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Endocrine. Pituitary gland 5-2. Hyperpituitarism. What two hormones are affected with hyperpituitarism? GH ADH. Hyperpituitarism. h GH Adult Acromegaly Child Gigantism h ADH Syndrome of Inappropriate Antidiuretic Hormone (SIADH).

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Endocrine

Pituitary gland

5-2


Hyperpituitarism

  • What two hormones are affected with hyperpituitarism?

    • GH

    • ADH


Hyperpituitarism

  • hGH

    • Adult

      • Acromegaly

    • Child

      • Gigantism

  • h ADH

    • Syndrome of Inappropriate Antidiuretic Hormone (SIADH)


Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

  • Definition

    • Excess ADH

  • What does ADH do?

    • Causes kidneys to reabsorb water 

    • i urine output 

    • h fluid volume


SIADH - Etiology

  • #1

    • Lung CA

  • Other CA

  • COPD


SIADH – S&S

  • Water retention

    • Edema

    • Wt gain

  • Urine

    • Concentrated

    • Sp. gravity

      • h


SIADH: S&S

  • Hyponatremia

    • < 130

    • Normal 135-145 meq/dl

    • Muscle cramps

    • Weakness

  • Serum Osmolality

    • Decreased

    • Blood leaks into brain 

    • Brain swelling 

    • Lethargy, seizures, coma

    • Deathmosis


SIADH: Medical treatment

  • Tx underlying disorder

  • Resolve fluid volume excess

    • Restrict H2O

    • Promote H20 voiding

  • Sodium replacement


SIADH: Rx

Furosemide (Lasix)

  • Action

    • Enhance diuresis

  • Nrs consideration

    • P Fluid & electrolyte panels

    • I&O

    • VS

    • q day wt


SIADH: Rx

Demeclcycline hydrochloride (Declomycin)

  • Action

    • Enhances Na+ retention

      Fludrocortisone (Florinef)

  • Action

    • Enhances Na+ retention

  • Nrs. Consideration

    • Fluid restriction


  • SIADH: Nrs. Dx

    • Fluid Volume Excess


    Hypopituitarism

    • Definition

      • i secretion of pituitary hormones

    • Etiology

      • #1 Tumor

      • Congenital defects

      • Pituitary infarction

      • Pituitary surgery

      • Pituitary CA


    Hypopituitarism

    • Clinical manifestations are slow to appear & are not really apparent until 75% of the pituitary is destroyed


    Hypopituitarism:

    • Primary

      • Trouble w/ the Pituitary

      • i Pituitary hormone

    • Secondary

      • Trouble somewhere else (not pituitary) 

      • i pituitary hormone

      • Usually hypothalmus


    Hypopituitarism: Growth hormone

    • Dx:

      • Dwarfism

    • S&S (i GH)

      • Apparent by 6 months

      • Delayed puberty

      • Growth rate ½ unto 4 ft.

      • Body proportions = normal

      • Accel. aging


    Hypopituitarism: FSH & LH

    • Female

      • Amenorrhea

      • Infertility

      • i libido

      • Breast atrophy

    • Male

      • Weakness

      • Impotence

      • i libido

      • Testicles soften & shrink


    Hypopituitarism: TSH

    • Severe growth retardation (even w/ tx)

    • S&S (i TSH)

      • Think slow

      • Lethargy

      • Bradycardia

      • Slow thoughts

      • Cold intolerance


    Hypopituitarism: ACTH

    • ACTH

      • Handle stress

    • S&S (i ACTH)

      • Fatigue

      • Wt loss

      • Anorexia

      • Depigmentation of skin

      • V/S when stressed

        • Fever

        • Hypotension


    Hypopituitarism: Prolactin

    • S&S (i prolactin)

      • Absent postpartum lactation


    Hypopituitarism: Simmond’s Disease

    • AKA

      • Panhypopituitarism

    • Definition

      • Total absence of all pit. hormones

    • Etiology

      • Surgery

      • Infection

      • Injury

      • Tumor


    Hypopituitarism: Simmond’s Disease

    • Clinical Manifestations

      • Wt loss

      • Gen. debility

      • Weak

      • i libido

      • Cold intolerance

    • Tx

      • Administration of all Pit. hormones


    Hypopituitarism: ADH

    • Dx:

      • Diabetes Insipidus

    • Definition

      • i ADH

        • Vasopressin


    Hypopituitarism: Diabetes Insipidus

    • Etiology

      • Injury to pituitary or hypothalamus

      • Pregnancy

      • Medication use

        • Lithium

        • Lasix

      • Kidney not respond to ADH


    Hypopituitarism: Diabetes Insipidus

    • Clinical manifestations

      • Polyuria

        • Sp. gravity of urine

          • i

        • Serum osmolality

          • h

        • Na+ levels

          • h

          • Hypernatremia

          • > 145


    Hypopituitarism: Diabetes Insipidus

    • Extreme thirst

      • Cold beverages

    • Wt. loss

    • Dizziness

    • Constipation

    • Fatigue


    Hypopituitarism: Diabetes Insipidus

    • Complications

      • Hypovolemia

      • Circulatory collapse

      • Unconsciousness

      • CNS damage

    • Prognosis

      • OK (w/ fluid)


    Hypopituitarism: Diabetes Insipidus

    • Medical treatment

      • Fluid replacement

      • Replace hormone

        • ADH/Vasopressin

      • Fix underlying cause


    Hypopituitarism: Diabetes InsipidusRx

    Desmopressin acetate (Stimate)

    • Action

      • Synthetic ADH

    • Route

      • Parenteral

      • Nasal

    • Nrs. Considerations

      • Clear nasal passage


    Hypopituitarism: Diabetes InsipidusRx

    Vasopressine (Pitressin)

    • Action

      • ADH hormone

    • Route

      • Parenteral

      • Nasal

    • S/E

      • Increased BP


    Hypopituitarism: Diabetes InsipidusRx

    • If D.I. is due to kidney

      • More ADH not help


    Hypopituitarism: Diabetes Insipidus

    • Nrs. Dx

      • Fluid Volume Deficit

    • Nursing interventions

      • I&O

      • P Electrolytes

      • h Na+ intake

      • VS


    Mrs. Waterfall

    • What would the name of this disorder be?

    • 2. What is causing the elevated ADH levels?

      3. What other lab values would coincide with this disorder?


    Mrs. Waterfall

    4. What nursing diagnosis is appropriate for this disorder?

    5. What interventions would you as a nurse start with this diagnosis?

    6. What medications would you expect the doctor to order?


    Ms. Pealot

    • Why is Ms. Pealot not started on insulin?

    • 2. What hormonal irregularity causes diabetes insipidus?

      3. What can cause diabetes insipidus?

      4. Besides polyuria & polydipsia, what other clinical manifestations would you expect?


    5. What dx tests would confirm the dx of diabetes insipidus?

    6. What nrs. dx would best apply to Ms. Pealot?

    7. What nrs. interventions would you implement?

    8. What doctors order would you expect to see?


    Pituitary Tumors

    • Definitions

      • Anterior Pit.

    • Clinical Manifestations

      • H/A

      • Visual problems

      • Personality changes

      • Dementation

      • S&S of hypopituitarism


    Pituitary Tumors

    • Medical treatment

      • Remove tumor

      • Radiation

      • Cryohypophysectomy

    • Rx

      • Hormone replacement


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