Transcript Pituitary Gland - Porterville College

Endocrine
Day 5-1
Pituitary Gland
Hypothalamus
• Description
– Attached to pituitary
gland
• Infundibulum
– Brain
• Diencephalon
Hypothalamus
• Function
– Stimulate the
pituitary to secrete its
hormones
Pituitary
• Description
– “Master gland”
– Why?
– 9 hormones
Pituitary
• Description
– Size – pea
– Anterior lobe
• Adenohypophysis
• 7 hormones
– Posterior lobe
• Neurohypophysis
• 2 hormones
Anterior Pituitary Hormones
• Thyroid-stimulating hormone
(TSH)
• Adrenocorticothropic hormone
(ACTH)
• Follicle-stimulating hormone
(FSH)
• Luteinizing Hormone (LH)
• Melanocyte-stimulationg
hormone (MSH)
• Growth Hormone (GH)
Somatoropin
• Prolactin / Lactogenic hormone
Thyroid-stimulating Hormone
• Function
– Stim. thyroid growth
– Stim. secretion of
thyroid hormones
• Stimulated by:
–
–
–
–
–
Hypothalamus
i T3 / T4
i Metabolism
Cold temps
Stress
Adrenocorticotropic Hormone (ACTH)
• Function
– Stim. adrenal cortex
growth
– Stim. secretion of
glucocorticoids
• Stimulated by:
–
–
–
–
Hypothalamus
Stress
Hypoglycemia
i glucocorticoids
Follicle-Stimulating Hormone (FSH)
• Function
– Gonadotropin
– Female
• Stimulated ovaries to
mature
• Estrogen production
– Male
• Stim. Sperm
production
Luteinizing Hormone (LH)
• Function
– Gonadotropin
– Female
• Stim. Ovulation
– Male
• Stim. testes to produce
testosterone
Melanocyte-stimulating Hormone (MSH)
• Function
– h melanin
Growth Hormone (GH) Somatotropin
• Function
– Stim. Growth
– Stim. Protein
sysnthesis
– h serum glucose
levels
• Insulin-antagonist
• Stimulated by:
–
–
–
–
–
Hypothalmus
i growth hormone
Stress
Exercise
Hypoglycemia
Prolacting / Lactogenic Hormone
• Function
– Stim. breast
development during
pg
– Milk secretion p
delivery
Posterior Pituitary Hormones
• Anti-diuretic Hormone
(ADH)
– A.K.A: Vasopressin
• Oxytocin
Anti-diuretic Hormone (ADH) Vasopressin
• Function
– Stim. H2O retention 
– i urine output 
– h H2O in serum/body
• Stimulated by:
–
–
–
–
–
h Serum Osmolality
i BP
Stress
Pain
Exercise
Oxytocin
• Function
– Stim. Uterine
contractions
– Breast to release milk
Small Group Questions
1. Are Gonadotropins?
2. Cause increase synthesis of melanin?
–
3. Cause ovulation?
4. Cause water retention?
5. In high levels causes increased BP?
Small Group Questions
6.
7.
8.
9.
10.
Increase protein synthesis?
Increased metabolism of fatty acids for energy?
Is also called vasopressin?
Is also known as somatotropin?
Is an insulin antagonist?
