Study Guide1 Flashcards
What is the difference between Acute Pituitary Failure and Chronic Pituitary Failure?
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
Explain the effects of infundibulum (pituitary stalk) compression of each of the pituitary hormones?
All hormones decrease Prolactin INCREASE
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
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.
Your patient has acromegaly and needs to undergo an abdominal surgery what are some considerations you might have for this patient? INTRAOP
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.
Your patient has acromegaly and needs to undergo an abdominal surgery what are some considerations you might have for this patient? POSTOP
High incidence of obstructive sleep apnea – monitor for airway obstruction & alterations in BP/cardiac function post-operatively.
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.
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
Differences size between microadenoma and Macroadenoma?
Microadenoma –> Smaller Macroadenoma –> Larger
Differences Hormones between microadenoma and Macroadenoma?
Micro -> Increase PRL and GH Macro–> non-secreting
Differences general effects between microadenoma and Macroadenoma?
Micro: Hypersecretion of one hormone 55% of tumores Macro: COMPRESSION SYNDROME: Headaches, visual disturbance, CN deficits, Hypopituitary 45% of tumors
How does impingement of 3rd ventricle affect CSF flow? consequences?
Obstruction of CSF flow Obstructive Hydrocephalus leading to Increase ICP
Anesthesia concerns would you have with patient with compression of 3rd ventricle?
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
Cushing syndrome results from
Excess Cortisol Secretion
Regarding anesthesia, increase neck size secondary to facial changes may increase difficulty of
Mask ventilation
Acute stress is _______while chronic stress is _______
Immunoenhancing; Immonsuppressing
Cortisol on BG
Increase
Cortisol of secretion of gastric acid
Increase
Patient experience physiological stresses will have increased level of which hormones
Cortisol, EPI,NE
What is the difference between primary and secondary endocrine disorder?
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 .
Compression or impingement of 3rd ventricle
N/V AMS HA Papilledema
What is pituitary hyperthyroidism and primary hyperthyroidism. If the patient is mistakenly treated for primary hyperthyroidism , what could be results?
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.
What is the difference between Neurogenic and Nephrogenic
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
What is the difference between ACROMEGALY and GIGANTISM
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.
Usually treated with DOPAMINE AGONIST
Hyperprolactinemia
Tumors responsible can also co-secrete GH, PRL & ACTH
Pituitary Hyperthyroidism
Polydipsia, nocturia, Polyuria, Hypernatreim, increase plasma osmolality, large volume of dilute urine
DI
Lethary, hyponatremia, perhaps seizure, decreased plasma osmolality, concentrated urine, nausea, HA, confusion
SIADH
HTN, tachycardia, palpitations, severe headaces, diaphoresis, heat intolerance, weight loss, constipation
Pheochromocytoma
Virilization: lack of breast development, hirsutimsm, increased muscle bulk
Adrenal adenoma causing hypersecretion of androgen in a woman
Hypertension, hypokalemia, increased blood pH, increase urine POTASSIUM
Primary HYPERALDOSTERONISM
Increased aldosterone, hypokalemia, usually treated with spironolactone
CONN’s
Addison’s disease
Weakness, fatigue, hypotension, hyperkalemia, hypoglyvemia, elevated ACTH
Addison’s Crisis
Weakness, fatigability, skin hyperpigmentation, ANOREXA, vascular collapse and death
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
Identify the picture
A. Blurred disc margins
B. Papilledema
Identify condition
A. Sharp disk Margin
B. Normal disc margin
Identify the Labeled
Not a sign of excess thyroid
hypoventilation
Steroids from Most POTENT to less POTENT (DMCA)
Dexamethasone
Methylprednisolone
Cortisol
Aldosterone
Cushing syndrome
Hypokalemia
Metabolic alkalosis
Hypertension
Hyperglycemia
Excess cortisol
Muscle wasting
