Pituitary gland
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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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PITUITARY GLAND

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Pituitary gland

PITUITARY GLAND

  • Where is it located???

  • Name its’ 3 parts or sections.

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


Pituitary gland1

Pituitary Gland


Anterior pituitary adenohypophysis

Anterior Pituitary(adenohypophysis)

  • SECRETES 6+ HORMONES:

    • 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


Pituitary gland

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

Positive vs Negative Feedback Mechanisms

  • Give some examples of

    • Negative

    • Positive


Anterior hyperpituitary disorders

Anterior HYPERpituitary Disorders

  • ETIOLOGY

    • 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

Pituitary Tumors

  • 10% OF ALL BRAIN TUMORS

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

  • tumors usually cause hyper release of hormones

    (Recall all hormones)


Anterior hyperpituitary disorders1

Anterior HYPERpituitary Disorders

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

  • Too much release of Lutenizing Hormone (LH)?


Anterior pituitary hyperfunctioning

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

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, HTN, wt. gain, H/A, visual disturbances, diabetes mellitus, enlargement of the heart and liver


Pituitary gland

  • GIGANTISM IN CHILDREN

  • ACROMEGALY IN ADULTS


Pituitary gland

What assessment findings would the nurse document?


Pituitary gland

What assessment findings would the nurse document?


Medical interventions for pituitary tumors

Medical Interventions for Pituitary Tumors

  • Medications

    • *Parlodel (bromocriptine) to

      ________ & GH levels.

  • Radiation therapy

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


Pituitary gland

  • *Neurosurgery:

    • procedure called “transsphenoidal hypophysectomy”; New Method

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


Transsphenoidal hypophysectomy

Transsphenoidal Hypophysectomy


Nursing management nursing diagnosis

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 diagnosis1

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 diagnosis2

Nursing Management &Nursing Diagnosis

  • Knowledge deficit r/t post-op teaching

    • pain control

    • ambulation

    • hormone replacement

    • activity


Incisional disruption after transsphenoidal hypophysectomy

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

Post-op CSF Leak where sella turcica was entered

any clear rhinorrhea - test for glucose

+ glucose = CSF Leak

Notify physician

HOB 30 degrees

Bedrest


Post op problems cont

Post op problems cont.

Periocular edema/ecchymosis

Headaches

Visual field cuts/diplopia

Meningitis


Post operative care

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

Other deficiency:

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

  • Can you live without glucocorticoids????


Other deficiency1

Other deficiency:

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

  • What were those hormones called again?


Anterior pituitary hypofunction

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

S & S Anterior Pituitary HYPOfunctioning

  • GH

  • FSH/LH

  • Prolactin

  • ACTH

  • TSH


Medical management

Medical Management

  • neurosurgery -- removal of tumor

  • radiation - tumor size

  • hormone replacement

    • cortisol, thyroid, sex hormones


Nursing management

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

Posterior Pituitary(Neurohypophysis)

What hormones are released by the posterior pituitary?

_____ & _____are released when signaled by hypothalamus


Adh vasopressin avp

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

Bonus Round...

  • Under what conditions is ADH released?

  • ADH has vasoconstrictive or vasodilation action???


Pituitary gland

  • http://www.cvphysiology.com


Oxytocin

Oxytocin

  • Controls lactation & stimulates uterine contractions

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


Posterior hyperpituitary disorders

Posterior HYPERpituitary Disorders

  • SIADH (TOO MUCH ADH!!)

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

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


Think tank

Think tank:

  • If you have increased ADH secretion...

    What would the clinical signs/symptoms be?


Clinical manifestations siadh

Clinical manifestations-SIADH

  • Weight gain or weight loss?

  • or urine output?

  • or serum Na levels?

    • thirst

    • weakness

    • muscle cramps

    • H/A

    • Diarrhea


If hyponatremia worsens development of neurological manifestations

If hyponatremia worsensdevelopment of neurological manifestations

  • lethargy

  • decrease tendon reflexes

  • abdominal cramping, vomitting

  • coma

  • seizures


Diagnostic tests siadh

Diagnostic Tests-SIADH

  • Serum Na+ <134meq/l

  • Serum osmolality <280 OSM/kg H2O

  • urine specific gravity >1.005

  • or normal BUN


Medical treatment

Medical Treatment

  • ***FLUID RESTRICTION

    • 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

Nursing Interventions-SIADH

  • Fluid restriction

  • Daily weights

  • 1 lb. weight = 500ml fluid retention

  • Accurate I & Os


Nursing management siadh

Nursing Management-SIADH

  • F & E imbalances

    • fluid intake

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


Posterior hypopituitary adh disorders

Posterior HYPOpituitaryADH Disorders

Diabetes Insipidus

(too little ADH)


Etiology of di

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

Clinical Manifestations-DI

  • Polydipsia

  • Polyuria (10L in 24 hours)

  • Severe fluid volume deficit

    • wt loss

    • tachycardia

    • constipation

    • Shock


Diagnostic tests di

Diagnostic Tests-DI

  • or urine specific gravity

    orserum Na

    orserum osmolality


Diagnostic tests di1

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

Labs?

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 tests reading the results water deprivation

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

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

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


Pituitary gland

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

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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