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23 Cards in this Set

  • Front
  • Back

Where is the pituitary gland located? What is it attached to?

- Located at the base of the brain in the bony cavity of the sphenoid bone (sella turcica)




- It is the size of a pea (500 mg) and attached to the overlying hypothalamus by the hypophyseal stalk (pituitary stalk)

How much of the pituitary is the anterior pituitary? What does it secrete?

- The anterior pituitary is 80% of the pituitary gland




- It secretes 6 hormones:


* Growth Hormone


* Adrenocorticotrophic hormone (ACTH)


* TSH


* FSH


* LH


* Prolactin



What stimulates or inhibits the release of anterior pituitary hormones to act on target organs?

- The hypothalamic–pituitary–adrenal axis (HPA axis)



- Hormones from the hypothalamus




- Closed loop negative feedback

What are causes of hyposecretion in the pituitary?

- Pan hypopituitarism is the most common response (generalized pituitary dysfunction) instead of one specific hormone reduced




-Causes:


* Tumor


* Postpartum shock (Sheehan's syndrome)


* Irradiation


* Trauma


* Hypophysectomy

What is the treatment for a pituitary tumor?

Transsphenoidal resection

What medications may a pt. need preop when they are awaiting transsphenoidal resection?

- Thyroid replacement




- Corticosteroid coverage

If the pt. develops diabetes insipidus intraoperatively, what medication will you use to treat this?

- Vasopressin

Will you deep extubate a pt. having a transphenoidal resection?

- No, the pt. needs to be awake so a neurological exam can be performed



- Prepare the pt. preoperatively for this as well as explain that they will have nasal packing and this will be uncomfortable. They will have to breathe through their mouth

What is dwarfism a result of ? Are these individuals at risk for a difficult airway? What is the treatment for dwarfism?

- Hyposecretion of growth hormone (GH)




- Yes these individuals are often at risk for a difficult airway




- These individuals receive human growth hormone

What causes hypersecretion of the anterior pituitary?

- Pituitary adenomas that may over-secrete:


* Prolactin


* ACTH


* GH

What are treatments for prolactin-secreting tumors?

- Bromocriptine (dopamine agonist)




- Microsurgical removal

What is the difference between gigantism and acromegaly?

- Acromegaly: Produced by sustained hypersecretion of GH after adolescence.



- Gigantism: Hypersecretion of GH before puberty (before closure of growth plates).

What is the treatment for over-secretion of GH?

- Microsurgical removal of tumor




- Octreotide




- Bromocriptine




- Gland irradiation

What are airway considerations for a patient with gigantism or acromegaly?

- Facial deformities, large nose hinder masking


- Macroglossia, enlarged thyroid, hypertrophy of epiglottis, overgrowth of soft tissue in upper airwaydifficult DL



- Subglottic narrowing, vocal cord enlargement use of smaller ETT.



- Turbinate enlargement precludes nasal intubations.

What are intraop considerations for oversecretion of GH?

- Thyroid replacement




- Steroid coverage




- Close monitoring of glucose and electrolytes




- Awake extubation- predisposed to airway obstruction

Which hormones does the posterior pituitary secrete? How are these hormones secreted?

- Antidiuretic hormone (Vasopressin or ADH)




- Oxytocin




- The posterior pituitary is composed of terminal neuron endings that originate in the hypothalamus




- ADH and oxytocin are synthesized in the hypothalamus and stored in the posterior pituitary

True or False. Nephrogenic DI can have multiple causes such as: x-linked inherited trait, hypercalcemia, hypokalemia, medication-induced nephrotoxicity, Ethanol, Phenytoin, Chlorpromazine, or Lithium

True. Nephrogenic DI is the inability of renal collecting duct receptors to respond to ADH

True or False. Neurogenic DI is hypersecretion of ADH and is caused by headtrauma, neurosurgical procedures, infiltrating pituitary lesions, brain tumors.

False. Neurogenic DI is hyposecretion of ADH

True or False. There are many factors related to surgery that increase ADH release.

True. ADH is stimulated by:


* Pain


* Stress


* Nausea


* Decreased BP


* Decreased blood volume


* Various medications (morphine, nicotine)


* Angiotensin II


* Positive pressure ventilation


* Increased serum osmolarity


* Increased plasma sodium ion concentration



What is the treatment for DI?

- Vasopressin (Arginine vasopressin/ AVP) at 0.5-15 U/hr




- DDAVP(Arginine Desmopressin): 0.3 µg/kg IV over 15-30 min or2-4 µg/ day in two divided doses.




- Both vasopressin and DDAVP cause:Splanchnic vasoconstriction. Increased smooth muscle contractility.

True or false. Besides low urine output, surgical patients with SIADH exhibit delayed awakening from anesthesia

True

What are treatments for SIADH?

- Fluid restriction




- Slow IV infusion of 3% hypertonic solution




- IV Lasix




- Demeclocycline (tetracycline antibiotic)





How many types of MEN syndrome are there?

There are 3 types:




- MEN 1


* Wermer's syndrome: Consists of pancreatic, pituitary, and parathyroid tumors




- MEN IIa


* Sipple’s syndrome: Medullary thyroid cancer, parathyroid adenoma, pheochromocytoma




- MEN IIb


* Mucosal neuroma syndrome: Medullary thyroid tumor, pheochromocytoma, neuromas of the oral mucosa, marfanoid habitus