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Pathophys II > Endocrine Pituitary Gland > Flashcards

Endocrine Pituitary Gland Flashcards

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1
Q

Endocrine glands

A

secrete hormones directly into the surrounding ECF

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2
Q

Exocrine glands

A

products are discharged through ducts

ex. salivary, sweat glands

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3
Q

What are the important endocrine glands?

A 
pituitary gland
thyroid gland
parathyroid glands
pancreas
adrenal glands
ovaries & testes
placenta
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4
Q

The mediators of the endocrine system are

A

*hormones

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5
Q

Hormones are _________ that transport information (a message) from one set of cells (endocrine cells) to another (target cells)

A

chemical messengers***

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6
Q

____________ is the primary event that initiates a response to a hormone

A

binding to a target cell receptor

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7
Q

The hormone receptor has high

A

specificity and affinity for the correct hormone

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8
Q

The location of the receptor directs the

A

hormone to the correct target organ or target cell

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9
Q

Some hormones, such as ________, have wide spread target sites while others, such as _______, act on one target issue

A

insulin; TSH

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10
Q

The synthesis and secretion of hormones by endocrine glands are regulated by:

A

neural control
biorhythms
feedback mechanisms

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11
Q

Describe neural control

A

can suppress or stimulate hormone secretion
stimuli include pain, smell, touch, stress, sight, & taste
hormones under neural control include catecholamines, ADH, cortisol

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12
Q

Describe biorhythms

A

genetically encoded or acquired biorhythms
the intrinsic hormonal oscillations may be circadian, weekly, or seasonal
they may vary with stages of life

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13
Q

Feedback mechanisms include

A

negative feedback

positive feedback

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14
Q

The regulatory pathway of tropic hormones includes

A

hypothalamus–> pituitary gland–> target gland

the target gland hormone provides feedback to the pituitary gland and the hypothalamus

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15
Q

The anterior pituitary secretes these hormones

A 
growth hormone
adrenocorticotropic hormone
thyroid-stimulating hormone
follicle-stimulating hormone
Luteinizing hormone
prolactin
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16
Q

The blood supply to the pituitary is via the

A

superior and inferior hypophyseal arteries

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17
Q

The pituitary collects and integrates information from almost everywhere in the body

A

& uses this information to control the secretion of vital pituitary hormones

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18
Q

Pituitary hormone secretion is regulated by

A

feedback control from peripheral target organ hormones or other target products

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19
Q

The pituitary and hypothalamus have virtually no

A

blood brain barrier; this allows feedback products to have a potent effect on them

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20
Q

The pituitary located at the base of the brain and has two distinct portions:

A

the anterior lobe (adenohyophysis) and the posterior lobe (neurohypophysis)

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21
Q

Describe the anterior pituitary target cell type, the anterior pituitary hormone, the hormone target site, and the primary peripheral feedback hormone for thyrotropin-releasing hormone.

A

Anterior pituitary target cell type: Thyrotroph
Anterior pituitary hormone: Thyroid-stimulating hormone (TSH)
Hormone target site: thyroid glands
Primary peripheral feedback hormone: Triiodothyronine

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22
Q

Describe the the anterior pituitary target cell type, the anterior pituitary hormone, the hormone target site, and the primary peripheral feedback hormone for corticotropin-releasing hormone.

A

anterior pituitary target cell type: corticotroph
anterior pituitary hormone: adrenocorticotropic hormone
hormone target site: zona fasciculata & zona reticularis of adrenal cortex
primary peripheral feedback hormone: cortisol

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23
Q

Describe the the anterior pituitary target cell type, the anterior pituitary hormone, the hormone target site, and the primary peripheral feedback hormone for gonadotropin-releasing hormone.

A

anterior pituitary target cell type: gonadotroph
anterior pituitary hormone: follicle stimulating hormone luteinizing hormone
hormone target site: gonads (testes, ovaries)
primary peripheral feedback hormone: estrogen, progesterone, testosterone

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24
Q

Describe the the anterior pituitary target cell type, the anterior pituitary hormone, the hormone target site, and the primary peripheral feedback hormone for prolactin-releasing factor.

