Study Guide1

Question 1

What is the difference between Acute Pituitary Failure and Chronic Pituitary Failure?

Answer 1

Profound hypotension and Shock Acute pituitary failure leads to adrenal insufficiency HPA axis failure ACTH and cortisol have short half lives Treatment with corticosteroids Chronic Pituitary Failure Decrease GH Decrease ACTH , TSH decrease later

Question 2

Explain the effects of infundibulum (pituitary stalk) compression of each of the pituitary hormones?

Answer 2

All hormones decrease Prolactin INCREASE

Question 3

Your patient has acromegaly and needs to undergo an abdominal surgery what are some considerations you might have for this patient? PREOP MasK ventilation? Mandibular? Laryngoscopy? Laryngeal nerve>? What may be required

Answer 3

Mask ventilation difficult due to enlarged mandible and facial bones. • Mandibular hypertrophy = increased distance from lips to vocal cords. • Direct laryngoscopy difficult due to enlarged tongue, epiglottis and glottic structures. • Hoarseness/stridor may indicate stretching of laryngeal nerve and impaired mobility of cricoarytenoid joints – smaller diameter tracheal tube may be required.

Question 4

Your patient has acromegaly and needs to undergo an abdominal surgery what are some considerations you might have for this patient? INTRAOP

Answer 4

High incidence of Peripheral Neuropathy – avoid positioning extremities in a manner that may exacerbate altered nerve function. – ie. Pt.’s elbows should remain extended to minimize tension on ulnar nerve. – Extension of Pt.’s hands should be avoided to preclude stretching of ulnar and median nerves. • Arrhythmias and ECG changes are common – 12-lead ECG helpful to detect new-onset changes.

Question 5

Your patient has acromegaly and needs to undergo an abdominal surgery what are some considerations you might have for this patient? POSTOP

Answer 5

High incidence of obstructive sleep apnea – monitor for airway obstruction & alterations in BP/cardiac function post-operatively.

Question 6

Your patient was recently diagnosed with pituitary microadenoma, but said I don’t understand what that means. How would you explain this to your patients in terms of the pathology itself and what signs and symptoms might they expcect.

Answer 6

Hypersecretion of one hormone usually Most common a combination of Prolactin and GH Signs and symptoms to expect: Increase GH and prolactin Increage GH –> Acromegaly or Gigantism Increase PRL–> Galactorrhea, amenorrhea, infertility, decreased libido, osteopenia, impotence and ED

Question 7

Differences size between microadenoma and Macroadenoma?

Answer 7

Microadenoma –> Smaller Macroadenoma –> Larger

Question 8

Differences Hormones between microadenoma and Macroadenoma?

Answer 8

Micro -> Increase PRL and GH Macro–> non-secreting

Question 9

Differences general effects between microadenoma and Macroadenoma?

Answer 9

Micro: Hypersecretion of one hormone 55% of tumores Macro: COMPRESSION SYNDROME: Headaches, visual disturbance, CN deficits, Hypopituitary 45% of tumors

Question 10

How does impingement of 3rd ventricle affect CSF flow? consequences?

Answer 10

Obstruction of CSF flow Obstructive Hydrocephalus leading to Increase ICP

Question 11

Anesthesia concerns would you have with patient with compression of 3rd ventricle?

Answer 11

Careful pre-op sedation (more sensitive to sedative drugs) Drugs induced hypoventilation can exacerbate intracranial HTN due to HYPERCAPNIA induced cerebral vasodilation Careful titration to avoid hypotension Ketamine and high dose VA can increase ICP

Question 12

Cushing syndrome results from

Answer 12

Excess Cortisol Secretion

Question 13

Regarding anesthesia, increase neck size secondary to facial changes may increase difficulty of

Answer 13

Mask ventilation

Question 14

Acute stress is _______while chronic stress is _______

Answer 14

Immunoenhancing; Immonsuppressing

Question 15

Cortisol on BG

Answer 15

Increase

Question 16

Cortisol of secretion of gastric acid

Answer 16

Increase

Question 17

Patient experience physiological stresses will have increased level of which hormones

Answer 17

Cortisol, EPI,NE

Question 18

What is the difference between primary and secondary endocrine disorder?

