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DNURS 828 Endocrine > Hypothalamus and Pituitary > Flashcards

Hypothalamus and Pituitary Flashcards

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1
Q

The hypothalamus and pituitary gland form a unit that exerts control over the function of:

A

Thyroid
Adrenals
Gonads

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2
Q

The pituitary is the:

A

“master gland”

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3
Q

The hypothalamic-pituitary axis (HPA) is responsible for:

A

Brain-endocrine interactions

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4
Q

The hypothalamus is the:

A

coordinating center of the endocrine system

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5
Q

They hypothalamus consolidates signals from:

A

-Upper cortical inputs
-autonomic function
-environmental cues
-Peripheral endocrine feedback

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6
Q

The hypothalamus delivers precise signals to the _____ gland which releases hormones that influence other endocrine systems

A

Pituitary gland

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7
Q

The pituitary gland rests in the _____ bone in the area called the _____ ____

A

Sphenoid bone
Sella tursica

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8
Q

4 divisions of the pituitary gland:

A

1.) Anterior pituitary/ adenohypophysis
-largest

2.) Pars Intermedius
-gone after fetal development

3.) Pars tubularis
-highly vascular, no known hormones secreted

4.) Posterior pituitary/ neurohypophysis

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9
Q

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

A

Distinct

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10
Q

The anterior and posterior pituitary have different:

A

Connections to the hypothalamus

cell types

Secrete different hormones

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11
Q

The anterior pituitary is highly vascularized and connected to the hypothalamus via a:

A

Portal venous network

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12
Q

The anterior pituitary is responsible for the regulation of the _____, ____, and _____ glands

A

Thyroid
Adrenal
Mammary

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13
Q

The anterior pituitary also regulates ____ ___, _____, and ____

A

Growth hormone
Gonads
Melanocytes

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14
Q

Somatotropes

A

30-40%
-Most abundant
-Growth hormone (GH)

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15
Q

Corticotropes

A

20%
Adrenocorticotropic hormone (ACTH)

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16
Q

Thyrotropes

A

3-5%
Thyroid-stimulating hormone (TSH)

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17
Q

Gonadotropes

A

3-5%
Luteinizing hormone (LH)
Follicle-stimulating hormone (FSH)

goes right to site of action

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18
Q

Lactotropes

A

3-5%
Prolactin (PRL)

goes right to site of action

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19
Q

The posterior pituitary is largely a collection of ____ ___ from the hypothalamus

A

axonal projections

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20
Q

The posterior pituitary produces what 2 hormones

A

Oxytocin
Vasopressin (ADH)

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21
Q

What does Oxytocin do?

A

Regulates uterine contractions

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22
Q

What does Vasopressin (ADH) do?

A

Regulates water balance

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23
Q

Where are the hormones synthesized before being transported intracellularly for secretion from the pituitary?

A

Hypothalamus

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24
Q

The posterior pituitary is fed by which artery?

