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PITUITARY GLAND. Where is it located??? Name its’ 3 parts or sections. What hormones are secreted by the pituitary gland???. Pituitary Gland. Anterior Pituitary (adenohypophysis). SECRETES 6+ HORMONES: ACTH (adrenocorticotropic hormone) aka (corticotrphin)

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  • Where is it located???

  • Name its’ 3 parts or sections.

  • What hormones are secreted by the pituitary gland???

Pituitary Gland

Anterior Pituitary(adenohypophysis)


    • ACTH (adrenocorticotropic hormone)

      • aka (corticotrphin)

        release of cortisol in adrenal glands

    • TSH (thyroid stimulating hormone)

      • aka (thyrotropin)

        release of T3 & T4 in thyroid gland

    • GH (growth hormone)

      • aka (somatotropin)

        stimulates growth of bone/tissue

ANTERIOR PITUITARY(adenohypophysis)

  • FSH (follicle stimulating hormone)

    stimulates growth of ovarian follicles & spermatogenesis in males

  • LH (lutenizing hormone)

    regulates growth of gonads & reproductive activities

  • Prolactin

    • aka (luteotropin/mammotropin)

      promotes mammary gland growth and milk secretion

Positive vs Negative Feedback Mechanisms

  • Give some examples of

    • Negative

    • Positive

Anterior HYPERpituitary Disorders


    • Primary: the defect is in the gland itself which releases that particular hormone that is too much or too little.

      • Example: Cushings

    • Secondary: defect is somewhere outside of gland

      i.e. GHRH from hypothalamus

      TRH from hypothalamus

Pituitary Tumors


  • What are the diagnostic tests to diagnose a pituitary tumor?

  • tumors usually cause hyper release of hormones

    (Recall all hormones)

Anterior HYPERpituitary Disorders

  • What would happen if you had TOO MUCH secretion of prolactin?

  • Too much release of Lutenizing Hormone (LH)?

Anterior PituitaryHYPERfunctioning

  • 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?

Too Much Growth Hormone


    • skeletal growth; may grow

      up to 8 ft. tall and > 300 lbs


    • enlarged feet/hands, thickening of bones, prognathism, HTN, wt. gain, H/A, visual disturbances, diabetes mellitus, enlargement of the heart and liver



What assessment findings would the nurse document?

What assessment findings would the nurse document?

Medical Interventions for Pituitary Tumors

  • Medications

    • *Parlodel (bromocriptine) to

      ________ & GH levels.

  • Radiation therapy

    • external radiation will bring down GH levels 80% of time

  • *Neurosurgery:

    • procedure called “transsphenoidal hypophysectomy”; New Method

    • Most common method: incision is made thru floor of nose into the sella turcica.

Transsphenoidal Hypophysectomy

Nursing Management &Nursing Diagnosis

  • Pre op hypophysectomy

    • Anxiety r/t

      • body changes

      • fear of unknown

      • brain involvement

      • chronic condition with life long care

Nursing Management &Nursing Diagnosis

  • Sensory-perceptual alteration r/t visual field cuts

    • diplopia

    • secondary to pressure on optic nerve.

  • Alteration in comfort (headache) r/t

    tumor growth/edema

Nursing Management &Nursing Diagnosis

  • Knowledge deficit r/t post-op teaching

    • pain control

    • ambulation

    • hormone replacement

    • activity

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

Post-op CSF Leak where sella turcica was entered

any clear rhinorrhea - test for glucose

+ glucose = CSF Leak

Notify physician

HOB 30 degrees


Post op problems cont.

Periocular edema/ecchymosis


Visual field cuts/diplopia


Post operative care

Post-op complications of hormone deficiency:

What would happen if you didn’t have enough ADH?

What is that disorder called?

Other deficiency:

  • Decrease ACTH will require cortisone replacement due to decrease glucocorticoid production.

  • Can you live without glucocorticoids????

Other deficiency:

  • in sex hormones can lead to infertility due to decreased production of ova & sperm

  • What were those hormones called again?

Anterior PituitaryHYPOfunction

  • Etiology (rare disorder) may be due to disease, tumor, or destruction/removal of the gland.

  • Diagnostic tests

    • CT Scan

    • Serum hormone levels

S & S Anterior Pituitary HYPOfunctioning

  • GH

  • FSH/LH

  • Prolactin

  • ACTH

  • TSH

Medical Management

  • neurosurgery -- removal of tumor

  • radiation - tumor size

  • hormone replacement

    • cortisol, thyroid, sex hormones

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

Posterior Pituitary(Neurohypophysis)

What hormones are released by the posterior pituitary?

