SHERPATH: Pituitary Disorders
Which information accurately describes acromegaly? Select all that apply. A. An excess secretion of growth hormone in adults. B. An excess secretion of antidiuretic hormone in adults. C. Usually caused by a benign, slow-growing pituitary adenoma. D. Usually caused by drug therapy, like chemotherapy or general anesthesia. E. Approximately 79.4 out of every 1 million adults in the US are diagnosed annually.
A. An excess secretion of growth hormone in adults. Acromegaly is an excess secretion of growth hormone in adults. C. Usually caused by a benign, slow-growing pituitary adenoma. Acromegaly is usually caused by a slow-growing, benign pituitary adenoma. E. Approximately 79.4 out of every 1 million adults in the US are diagnosed annually. There are approximately 79.4 out of every 1 million adults in the US that are diagnosed annually for acromegaly.
Which disorders are affected by an alteration in the production of antidiuretic hormone? Select all that apply. A. Diabetes insipidus (DI) B. Syndrome of inappropriate antidiuretic hormone (SIADH) C. Acromegaly D. Bronchogenic carcinoma E. Central nervous system (CNS) infection
A. Diabetes insipidus (DI) DI is a disorder where ADH is insufficiently secreted or received causing a decrease in intravascular fluid. B. Syndrome of inappropriate antidiuretic hormone (SIADH) SIADH is a disorder where ADH is insufficiently secreted causing an increase in intravascular fluid.
Which disorder is found in approximately 1 in 25,000 people in the US and is often caused by a deficient secretion of vasopressin? A. Diabetes insipidus (DI) B. Syndrome of inappropriate antidiuretic hormone (SIADH) C. Acromegaly D. Bronchogenic carcinoma
A. Diabetes insipidus (DI) DI is found in about 1 in every 25,000 people in the US and is caused by a decrease in vasopressin secretion, or by a failure of the kidneys to respond to vasopressin.
Which dehydration manifestations occur in people with DI? A. Dry skin, poor skin turgor, and hypotension B. Large tongue, thick lips, and enlarged hands C. Protruding mandible, thick skull, and wide nose D. Hyponatremia, muscle cramping, and weakness
A. Dry skin, poor skin turgor, and hypotension Dehydration is a common complication of DI that results in dry skin, poor skin turgor, confusion, headaches, hypotension, and tachycardia.
Compared to nephrogenic diabetes insipidus (DI), which causes are attributed to only central, or neurogenic, DI? Select all that apply. A. Head injury B. Brain tumor C. Use of lithium D. Deficiency of vasopressin E. Adequate amount of vasopressin, but kidneys fail
A. Head injury Compression on the pituitary gland due to brain injury, tumors, and infection are common causes of central DI. B. Brain tumor A brain tumor can apply pressure to the pituitary because of its location and the growth of the tumor, leading to central DI. D. Deficiency of vasopressin A deficiency of vasopressin is the main contributing factor in central DI which ultimately leads to a decrease in intravascular fluid.
Which clinical manifestations would be recognized in a person with acromegaly? Select all that apply. A. Large tongue B. Enlarged brow C. Smaller eye socket D. Protruding mandible E. Bowed long leg bones
A. Large tongue Soft tissue in the oral mucosa enlarges causing the tongue to become enlarged. B. Enlarged brow Due to excessive bone and soft tissue growth, facial features will be overgrown such as an enlarged brow. D. Protruding mandible Due to excessive bone and soft tissue growth, facial features will be overgrown such as a protruding mandible.
Which condition is associated with syndrome of inappropriate antidiuretic hormone (SIADH)? A. Oliguria B. Polyuria C. Hypernatremia D. Decreased fluid volume
A. Oliguria Oliguria is a common manifestation of SIADH due to the pathophysiological response to ADH in the blood stream.
Which clinical manifestations indicate a person has central, or neurogenic diabetes insipidus (DI)? Select all that apply. A. Polyuria B. Oliguria C. Nocturia D. Polydipsia E. Hyponatremia
A. Polyuria Polyuria is a classic clinical manifestation of DI due to a deficit of ADH secretion. C. Nocturia Night time urination is often increased in DI due to a deficit of ADH secretion. D. Polydipsia Increased thirst is a classic clinical manifestation of DI due to a deficit in intravascular fluid.