A

anterior pituitary target cell type: lactotroph
anterior pituitary hormone: prolactin
Hormone target site: breasts
primary peripheral feedback hormone: none

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25
Describe the anterior pituitary target cell type for prolactin-inhibitory factor
lactotroph | there is no peripheral feedback hormone
26
Describe the the anterior pituitary target cell type, the anterior pituitary hormone, the hormone target site, and the primary peripheral feedback hormone for growth-hormone releasing hormone
anterior pituitary target cell type: somatroph anterior pituitary hormone: growth hormone hormone target site: all tissues primary peripheral feedback hormone: growth hormone, insulin, growth factor-1
27
Describe the the anterior pituitary target cell type, the anterior pituitary hormone, the hormone target site, and the primary peripheral feedback hormone for growth hormone inhibitory factor (somatostatin).
anterior pituitary target cell type- somatroph anterior pituitary hormone: growth hormone hormone target site: all tissues primary peripheral feedback hormone: growth hormone, insulin, growth factor 1
28
Pituitary disorders can be
primary disorder secondary disorder tertiary disorder
29
Describe what a primary pituitary disorder involves
defect to the peripheral endocrine gland
30
Describe a secondary pituitary disorder.
defect to the pituitary
31
Describe a tertiary disorder.
defect to the hypothalamus
32
Anterior pituitary hyposecretion is known as
panhypopituitarism- generalized pituitary hypofunction
33
Causes of anterior pituitary hyposecretion include:
``` nonfunctioning tumors compress and destroy normal pituitary tissue hypophysectomy postpartum shock irradiation trauma infiltrative disorders ```
34
Surgical removal of a tumor of the pituitary gland may require
thyroid hormone glucocorticoids vasopressin
35
Surgical removal of the tumor or the pituitary gland can be done to
decompress or remove the tumor | to control bleeding
36
Anterior pituitary hypersecretion is usually caused by
genign adenomas
37
The three most common tumors of the anterior pituitary produce
prolactin--> amenorrhea, infertility/decreased libido, impotence ACTH--> Cushing's disease GH--> promotes growth of all tissues capable of growing tumors that secrete thyrotropin or gonadotropin are very rare
38
Growth hormone secretion increases during
stress, hypoglycemia, exercise, and deep sleep
39
Growth hormone exerts its effects on
almost every part of the body
40
Pulsatile fluctuations of growth hormone releasing hormone and growth hormone inhibiting hormone regulate
synthesis throughout the day
41
A major target for growth hormone is
the liver- GH stimulates production of insulin-like growth factor type 1 (IGF-1) which mediates many of the effects of GH
42
_______________ undergo hypertrophy and hyperplasia due to GH and IGF-1
skeletal muscle, heart, skin, and visceral organs
43
Growth hormone hypersecretion is usually caused by a
growth hormone secreting pituitary adenoma
44
Growth hormone hypersecretion is known as _____ in adults
acromegaly | acromegaly is the sustained hypersecretion of GH after adolescence
45
Gigantism is the
hypersecretion of GH prior to puberty (before closure of the growth plates- may reach 8 to 9 feet tall)
46
Common features of acromegaly include
skeletal overgrowth, soft tissue overgrowth, visceromegaly, osteoarthritis, glucose intolerance, skeletal muscle weakness, extrasellar tumor extension, peripheral neuropathy, challenging intubations
47
Comorbidities of acromegaly include
hypertension, cardiomyopathy, ischemic heart disease, diabetes, osteoarthritis, skeletal muscle weakness/fatigue, increased lung volumes, sleep apnea (d/t all of the airway changes), increased liver, spleen, kidneys, & heart
48
Treatment for acromegaly includes
restore normal GH levels preferred initial treatment is microsurgical removal of the tumor with preservation of the gland for small tumors, a transsphenoidal approach- going through sinus cavities for large tumors an intracranial approach irradiation and/or suppressant drug therapy are adjunctive treatments or for non surgical candidates
49
Anesthetic considerations for the surgery patients with acromegaly include:
