Author: Rex Russell
Case Reports in Anesthesia
59 year old female for D&C and hysteroscopy with a history of pituitary adenoma, empty sella syndrome, Adrenal insufficiency, HTN, OSA, and BMI of 31. The patient was taking cabergoline to inhibit the secretion of prolactin via agonism of dopamine receptors. The patient also had a history of PONV and was very concerned with this prior to surgery.
The patient had been followed for several years for her pituitary adenoma and had had no recent changes in her medical status. I verified that her labs were within normal limits and proceeded with a general anesthetic with LMA.
The pituitary gland occupies the sella turcica of the sphenoid bone at the base of the skull, the roof of which is created by an incomplete fold of dura, the diaphragma sella, through which passes the pituitary stalk.
|Hormone and site of production||Target organ and function|
|ACTH pars distalis||Adrenal glands: stimulates the glands to produce glucocorticoids and aldosterone|
|GH pars distalis||Musculoskeletal system: anabolic effects on bone and muscle. Promotes lipolysis, increases free fatty acid levels, and impairs glucose utilization and cellular sensitivity to insulin|
|Prolactin pars distalis||Mammary glands: stimulates the glands to produce milk|
|Ovary: inhibits the actions of gonadotropins on the ovary|
|FSH and LH pars tuberalis||Gonads: stimulate the testes to produce sperm and testosterone, and the ovaries to produce eggs and oestrogen|
|TSH pars tuberalis||Thyroid: stimulates the gland to produce thyroid hormones|
|Beta-melanocyte-stimulating hormone pars intermedia||Skin: causes increased pigmentation|
|Endorphins and encephalins pars intermedia||Brain and immune system: inhibits pain sensations|
|Antidiuretic hormone||Kidneys: regulates the amount of water excreted by the kidneys and maintains water balance in the body|
|Oxytocin||Uterus: contracts the uterus during childbirth and immediately after delivery|
|Mammary glands: stimulates contractions of the milk ducts in the breast leading to the let-down reflex, which moves milk to the nipple in lactating women|
|Increased secretion||Growth hormone (GH)||Catecholamines||Glucagon||Renin|
|Adrenocorticotrophic hormone (ACTH)||Cortisol|
|Arginine vasopressin (posterior pituitary) (AVP)|
|Unchanged secretion||Thyroid stimulating hormone (TSH)|
|Luteinizing hormone (LH)|
|Follicle stimulating hormone (FSH)|