Transcript Pituitary Disorders

PITUITARY GLAND
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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)
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SECRETES 6+ HORMONES:
 ACTH (adrenocorticotropic hormone)
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aka (corticotrphin)
release of cortisol in adrenal glands
 TSH (thyroid stimulating hormone)
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aka (thyrotropin)
release of T3 & T4 in thyroid gland
 GH (growth hormone)
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aka (somatotropin)
stimulates growth of bone/tissue
ANTERIOR PITUITARY
(adenohypophysis)
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FSH (follicle stimulating hormone)
stimulates growth of ovarian follicles &
spermatogenesis in males
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LH (lutenizing hormone)
regulates growth of gonads &
reproductive activities
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Prolactin
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aka (luteotropin/mammotropin)
promotes mammary gland growth and
milk secretion
Positive vs Negative
Feedback Mechanisms
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Give some examples of
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Negative
Positive
Anterior HYPERpituitary
Disorders
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ETIOLOGY
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Primary: the defect is in the gland itself
which releases that particular hormone
that is too much or too little.
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Example:
Secondary: defect is somewhere outside
of gland
i.e. GHRH from hypothalamus
TRH from hypothalamus
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Pituitary Tumors
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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
Disorders
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What would happen if you had TOO
MUCH secretion of prolactin?
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Too much release of Lutenizing
Hormone (LH)?
Anterior Pituitary
HYPERfunctioning
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What would happen if you had too
much growth hormone secretion???
Too Much Growth Hormone
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GIGANTISM IN CHILDREN
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skeletal growth; may grow
up to 8 ft. tall and > 300 lbs
ACROMEGALY IN ADULTS
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enlarged feet/hands, thickening of bones,
prognathism, HTN, wt. gain, H/A, visual
disturbances, diabetes mellitus,
enlargement of the heart and liver
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GIGANTISM IN CHILDREN
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ACROMEGALY IN ADULTS
What assessment findings would the nurse
document?
Medical Interventions
for Pituitary Tumors
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Medications
 *Parlodel (bromocriptine) to
________ & GH levels.
Radiation therapy
 external radiation will bring down GH
levels 80% of time
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*Neurosurgery:
 procedure called “transsphenoidal
hypophysectomy”
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Most common method: incision is
made thru floor of nose into the
sella turcica.
Transsphenoidal
Hypophysectomy
Nursing Management &
Nursing Diagnosis
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Pre op hypophysectomy
 Anxiety r/t
body changes
 fear of unknown
 brain involvement
 chronic condition with life long care
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Nursing Management &
Nursing Diagnosis
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Sensory-perceptual alteration r/t visual
field cuts
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diplopia
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secondary to pressure on optic
nerve.
Alteration in comfort (headache) r/t
tumor growth/edema
Nursing Management &
Nursing Diagnosis
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Knowledge deficit r/t post-op teaching
 pain control
 ambulation
 hormone replacement
 activity
Incisional disruption after
transsphenoidal hypophysectomy
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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
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any clear rhinorrhea - test for glucose
+ glucose = CSF Leak
 Notify physician
 HOB 30 degrees
 Bedrest
Post op problems cont.
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Periocular edema/ecchymosis
Headaches
Visual field cuts/diplopia
Meningitis
Post operative care
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Post-op complications of hormone
deficiency:
 What would happen if you didn’t have
enough ADH?
 What is that disorder called?
Other deficiency:
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Decrease ACTH will require cortisone
replacement due to decrease
glucocorticoid production.
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Can you live without
glucocorticoids????
Other deficiency:
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in sex hormones can lead to
infertility due to decreased production
of ova & sperm
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What were those hormones called
again?
Anterior Pituitary
HYPOfunction
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Etiology (rare disorder) may be due to
disease, tumor, or destruction/removal of
the gland.
