDUS - Nephrogenic (die don’t collect)

A

Nephrogenic: Inadequate response of renal collecting tubules to ADH even when levels are normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

DI: Pathophysiology - bladder?

A

Fluid and electrolyte imbalance d/t ↑urine output and ↑ serum osmo
Large bladder capacity and hydronephrosis in long standing DI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

DI: CLINICAL MANIFESTATION - BP?

A

POLYURIA
POLYDIPSIA
NOCTURIA
HYPOTENSION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

DI: EVALUATION - how many liters of urine a day?

A

Eliminate other differential diagnosis which may cause polyuria state
Dx criteria
Polyuria (2-20 L/day)
Polydipsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

DI: what medication?

A

IV fluid and hormone replacement DDAVP (desmopressin) (analog of ADH) SC, IV, IM, intranasal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

DI: NURSING CONSIDERATIONS - what intranasal spray? (die is depressing)

A

Strict I&O
Monitor urine specific gravity
Daily weights
Goal is maintaining fluid and electrolyte balance
Discharge teaching with intranasal Desmopressin (synthetic vasopressin- increases water) BID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

DISORDERS OF THE ANTERIOR PITUITARY

A

Disorders of the Anterior Pituitary may involve either hypopituitarism or hyperpituitarism
Hypopituitarism etiology:
Inadequate supply of the hypothalamic-releasing/inhibiting hormones
Damage to the pituitary stalk
Inability of the pituitary to produce hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

HYPOPITUITARISM - Pituitary infarction (hemorrage) is seen in the setting of (little pitt and sheeran are pregnant)

A

Sheehan Syndrome: Ischemic pituitary necrosis caused by severe postpartum hemorrhage ( may lead to failure to lactate and amenorrhea)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

HYPOPITUITARISM: s/sx

A

S/S vary depending on the degree of dysfunction and response of the target glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

HYPOPITUITARISM: EVALUATION (measure little brad’s hormones and MRI)

A

Simultaneous measurement of all trophic hormones from the pituitary and the target glands
Imaging: MRI, CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

HYPERPITUITARISM: GH HYPERSCRETION

A

Benign autonomic GH secreting pituitary adenoma
Acromegaly:
Gigantism:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

ACROMEGALY: CLINICAL manifestation - and edema where?

A

Enlarged tongue, interstitial edema, coarse skin and body hair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

ACROMEGALY: diagnosis (agro glucose)

A

Diagnosis:
MRI, CT, visual exam
Fails GH suppression during oral glucose tolerance test (GH levels fail to fall below 1/ng/ml)
Elevated IGF- 1 levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

meds - ACROMEGALY (aggro octavia and peg need meds)

A

Octreotide/lanreotide ( Somatostatin analogues)
Reduces elevated GH levels and causes tumor shrinkage
SQ or IM
Pegvisomant (Growth hormone receptor agonist)
Most effective treatment to date
Costly, given SQ
Cabergoline (Dopamine agonist):
Used off label to lower IGH1 levels
Given PO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Trans-sphenoidal Hypophysectomy (remove pituitary): Nursing consideration (trans needs hormones)

A

Preop teaching:
Avoid vigorous coughing, straining and sneezing to prevent CSF leakage
Need for life-long hormone replacement therapy after total hypophysectomy
Decrease or loss of fertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

post op care - Trans-sphenoidal Hypophysectomy: Common post-op complications (trans leaks)

A

Common post-op complications – epitaxis and CSF leak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

nephron - Responds to aldosterone in the (alden is distant)

A

distal convoluted tubes to reabsorb Na and water in exchange for K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

nephron - Acid base balance controlled by what 2 things?

A

Acid base balance by controlling H+ and HCO3-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

nephron - ANF/ANP (anough w/ the bp)

A

lowers bp =

Responds to ANF/ANP (decrease sodium) to excrete Na and inhibits renin
Juxtaglomerular cells of kidney excretes renin in response to ↓ renal perfusion, ↓ arterial BP, ↓ ECF, ↓ serum Na and ↑ urinary Na

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

nephron - PTH (pth, just reabsorb it)

A

Responds to PTH by reabsorbing Ca and excreting Phos
Activates Vit D for proper Ca absorption in the GI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

posterior pituitary - SIADH (too much is inappropriate)

A

SIADH - Syndrome of Inappropriate ADH
Excess ADH secretion results in water retention leading to serum hypo-osmolarity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

posterior pituitary - Diabetes Insipidus

A

DI - Diabetes Insipidus
Insufficient secretion of ADH resulting in increased water loss leading to serum hyper-osmolarity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

SIADH - most common causes - but from where? (sia has a tumor in her lungs)

A

Ectopically producing ADH tumor cells from SSC of lung in 70% of cases
Head trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

SIADH - other causes (Sia has lung problems)

A

PNA, TB, CF, resp failure, Guillain-Barre
Post pituitary surgery as stored ADH is released

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

CNS disorders that cause SIADH (3 of them) (Sia and don)

A

encephalitis, meningitis, intracranial hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

meds for SIADH (sia is psychotic)

A

anti-psychotics, antidepressant,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

SIADH - urine?

