52B Exam III - Pituitary/Neurosensory disorders

the anterior pituitary

recessed foreheard

cleft lip and palate

• 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

• give daily subQ shots of GH throught adolescence (give at bedtime)
• surgery if tumor is causing problem

• 7.5-10cm the first year
• 5cm each year following

a hormone-sectreting adenoma

• hyper- school age/adolescence
• hypo- after birth (watch growth curve)

• 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

large tumor causing pressure

• x-ray/ MRI of head to show tumor/sinus size
• CT scan
• glucose suppression test - infusion of glucose should decrease GH levels

• 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

• -nasal pack remains in place 2-3 days post op
• -mouth breathing is necessary
• -avoid tooth brushing, caughing, sneezing, nose blowing, and bending over

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.

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

7yr

to look for tumors

cotton is touched to cornea and pt should blink. this tests cranial nerve V

• hyper - wide set eyes
• hypo - close set eyes

abnormally small eyes

protruding eyes

sunken eyes

drooping eyelid

• malalignment of the eyes
• can be inward (esotropia/esophoria) or outward (exotropia/exophoria)

• double vision from strabismus
• -patch uninvolved eye to force use of deviated eye
• -corrective lenses
• -surgical correction

hearing tests done on babies especially if treated with gentamicin

hearing issues

scarlet fever/rheumatic fever

• 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