_____ & _____are released when signaled by hypothalamus

ADH (Vasopressin/AVP)

  • secreted by cells in the hypothalmus and stored in posterior pituitary

  • acts on distal & collecting tubules of the kidneys making more permeable to H20 -- orvolume excreted?

Bonus Round...

  • Under what conditions is ADH released?

  • ADH has vasoconstrictive or vasodilation action???

  • http://www.cvphysiology.com


  • Controls lactation & stimulates uterine contractions

  • ‘Cuddle hormone’Research links oxytocin and socio-sexual behaviors

Posterior HYPERpituitary Disorders


  • small cell lung cancer, Ca duodenum/pancreas, trauma, pulmonary disease, CNS disorders

  • drugs -- Vincristine, nicotine, general anesthetics, tricyclic antidepressants

Think tank:

  • If you have increased ADH secretion...

    What would the clinical signs/symptoms be?

Clinical manifestations-SIADH

  • Weight gain or weight loss?

  • or urine output?

  • or serum Na levels?

    • thirst

    • weakness

    • muscle cramps

    • H/A

    • Diarrhea

If hyponatremia worsensdevelopment of neurological manifestations

  • lethargy

  • decrease tendon reflexes

  • abdominal cramping, vomitting

  • coma

  • seizures

Diagnostic Tests-SIADH

  • Serum Na+ <134meq/l

  • Serum osmolality <280 OSM/kg H2O

  • urine specific gravity >1.005

  • or normal BUN

Medical Treatment


    • Stop drugs causing issue

    • LIMIT TO 1000ML/24HRS

      • may be as little as 500-600ml/24hrs

    • IF CHF -- Lasix (temporary fix)

      • What do watch for?

    • Treat underlying problem

      • Chemo, radiation

    • demeclocycline (Declomycin) & Lithium

      • 600 po-1200mg/day to inhibit ADH

Nursing Interventions-SIADH

  • Fluid restriction

  • Daily weights

  • 1 lb. weight = 500ml fluid retention

  • Accurate I & Os

Nursing Management-SIADH

  • F & E imbalances

    • fluid intake

  • High risk for injury r/t complications of fluid overload (seizures)

Posterior HYPOpituitaryADH Disorders

Diabetes Insipidus

(too little ADH)

Etiology of DI

  • 50% idiopathic

    • Central (aka. neurogenic)

      • usually occurs suddenly

      • head trauma, brain tumors, infection

    • Nephrogenic

      • inability of tubules to respond to ADH

      • drug therapy, renal damage, heredity

    • Psychogenic

      • what is this?

Clinical Manifestations-DI

  • Polydipsia

  • Polyuria (10L in 24 hours)

  • Severe fluid volume deficit

    • wt loss

    • tachycardia

    • constipation

    • Shock

Diagnostic Tests-DI

  • or urine specific gravity

    orserum Na

    orserum osmolality

Diagnostic Tests - DI

Water deprivation test

Urine output

>4000ml/24hr ----- fluid restrict at start of test

<4000ml/24hr ---- fluid restrict at midnight

Baseline weight, HR & BP


Hold fluids for 6hrs (usually 6am-12noon)

Hourly urine monitoring for urine SG, osmolality & volume

Draw sample for plasma osmolality when urine osmolality increases <30mOsm/kg

When plasma osmolaity is >288mOsm/kg, pt is deydrated --- admin vasopressin

5 units of Vasopressin (ADH) Subq

Obtain urine osmolality 30-60minutes after injection

Discontinue test if pt weight drops >2kg at any time

DI- Diagnostic TestsReading the Results – Water deprivation

  • After ADH administered:

    • Normal or psychogenic

      • Urine osmolality normal

    • Central

      • Urine osmolality increases

    • Nephrogenic

      • Minimal to no response

  • What is this patient at risk for?

  • Is this test done at home or an acute care facility.

Medical Management-DI

  • Identification of etiology, H & P

  • Tx of underlying problem

  • Central

    • IV fluids?

    • DDAVP (oral, IV, nasal spray)

    • Pitressin s.c. IM, nasal spray

    • Chlorpropamide

  • Nephrogenic

Neprhogenic DI Treatment

  • Dietary restriction of Na

    • < 3grams/day

  • Thiazide diurectics (HCTZ, diuril)

    • Allows kidney to absorb more H20 in loop of Henle & distal tubule

    • Increases the amount of Na excreted in the urine

  • Indocin (NSAID)

    • Increases renal response to ADH

Mechanism of action of the paradoxical effect of thiazide diuretics on NDI.

Magaldi A J Nephrol. Dial. Transplant. 2000;15:1903-1905

© European Renal Association-European Dialysis and Transplant Association

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

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