Pituitary Disorders
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| Which Endocrine gland exerts control over the other endocrine glands? | Pituitary gland
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| Which endocrine gland works closely with the hypothalamus? | Pituitary gland
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| 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
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| 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
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| Hormones produced by the posterior pituitary gland: | *ADH (anti-diuretic hormone) *Oxytocin
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| The Anterior pituitary is also known as what? | adenohypophysis
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| The Posterior pituitary is also known as what? | neurohypophysis
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| 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
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| True or False: Acromegaly is correctable with aggressive surgery. | False. Growth changes that occur are irreversible despite adequate surgical & medical intervention
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| 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
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| 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
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| What may acromegaly result in specifically in males? | Impotence
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| What may acromegaly result in specifically in females? | deepened voice, increased facial hair and amenorrhea
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| What are signs of early heart failure in cases with acromegaly? | *Dyspnea *Tachycardia *Weak pulse *Hypotension
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| What is the most definitive test for acromegaly? | oral glucose challenge test
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| 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
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| PT is NPO for how long before an oral glucose challenge test? | 8 hours (According to instructor, module test may say 12 hours)
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| What two drugs are given in Tx for acromegaly? | *Cabergoline (Dostinex) *Bromocriptine (Parlodel) *Somatostatin analogs {Octreotide (Sandostatin, Depot) Lanreotide SR (Ipstyl)}
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| What must be done before administering Cabergoline and why? | Take patient’s B/P before administering, HTN is a side effect of cabergoline
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| What side effects must the PT on Cabergoline (Dostinex) and Bromocriptine (Parlodel) be monitored for? | headache, nausea, nasal congestion and abdominal cramps
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| What are the purpose of the drugs used to Tx acromegaly? | Suppress GH secretion
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| 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
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| Contraindications for Octrotide (Sandostatin, Depot)? | *Diabetics on insulin or an oral hypoglycemic *Chronic renal failure
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| 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
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| When does gigantism occur? | childhood before closure of the epiphyses
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| What test is used to diagnose gigantism? | GH suppression test (Glucose loading test)
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| 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
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| In addition to a deficiency of GH, what other hormones may be lacking in a PT with dwarfism? | *adrenocorticotropic hormone (ACTH) *TSH *gonadotropins
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| Fill in the blanks: Many people with hypopituitary dwarfism are able to reproduce normal _______, unless there is an accompanying deficiency in ___________ | offspring, gonadotropins
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| What is the birth weight of neonates with dwarfism? | Normal birth weight
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| 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
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| What is the most definitve diagnosis for dwarfism? | Decreased plasma levels of GH
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| When must a PT be placed on NPO before testing for Decreased plasma levels of GH? | NPO after midnight
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| Complications experienced from dwarfism are often of what? | musculoskeletal and cardiovascular systems
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| How does GH relate to blood glucose? | GH mobilizes food molecules, causing an increase in blood glucose concentration
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| Dopamine agonists are used in Tx of what problems? | acromegaly and parkinsons
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| What is the therapeutic effect of dopamine agonists? | decreased growth hormone in acromegaly
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| What side effect can dopamine agonists cause in PTs with acromegaly? | digital vasospasm
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| What must be monitored periodically during Dopamine agonist therapy? | GH and insulin-like growth factor (IGF-I) concentrations
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| 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
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| 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.
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| What is diabetes insipidus? | Disorder of the posterior pituitary in which ADH is deficient. May be transient or permanent
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| What is the primary cause of diabetes insipidus? | malfunction of the posterior pituitary
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| Diabetes insipidus is secondary to what conditions? | *Head trauma/tumor *Infectons such as encephalitis or meningitis
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| 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
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| What electrolyte imbalance may occure from diabetes insipidus? | Hypernatremia (Water is lost, not sodium). Hypertonic dehydration may occur.
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| What is the serum sodium level in a PT with diabetes insipidus? | >145 mEq/L (normal 135-145 mEq/L)
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| 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)
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| What is the therapeutic effect of ADH (vasopressin) in PTs with diabetes insipidus? | decreased urine output and increased urine osmolality in diabetes insipidus.
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| What are the contraindications of ADH (vasopressin)? | *Chronic renal failure with increased BUN *Hypersensitivity to beef or pork proteins
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| What are the S/Sx of water intoxication in a PT on ADH (vasopressin)? | *Weight Gain *Headache *CONFUSION *Drowsiness
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| 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).
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| Intranasal ADH (vasopressin) can control bleeding in what? | certain types of hemophilia and von Willebrand's disease
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| What drug may cause a decreased therapeutic effect of ADH (vasopressin) | Lithium
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| 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
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| 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
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