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Endocrine - Troutmanm > Pituitary > Flashcards

Pituitary Flashcards

1
Q

The hypothalamus and pituitary gland form a unit that exerts control over the function of several endocrine glands, what are they?

A

Thryoid
Adrenals
Gonads

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2
Q

The pituitary is the

A

“master gland”

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3
Q

What is the hypothalamic pituitary axis (HPA) responsible for?

A

brain-endocrine interactions

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4
Q

What is the coordinating center of the endocrine system?

A

Hypothalamus

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5
Q

Where does they hypothalamus get its input signals from?

A

upper cortical inputs, autonomic function, environmental cues, and peripheral endocrine feedback

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6
Q

T/F: The hypothalamus delivers precise signals to the pituitary gland which release hormones that influence other endocrine systems.

A

TRUE

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7
Q

*** The pituitary gland rests in the sphenoid bone, in an area called the

A

Sella Tursica

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8
Q

*** There are 4 divisions of the pituitary

A

Anterior pituitary or adenohypophysis

Pars intermedius

Pars tubularis

Neurohypophysis

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9
Q

*** Which division is the largest

A

Anterior pituitary or adenohypophysis

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10
Q

*** Which division is gone after fetal development

A

Pars intermedius

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11
Q

***What division is highly vascularized with no known hormones secreted?

A

Pars tubularis

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12
Q

The anterior and posterior portions of the pituitary are ____ from one another

A

distinct

different connections to hypothalamus
different cell types
secrete different hormones

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13
Q

What is another name for the anterior pituitary?

A

adenohypophysis

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14
Q

Is the anterior pituitary highly vascularized?

A

yes

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15
Q

*** How is they anterior pituitary connected to the hypothalamus?

A

via a portal venous network

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16
Q

What glands is the anterior pituitary responsible for?

A

thyroid, adrenal and mammary glands

Also regulates growth hormone, gonads (FSH & LH), and melanocytes

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17
Q

What are the anterior pituitary cell types? (5)

A 
Somatotropes
Corticotropes
Thyrotropes
Gonadotropes
Lactotropes
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18
Q

What do Somatotropes secrete?

A 
Growth Hormone (GH)
(most abundant cell type)
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19
Q

What do Corticotropes secrete?

A

Adrenocorticotropic Hormone (ACTH)

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20
Q

What do Thyrotropes secrete?

A

Thyroid Stimulating Hormone (TSH)

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21
Q

What do Gonadotropes secrete?

A

Luteinizing & Follicle Stimulating Hormone (FSH/LH)

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22
Q

What do Lactotropes secrete?

A

Prolactin (PRL)

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23
Q

The posterior pituitary is also called the

A

neurohypophysis

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24
Q

The posterior pituitary is largely a collection of _____ projections from the hypothalamus

A

Axonal

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25
Q

What hormones does the posterior pituitary produce?

A

Oxytocin and vasopressin (ADH)

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26
Q

What does oxytocin regulate?

What dose ADH regulate?

A

uterine contractions

water balance

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27
Q

How are hormones that are synthesized in the hypothalamus transported for secretion by the posterior pituitary?

A

intracellulary

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28
Q

*** Where is vasopressin (ADH) synthesized?

A

supraoptic nuclei

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29
Q

ADH increases permeability of the collecting ducts, which increases free water absorption. What does this do to urine & plasma osmolality, and ECF volume?

A

Increased urine osmolality
Decreased plasma osmolality
Increased ECF volume

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30
Q

Vasopressin causes contraction of vascular smooth muscle producing what effect?

A

vasoconstrictive pressor effect

more prevalent in large doses

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31
Q

What is the V1 receptor?

A

presser effect

Prevalent with extreme increases in circulating levels, ie hemorrhage

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32
Q

What is the V2 receptor?

A

ADH effect

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33
Q

What is the stimulus for the release of vasopressin (ADH)?

A

Osmoreceptor in hypothalamus (HT) activated by plasma osmolality >290 mosm/kg

Other receptors in HT send sensation of thirst

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34
Q

What does decreased ECF volume activate?

A

stretch receptors in great veins, atria, pulmonary vessels for ADH release

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35
Q

What are some other stimulators for release?

A

angiotensin II, nicotine, nausea, pain, stress

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36
Q

What is the release of ADH depressed by?

A

decreased plasma osmolality, increased ECF volume and alcohol

37
Q

What receptors are activated with large volume changes?

A

baroreceptors in Carotid Sinus and Aortic arch

38
Q

What is SIADH?

A

Too much ADH

holding onto water

39
Q

What does SIADH cause?

A

water retention

hyponatremia (low Na+) with concentrated urine and hypoosmolar (dilute) plasma

40
Q

What are causes of SIADH?

A

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

(TBI most common)

41
Q

Treatment for SIADH

A

limit fluid intake

find cause

42
Q

What 2 processes can cause hyponatremia?

A

increase in TBW
or
excess Na loss

43
Q

Symptoms of hyponatrmemia relate to rapidity of onset. Usually asypotmatic until na level of ____. With serious symptoms below

A

125

120

44
Q

What are mild, mod, and severe symptoms of hyponatremia

A

Mild: anorexia, nausea, weakness
Mod: lethargy, confusion
Severe: seizures, coma, death

45
Q

What Na level is safe for elective procedures?

