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Endocrine - Summer 2019 > Pituitary > Flashcards

Pituitary Flashcards

1
Q

The hypothalmus and pituitary gland form a unit that exerts control over the function of several endocrine glands including…

A

thyroid, adrenals, gonads

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2
Q

The pituitary is AKA

A

master gland

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3
Q

The hypothalmic pituitary axis (HPA) is responsible for ___-_____ interaction

A

brain-endocrine

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4
Q

The _______ is the coordinating center of the endocrine system

A

hypothalmus

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5
Q

The ________ consolidates signals from the upper cortical inputs, autonomic function, environmental cues, and peripheral endocrine feedback

A

hypothalmus

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6
Q

The hypothalmus delivers precise signals to the _______ which releases hormones that influence other endocrine systems

A

pituitary

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7
Q

**The pituitary gland rests in sphenoid bone area called the _____ ______ and has ____ divisions

A

sella tursica / 4

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8
Q

**What are the 4 divisions of the pituitary?

A

Anterior pituitary or adenohypophysis, Pars intermedius, Pars tubularis, neurohypophysis

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9
Q

**Anterior pituitary or adenohypophysis is the _________. The pars intermedius is actually gone after ______ development. The Pars tubularis is highly ________, and no known hormones secreted. Then you have the neurohypophysis.

A

largest, fetal, vascular

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10
Q

The anterior and posterior portions of the pituitary are ______ from one another. They have different connections to the _________. They have different _____ types and they secrete different _______.

A

distinct / hypothalmus / cell / hormones

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11
Q

The anterior pituitary is also called the __________. It is highly _______ and connected to the hypothalmys via a portal ________ network. It is responsible for the regulation of THYROID, ADRENAL and MAMMARY glands. IT also regulates growth hormone, gonads and melanocytes.

A

adenohypophysis / vascularized / venous

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12
Q

Thryotopic cells secrete _____

A

TSH

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13
Q

Mammotropic cells secrete _____

A

Prolactin

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14
Q

Corticotropic cells secrete __________

A

Adrenocortocotropic hormone

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15
Q

Somatotropic cells secrete ______

A

growth hormone

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16
Q

Gonadotropic cells secrete ________

A

follicle-stimulating hormone and Leutenizing hormone

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17
Q

Pars intermedia cells secrete _________

A

melanocyte-stimulating hormone

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18
Q

What is the most abundant anterior pituitary cell type?

A

somatotropes

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19
Q

The posterior pituitary is also called the _________

A

nuerohypophysis

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20
Q

The posterior pituitary is largely a collection of axonal projections from the _________. It produces only two hormones, _______ and _________. These regulate uterine contractions and water balance. They are synthesized in the hypothalmus and transported intracellularly for secretion from the pituitary

A

hypothalmus / oxytocin / vasopressin

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21
Q

Supraoptic nucleus, cells secrete _____.

A

oxytocin (slide 9)

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22
Q

Paraventricular nucleus, cells secrete _____

A

ADH (slide 9)

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23
Q

**The supraoptic nucleus is the dominant site of synthesis of _______. ADH increases the permeability of the ______ _______, increasing free water reabsorption.

A

ADH / Colllecting ducts

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24
Q

Net effect of ADH secretion

A

increased urine osmolaltiy, decreased plasma osmolality, increased ECF volume

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25
Q

ADH can cause contraction of vascular smooth muscle producing vasoconstrictive pressor effect. This is more prevelant at _______ doses.

A

large

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26
Q

**V1 receptor: PRESSOR EFFECT

A

prevalent with extreme increases in circulating levels (ex: hemorrhage)

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27
Q

**V2 receptor: ____ Effect

A

ADH

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28
Q

Stimulus for ADH release: Osmoreceptor in hypothalmus is activated by plasma osmolality greater than

A

290 mosm/kg

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29
Q

Decreased ECF volume activates stretch receptros in great veins, atria, pulmonary vessels for ____ release

A

ADH

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30
Q

Other stimulators for ADH release

A

angiotensin II, nicotine, nausea, pain, stress

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31
Q

ADH release is depressed by what?

A

decreased plasma osmolality, increased ECF volume, alcohol

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32
Q

osmolality =

A

number of paricles / vol H20

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33
Q

Large volume changes can activate baroreceptors in ____ ____ and ____ ____

A

carotid sinus / aortic arch

34
Q

SIADH is from an autonomous release from pituitary or tumor that causes what?

A

water retention, hyponatremia with concentrated urine and hypoosmolar (dilute) plasma

35
Q

Other causes for SIADH

A

CNS disorders, cold stress, trauma, drug induced, squamous cell lung CA

36
Q

Treatment for SIADH

A

find cause and limit fluid intake

37
Q

Low Na reflects what?

A

Water retention from an absolute increase in total body water OR Na loss in excess of water

38
Q

Hyponatremia is usually asymptomatic until level of _____mEq/L, with serious symptoms below _____mEq/L

39
Q

Symptoms of mild hyponatremia

A

anorexia, nausea, weakness

40
Q

Symptoms of moderate hyponatremia

A

lethargy, confusion

41
Q

Symptoms of sever hyponatremia

A

seizures, coma, death

42
Q

Na level safe for elective procedures

43
Q

Na level < 130 may lead to ____ ______

A

cerebral edema

44
Q

Na level <130 intraoperatively causes a ______ in MAC. Postoperatively causes what?