airway management sleep apnea >60% postoperative respiratory obstruction or failure systemic hypertension, ischemic heart disease, and arrhythmias skeletal muscle weakness hyperglycemia entrapment neuropathies if adrenal or thyroid axis impairment- may need stress-level glucocorticoid therapy & thyroid replacement
50
Describe the airway management concerns for the patient with acromegaly.
enlarged tongue, lips, nasal turbinates, & epiglottis, overgrowth of the mandible, vocal cord dysfunction lead to upper airway obstruction, difficult mask fit, impaired visualization of cords, subglottic narrowing, dyspnea/hoarseness--> larynx involved
51
Preoperative preparation for the patient with pituitary surgery includes
thorough H&P concentrate on symptoms associated with acromegaly labs should include glucose, electrolytes, and hormone levels images should be done to determine the extent of the tumor invasion EKG- look for signs of left ventricular hypertrophy and arrhythmias consider an echo if the patient has cardiac dysfunction optimized cardiac function check collateral circulation at the wrist prior to a-line insertion--> hypertrophy of carpal tunnel ligament may impede ulnar artery flow
52
Anesthetic considerations for the transsphenoidal approach include
head of bed is elevated 15 degrees a-line is usually inserted a lumbar drain may be placed consider monitoring for venous air emboli usually not significant blood loss use of submucosal injection of epinephrine containing solutions or use of topical vasoconstrictors may result in hypertension the anesthetic technique chose should allow for muscle relaxation, smooth extubation and rapid neurlogoical assessment
53
For the transphenoidal approach intraoperative hypotension may be due to
inadequate cortisol secretion- replace with hydrocortisone 50 to 100 mg IV
54
For the transsphenoidal approach, blood loss is
usually minimal, there is the potential for large amounts of blood loss if a large cavernous sinus is inadvertently entered
55
With the transsphenoidal approach, a venous air embolism is possible if
large tumor invading a large sinus and/or steep head up position
56
Surgical complications of transsphenoidal approach include
cranial nerve damage, epistaxis, hyponatremia, cerebral spinal fluid leaks diabetes insipidus
57
Diabetes insipidus can occur
intra or postoperatively because of surgical trauma to the posterior pituitary- the trauma is reversible results in insufficient ADH
58
Diagnosis of diabetes insipidus is through
measuring serum electrolytes, hyperosmolar plasma, and urine osmolariy
59
Treatment of diabetes insipidus involves
monitor urine output and electrolytes- can give DDAVP, restrict Na intake
60
The posterior pituitary secretes
antidiuretic hormone (ADH or arginine vasopressin) and oxytocin
61
ADH controls
renal water excretion and reabsorption and is a major regulator of serum osmolarity
62
Oxytocin powerfully stimulates
uterine contractions, stimulates myoepithelia cells of the breast for milk ejection during lactation, is used for inducing labor and decreasing postpartum bleeding
63
The posterior pituitary antidiuretic hormone has three types of vasopressin receptors:
V1- mediates vasoconstriction V2- mediates water reabsorption in the renal collecting ducts V3- found in the CNS and stimulate modulation of corticotrophin secretion
64
Stimuli for ADH release include
``` increased plasma sodium increased serum osmolality decreased blood volume smoking (nicotine) pain stress nausea vasovagal reaction angiotensin II positive pressure ventilation ```
65
Types of diabetes insipidus include
neurogenic or central- caused by inadequate release of ADH | nephrogenic- renal tubular resistance to ADH
66
Causes of neurogenic diabetes insipidus include
head trauma, brain tumors, neurosurgery, infiltrating pituitary lesions
67
Neurogenic diabetes insipidus may be associated with
hypokalemia, hyperkalemia, genetic mutations, hypercalcemia, and medication induced nephrotoxicity
68
Inhibitors of ADH action or release include
ethanol, demeclocycline, phenytoin, chloropromazine, lithium
69
Symptoms of ADH deficiency include