Which statement best explains oliguria, hyponatremia, and muscle cramping as a result of SIADH? A. Reabsorption of water causes a dilution of sodium due to the increased intravascular fluid caused by scant urine output. B. ADH secretion is depleted, causing the kidneys to malfunction and stop producing urine, resulting in altered electrolytes. C. Kidney function is altered due to an increase in ADH, causing excessive excretion of urine, which causes sodium levels to decrease. D. Osmolality in the renal tubules is altered due to an increase in sodium, thus resulting in excessive water excretion through the kidneys.
A. Reabsorption of water causes a dilution of sodium due to the increased intravascular fluid caused by scant urine output. Hyponatremia in SIADH is due to increased intravascular fluid caused by an excess in ADH resulting in very little urine excretion which dilutes the sodium levels, causing muscle cramping and other mental symptoms.
Which are causes of syndrome of inappropriate antidiuretic hormone (SIADH)? Select all that apply. A. Lithium B. Ibuprofen usage C. Small cell lung cancer D. Traumatic brain injury E. Hereditary renal disease
B. Ibuprofen usage Excessive use of NSAIDs (ibuprofen) and other medications such as opioids and chemotherapy drugs have been attributed to the etiology of SIADH. C. Small cell lung cancer SIADH is a clinical manifestation of other disorders and has been linked to malignant tumors, especially small cell lung cancer and pancreatic cancer. D .Traumatic brain injury Disorders and trauma of the CNS, such as stroke and traumatic brain injury, have been linked to pituitary disorders including SIADH.
Which statement best explains fluid retention in a patient with syndrome of inappropriate antidiuretic hormone (SIADH)? A. Decreased intravascular fluid due to decreased ADH secretion B. Increased intravascular fluid due to excessive ADH secretion C. Increased intravascular fluid due to failure of kidneys to respond to ADH D. Decreased intravascular fluid with increased urine output (polyuria)
B. Increased intravascular fluid due to excessive ADH secretion Increased intravascular fluid is a reason to monitor for fluid retention and excessive ADH secretion occurs with SIADH.
Which mechanisms represent pathophysiologic components of acromegaly? Select all that apply. A. Decreased intravascular fluid B. Overgrowth of bones and soft tissue C. Release of insulin-like growth factor from liver D. Excessive secretion of human growth hormone E. Increased serum osmolality to allow hypersecretion of hormones
B. Overgrowth of bones and soft tissue Acromegaly results in overgrowth of bones and soft tissue through widening and thickening. C. Release of insulin-like growth factor from liver The liver is triggered to release another growth type hormone, an insulin like growth factor that facilitates the exacerbation of acromegaly. D. Excessive secretion of human growth hormone Acromegaly is triggered by the pituitary gland secreting excessive amounts of human growth hormone (GH) into the blood stream triggering a domino effect of outcomes that manifest in this rare disorder.
Which disorder is more prevalent in older adults and hospitalized patients, and is seen in people recovering from spinal surgery or traumatic brain injuries? A. Diabetes insipidus (DI) B. Syndrome of inappropriate antidiuretic hormone (SIADH) C. Acromegaly D. Bronchogenic carcinoma
B. Syndrome of inappropriate antidiuretic hormone (SIADH) SIADH is a clinical manifestation of other disorders and is more common in older adults and hospitalized patients recovering from spinal surgery or traumatic brain injuries.
Which clinical manifestations would be expected in a person who has been diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH)? A. Nocturia and excessive thirst B. Dehydration and excessive urine output C. Oliguria, hyponatremia, muscle cramping D. Polyuria, hypernatremia, poor skin turgor
C. Oliguria, hyponatremia, muscle cramping Oliguria, hyponatremia, muscle cramping, along with fluid retention and weight gain are all clinical manifestations of SIADH.
Which is the pathophysiological action leading to dehydration in a person with diabetes insipidus (DI)? A. Increased ADH production B. Decreased ADH metabolism C. Polyuria with decreased intravascular fluid D. Oliguria with increased intravascular fluid
C. Polyuria with decreased intravascular fluid Polyuria and decreased intravascular fluid are the result of the pathophysiological actions of DI which is triggered by a decrease in ADH or a decreased response of the kidneys to ADH.