A

decrease / agitation, confusion, somnolence

45
Q

What can happen from correcting hyponaremia too fast?

A

Central Pontine Myelinolysis. Seen with change in [Na] > 0.5mEq/L/hr

46
Q

Central Pontine Myelinolyisis

A

Serious permanent neurologic sequalae and death can occur. Spastic quadriplegia, pseudobulbar palsy (inability to control facial movements), and varying degrees of encephalopathy or coma from acute, noninflammatory demylenation that centered within the basis of the pontis

47
Q

Conditions predisposing patients to CPM

A

alcoholism, liver dz, malnutrition, hyponatremia

48
Q

Risk factors for CPM in the hyponatremic patient include what?

A

serum sodium less than 120 mEq/L for 48 hrs. Aggressive IV fluid therapy with hypertonic saline solutions. Development of hypernatremia during treatment

49
Q

When do symptoms of CPM appear

A

usually from 48-72 hrs post therapy

50
Q

Diabetes insipidus is characterized by what?

A

excessive thirst and dilute urine

51
Q

DI is where there is ____ ______ caused by inability to release (central-most common) or inability of kidney to respond (renal)

A

ADH deficiency

52
Q

DI results in excretion of large amounts of ________ urine with _______ plasma and polydipsia, polyuria without hyperglycemia

A

hyposmotic / hyperosmotic

53
Q

What keeps a DI patient for severe dehydration

A

water intake

54
Q

Treatment for DI

A

Give exogenous ADH (desmopressin nasal spray) for central. Give demeclocycline for renal-decreases responsiveness of collecting tubules to ADH

55
Q

Hypernatremia is a result of loss of ______ in excess of ____ or retention of large quantites of Na

56
Q

(Hypernatremia) Transient ________ DI is common post head injury or surgery

57
Q

(Hypernatermia) Nephrogenic DI causes?

A

chronic renal dz, lithium toxicity, hypercalcemia, hypokalemia, tubulointerstitial dz (drugs), and a rare hereditary form

58
Q

With Hypernatremia you will have _______ MAC, with decreased uptake of inhalation agents from decreased ____

A

increased / CO

59
Q

Someone that is hypernatremic and hypovolemia would require _____ doses of IV agents

60
Q

Na <130, what would you do?

A

postpone elective surgery

61
Q

Hypernatremia symptoms

A

restlessness, lethargy, hyperreflexia and can proceed to seizures, coma, death. Symptoms correlate with rapidity of development.

62
Q

What does rapid correction of hypernatremia result in?

A

seizures, brain edema, permanent neurologic damage, death

63
Q

**Where is oxytocin secreted from?

A

Supraoptic Nucleus of the posterior pituitary

64
Q

Oxytocin is responsible for _____ of uterus during labor. This includes the myoepithelial cells of the lactating breast and smooth muscle of uterus.

A

contraction

65
Q

Secretion and sensitivity to oxytocin increase in ____ pregnancy

66
Q

Milk ejection reflex includes stimulation of touch receptors in the breast by infant suckling, activation of afferent fibers to the supraoptic nuclei and paraventricular nuclei which results in release of ________, contraction of myopeithelial cells and ejection of milk

67
Q

**Labor effects and breast feeding effects are example of __________ feedback

68
Q

Oxytocin is used in OB to increase contraction of uterus to organize labor or to contract uterus to decrease ____ _____ after birth

A

blood loss

69
Q

Complications of pitocin administratioin

A

fetal distress due to hyperstimulation, uterine tetany, maternal water intoxication (ADH effects, rare). Rapid IV infusion can cause hypertension, tachycardia, nausea and vomiting and rarely seizures

70
Q

How is Ptiocin administered?

A

usually add 20 units (no more than 40 units) to 1 liter of crystalloid and titrate to uterine contraction

71
Q

**Pituitary tumors are often found as a results of compression on adjacent structures, such as visual changes with impingement of the _____ _____

A

optic chiasm (lateral visual fields are lost)

72
Q

Compression of the optic chiasm can result in ______ _______

A

bitemoral hemianopsia

73
Q

Pituitary tumors can manifest with systemic effects due to ________ changes

74
Q

Acromegaly from overproduction of Growth Hormone is associated with _______ ______

A

difficult airways

75
Q

Hyperthyroid is associated with tachycardia and ____ _____

A

weight loss

76
Q

T/F Cushing’s disease is associated with difficult airway?

77
Q

Panyhypopituitarism is treated with what?

A

cortisol, levothyroxine, DDAVP

78
Q

Most pituitiary resections are done with _________ approach, though some may require craniotomy

A

transphenoidal

79
Q

** T/F Patients undergoing pituitary resection may develop DI due to loss of ADH and it could be temporary or permanent

80
Q

Treatment for DI from loss of ADH

A

DDAVP 0.5 to 1 mcg IV or SQ and with volume replacement

Endocrine - Summer 2019 (7 decks)

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