A

Concentrated urine (increased urine osmolality)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

SIADH - Serum Na <134 mEq/L - where is the excess water?

A
  • anorexia, DOE, fatigue, dulled sensorium, ↓ UOP- urine output
    -peripheral edema usually absent (excess water remains in intravascular space)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

SIADH - Serum Na < 120 mEq/L (120 min of vomiting)

A
  • vomiting, abd cramps, muscle cramps
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

SIADH - Serum Na < 115 mEq/L (less than 120 is bad)

A
  • cerebral edema may occur → confusion, lethargy, seizure, coma ( irreversible neurologic damage)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

SIADH - criteria for diagnosis - Serum hypo-osmolality

(little oz and sia are less than 280 degrees)

A

Serum hypo-osmolality: < 280 mOsm/kg or 280 mmol/kg (normal 280-295)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

SIADH - criteria for diagnosis - Urine hyperosmolality (ur in over 100, Sia)

A

Urine hyperosmolality >100 mOsm/kg

43
Q

SIADH - criteria for diagnosis - renal functions, etc? (just make sure it’s not renal)

A

Normal renal, adrenal and thyroid function

44
Q

SIADH - criteria for diagnosis - Absence of

A

pre-existing conditions that may alter volume status such as:
Heart failure
Renal insufficiency
Diuretic use

45
Q

SIADH - Rapid correction leads to a (Sia in central point)

A

severe neurologic syndrome known as Central Pontine Myelinolysis

46
Q

SIADH - Fluid restriction - how much?

A

Fluid restriction if hyponatremia is mild (800 to 1000 mL/24 hrs)

47
Q

when does SIADH usually resolve w/ treatment?

A

Resolution usually occurs within 3 days: 2-3 kg of free water loss

48
Q

SIADH treatment - STADOL (staled sia in the cns)

A

STADOL: Inhibits ADH secretion if it’s CNS etiology

49
Q

SIADH treatment - CONIVAPTAN (captain agonizes over sia)

A

CONIVAPTAN: ADH receptor antagonist. IV therapy for hospital use for hyponatremia.

50
Q

SIADH - DEMECLOCYCLINE (sia is in a chronic cycline)

A

DEMECLOCYCLINE : For chronic SIADH. Blocks ADH at the renal collecting tubules.

51
Q

SIADH - treatment for ectopically secreted ADH? (ectopically screwed)

A

There is no drug therapy for ectopically secreted ADH

52
Q

central DI (central CNS)

A

related to insufficient secretion by the CNS

53
Q

primary DI (primarily psycho)

A

Chronic excessive intake of water; psychological component

54
Q

Acquired nephrogenic DI (acquired die from kidney disease)

A

associated with disorders (pyelonephritis, uropathies, polycystic disease)
damage to renal tubules from medications: (Lithium, colchicine, Amphotericin B, diuretics, demeclocycline)
Genetic

55
Q

DI - heart rhythm?

A

TACHYCARDIA

56
Q

DI - sodium?

A

HYPERNATREMIA

57
Q

DI - Low urine specific gravity: what number

A

Low urine specific gravity: < 1.005

58
Q

DI - urine osmo - what number (DI oz, less than 100)

A

Low urine osmo : < 100 mOsm/kg

59
Q

DI - sodium? what number?

A

Hypernatremia > 145mg/dL

60
Q

DI - erum osmo - high or low, and what number? (Euro oz is almost 300)

A

High serum osmo > 295 mOsm/kg

61
Q

DI - diagnosis (die during water deprivation)

A

Dx: Water deprivation test then administration of Desmopressin:

62
Q

meds for central DI (central die gets Cs)

A

Chlorpropamide, Carbamazepine (antidiuretics)

63
Q

meds for Nephrogenic DI - not what you’d think

A

Low Na diet to <3g/day helps to ↓ UOP
Thiazide diuretics (Na and water loss→ mild hypovolemia→ ↓ GFR → ↑ proximal Na and water reabsorption →less water and solutes delivered to distal tubules and collecting ducts leading to less urine loss
Indomethacin increases renal response to ADH

64
Q

DI - S&S of hypernatremia

A

N/V, headache, lethargy, irritability, mental dullness, seizure

65
Q

most common cause of hypopituitarism (little pitt has a tumor)

A

tumor or infarction of the gland

66
Q

hypopituatarism - causes (little pitt has shock and sickle cell)

A

Shock
Sickle cell disease

67
Q

hypopituatarism treatment

A

Permanent target gland hormone replacement with corticosteroids, thyroxine and sex hormones

68
Q

hyperpitutarism - Acromegaly: - when does it occur? (the plate closure)

(Aggro after the fact)

A

rare and insidious (4 in1 million adults in the US)
somatic growth and organomegaly
Occurs after epiphyseal plate closure

69
Q

hyperpituitarism - Gigantism: (giant lines before)

A

Linear growth before closure of epiphyseal plates

70
Q

acromeglia - face- and what about chest?

