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
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SECRETES 6+ HORMONES:
 ACTH (adrenocorticotropic hormone)
release of cortisol in adrenal glands
 TSH (thyroid stimulating hormone)
release of T3 & T4 in thyroid gland
 GH (growth hormone)
stimulates growth of bone/tissue
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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
promotes mammary gland growth
and milk secretion
ANTERIOR HYPER PITUITARY
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 HYPER PITUITARY
DISORDERS
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ETIOLOGY
Primary: the defect is in the gland itself
which releases that particular hormone
that is too much or too little.
 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
ANTERIOR PITUITARYHYPERfunctioning
Sing along
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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
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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, diabetes, HTN, wt. gain, H/A,
Visual disturbances, diabetes mellitus
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GIGANTISM IN CHILDREN
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ACROMEGALY IN ADULTS
What assessment findings would the nurse
document?
What assessment findings would the nurse
document?
MEDICAL INTERVENTIONS
FOR PITUITARY TUMOR
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Medications
 Parlodel (bromocriptine) to
________ & GH levels.
Radiation therapy
 external radiation will bring down GH
levels 80% of time
Transsphenoidal
Hypophysectomy
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Neurosurgery:
 procedure called “transsphenoidal
hypophysectomy”; New Method
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Most common method: incision is
made thru floor of nose into the
sella turcica.
Nursing Management
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Pre op hypophysectomy
 Anxiety r/t
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a. body changes
b. fear of unknown
c. brain involvement
d. chronic condition with life long care
Sharmyn
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Sensory-perceptual alteration r/t
a. visual field cuts
b. diplopia
 secondary to pressure on optic
nerve.
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Alteration in comfort (headache) r/t
a. tumor growth/edema
Knowledge deficit r/t
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Post-op teaching
 pain control
 ambulation
 hormone replacement
 activity
Post operative care
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Post-op complications of hormone
insufficiency:
 What would happen if you didn’t have
enough ADH?
 What is that disorder called?
Other insuffciency:
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Decrease ACTH will require cortisone
replacement due to decrease
glucocorticoid production.
Can you live without
glucocorticoids????
Other deficiency:
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in sex hormones can lead to
infertility due to decrease production of
ova & sperm
What were those hormones called
again?-
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
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CSF leak usually resolves within 72
hrs.
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If not - spinal taps done to decrease
pressure
Post op problems cont.
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Periocular edema/ecchymosis
Headaches
Visual field cuts/diplopia
 What is the most important nursing
intervention for these
problems????
ANTERIOR PITUITARYHypofunction
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1. Etiology (rare disorder) may be due to
disease, tumor, or destruction 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)
Question??? What hormones are
released by the posterior pituitary?
_____ & _____are released when
signaled by hypothalamus
ADH (Vasopressin)
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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?
Bonus Round...
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Under what conditions is ADH
released???
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ADH has vasoconstrictive or
vasodilation action???
ANSWERS:
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released in response to decrease blood
volume, increase concentration of Na+
or other substances, pain, stress
ADH has vasocontrictive properties
Oxytocin
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Controls lactation & stimulates uterine
contractions
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‘Cuddle hormone’
Research links oxytocin and socio-sexual
behaviors
Posterior Hyper pituitary
Disorders
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SIADH (TOO MUCH ADH!!)
lung cancer, Ca duodenum/pancreas,
trauma, pulmonary disease, CNS
disorders, drugs -- Vincristine,
nicotine, general anesthetics,
tricyclic antidepressants
Think tank:
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If you are having too much ADH... 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?
weakness
muscle cramps
H/A
Diarrhea
If hyponatremia worsens will
develop neuro manifestations
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lethargy
decrease tendon reflexes
seizures
Diagnostic Tests-SIADH
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Serum Na+ <135meq/l
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Serum osmolality <275 OSM/kg H2O
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urine specific gravity
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or normal BUN
Medical Treatment
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***FLUID RESTRICTION
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LIMIT TO 1000ML/24HRS
IV 3% NaCl to replace Na
IF CHF -- Lasix (temporary fix)
Treat underlying problem --Chemo,
radiation
Declomycin 600 po-1200mg/day
to inhibit ADH
Nursing Interventions-SIADH
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Fluid restriction may be as little as 500600ml/24hrs
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)
What do you think the S&S would be
if you had too little ADH???
Etiology
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50% idiopathic
 a. central -- i.e. brain tumors
 b. nephrogenic - inability of tubules
to respond to ADH
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
or
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or
or
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urine specific gravity
serum Na
serum osmolality
Dehydration test:
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2 units of Vasopressin (ADH) mixed in saline
administered over 2 hrs then check urine
osmolality levels
Medical Management-DI
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Identification of etiology, H & P
Tx of underlying problem
DDAVP (nasal spray)
Pitressin s.c. IM, nasal spray
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