Exam 3, Day 1 Lecture Flashcards by Ian bicol

An anesthetic technique allowing for ________ and _____ is desirable in transsphenoidal surgical approach.

smooth intubation and extubation rapid neurological assessment

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ACTH controls secretion of adrenal cortex hormones which affect _____, _____ and ____ metabolism

carbohydrates, protein, and lipid metabolism

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The name of the portal system involved at the hypothalamus and pituitary glands.

hypothalamo-hypophyseal portal system ….. or hypophyseal portal system

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6 Factors known to increase GH secretion

Starvation 2. Hypoglycemia or low fatty acids 3. Exercise 4. Excitement 5. Trauma 6. the 1st 2 hours of deep sleep

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Components of bone matrix (2)

protein and minerals

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Prolactin-secreting macroadenomas respond frequently to medication such as (3)

bromocriptine cabergoline pergolide (damages heart valves)

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Post GH theapy, IGF-1 level are checked after ____ month(s)

one

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Acquired Causes of Hypopituitarism (5)

Cranial irradiation Lymphocytic hypophysitis Infiltrative disorders Pituitary Apoplexy Empty Sella Syndrome

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The symptoms of pituitary apoplexy may occur immediately or may develop over ___ days

1 - 2 days

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Secretion of adenohypophyseal hormones is controlled by _______ which are secreted from the hypothalamus and traveling through the hypophyseal portal veins to the capillaries of the anterior pituitary.

hypothalamic releasing and hypothalamic inhibiting hormones.

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This i referred to as the master gland.

Anterior pituitary gland

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The growth promoting action of GH requires both ____ and ____.

insulin and carbohydrates

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The anterior pituitary is glandular develops from _____ of pharyngeal epithelium

Rathke’s pouch

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This blood vessel is located in the cavernous sinus

internal carotid artery

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This is located superior to the pituitary stalk.

Optic chiasm

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This is a channel for venous blood anterior to the sphenoid bone

carvernous sinuses.

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Some cases of dwarfism are due to panhypopituitarism. This condition is specifically called ___.

pituitary dwarfism.

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Mass effect: Lateral extension may compress CN 3,4,6, V1,V2 leading to ___.

Diplopia

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True or False: Hormone resistance may be due to mutation at the receptor site.

True

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A cartilage at both ends of the bone which is the site for new bone deposition.

Epiphyseal plate

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This condition has an excessive growth and height significantly above average due to an excess of growth hormone during childhood, BEFORE the epiphyseal plates have closed.

Gigantism

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4 Causes of panhypopituitarism

Congenital Tumors (adenoma, craniopharyngioma) TBI Thrombosis of pituitary vessel

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What occurs when chondrocytes are converted to osteogenic cells?

bone deposition

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Safest approach in surgically removing tumors of the pituitary gland.

transsphenoidal via nasal cavity

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Type of intubation which should be considered for patients with acromegaly

fiberoptic-guided intubation. (Endotracheal intubation may present a challenge)

The most common cause of hyper secretion of anterior pituitary.

hyperfunctioning pituitary adenoma

What is the indirect effect of GH?

GH causes the liver to make at least 4 insulin-like growth factors (IGF-1 is the most important)

The hypothalamic-pituitary portal plexus allows transmission of _____ without significant systemic dilution. Consequently, pituitary cells are exposed to sharp spikes of releasing factors and in turn release their hormones as discrete pulses.

hypothalamic peptide pulses

Nerves associated with proximity to the pituitary gland. (5)

CN 3,4,6: for extrinsic eye movement Opthalmic nerve V1 Maxillary nerve V2

The axon terminals of the dorsal medial, ventral medial, and infundibular nuclei terminates at \_\_\_\_\_.

median eminence of the infundibulum.

The 3 most common hypersecreting pituitary tumors are those that produce

Prolactin (most common), ACTH, GH

6 Clinical presentation of Pituitary Apoplexy

Nausea, vomiting Vertigo Meningismus Variable onset of severe headache +/- visual defects +/- altered consciousness

The major blood source of anterior Pituitary gland.

Hypothalamic-pituitary portal plexus.

These cells (2) increase protein deposition in the bone matrix

Chondrocytes: cartilage-making cells Osteocytes: bone-making cells

Other name for posterior pituitary gland

Neurohypohysis

Inflammation of the hypophysis due to influx of lymphocytes

Lymphocytic hypophysitis

Achondroplasia is directly related to mutations in _____ and is unrelated to pituitary disorder.

Fibroblast growth factor receptor 3 (FGFR3)

This medication is used to treat acromegaly. It is a GH receptor antagonist (GHIH)

Pegvisomant (somavert)

This results when the pituitary gland produces excess growth hormone AFTER epiphyseal plate closure at puberty.

Acromegaly

This is referred to as the bone formation within the cartilage model.

Endochondral ossification (Bone growth)

Hypothalamic releasing and inhibiting hormones travel through the _____ to the capillaries of the Anterior pituitary gland.

hypophyseal portal veins

This is a branch of the cavernous part of the internal carotid artery

Inferior hypophyseal artery

True or False: In empty sella syndrome, hypopituitarism may develop insidiously.