A

Enlarged facial bones leading to protrusion of lower jaws (mandibular prognathism) and forehead (frontal bossing) and bones of the hands
Elongation of the ribs at the bone cartilage junction leading to barrel-chest

71
Q

acromeglia - physical symptoms (agro headaches)

A

Headaches occur in 50-87% of cases, as well as seizures, visual disturbances, papilledema
Hypertension
Obstructive sleep apnea (OSA)
DM

72
Q

acromeglia - treatment (agro radiation)

A

Surgery, radiation or pharmacotherapy or a combination of three

73
Q

Trans-sphenoidal Hypophysectomy = Monitor for

A

visual and neuro changes (sign of hematoma)

74
Q

Trans-sphenoidal Hypophysectomy - HOB

A

HOB at 30 degrees to avoid pressure on the Sella Tursica; reduces headache

75
Q

Trans-sphenoidal Hypophysectomy - oral care

A

Gentle mouth care Q4hrs, no tooth brushing for 10 days so suture line stays intact, avoid coughing

76
Q

Trans-sphenoidal Hypophysectomy = how to test for CSF?

A

Test any clear nasal draining for CSF (leaks usually resolve in 48-72hrs)
Glucose > 30mg/dL indicates CSF

77
Q

Trans-sphenoidal Hypophysectomy -what is a common problem w/ the loss of ADH? and how to treat it?

A

Transient cerebral edema or DI common because of loss of ADH: treat with IV vasopressin

78
Q

conivaptin - side effect? (captain has bad kidneys)

A

Nephrotoxic.

79
Q

demecycline - side effects? (same)

A

Nephrotoxic and also a tetracycline which can increase risk for fungal infections

80
Q

central DI - causes

A

Organic lesion of the hypothalamus or the pituitary interferes with ADH synthesis, transport, or release (brain tumors, thrombosis, infection, hypophysectomy)
Closed head trauma

81
Q

DI - water deprivation test - central DI (central park water is rapidly declining)

A

pts with central DI respond with rapid decrease in UOP and increased in urine osmo.

82
Q

hypopituitarism - causes - (little pitt hit his head w/ don)

A

Head trauma
Infections such as meningitis, syphilis, TB
Vascular malformation, subarachnoid bleed
Surgical ablation of tumor

83
Q

hypopituatarism treatment - GH replacement (and what if secondary tumor forms?)

A

GH replacement: Costly, pre-pubertal children respond better that adults
Hypophysectomy or radiation if secondary to tumor

84
Q

giantism - what happens? (IGF giants)

A

Subsequent increase production of insulin-like growth factor I (IGF-1)

85
Q

giantism - problems (heart)

A

Increased mortality d/t cardiac hypertrophy, HTN, DM2 and malignancies

86
Q

Selective hypopituitarism (select 1 or the other)

A

Deficiency of only one pituitary hormone

87
Q

Panhypopituitarism

A

all hormones are absent

88
Q

hypopituatarism -cortisol (little pitt has no cort)

A

Cortisol deficiency from lack of ACTH
potentially a life threatening condition

89
Q

hypopituatarism - Thyroid

A

Thyroid deficiency from lack of TSH

90
Q

hypopituatarism - Gonad failure

A

from lack of FSH and LH

91
Q

hypopituatarism - GH

A

GH deficiency leading to pituitary dwarfism (Laron syndrome)

92
Q

hypopituatarism - milk production

A

Milk production dysfunction d/t deficient PRL

93
Q

DI - water depravation test - nephrogenic DI

A

Pt with nephrogenic DI will only have mild increase in urine osmo

94
Q

DI - what is happening? (die can’t concentrate)

A

Patients with DI have partial or total inability to concentrate urine

95
Q

meds for SIADH (Sia and tegan)

A

Tegretol (anticonvulsant), narcotics, anesthesia

96
Q

acromegly - Octreotide/lanreotide (aggro octavia is not growing)

A

Octreotide/lanreotide ( Somatostatin analogues)
Reduces elevated GH levels and causes tumor shrinkage
SQ or IM

97
Q

acromegly - Pegvisomant (aggro peg is really effective)

A

Pegvisomant (Growth hormone receptor agonist)
Most effective treatment to date
Costly, given SQ

98
Q

acromegly - Cabergoline

A

Cabergoline (Dopamine agonist):
Used off label to lower IGH1 levels
Given PO

99
Q

acromegly - joints?

A

Narrowing of the joint space leading to arthritis and joint pain

100
Q

hypopituitarism - can cause what? (little pit and addy)

A

May also lead to Addisonian Crisis (acute decrease in cortisol levels)

101
Q

SIADH - urine specific gravity (Sia higher than space)

A

or urine specific gravity of >1.025 (1.01 to 1.02)

102
Q

acromeglia - treatment - what surgery? (agro trans)***

A

Hypophysectomy via Trans-sphenoidal approach to remove GH secreting adenoma

103
Q

SIADH - kidneys? (Sia in the ducts)

A

collecting ducts***

104
Q

hypoglycemia - when should you not use IV?

A

NO IV and unconscious pt: glucagon IM in deltoid

XIO (372 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions