SIADH
causes of SAIDH
intracranial tumors, hypothyroidism, porphyria, and lung carcinoma
elevated ADH likely to occur following major surgeries
DI reflects the absence of _____ caused by destruction to _____ or failure of
absence of ADH caused by the destruction of the posterior pituitary (neurogenic DI) or failure of renal tubules to respond to ADH (nephrogenic)
acromegaly is due to
excessive secretion of growth hormone in adults caused by an adenoma in the anterior pituitary gland
treatment for acromegaly
transsphenoidal surgery for excision of pituitary adenoma
if surgery not feasible- Long-acting somatostatin analogue
where is the pituitary gland located
sella turcica at the base of he brain consisting of anterior and posterior pituitary
what findings are suggestive of SIADH
inappropriately increased urinary sodium and osmolarity in the presence of hyponatremia and decreased serum osmolarity
which form of DI responds to ADH
neurogenic
what serum level is elvated wih acromegaly
Anesthesia implications for acromegaly: face mask
distored facial anatomy may interfere with placement of face mask
what are the 6 hormones released by the anterior pituitary that is under the control of the hypothalamus
growth hormone
ACTH
TSH
FSH
LH
prolactin
abrupt decreases in serum sodium can result in
cerebral edema
symptoms of DI
polyuria, polydipsia, low urine osmol, high serum osmol
an oral glucose tolerance test can be performed measuring plasma growth horomone which remains
1 ng/mL 2 hrs after ingeesting 75 g glucose
anesthesia implications with acromegaly: DL
enlarged tongue and epiglottis predisposes to upper AW obstruction and interferes with visualization of vocal cords
vasopressin and oxytocin are synthesized in the ______ then transported and stored in the _____ _______
hypothalamus; posterior pituitary
treatment of SIADH
fluid restriction, salt tablets, loop diuretics
ADH antagonists - demeclocycline
treatment of DI
IV fluids and electrolyte replacement
neuro: DDAVP
nephro: low salt, low protein, diuretics, NSAIDs
overgrowth of soft tissues - susceptible to upper airway obstruction
hoarseness and abnormal movement of vocal cords or RLN paralysis may result from overgrowth of the surrounding cartilaginous structures
T/F with acromegaly the distance between the lips and vocal cords is increased due to mandible overgrowth
T/F glottic opening may be widened due to vocal cord enlargement
true
false - the glottic opening may be narrowed due to vocal cord enlargement
overproduction of anterior pituitary hormones is associated with hypersecretion of ACTH also known as what and caused by
Cushing Syndrome (hypersecretion ACTH) by anterior pituitary adenomas
hyponatremia may be treated with
hypertonic saline @ <6-8 mEq/L/24 hr
anesthesia consdierations for DI
monitor UOP, and serum electrolyte concentrations
why does peripheral neuropathy occur with acromegaly
nerve trapping by connective tissues
anesthesia implications with intubating patients with acromegaly
may require smaller ETT, Video laryngoscopy, and awake fiberoptic intubation
vasopressin stimulus for the release of hormones from the posterior pituitary arises from