A

inferior hypophyseal artery

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25
The hypothalamus is supplied by which artery?
superior hypophyseal artery
26
How is the anterior pituitary supplied blood?
Venous by way of long portal vessels
27
Which nerve fiber supplies oxytocin?
Paraventricular nucleus
28
Which nerve fiber supplies antidiuretic hormone (vasopressin)?
Supraoptic nucleus
29
What is the mechanism of action of vasopressin?
Increases permeability of the collecting ducts, increasing free water absorption. -increased urine osmolality -decreased plasma osmolality -Increased ECF volume
30
How does Vasopressin (ADH) produce vasoconstrictive/pressor effects?
Causes contraction of vascular smooth muscle -more prevalent in large doses
31
V1 receptor:
Pressor effect -vasoconstriction = increased arterial pressure -prevalent w extreme increases in circulating levels (hemorrhage)
32
V2 receptor:
ADH effect - renal fluid reabsorption= increased blood volume = increased arterial pressure
33
Vasopressin is released from the posterior pituitary d/t :
Angiotensin 2 Sympathetic stimulation Hyperosmolarity Hypovolemia HoTN
34
Stimulus for release of vasopressin (ADH):
Osmoreceptor in the hypothalamus is activated by plasma osmolarity > 290 mosm/L -other receptors in the hypothalamus send sensation of thirst
35
Decreased ECF volume activates ____ receptors in the ____ ____, _____, and _____ ____ for ADH release
stretch receptors -great veins -atria -pulmonary vessels
36
Other stimulators of ADH release:
-High sodium -Low BP -angiotensin 2 -nicotine -nausea -pain -stress -PPV
37
Release of ADH is depressed by:
-Decreased plasma osmolality -Increased ECF volume -Alcohol
38
Large volume changes activate:
baroreceptor in the carotid sinus and aortic arch
39
Diabestes insipidus (DI)
excessive thirst= dilute urine
40
What is Diabetes insipidus caused by?
ADH deficiency caused by an inability to release (neurogenic/central- most common) or inability of kidney to respond (nephrogenic)
41
What are the results of Diabetes Insipidus?
Excretion of large amounts of hypoosmotic urine w hyperosmotic plasma polydipsia, polyuria w/o hyperglycemia
42
What keeps DI pts from severe dehydration?
Water intake
43
Treatment for DI:
Limit sodium intake Give ADH (1-Deamino-8-D-arginine vasopressin/ DDAVP for central
44
What is Hypernatremia a result of?
Loss of H2O, an excess of Na or retention of large quantities of sodium.
45
When is transient central DI commonly seen?
Post-head injury or surgery
46
What can cause Nephrogenic DI?
Chronic renal disease Lithium toxicity Hypercalcemia Hypokalemia Tubulointerstitial disease (drugs)
47
Above what sodium level should elective surgery be cancelled?
> 150
48
What are symptoms of hypernatremia?
Restlessness Lethargy Hyperreflexia Seizure Coma Death
49
Is MAC increased or decreased w hypernatremia?
Increased
50
Is MAC increased or decreased w hypernatremia?
Increased (decreased potency)
51
Is the uptake of inhalation agents increased or decreased with hypernatremia?
Decreased from decreased CO
52
What can rapid correction of hypernatremia result in?
-Seizures -Brain edema -Permanent neurologic damage -Death
53
What is Syndrome if inappropriate ADH (SIADH)?
ADH overload
54
What causes SIADH?
Autonomous release from the pituitary (or tumor) CNS disorders Head trauma Squamous cell lung cancer (SCC of lung) Pulmonary infection Pituitary signs and symptoms
55
What are the symptoms of SIADH?
Water retention dilutional hyponatremia Concentrated urine Hypoosmolar (dilute plasma) Water intoxication Brain edema= CNS effects --> lethargy, seizure, coma
56
Treatment for SIADH
Tx underlying cause restrict fluid Demeclocycline
57
What causes hyponatremia?
Low Na+ reflects water retention either from an absolute increase in total body water (TBW) or Na+ loss in excess of H2O
58
Until what level is hyponatremia asymptomatic?
125 mEq/L
59
When can you see serious symptoms with hyponatremia
Below 120 mEq/L
60
Mild hyponatremia:
anorexia, nausea, weakness
61
Moderate hyponatremia:
lethargy, confusion
62
Severe hyponatremia:
seizures, coma, death
63
