1 / 49

PITUITARY GLAND

PITUITARY GLAND. Where is it located??? Name its’ 3 parts or sections. What hormones are secreted by the pituitary gland???. Pituitary Gland. ANTERIOR PITUITARY. SECRETES 6+ HORMONES: ACTH (adrenocorticotropic hormone) release of cortisol in adrenal glands

issac
Download Presentation

PITUITARY GLAND

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. PITUITARY GLAND • Where is it located??? • Name its’ 3 parts or sections. • What hormones are secreted by the pituitary gland???

  2. Pituitary Gland

  3. ANTERIOR PITUITARY • SECRETES 6+ HORMONES: • ACTH (adrenocorticotropic hormone) release of cortisol in adrenal glands • TSH (thyroid stimulating hormone) release of T3 & T4 in thyroid gland • GH (growth hormone) stimulates growth of bone/tissue

  4. FSH (follicle stimulating hormone) stimulates growth of ovarian follicles & spermatogenesis in males • LH (lutenizing hormone) • regulates growth of gonads & reproductive activities • Prolactin promotes mammary gland growth and milk secretion

  5. ANTERIOR HYPER PITUITARY DISORDERS • What would happen if you had TOO MUCH secretion of prolactin? • Too much release of Lutenizing Hormone (LH)?

  6. ANTERIOR HYPER PITUITARY DISORDERS • ETIOLOGY • Primary: the defect is in the gland itself which releases that particular hormone that is too much or too little. • Secondary: defect is somewhere outside of gland i.e. GHRH from hypothalamus TRH from hypothalamus

  7. PITUITARY TUMORS • 10% OF ALL BRAIN TUMORS • What are the diagnostic tests to diagnose a pituitary tumor? • tumors usually cause hyper release of hormones

  8. ANTERIOR PITUITARY-HYPERfunctioning Sing along • What would happen if you had too much growth hormone secretion??? • Which goolish character on the Addam’s Family may have had too much GH secretion?

  9. TOO MUCH GROWTH HORMONE • GIGANTISM IN CHILDREN • skeletal growth; may grow up to 8 ft. tall and > 300 lbs • ACROMEGALY IN ADULTS • enlarged feet/hands, thickening of bones, prognathism, diabetes, HTN , wt. gain, H/A, • Visual disturbances, diabetes mellitus

  10. GIGANTISM IN CHILDREN • ACROMEGALY IN ADULTS

  11. What assessment findings would the nurse document?

  12. What assessment findings would the nurse document?

  13. MEDICAL INTERVENTIONS FOR PITUITARY TUMOR • Medications • Parlodel (bromocriptine) to ________ & GH levels. • Radiation therapy • external radiation will bring down GH levels 80% of time

  14. Transsphenoidal Hypophysectomy

  15. Neurosurgery: • procedure called “transsphenoidal hypophysectomy”; New Method • Most common method: incision is made thru floor of nose into the sella turcica.

  16. Nursing Management • Pre op hypophysectomy • Anxiety r/t • a. body changes • b. fear of unknown • c. brain involvement • d. chronic condition with life long care • Sharmyn

  17. Sensory-perceptual alteration r/t a. visual field cuts b. diplopia • secondary to pressure on optic nerve. • Alteration in comfort (headache) r/t a. tumor growth/edema

  18. Knowledge deficit r/t • Post-op teaching • pain control • ambulation • hormone replacement • activity

  19. Post operative care • Post-op complications of hormone insufficiency: • What would happen if you didn’t have enough ADH? • What is that disorder called?

  20. Other insuffciency: • Decrease ACTH will require cortisone replacement due to decrease glucocorticoid production. • Can you live without glucocorticoids????

  21. Other deficiency: • in sex hormones can lead to infertility due to decrease production of ova & sperm • What were those hormones called again?-

  22. Incisional disruption after transsphenoidal hypophysectomy • Avoid bending and straining X 2 months post transsphenoidal hypophysectomy, • Use stool softeners • Avoid coughing • Saline mouth rinses • No toothbrushes for 7-10 days

  23. Post-op CSF Leak where sella turcica was entered • any clear rhinorrhea - test for glucose • + glucose = CSF Leak • Notify physician • HOB 30 degrees • Bedrest

  24. CSF leak usually resolves within 72 hrs. • If not - spinal taps done to decrease pressure

  25. Post op problems cont. • Periocular edema/ecchymosis • Headaches • Visual field cuts/diplopia • What is the most important nursing intervention for these problems????