polyuria- Hallmark symptom inability to produce a concentrated urine dehydration hypernatremia low urine osmolarity- <300 mOsm/L urine specific gravity <1.010 Urine volume >2 mL/kg/hr Serum osmolarity >290 mOsm/L and sodium >145 mEq/L neurological symptoms of hyperreflexia, weakness, lethargy, seizures, and coma
70
______ is the major mechanism for controlling DI in awake patients
thirst
71
Medical treatment of DI depends on
the degree of ADH deficiency
72
Mild DI or incomplete DI can be treated with
medications that augment or release of ADH or increase receptor sensitivity such as chlorpropamide, carbamazepine, clofibrate
73
Significant DI-complete DI can be treated with
ADH preparations such as DDAVP | it is considered to be plasma osmolarity >290 mOsm/L
74
DDAVP is a
selective V2 agonist with a duration of action of 8 to 12 hours can be administered orally, subcutaneously, IV, & nasally
75
DDAVP has less
vasopressor activity | enhances antidiuretic properties
76
Preoperative assessment for the patient with DI includes
careful assessment of plasma electrolytes, renal function, and plasma osmolarity dehydration makes these patients very sensitive to the hypotensive effects of general anesthetics intravascular volume should be replaced with isotonic fluids over 24 to 48 hours
77
Preoperative treatment of diabetes insipidus includes preoperative administration of vasopressin is
not necessary for incomplete DI because the stress of surgery increases ADH secretion
78
Complete DI preoperative treatment includes
desmopressin vasopressin caution is necessary in patients with CAD--> ADH substitutes like ADH cause hypertension due to arterial vasoconstriction
79
Labs to measure for the patient with DI in the intraoperative and immediate postoperative period include
plasma osmolarity, urine output, and serum sodium
80
________ fluids should be given during the intraoperative period for patients with ADH deficiency and if the plasma osmolarity rises above 290 mOsm/L, _______ should be administered
isotonic fluids | D5W
81
Hypersecretion of ADH is known as
syndrome of inappropriate ADH
82
SIADH is a disorder characterized by
high circulating levels of ADH relative to plasma osmolarity and serum sodium concentration
83
With SIADH, ADH secretion cause the
kidneys to continue to reabsorb water despite the presence of hyponatremia & plasma hypotonicity expansion of ICF and ECF occurs as well as hemodilution and weight gain
84
In SIADH, urine is
hypertonic relative to plasma and urine output is usually low
85
Treatment for SIADH includes
fluid restriction | if patient is symptomatic or serum Na is <115-120 mEq/L consider hypertonic saline
86
Clinical features of SIADH include
water intoxication, dilutional hyponatremia, & brain edema
87
Brain edema results in
lethargy, headache, nausea, mental confusion, seizures, and coma
88
With dilutional hyponatremia, the severity of symptoms is
related to the degree of hyponatremia and the rate of decrease in serum sodium
89
Causes of SIADH include
hypothyroidism, pulmonary infection, lung carcinoma, head trauma, intracranial tumors, pituitary surgery, and medications
90
The most common cause of SIADH is
neoplasms particularly small-cell carcinomas of the lung
91
Preoperative evaluation of the patient with SIADH includes
careful volume status evaluation perioperative fluid management- fluid restriction that involves the use of an isotonic solution CVP can help with guiding volume replacement frequent measures of urine output, urine osmolarity, plasma osmolarity, and serum sodium concentration prevent nausea because it is potent for releasing ADH
92
For mild SIADH with no symptoms of hyponatremia, the treatment is
treat with water restriction of 800 to 1000 mL/day of NS
93
SIADH with acute, severe hyponatremia is defined as a plasma sodium concentration of
<115-120 mEq/L or acute neurological symptoms may require IV hypertonic saline with or without a loop diuretic
94
Serum sodium should be measured every
2 hours during treatment
95
To prevent acute loss of brain water and possible permanent neurological damage
known as central pontine demyelination syndrome, plasma concentration of Na must be replaced slowly at a rate not to exceed 1 to 2 mEq/L/hr or 6 to 12 mEq/L in 24 hours

Pathophys II (43 decks)

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