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

slide5

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:
    • 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???
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
slide12
GIGANTISM IN CHILDREN
  • ACROMEGALY IN ADULTS
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
slide16
*Neurosurgery:
    • procedure called “transsphenoidal hypophysectomy”
    • Most common method: incision is made thru floor of nose into the sella turcica.
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 -- or volume excreted?
normal lab values r t adh
Normal Lab Values r/t ADH
  • Serum osmolality 285-295mOsm/L
  • Serum Na 135-145mEq/L
  • Urine Specific Gravity 1.010-1.025

some texts 1.020-1.030

  • Urine Osmolality 500-800mOsm
  • Urine Na 15-240mEq/L/day
bonus round
Bonus Round...
  • ADH has vasoconstrictive or vasodilation action???
  • Under what conditions is ADH released?
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 late signs
If hyponatremia worsens development of neurological manifestations: LATE signs
  • 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
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
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
slide54

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