A

> 130

46
Q

What happens at a Na level <130

A

may lead to cerebral edema

47
Q

What does low Na cause intraop?

A

decrease in MAC

48
Q

What does low Na cause postop?

A

agitation, confusion, somnolence

49
Q

How do you correct hyponatramia?

A

SLOWLY

50
Q

What happens when you correct sodium level too quick?

A

Central Pontine Myelinolysis

51
Q

What is Central Pontine Myelinolysis

A

demyelinating lesions in the pons

Seen with change in [Na]>0.5meq/L/hr

52
Q

What are S/S of Central Pontine Myelinolysis?

A

Spastic quadriplegia, pseudobulbar palsy (inability to control facial movements), and varying degrees of encephalopathy or coma from acute, noninflammatory demyelination that centered within the basis pontis

53
Q

What are conditions predisposing patients to CPM

A

alcoholism, liver disease, malnutrition, and hyponatremia.

54
Q

What are risk factors of CPM in the hyponatremic patient?

A

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

55
Q

When do symptoms of CPM occur?

A

48-72 hrs post therapy

56
Q

What is diabetes insipidus?

A

too little ADH (peeing a lot)

57
Q

Symptoms of DI

A

excessive thirst

polyuria (dilute urine)

58
Q

What is the ADH insufficiency cause by?

A

inability to release ADH (central - most common)
or
inability of the kidney to respond (renal)

59
Q

What does DI result in?

A

excretion of large amounts of hyposmotic urine with hyperosmotic plasma and polydipsia, polyuria without hyperglycemia.

60
Q

What needs to be done to keep these patients from severe dehydration?

A

water intake!

61
Q

What is treatment for central DI?

A

exogenous ADH (DDAVP)

62
Q

What is treatment for renal DI?

A

demeclocycline - decreases responsiveness of collecting tubules to ADH

63
Q

What are the causes of hypernatremia?

A

loss of water

large retention/intake Na

64
Q

When is transient DI common?

A

post head injury or surgery

65
Q

What is nephrogenic DI from?

A

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

66
Q

What does hypernatramia do to MAC?

A

Increased MAC, with decreased uptake of inhalation agents from decreased CO

67
Q

Does hypernatrmia cause increased or decreased doses of IV agents?

A

decreased

68
Q

At what Na level would you postpone elective surgery?

A

> 150

69
Q

What are symptoms of hypernatremia?

A

restlessness, lethargy, hyperreflexia and can proceed to seizures, coma, death

symptoms correlate with rapidity of onset

70
Q

What does rapid correct of hypernatremia result in?

A

seizures, brain edema, permanent neurologic damage, death

71
Q

*** Where is oxytocin secreted from?

A

Supraoptic (SO) nucleus of the posterior pituitary

72
Q

What does oxytocin do to the uterus?

A

contraction of uterus during labor

73
Q

Besides contraction of the uterus, what other actions come from oxytocin?

A

Contraction of myoepithelial cells of the lactating breast

Secretion and sensitivity increase in late pregnancy

Milk ejection reflex includes the stimulation of touch receptors in the breast by infant suckling, activation of afferent fibers to the SO and paraventricular (PV) nuclei –> release of oxytocin, contraction of myoepithelial cells and ejection of milk

74
Q

Labor effects and breast feeding are examples of what type of feedback?

A 
Positive feedback
(one of the only positive feedback mechanisms)
75
Q

T/F: Oxytocin contracts uterus to decrease blood loss after birth

A

True

76
Q

What are complications of oxytocin

A

fetal distress due to hyperstimulation, uterine tetany, maternal water intoxication (ADH effects, rare)

77
Q

What does rapid IV admin of oxytocin causes?

A

hypertension, tachycardia, nausea and vomiting, and rarely seizures

78
Q

How are pituitary tumors often found?

A

often found as a result of compression on adjacent structures, such as visual changes with impingement of the optic chiasm

79
Q

What does compression of the optic chiasm cause?

A

bitemoral hemianopsia

80
Q

Pituitary Tumors can manifest with _____ ______ due to hormonal changes

A

systemic effects

81
Q

Patients undergoing pituitary resection should undergo evaluation of their hormonal function to detect either _______ or ________

A

hypersecretion or panhypopituitarism

82
Q

What does too much growth hormone cause?

A

acromegaly, difficult airway

83
Q

What does too much thyroid stimulating hormone (TSH) cause?

A

hyperthyroid, tachycardia, weight loss

84
Q

What does too much ACTH cause?

A

Cushing’s disease, difficult airway and access

85
Q

If a patient has panhypopituitarism, what do they need?

A

need hormone replacement with cortisol, levothyroxine, DDAVP (vasopressin)

86
Q

Most pituitary resections done with ______ approach, those some may require craniotomy

A

transsphenoidal

87
Q

Patients may develop ___ due to loss of ADH. May be temporary or permanent, may be evident intraop or postop

A

DI

Suspect with high urine output, confirm with urine specific gravity <1.005

88
Q

Treatment of DI

A

Treatment with DDAVP 0.5 to 1 micrograms IV or SQ, and with volume replacement

Endocrine - Troutmanm (7 decks)

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