Above what sodium level is safe for elective procedures?
>130
64
Anesthetic implications for a sodium level less than 130:
May lead to cerebral edema Decreased MAC Post-op agitation, confusion, somnolence Tx: Hypertonic 3% saline, furosemide
65
What can happen is hyponatremia is corrected too quickly?
Central pontine myelinolysis -demyelinating lesions in the pons
66
What are the recommended correction guidelines for hyponatremia?
1-2 mEq /hr <12 mEq /24 hrs
67
What are symptoms associated w Central Pontine Myelinolysis?
Spastic quadriplegia pseudobulbar palsy (inability to control facial movements) varying degrees of encephalopathy or coma from acute, noninflammatory demyelination that is centered within the basis pontis
68
Conditions predisposing pts to CPM:
Alcoholism Liver disease Malnutrition Hyponatremia
69
Risk factors for CPM in the hyponatremic pt include:
Serum sodium less than 120 mEq for more than 48 hrs Aggressive IV fluid therapy w hypertonic saline solutions Development of hypernatremia during tx
70
How often should serum Na+ be monitored?
Every 1-2 hrs.
71
Where is Oxytocin (Pitocin) secreted from?
paraventricular nucleus of posterior pituitary
72
What does oxytocin do?
Causes contraction of myoepithelial cells of the lactating breast and smooth muscle of the uterus decreases blood loss after birth d/t uterine contractions
73
When does the secretion and sensitivity of oxytocin increase
late pregnancy
74
What causes the milk ejection reflex?
stimulation of touch receptors in the breast by infant suckling activation of afferent fibers sends signals to the supraoptic and paraventricular nuclei to release oxytocin , contraction of myoepithelial cells and ejection of milk
75
Labor effects and breastfeeding are examples of what?
Positive feedback
76
Is the blood-brain barrier intact to the hypothalamus?
NO
77
Complications of oxytocin?
Fetal distress d/t hyperstimulation Uterine tetany Maternal water intoxication (ADH effects, rare)
78
Rapid IV infusion of oxytocin can cause:
HTN Tachycardia N/V Seizures (rarely)
79
How are intracranial neoplasms found most often?
d/t hypersecretion of pituitary hormones
80
Galactorrhea
High prolactin secretion
81
Cushing disease
High ACTH High cortisol
82
Acromegaly
High growth hormone secretion
83
How are pituitary tumors often found?
As a result of compression on adjacent structures - visual changes w impingement of the optic chiasm
84
What can the compression of the optic chiasm result in?
Bitemporal hemianopsia (Impaired peripheral vision in the outer temporal halves of the visual field of each eye.)
85
Anesthetic implications for Acromegaly (increased GH)
-difficult mask -difficult intubation -Large tongue and epiglottis -enlarged mandible -distorted facial features -subglottic narrowing and vocal cord enlargement. -May consider downsizing ETT. -OSA is common. -High risk of HTN, cardiomyopathy, LVH, arrhythmias. -Enlarged spleen, heart, liver, kidneys -Skeletal overgrowth -Glucose intolerance -Preferred surgery is pituitary tumor removal
86
Anesthetic implications for Hyperthyroid (TSH)
Tachycardia Wt. loss
87
Anesthetic implications for Cushing's (ACTH)
Difficult airway and access
88
Panhypopituitarism
Need hormone replacement w cortisol, levothyroxine (synthetic T4), DDAVP (vasopressin)
89
What kind of tube would you use for pituitary surgery?
ETT oral Rae
90
Implications for pituitary surgery:
Head pins Deep extubate Procedure 2-4 hrs Dura is opened to expose tumor and repaired w fat or bone graft EBL 20-200 ml Keep pt normotensive and normocapneic
91
Why should you avoid hypocapnia in pituitary surgery?
Hypocapnia lowers ICP and pulls pituitary tumor further into brain
92
Which hormones are released by the anterior pituitary gland? Prolactin Luteinizing hormone Antidiuretic hormone Oxytocin Corticotropin-releasing hormone Growth Hormone
Prolactin Luteinizing hormone Growth Hormone (anterior pituitary releases 6 hormones: "FLAT PiG) -Follicle-stimulating hormone -Luteinizing hormone -Adrenocorticotropin -Thyroid-stimulating hormone -Prolactin -Ignore -Growth hormone

DNURS 828 Endocrine (3 decks)

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