  26. ANTERIOR PITUITARY-Hypofunction • 1. Etiology (rare disorder) may be due to disease, tumor, or destruction of the gland. • Diagnostic tests • CT Scan • Serum hormone levels

  27. S & S Anterior Pituitary Hypofunctioning • GH • FSH/LH • Prolactin • ACTH • TSH

  28. Medical Management • neurosurgery -- removal of tumor • radiation - tumor size • hormone replacement • cortisol, thyroid, sex hormones

  29. Nursing Management • Assessment of S & S of hypo or hyper functioning hormone levels • Teaching-Compliance with hormone replacement therapy • Counseling and referrals • Support medical interventions

  30. Posterior Pituitary(Neurohypophysis) Question??? What hormones are released by the posterior pituitary? _____ & _____are released when signaled by hypothalamus

  31. ADH (Vasopressin) • secreted by cells in the hypothalmus and stored in posterior pituitary • acts on distal & collecting tubules of the kidneys making more permeable to H20 -- or volume excreted?

  32. Bonus Round... • Under what conditions is ADH released??? • ADH has vasoconstrictive or vasodilation action???

  33. ANSWERS: • released in response to decrease blood volume, increase concentration of Na+ or other substances, pain, stress • ADH has vasocontrictive properties

  34. Oxytocin • Controls lactation & stimulates uterine contractions • ‘Cuddle hormone’Research links oxytocin and socio-sexual behaviors

  35. Posterior Hyper pituitary Disorders • SIADH (TOO MUCH ADH!!) • lung cancer, Ca duodenum/pancreas, trauma, pulmonary disease, CNS disorders, drugs -- Vincristine, nicotine, general anesthetics, tricyclic antidepressants

  36. Think tank: • If you are having too much ADH... What would the clinical signs/symptoms be??

  37. Clinical manifestations-SIADH • Weight gain or weight loss? • or urine output? • or serum Na levels? • weakness • muscle cramps • H/A • Diarrhea

  38. If hyponatremia worsens will develop neuro manifestations • lethargy • decrease tendon reflexes • seizures

  39. Diagnostic Tests-SIADH • Serum Na+ <135meq/l • Serum osmolality <275 OSM/kg H2O • urine specific gravity • or normal BUN

  40. Medical Treatment • ***FLUID RESTRICTION • LIMIT TO 1000ML/24HRS • IV 3% NaCl to replace Na • IF CHF -- Lasix (temporary fix) • Treat underlying problem --Chemo, radiation • Declomycin 600 po-1200mg/day to inhibit ADH

  41. Nursing Interventions-SIADH • Fluid restriction may be as little as 500-600ml/24hrs • Daily weights... • 1 lb. weight = 500ml fluid retention • Accurate I & Os

  42. Nursing Management-SIADH • F & E imbalances • fluid intake • High risk for injury r/t complications of fluid overload (seizures)

  43. Posterior HypopituitaryADH disorders Diabetes Insipidus (too little ADH) What do you think the S&S would be if you had too little ADH???

  44. Etiology • 50% idiopathic • a. central -- i.e. brain tumors • b. nephrogenic - inability of tubules to respond to ADH

  45. Clinical Manifestations-DI • Polydipsia • Polyuria (10L in 24 hours) • Severe fluid volume deficit • wt loss • tachycardia • constipation • shock

  46. Diagnostic Tests-DI • or urine specific gravity orserum Na orserum osmolality • Dehydration test: • 2 units of Vasopressin (ADH) mixed in saline administered over 2 hrs then check urine osmolality levels

  47. Medical Management-DI • Identification of etiology, H & P • Tx of underlying problem • DDAVP (nasal spray) • Pitressin s.c. IM, nasal spray

  48. Nursing Management-DI • Assess for F & E imbalances • High risk for sleep disturbances • Increase po/IV fluids • RF Injury (hypovolemic shock) • Knowledge deficit • High risk for ineffective coping

More Related