Pituitary Disorders

Which statement is accurate regarding the clinical manifestations of diabetes insipidus (DI)?

A deficit of ADH causes the kidneys to excrete too much urine (polyuria) Excessive thirst is a compensatory response to dehydration Loss of fluids causes hypotension, tachycardia, and even hypovolemic shock

Which is a hyperpituitary disorder of the anterior lobe of the pituitary gland?

Acromegaly is a disorder of the anterior lobe which is the result of hyper-secretion of hormones (specifically growth hormone).

Which disorder is more prevalent in women, increases with age, and is a rare condition only affecting about 25,000 people in the US?

Acromegaly is a rare condition with about 25,000 diagnosed cases in the US, predominantly in females between the ages of 55-64.

Which group of people is predominantly affected by acromegaly?

Adults (>25 years old) Acromegaly is a hyperpituitary disorder that is prevalent in adults, with incidences increasing with age.

Which information accurately describes acromegaly?

An excess secretion of growth hormone in adults Usually caused by a benign, slow-growing pituitary adenoma Approximately 70.4 out of every 1 million adults in the US are diagnosed annually

Which conditions are also seen in people diagnosed with acromegaly?

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 disorders are affected by an alteration in the production of antidiuretic hormone?

DI is a disorder where ADH is insufficiently secreted or received causing a decrease in intravascular fluid. 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?

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 pituitary disorder has complications including hypernatremia and severe dehydration?

Diabetes insipidus (DI) Both neurogenic and nephrogenic DI result in hypernatremia and dehydration due to excess water excretion.

Which disorder of the posterior lobe of the pituitary results in dehydration due to polyuria and decreased intravascular fluid?

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 information explains why a patient with SIADH has mental confusion, irritability, seizures, with potential progression to coma?

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 dehydration manifestations occur in people with DI?

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?

Head injury Brain tumor Deficiency of vasopressin Compression on the pituitary gland due to brain injury, tumors, and infection are common causes of central DI. A brain tumor can apply pressure to the pituitary because of its location and the growth of the tumor, leading to central DI. A deficiency of vasopressin is the main contributing factor in central DI which ultimately leads to a decrease in intravascular fluid.

Which clinical manifestations of acromegaly are not visible to the eye?

Headache Joint pain in long bones Carpal tunnel syndrome Headaches are common from compression due to overgrowth of bone and soft tissues. Joint pain, especially in the long bones, is common due to overgrowth of bone and soft tissue. Carpal tunnel syndrome is a common manifestation in acromegaly due to overgrowth of bone and soft tissue in the wrist.

Which are causes of syndrome of inappropriate antidiuretic hormone (SIADH)?

Ibuprofen usage Small cell lung cancer Traumatic brain injury Excessive use of NSAIDs (ibuprofen) and other medications such as opioids and chemotherapy drugs have been attributed to the etiology of SIADH. SIADH is a clinical manifestation of other disorders and has been linked to malignant tumors, especially small cell lung cancer and pancreatic cancer. Disorders and trauma of the CNS, such as stroke and traumatic brain injury, have been linked to pituitary disorders including SIADH.

Place the pathophysiological steps of syndrome of inappropriate antidiuretic hormone (SIADH) in order of occurrence.

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.

Match the disorders with their identifying pathophysiology.

Increased ADH causing increased water reabsorption - SIADH Excessive GH causing overgrowth of bone and soft tissue - Acromegaly Decreased ADH secretion and decreased water reabsorption - Neurogenic DI Adequate ADH secretion with failure of kidneys to respond - Nephrogenic DI

Which statement best explains fluid retention in a patient with syndrome of inappropriate antidiuretic hormone (SIADH)?

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.

Match the disorder to the risk factors that increase the prevalence.

Isolated familial history; increases with age - Acromegaly Stress; ectopic source such as bronchogenic carcinoma - SIADH Pituitary surgery; electrolyte imbalances affecting renal tubules - Diabetes Insipidus

Which clinical manifestations would be recognized in a person with acromegaly?

Large tongue Enlarged brow Protruding mandible Soft tissue in the oral mucosa enlarges causing the tongue to become enlarged. Due to excessive bone and soft tissue growth, facial features will be overgrown such as an enlarged brow. 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)?

Oliguria is a common manifestation of SIADH due to the pathophysiological response to ADH in the blood stream.

Which clinical manifestations would be expected in a person who has been diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH)?

Oliguria, hyponatremia, muscle cramping, along with fluid retention and weight gain are all clinical manifestations of SIADH.

Which mechanisms represent pathophysiologic components of acromegaly?

Overgrowth of bones and soft tissue Release of insulin-like growth factor from liver Excessive secretion of human growth hormone

Which clinical manifestations indicate a person has central, or neurogenic diabetes insipidus (DI)?

Polyuria Nocturia Polydipsia

Which is the pathophysiological action leading to dehydration in a person with diabetes insipidus (DI)?

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 statement best explains oliguria, hyponatremia, and muscle cramping as a result of SIADH?

Reabsorption of water causes a dilution of sodium due to the increased intravascular fluid caused by scant urine 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 disorder is more prevalent in older adults and hospitalized patients, and is seen in people recovering from spinal surgery or traumatic brain injuries?

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 statement describes neurogenic diabetes insipidus (DI)?

The pituitary gland fails to trigger the secretion of adequate amounts of ADH, resulting in decreased water reabsorption.

Which is an accurate explanation for bone growth and facial changes in an older adult with acromegaly?

The 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 information accurately describes the pathophysiology of acromegaly?

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.