Answer 18

Primary is caused by a problem in the gland that secretes a hormone whose action is directed toward OTHER TISSUES rather than another glands SECONDARY is caused by a problem in the gland that secretes a hormone who target tissues are another gland that stimulates or suppresses it .

Question 19

Compression or impingement of 3rd ventricle

Answer 19

N/V AMS HA Papilledema

Question 20

What is pituitary hyperthyroidism and primary hyperthyroidism. If the patient is mistakenly treated for primary hyperthyroidism , what could be results?

Answer 20

Pituitary hyperparathyrodism: caused increase in T3 and T4, palpitations, nervousness, heat intolerance. TSH secreting tumors usually large and invasive. Compression effects (HA, visual loss, CN palsies) Treated with beta blockers: Normal to HIGH TSH, HIGH T3 and T4 PRIMARY HYPERTHYROIDISM Primary Hyperthyroidism: LOW TSH , high T3 and T4 If patient was initially treated by removal of thyroid gland, they need hormone replacement therapy.

Question 21

What is the difference between Neurogenic and Nephrogenic

Answer 21

Neurogenic–> Treat with exogenous ADH caused by a problem in the hypothalamus or Posterior Pituitary that decreases the production of ADH Nephrogenic –> Caused by a problem in the kidney causes INSENSITIVITY to ADH

Question 22

What is the difference between ACROMEGALY and GIGANTISM

Answer 22

Acromegaly –> Occurs in adult with continuous levels of GH GIGANTISM–> Occurs in children and adolescents, Occurs in children and adolescent because their EPIPHYSEAL plates have not yet closed.

Question 23

Usually treated with DOPAMINE AGONIST

Answer 23

Hyperprolactinemia

Question 24

Tumors responsible can also co-secrete GH, PRL & ACTH

Answer 24

Pituitary Hyperthyroidism

Question 25

Polydipsia, nocturia, Polyuria, Hypernatreim, increase plasma osmolality, large volume of dilute urine

Answer 25

DI

Question 26

Lethary, hyponatremia, perhaps seizure, decreased plasma osmolality, concentrated urine, nausea, HA, confusion

Answer 26

SIADH

Question 27

HTN, tachycardia, palpitations, severe headaces, diaphoresis, heat intolerance, weight loss, constipation

Answer 27

Pheochromocytoma

Question 28

Virilization: lack of breast development, hirsutimsm, increased muscle bulk

Answer 28

Adrenal adenoma causing hypersecretion of androgen in a woman

Question 29

Hypertension, hypokalemia, increased blood pH, increase urine POTASSIUM

Answer 29

Primary HYPERALDOSTERONISM

Question 30

Increased aldosterone, hypokalemia, usually treated with spironolactone

Answer 30

CONN’s

Question 31

Addison’s disease

Answer 31

Weakness, fatigue, hypotension, hyperkalemia, hypoglyvemia, elevated ACTH

Question 32

Addison’s Crisis

Answer 32

Weakness, fatigability, skin hyperpigmentation, ANOREXA, vascular collapse and death

Question 33

Answer 33

CPAO

A. Coronary Artery

B. Pituiary Stalk

C. Anterior Cerebral Artery

D. Optic chiasm

OTAOMa

E. Oculomotor nerve

F. Trochlear nerve

G. Abducens

H. Opthalmic Branch of Trigeminal Nerve

I. Maxillary Branch of trigeminal nerve

Question 34

Identify the picture

Answer 34

A. Blurred disc margins

B. Papilledema

Question 35

Identify condition

Answer 35

A. Sharp disk Margin

B. Normal disc margin

Question 36

Identify the Labeled

Answer 36

Question 37

Not a sign of excess thyroid

Answer 37

hypoventilation

Question 38

Steroids from Most POTENT to less POTENT (DMCA)

Answer 38

Dexamethasone

Methylprednisolone

Cortisol

Aldosterone

Question 39

Cushing syndrome

Answer 39

Hypokalemia

Metabolic alkalosis

Hypertension

Hyperglycemia

Question 40

Excess cortisol

Answer 40

Muscle wasting