Diagnostic tests
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CT Scan
Serum hormone levels
S & S Anterior Pituitary
HYPOfunctioning
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GH
FSH/LH
Prolactin
ACTH
TSH
Medical Management
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neurosurgery -- removal of tumor
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radiation -
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hormone replacement
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tumor size
cortisol, thyroid, sex hormones
Nursing Management
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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)
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secreted by cells in the hypothalmus
and stored in posterior pituitary
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acts on distal & collecting tubules of
the kidneys making more permeable to
H20 -or
volume excreted?
Normal Lab Values r/t ADH
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Serum osmolality 285-295mOsm/L
Serum Na
135-145mEq/L
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Urine Specific Gravity 1.010-1.025
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some texts 1.020-1.030
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Urine Osmolality
Urine Na
500-800mOsm
15-240mEq/L/day
Bonus Round...
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ADH has vasoconstrictive or
vasodilation action???
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Under what conditions is ADH
released?
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http://www.cvphysiology.com
Oxytocin
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Controls lactation & stimulates uterine
contractions
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‘Cuddle hormone’
Research links oxytocin and socio-sexual
behaviors
Posterior HYPERpituitary
Disorders
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SIADH (TOO MUCH ADH!!)
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small cell lung cancer, Ca
duodenum/pancreas, trauma, pulmonary
disease, CNS disorders
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drugs -- Vincristine, nicotine, general
anesthetics, tricyclic antidepressants
Think tank:
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If you have increased ADH secretion...
What would the clinical signs/symptoms
be?
Clinical manifestations-SIADH
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Weight gain or weight loss?
or
urine output?
or
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serum Na levels?
thirst
weakness
muscle cramps
H/A
Diarrhea
If hyponatremia worsens
development of neurological
manifestations: LATE signs
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lethargy
decrease tendon reflexes
abdominal cramping, vomitting
coma
seizures
Diagnostic Tests-SIADH
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Serum Na+ <134meq/l
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Serum osmolality <280 OSM/kg H2O
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urine specific gravity >1.005
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or normal BUN
Medical Treatment
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***FLUID RESTRICTION
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Stop drugs causing issue
LIMIT TO 1000ML/24HRS
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IF CHF -- Lasix (temporary fix)
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What do watch for?
Treat underlying problem
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may be as little as 500-600ml/24hrs
Chemo, radiation
demeclocycline (Declomycin) & Lithium
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600 po-1200mg/day to inhibit ADH
Nursing Interventions-SIADH
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Fluid restriction
Daily weights
1 lb. weight = 500ml fluid retention
Accurate I & Os
Nursing Management-SIADH
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F & E imbalances
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fluid intake
High risk for injury r/t complications of
fluid overload (seizures)
Posterior HYPOpituitary
ADH Disorders
Diabetes Insipidus
(too little ADH)
Etiology of DI
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50% idiopathic
 Central (aka. neurogenic)
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usually occurs suddenly
head trauma, brain tumors, infection
Nephrogenic
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inability of tubules to respond to ADH
drug therapy, renal damage, heredity
Clinical Manifestations-DI
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Polydipsia
Polyuria (10L in 24 hours)
Severe fluid volume deficit
 wt loss
 tachycardia
 constipation
 Shock
Diagnostic Tests-DI
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or
or
or
urine specific gravity
serum Na
serum osmolality
Diagnostic Tests - DI
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Water deprivation test
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Urine output
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Baseline weight, HR & BP
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>4000ml/24hr ----- fluid restrict at start of test
<4000ml/24hr ---- fluid restrict at midnight
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
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After ADH administered:
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Normal or psychogenic
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Central
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Urine osmolality normal
Urine osmolality increases
Nephrogenic
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Minimal to no response
Medical Management-DI
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Identification of etiology, H & P
Tx of underlying problem
Central
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IV fluids?
DDAVP (oral, IV, nasal spray)
Pitressin s.c. IM, nasal spray
Chlorpropamide
Nephrogenic
Neprhogenic DI Treatment
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Dietary restriction of Na
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Thiazide diurectics (HCTZ, diuril)
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< 3grams/day
Allows kidney to absorb more H20 in loop of
Henle & distal tubule
Increases the amount of Na excreted in the
urine
Indocin (NSAID)
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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
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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