Endocrine
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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

Endocrine

Pituitary gland

5-2


Hyperpituitarism

Hyperpituitarism

  • What two hormones are affected with hyperpituitarism?

    • GH

    • ADH


Hyperpituitarism1

Hyperpituitarism

  • hGH

    • Adult

      • Acromegaly

    • Child

      • Gigantism

  • h ADH

    • Syndrome of Inappropriate Antidiuretic Hormone (SIADH)


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

SIADH - Etiology

  • #1

    • Lung CA

  • Other CA

  • COPD


Siadh s s

SIADH – S&S

  • Water retention

    • Edema

    • Wt gain

  • Urine

    • Concentrated

    • Sp. gravity

      • h


Siadh s s1

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

SIADH: Medical treatment

  • Tx underlying disorder

  • Resolve fluid volume excess

    • Restrict H2O

    • Promote H20 voiding

  • Sodium replacement


Siadh rx

SIADH: Rx

Furosemide (Lasix)

  • Action

    • Enhance diuresis

  • Nrs consideration

    • P Fluid & electrolyte panels

    • I&O

    • VS

    • q day wt


Siadh rx1

SIADH: Rx

Demeclcycline hydrochloride (Declomycin)

  • Action

    • Enhances Na+ retention

      Fludrocortisone (Florinef)

  • Action

    • Enhances Na+ retention

  • Nrs. Consideration

    • Fluid restriction


  • Siadh nrs dx

    SIADH: Nrs. Dx

    • Fluid Volume Excess


    Hypopituitarism

    Hypopituitarism

    • Definition

      • i secretion of pituitary hormones

    • Etiology

      • #1 Tumor

      • Congenital defects

      • Pituitary infarction

      • Pituitary surgery

      • Pituitary CA


    Hypopituitarism1

    Hypopituitarism

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


    Hypopituitarism2

    Hypopituitarism:

    • Primary

      • Trouble w/ the Pituitary

      • i Pituitary hormone

    • Secondary

      • Trouble somewhere else (not pituitary) 

      • i pituitary hormone

      • Usually hypothalmus


    Hypopituitarism growth hormone

    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

    Hypopituitarism: FSH & LH

    • Female

      • Amenorrhea

      • Infertility

      • i libido

      • Breast atrophy

    • Male

      • Weakness

      • Impotence

      • i libido

      • Testicles soften & shrink


    Hypopituitarism tsh

    Hypopituitarism: TSH

    • Severe growth retardation (even w/ tx)

    • S&S (i TSH)

      • Think slow

      • Lethargy

      • Bradycardia

      • Slow thoughts

      • Cold intolerance


    Hypopituitarism acth

    Hypopituitarism: ACTH

    • ACTH

      • Handle stress

    • S&S (i ACTH)

      • Fatigue

      • Wt loss

      • Anorexia

      • Depigmentation of skin

      • V/S when stressed

        • Fever

        • Hypotension


    Hypopituitarism prolactin

    Hypopituitarism: Prolactin

    • S&S (i prolactin)

      • Absent postpartum lactation


    Hypopituitarism simmond s disease

    Hypopituitarism: Simmond’s Disease

    • AKA

      • Panhypopituitarism

    • Definition

      • Total absence of all pit. hormones

    • Etiology

      • Surgery

      • Infection

      • Injury

      • Tumor


    Hypopituitarism simmond s disease1

    Hypopituitarism: Simmond’s Disease

    • Clinical Manifestations

      • Wt loss

      • Gen. debility

      • Weak

      • i libido

      • Cold intolerance

    • Tx

      • Administration of all Pit. hormones


    Hypopituitarism adh

    Hypopituitarism: ADH

    • Dx:

      • Diabetes Insipidus

    • Definition

      • i ADH

        • Vasopressin


    Hypopituitarism diabetes insipidus

    Hypopituitarism: Diabetes Insipidus

    • Etiology

      • Injury to pituitary or hypothalamus

      • Pregnancy

      • Medication use

        • Lithium

        • Lasix

      • Kidney not respond to ADH


    Hypopituitarism diabetes insipidus1

    Hypopituitarism: Diabetes Insipidus

    • Clinical manifestations

      • Polyuria

        • Sp. gravity of urine

          • i

        • Serum osmolality

          • h

        • Na+ levels

          • h

          • Hypernatremia

          • > 145


    Hypopituitarism diabetes insipidus2

    Hypopituitarism: Diabetes Insipidus

    • Extreme thirst

      • Cold beverages

    • Wt. loss

    • Dizziness

    • Constipation

    • Fatigue


    Hypopituitarism diabetes insipidus3

    Hypopituitarism: Diabetes Insipidus

    • Complications

      • Hypovolemia

      • Circulatory collapse

      • Unconsciousness

      • CNS damage

    • Prognosis

      • OK (w/ fluid)


    Hypopituitarism diabetes insipidus4

    Hypopituitarism: Diabetes Insipidus

    • Medical treatment

      • Fluid replacement

      • Replace hormone

        • ADH/Vasopressin

      • Fix underlying cause


    Hypopituitarism diabetes insipidus rx

    Hypopituitarism: Diabetes InsipidusRx

    Desmopressin acetate (Stimate)

    • Action

      • Synthetic ADH

    • Route

      • Parenteral

      • Nasal

    • Nrs. Considerations

      • Clear nasal passage


    Hypopituitarism diabetes insipidus rx1

    Hypopituitarism: Diabetes InsipidusRx

    Vasopressine (Pitressin)

    • Action

      • ADH hormone

    • Route

      • Parenteral

      • Nasal

    • S/E

      • Increased BP


    Hypopituitarism diabetes insipidus rx2

    Hypopituitarism: Diabetes InsipidusRx

    • If D.I. is due to kidney

      • More ADH not help


    Hypopituitarism diabetes insipidus5

    Hypopituitarism: Diabetes Insipidus

    • Nrs. Dx

      • Fluid Volume Deficit

    • Nursing interventions

      • I&O

      • P Electrolytes

      • h Na+ intake

      • VS


    Mrs waterfall

    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 waterfall1

    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

    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?


    Endocrine 5196782

    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

    Pituitary Tumors

    • Definitions

      • Anterior Pit.

    • Clinical Manifestations

      • H/A

      • Visual problems

      • Personality changes

      • Dementation

      • S&S of hypopituitarism


    Pituitary tumors1

    Pituitary Tumors

    • Medical treatment

      • Remove tumor

      • Radiation

      • Cryohypophysectomy

    • Rx

      • Hormone replacement


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