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68wm6 p2 Pit Dis

Pituitary Disorders

QuestionAnswer
Which Endocrine gland exerts control over the other endocrine glands? Pituitary gland
Which endocrine gland works closely with the hypothalamus? Pituitary gland
What is the system the pituitary gland uses to control the other glands? the negative feedback system: a decrease in function in response to stimuli
Hormones produced by the anterior pituitary gland: *GH (growth hormone) *TSH (thyroid stimulating hormone) *ACTH (adrenocorticotropic hormone) *Gonadotropic hormones: FSH (follicle stimulating hormone) & LH (luteinizing hormone) *MSH (melanocyte stimulating hormone) *Prolactin
Hormones produced by the posterior pituitary gland: *ADH (anti-diuretic hormone) *Oxytocin
The Anterior pituitary is also known as what? adenohypophysis
The Posterior pituitary is also known as what? neurohypophysis
Acromegaly is caused by what? Overproduction of somatotropin {growth hormone (GH)} in the adult from Idiopathic hyperplasia of the anterior pituitary gland or from tumor growth
True or False: Acromegaly is correctable with aggressive surgery. False. Growth changes that occur are irreversible despite adequate surgical & medical intervention
What are the visible changes brought on by acromegaly? enlargement of the cranium and lower jaw, with separation and malocclusion of the teeth, bulging forehead, bulbous nose, thick lips, enlarged tongue, and generalized coarsening of the facial features
What are the changes to the organs brought on by acromegaly? Hepatomagely, cardiomegaly and splenomegaly, and partial blindness due to pressure on the occular nerve
What may acromegaly result in specifically in males? Impotence
What may acromegaly result in specifically in females? deepened voice, increased facial hair and amenorrhea
What are signs of early heart failure in cases with acromegaly? *Dyspnea *Tachycardia *Weak pulse *Hypotension
What is the most definitive test for acromegaly? oral glucose challenge test
How does the oral glucose challenge test results differ in a normal healthy PT as opposed to a PT with acromegaly? *Normally, GH concentration falls during an oral glucose challenge test *With acromegaly, GH levels DO NOT fall
PT is NPO for how long before an oral glucose challenge test? 8 hours (According to instructor, module test may say 12 hours)
What two drugs are given in Tx for acromegaly? *Cabergoline (Dostinex) *Bromocriptine (Parlodel) *Somatostatin analogs {Octreotide (Sandostatin, Depot) Lanreotide SR (Ipstyl)}
What must be done before administering Cabergoline and why? Take patient’s B/P before administering, HTN is a side effect of cabergoline
What side effects must the PT on Cabergoline (Dostinex) and Bromocriptine (Parlodel) be monitored for? headache, nausea, nasal congestion and abdominal cramps
What are the purpose of the drugs used to Tx acromegaly? Suppress GH secretion
What are the surgical Tx for acromegaly? *Cryosurgery *Transphenoidal hypophysectomy- removal of tumor tissues through the nose *Proton beam therapy to destroy GH- secreting tumors
Contraindications for Octrotide (Sandostatin, Depot)? *Diabetics on insulin or an oral hypoglycemic *Chronic renal failure
What causes Gigantism? *Oversecretion of somatotropin (GH) as a result of hyperplasia of anterior pituitary *Defect in the hypothalamus, which directs the anterior pituitary to release excess amounts of GH *Disturbance in sex hormone production
When does gigantism occur? childhood before closure of the epiphyses
What test is used to diagnose gigantism? GH suppression test (Glucose loading test)
How will the GH suppression test (Glucose loading test) read in a PT with gigantism? Baseline levels of GH will be high in these patients
In addition to a deficiency of GH, what other hormones may be lacking in a PT with dwarfism? *adrenocorticotropic hormone (ACTH) *TSH *gonadotropins
Fill in the blanks: Many people with hypopituitary dwarfism are able to reproduce normal _______, unless there is an accompanying deficiency in ___________ offspring, gonadotropins
What is the birth weight of neonates with dwarfism? Normal birth weight
How do children with dwarfism appear? Well proportioned and well nourished but appear younger than their chronological age and a great deal shorter than peers
What is the most definitve diagnosis for dwarfism? Decreased plasma levels of GH
When must a PT be placed on NPO before testing for Decreased plasma levels of GH? NPO after midnight
Complications experienced from dwarfism are often of what? musculoskeletal and cardiovascular systems
How does GH relate to blood glucose? GH mobilizes food molecules, causing an increase in blood glucose concentration
Dopamine agonists are used in Tx of what problems? acromegaly and parkinsons
What is the therapeutic effect of dopamine agonists? decreased growth hormone in acromegaly
What side effect can dopamine agonists cause in PTs with acromegaly? digital vasospasm
What must be monitored periodically during Dopamine agonist therapy? GH and insulin-like growth factor (IGF-I) concentrations
What must a PT do if they missed a dose of Dopamine Agonists? Take missed doses within 4 hr of the scheduled dose or omit
What must be done if PT taking bromocriptine suffers blurred vision, sudden headache, severe nausea, & vomiting? Notify physician immediately, these are symptoms of tumor enlargement.
What is diabetes insipidus? Disorder of the posterior pituitary in which ADH is deficient. May be transient or permanent
What is the primary cause of diabetes insipidus? malfunction of the posterior pituitary
Diabetes insipidus is secondary to what conditions? *Head trauma/tumor *Infectons such as encephalitis or meningitis
What are the clinical manifestations of diabetes insipidus? *polyuria *polydipsia *Dilute urine, looking much like water, with a low specific gravity (1.001-1.005) *Urine output exceeds 200mL an hour for more than 2 consecutive hours
What electrolyte imbalance may occure from diabetes insipidus? Hypernatremia (Water is lost, not sodium). Hypertonic dehydration may occur.
What is the serum sodium level in a PT with diabetes insipidus? >145 mEq/L (normal 135-145 mEq/L)
What effect does ADH have on the body? *Kidneys to conserve water by decreasing the amount of urine produced. *Also constricts the arterioles, which results in increased blood pressure (Referred to as vasopressin)
What is the therapeutic effect of ADH (vasopressin) in PTs with diabetes insipidus? decreased urine output and increased urine osmolality in diabetes insipidus.
What are the contraindications of ADH (vasopressin)? *Chronic renal failure with increased BUN *Hypersensitivity to beef or pork proteins
What are the S/Sx of water intoxication in a PT on ADH (vasopressin)? *Weight Gain *Headache *CONFUSION *Drowsiness
What must be administered with ADH (vasopressin) and why? Administer 1-2 glasses of water at the time of administration to minimize side effects (blanching of skin, abdominal cramps, nausea).
Intranasal ADH (vasopressin) can control bleeding in what? certain types of hemophilia and von Willebrand's disease
What drug may cause a decreased therapeutic effect of ADH (vasopressin) Lithium
What effect does Syndrome for Inappropriate Secretion of Ant-Diuretic Hormone (SIADH) have on the body? Pituitary gland releases too much ADH -->In response to ADH, the kidneys reabsorb more water -->Urine output decreases -->Circulating volume expands -->Results in hyponatremia, hemodilution, and fluid overload without peripheral edema
How is Syndrome for Inappropriate Secretion of Ant-Diuretic Hormone (SIADH) diagnosed? *Decreased urine output *Hyponatremia (Sodium < 135 mEq/L) *BUN/Creatinine is low to normal *Urine specific gravity > 1.032, and urine Sodium will be elevated
Created by: Shanejqb