Which group of people is predominantly affected by acromegaly? A. Adults ( >25 years old) B. Teens (13-19 years old) C. Infants/Toddlers ( <5 years old) D. Children/Adolescents (5-12 years old)
A. Adults ( >25 years old) Acromegaly is a hyperpituitary disorder that is prevalent in adults, with incidences increasing with age.
Which pituitary disorder has complications including hypernatremia and severe dehydration? A. Diabetes insipidus (DI) B. Diabetes mellitus (DM) C. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) D. Acromegaly
A. Diabetes insipidus (DI) Both neurogenic and nephrogenic DI result in hypernatremia and dehydration due to excess water excretion.
Which statement describes neurogenic diabetes insipidus (DI)? A. The pituitary gland fails to trigger the secretion of adequate amounts of ADH, resulting in decreased water reabsorption. B. The adrenal glands fail to respond to the pituitary glands secretion of ADH, resulting in excessive urine output and hypernatremia. C. The pituitary gland triggers adequate secretion of ADH, but the kidneys fails to respond resulting in decreased water reabsorption D. The hypothalamus does not receive the message from the pituitary gland to secrete ADH, thus resulting in deficient hormonal production to the kidneys
A. The pituitary gland fails to trigger the secretion of adequate amounts of ADH, resulting in decreased water reabsorption. In central, or neurogenic, DI the pituitary gland does not trigger adequate secretion of ADH which causes decreased water reabsorption by the kidneys.
Place the pathophysiological steps of syndrome of inappropriate antidiuretic hormone (SIADH) in order of occurrence. ADH is released despite normal or low plasma osmolarity Intravascular fluid volume excess develops An increase in water reabsorption occurs in the renal tubules Urine production decreases (oliguria)
ADH is released despite normal or low plasma osmolarity Intravascular fluid volume excess develops Urine production decreases (oliguria) An increase in water reabsorption occurs in the renal tubules In SIADH, excess ADH is released regardless of plasma osmolarity thus increasing water reabsorption in the renal tubules. Due to this increase in reabsorption, urine output is decreased (oliguria) and intravascular fluid volume is increased.
Which statement is accurate regarding the clinical manifestations of diabetes insipidus (DI)? Select all that apply. A. Weight gain is due to increased intravascular fluid B. A deficit of ADH causes the kidneys to excrete too much urine C. Decreased sodium causes confusion, seizures, and irritability D. Excessive thirst is a compensatory response to dehydration E. Loss of fluids causes hypotension, tachycardia, and even hypovolemic shock
B. A deficit of ADH causes the kidneys to excrete too much urine A deficit of ADH causes the kidneys to excrete excessive amounts of urine which results in polyuria. D. Excessive thirst is a compensatory response to dehydration Excessive thirst, polydipsia, is a response of the body to a severe loss in fluid (dehydration) to compensate for the loss. E. Loss of fluids causes hypotension, tachycardia, and even hypovolemic shock Dehydration, excessive loss of fluids, can lead to hypotension, tachycardia, and even hypovolemic shock are manifestations of DI.
Which disorder of the posterior lobe of the pituitary results in dehydration due to polyuria and decreased intravascular fluid? A. Diabetes mellitus (DM) B. Diabetes insipidus (DI) C. Syndrome of inappropriate antidiuretic hormone (SIADH) D. Acromegaly
B. Diabetes insipidus (DI) Diabetes insipidus is a posterior lobe pituitary disorder that is the result of decreased ADH secretion therefore, the kidneys continue to form excessive amounts of urine (polyuria), which causes dehydration.
Which clinical manifestations of acromegaly are not visible to the eye? Select all that apply. A. Anorexia B. Headache C. Abdominal pain D. Joint pain in long bones E. Carpal tunnel syndrome
B. Headache Headaches are common from compression due to overgrowth of bone and soft tissues. D. Joint pain in long bones Joint pain, especially in the long bones, is common due to overgrowth of bone and soft tissue. E. Carpal tunnel syndrome Carpal tunnel syndrome
Which is an accurate explanation for bone growth and facial changes in an older adult with acromegaly? A. A depletion of human growth hormone during childhood prevented full growth so the pituitary gland is overproducing at this stage in life B. The pituitary gland secrets an excessive amount of growth hormone, causing the adult bone to become thicker/wider and the joints to enlarge C. An excessive amount of ADH is secreted causing an overproduction of calcium and mineral deposit on the bones of the hands, feet, and face D. The pituitary gland was not fully developed as a child and thus stimulation of growth hormone in adulthood is causing excessive calcium deposit on the bones
B. he pituitary gland secrets an excessive amount of growth hormone, causing the adult bone to become thicker/wider and the joints to enlarge Due to excessive growth hormone secretion and the triggering of IGF-1, the adult bone begins to overdevelop and becomes wider and thicker and the brow and jaw bones begin to protrude.