True

Cranial nerves that move the eyeballs.

CN 3 (oculomotor) ,4 (Trochlear),6 (Abducens)

Top 4 tissues where Growth Hormone receptor is significantly expressed.

1. B lymphoblasts 2. Adipocyte 3. Liver 4. Prostate

This are glial-like cells supporting the function of the neurons the projects down to the neurohypophysis. They don't secrete hormones.

Pituicytes

This is a sequence of chemical reactions that constructs or synthesizes molecules from smaller units, usually requiring input of energy (ATP) in the process.

Anabolism

Bone elongation continues until a person reaches their full adult height, but bones can become \_\_\_\_\_\_.

thicker throughout life due to GH.

True or False: Empty sella syndrome is often an incidental MRI Finding

true

Main symptom if any of the CN are accidentally damaged from pituitary surgery.

double vision

Pituitary masses may undergo clinically silent infarction with development of a partial or totally empty sella by ______ filling the dural herniation.

CSF

This is a decreased secretion of all pituitary hormones.

panhypopituitarism

Symptomatic patients who have suboptimal response to medical therapy benefit from \_\_\_\_.

microsurgical removal of the tumor.

Test peroformed prior to radial arterial catherter insertion.

Allen's test

Part of pituitary gland which contains cells that make hormones.

Anterior pituitary (Adenohypophysis, glandular part)

How many skeletal muscles attached to each eyeballs

6 (4 rectus muscles, 2 obliques muscles)

Incidence of Pituitary tumor

17 - 22% or 1 in 5 people

The highest concentration of any hypothalamic inhibiting and releasing hormones will be at which vein?

Primary plexus of the hypothalamic-hypophyseal portal system or at the hypophyseal portal veins. (they both have the same concentrations)

The neurosecretory cell's axon terminal for anterior pituitary gland is located in the \_\_\_\_.

hypothalamus.

GH promotes growth via \_\_\_\_, \_\_\_\_\_, and \_\_\_\_\_.

protein anabolism, mitosis, and differentiation

The main hormone for production of gamete (sex cells).

Luteinizing Hormone

This gland develops from an evangination of the hypothalamus.

Neurohypohysis

This syndrome is associated with postpartum shock causing hyposecretion of anterior pituitary gland.

Sheehan's Syndrome

Meningeal irritation with symptoms suggesting meningitis.

Meningismus

Mass effect: Inferior extension may lead to \_\_\_\_.

CSF rhinorrhea.

When does Epiphyseal plate closure occurs?

Puberty

The most important function of GH is \_\_\_.

Increased DNA transcription into mRNA

Growth hormone therapy is indicated when evoked GH level is \_\_\_\_.

\< 3 micrograms/ L

Acromegaly progression characteristics (5)

Cardiomyopathy Hypertension Accelerated atherosclerosis Coarse facial features Overgrowth of internal organs Limited exercise tolerance

This is noticeably absent from the list of effects of panhypopituitarism onset in adulthood

GH deficiency.

When does growth hormone level starts decreasing?

after puberty

True or False: Rarely, functional pituitary adenomas may arise within the rim of pituitary tissue, and these are not always visible on MRI.

True

Two hormones needed for nursing successfully.

oxytocin and prolactin

Mass effect: Superior extension may compromise \_\_\_\_.

optic pathways leading to impaired visual acuity and visual field defects. May also produce hypothalamic syndrome (disturbed sleep,thirst, satiety, temperature regulation)

This occur with venous occlusions where blood can collect in infarcted zones.

Red infarct

Name 2 gonadotropins. They target the testes and ovaries.

FSH and LH

Medications used in evoked GH test (2)

Arginine GH-releasing hormone

True or False: Panhypopituitarism is more common than just a single hormone hypo secretion.

true

This hormone is responsible for mammary development and milk production.

Prolactin

The most common type of dwarfism is due to \_\_\_.

achondroplasia

This tests measures the ability of the pituitary gland to release GH after administration of a medication.

Evoked GH

Adeno means relating to a \_\_\_\_.

gland

This is a branch of the cerebral part of the internal carotid artery

Superior hypophyseal artery

One way that bone grows is by replacing the _____ with bone. (type of bone formation)

hyaline cartilage model

The decrease in glucose reuptake in skeletal muscle and adipose tissue is a result from \_\_\_\_\_.

GH-induced insulin resistance (similar to type 2 DM)

Pituitary glands are encased by \_\_\_\_. It is a depression in the sphenoid bone.

Sella turcica

The main effect of Growth hormone is \_\_.

promotion of protein anabolism

Other name of IGF-1

Somatomedin C

Hormones of the supraoptic and paraventricular nuclei are released at the \_\_\_\_.

Pars nervosa

This is a neurosurgical emergency caused by hemorrhagic infarction of a pituitary adenoma or tumor.

Pituitary apoplexy

Exam 3, Day 1 Lecture Flashcards

(90 cards)