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what part of the pituitary gland secretes growth hormone?
the anterior pituitary
what is frontal bossing?
what facial deformaties sometimes occur with dwarfism?
cleft lip and palate
what are three ways we can test growth hormone production?
- after 20 minutes of strenuous exercise retest, GH should increase
- give levadopa or insulin to induce hypoglycemia, should increase GH
- can use more sensitive radioimmunoassay
how can we treat hypopituitarism?
- give daily subQ shots of GH throught adolescence (give at bedtime)
- surgery if tumor is causing problem
how much should the child grow following treatment the first year and so on?
- 7.5-10cm the first year
- 5cm each year following
what is another term for a pituitary tumor that results in hypersectretion of GH?
a hormone-sectreting adenoma
at what age does hypersecretion of the pituitary gland occur vs hyposecretion?
- hyper- school age/adolescence
- hypo- after birth (watch growth curve)
what is thw difference between gigantism (this is proper spelling!) and acromegaly?
- gigantism - occurs before epiphoseal discs close so it is rapid proportional growth of all bones (can be 8-9 feet tall)
- acromegaly - growth after epiphoseal closure
why can people with hypersectretion of the pituitary have headache/vision changes?
large tumor causing pressure
what are some diagnostic tests to determine hypersecretion of the pituitary?
- x-ray/ MRI of head to show tumor/sinus size
- CT scan
- glucose suppression test - infusion of glucose should decrease GH levels
describe two options for treating hypersecretion of the pituitary
- 1. proton beam/alpha particle radiation - effective but slow. can cause hypopituitarism and/or optic nerve damage.
- 2. hypophysectomy (surgical removal of tumor) - must replace other hormones for the rest of their lives.
- -incision under the upper lip
- -tumor removed through sellaturcica
- -muscle graft to patch
- -nasal packing inserted and dressing applied
- ***or a transfrontal craniotomy if inaccessible
what teaching is needed for a postop pt with a hypophysectomy?
- -nasal pack remains in place 2-3 days post op
- -mouth breathing is necessary
- -avoid tooth brushing, caughing, sneezing, nose blowing, and bending over
what is diabetes insipidus? what can cause it?
if the pituitary is removed (or damaged) there can be a lack of the hormone vasopressin which works with ADH to concentrate urine. this means that the pt can have some symptoms resembling diabetes mellitus (but is NOT due to insulin/BG issues!), such as polyuria and low spacific gravity of urine.
how does growth hormone effect insulin?
GH is an insulin antagonist. this means that it decreases the abilities of insulin to stimulate uptake of glucose, and can cause transient diabetes millitus
by what age does a child usually have 20/20 vision?
why do we check red reflexes?
to look for tumors
how is the cornial reflex tested? ad what nerve is involved?
cotton is touched to cornea and pt should blink. this tests cranial nerve V
what is hyper/hypotelorism?
- hyper - wide set eyes
- hypo - close set eyes
what is microphthalmia?
abnormally small eyes
what is exophthalmos?
what is enophthalmos
what is ptosis?
what is strabismus? what are the two types called?
- malalignment of the eyes
- can be inward (esotropia/esophoria) or outward (exotropia/exophoria)
what is diplopia? how can it be treated?
- double vision from strabismus
- -patch uninvolved eye to force use of deviated eye
- -corrective lenses
- -surgical correction
what is ALGO testing?
hearing tests done on babies especially if treated with gentamicin
what does late speech development usually mean?
"strawberry tongue" is a possible sign of what disease?
scarlet fever/rheumatic fever
describe speech progression in early childhood (up to school age)
- first - nouns (mama/dada) and some verbs (go/byebye)
- toddler - adds adjunctives and adverbs to qualify nouns (big dog)
- then - qualify nouns and verbs (go very fast)
- later - pronouns abd gender words (he/she)
- school age - structurally complete sentences of 5-7 words