Which disorder is more prevalent in women, increases with age, and is a rare condition only affecting about 25,000 people in the US? A. Diabetes insipidus (DI) B. Syndrome of inappropriate antidiuretic hormone (SIADH) C. Acromegaly D. Bronchogenic carcinoma
C. Acromegaly Acromegaly is a rare condition with about 25,000 diagnosed cases in the US, predominantly in females between the ages of 55-64.
Which information explains why a patient with SIADH has mental confusion, irritability, seizures, with potential progression to coma? A. Reabsorption of water back into the intravascular fluid increases brain permeability B. Polyuria causes excess loss of fluid leading to dehydration of the brain fluids C. Diluted serum sodium levels cause cerebral edema and swelling of brain cells and neurons D. Hypersecretion of the pituitary gland causes a disturbance in the blood-brain barrier
C. Diluted serum sodium levels cause cerebral edema and swelling of brain cells and neurons Cerebral edema from declining plasma osmolality and swelling of brain cells and neurons cause mental confusion, irritability, seizures and even coma.
Which is a hyperpituitary disorder of the anterior lobe of the pituitary gland? A. Diabetes Insipidus (DI) B. Diabetes mellitus (DM) C. Syndrome of inappropriate antidiuretic hormone (SIADH) D. Acromegaly
D. Acromegaly Acromegaly is a disorder of the anterior lobe which is the result of hyper-secretion of hormones (specifically growth hormone).
Which conditions are also seen in people diagnosed with acromegaly? A. Anorexia and weight loss B. Oliguria and muscle cramping C. Diabetes insipidus and respiratory distress D. Cardiovascular disease and diabetes mellitus
D. Cardiovascular disease and diabetes mellitus Cardiovascular disease including hypertension, diabetes mellitus, and changes in vision are common conditions due to excessive GH and its effect on insulin and cardiovascular system.
Which information accurately describes the pathophysiology of acromegaly? A. Excessive fluid builds up in the joints and intravascular tissue due to an increase in the production of ADH causing swelling and inflammation. B. Excessive growth hormone is secreted in adolescence, resulting in overgrowth of bone and soft tissue altering size and stature, including facial features. C. The pituitary gland does not produce enough growth hormone during childhood and tries to catch up in adulthood, so bones are thicker instead of longer. D. There is an excessive amount of growth hormone secreted in adulthood, causing bones and soft tissue to thicken resulting in changes in hands, feet, and facial features.
D. There is an excessive amount of growth hormone secreted in adulthood, causing bones and soft tissue to thicken resulting in changes in hands, feet, and facial features. The pituitary gland secretes an excessive amount of growth hormone, causing bone and soft tissue to thicken. Hands, feet, facial features, and joints are all affected.
Match the disorders with their identifying pathophysiology. Increased ADH causing increased water reabsorption Excessive GH causing overgrowth of bone and soft tissue Decreased ADH secretion and decreased water reabsorption Adequate ADH secretion with failure of kidneys to respond Nephrogenic DI SIADH Neurogenic DI Acromegaly
Increased ADH causing increased water reabsorption - SIADH Excessive GH causing overgrowth of bone and soft tissue - Neurogenic DI Decreased ADH secretion and decreased water reabsorption - Nephrogenic DI Adequate ADH secretion with failure of kidneys to respond - Acromegaly
Match the disorder to the risk factors that increase the prevalence. Isolated familial history; increases with age Stress; ectopic source such as bronchogenic carcinoma Pituitary surgery; electrolyte imbalances affecting renal tubules Syndrome of inappropriate antidiuretic hormone (SIADH) Diabetes insipidus (DI) Acromegaly
Isolated familial history; increases with age - Acromegaly Stress; ectopic source such as bronchogenic carcinoma - Syndrome of inappropriate antidiuretic hormone (SIADH) Pituitary surgery; electrolyte imbalances affecting renal tubules - Diabetes insipidus (DI)