Small Group Questions
11. Secreted in response to cold temp and stress?
12. Secreted in response to decreased BP?
13. Secreted in response to decreased somatotropin?
14. Secreted in response to hypoglycemia?
15. Secreted in response to increased plasma osmolality?
Small Group Questions
16. Secreted in response to decreased glucocorticoids?
17. Stim. Ovaries to mature and produce estrogen?
18. Stim. sperm production?
19. Stim adrenal cortex growth?
20. Stim. breast development?
Small Group Questions
21. Stim. Testes to produce testosterone?
22. Stim secretion of glucocorticoids?
23. Stim. secretion of thyroid hormone
24. Stim. Thyroid to grow
25. Stim uterine contractions
Hyperpituitarism
• Definition
– h secretion of
pituitary hormones
• Etiology
– Usually 20-40 yrs
– Tumor
– Usually GH or ADH
Hyperpituitarism
Growth hormone Excess
• Affects
– Depends on age
– Epiphyses
• Epiphyses open
(young)
– Gigantism
Gigantism
• Definition
– h GH before
epiphyses closed
• Etiology
– Hyperplasia of
anterior pituitary
– h in number of cells
– Can  tumor
Gigantism
• Clinical manifestations
– Onset
• Infants / children
– > 8 feet
– Proportional overall
growth
– Do not have strength
that size implies
Gigantism
• Medical treatment
– Irradiation of anterior
pituitary
– Removal of pit via
surgery
Gigantism
• High Risk for:
–
–
–
–
–
Heart failure
Hypertension
Thickened bones
Osteoporosis
Delayed sexual
development
Gigantism
• Pharmacology
– IF pituitary is
destroyed or
removed
• Replace pituitary
hormones
Gigantism
• Nursing interventions
– Listen
– Growth chart
measurements
– Long beds
Hyperpituitarism
• Growth hormone
– Increased production
• Affects
– Depends on age
– Epiphyses
• Epiphyses closed
(adult)
– Acromegaly
Acromegaly
• Definition
– h GH after epiphyses
have closed
• Etiology
– 30-50 yrs
– Hyperplasia
– Tumor
Acromegaly
• Clinical S&S
– Gradual onset
– Hypertrophy
• Increase in volume of
tissue d/t enlargement
of existing cells
– “hulking”
• Enlarge jaw
• Thick tongue
Acromegaly
• Clinical S&S
– Tufted
• Thick fingers with tips
like arrowheads
Acromegaly
• S&S
– Moist, weak, doughy
handshake
– Heart, liver spleen
enlarged
– Diaphoresis
– Oily, leathery skin
– Laryngeal
hypertrophy
Acromegaly
• S&S
–
–
–
–
Heat intolerance
Weight gain
Joint pain
Hirsutism
• Excessive hairiness
– i libido
• Impotence
• Oligomenorrhea
• Infertility
Acromegaly: Medical Tx
• Diagnosis
–
–
–
–
–
Hx
S&S
X-ray
CT scan
Lab
• h GH
Acromegaly: Medical Tx
• Prognosis
– ?? Cause
– i Life span
– DM ???
•
•
•
•
•
↑GH 
h Glucose levels 
h Insulin 
Stress pancreas 
DM type 2
Acromegaly: Medical Tx options
• Radiation
• Medication
• Surgery
Transsphenoid hypophysectomy
• Post-op care
– Nasal packing
• Check for drainage
–
–
–
–
S&S infection
Nuchal rigidity
Pain control
NO
•
•
•
•
Coughing
Straining
Vomiting
Sneezing
Transsphenoid hypophysectomy
• Post-op care
– Incentive spirometer
– No brush teeth x
2wks
– No lifting x 3 months
Acromegaly: Rx
Bromocriptine mesylate
(Parlodel)
• Action
– Inhibits GH (and
prolactin)
• Nrs considerations
– Give c food
• S/E
– Drowsiness
– Stim. ovulation
Acromegaly: Nrs interventions
•
•
•
•
•
•
HX
S&S
Glucose
Gait changes
Vital sign changes
Jaw changes 
dysphagia
Which of the following statements about
acromegaly is not true?
A. Most cases are due to GH hypersecretion
B. The diagnosis is usually obvious
C. Patients may experience a gradual change in their
voice
D. Enlarged hands and feet are typical
All these comorbidities are common with
acromegaly, except:
A. Sleep apnea
B. Insulin resistance
C. Obesity
D. Biventricular hypertrophy
Which of these treatments is best for a 35-yearold patient with a small pituitary adenoma?
A. Octreotide
B. Radiation
C. Surgery
D. Bromocriptine
Small group questions
1. What hormonal disturbance causes acromegaly?
2. 2. What signs and symptoms might you expect to
see Mrs. Gandios exhibit?
3. What 2 dx tests might have been performed to dx
Mrs. Grandios?
Small Group Questions
4. What med. Tx do you expect to be implements with Mrs.
Grandios?
5. What complications might you assess or monitor for with Mrs.
Grandios? How would you assess for this?
6. Mrs. Grandios was prescribed Parlodel. What would you tell
her about this medication?