Pituitary Disorders - Austin Community College

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HORMONES
Circulate via the bloodstream
 Secreted in minute amounts
 Inactivated or excreted by the liver
or kidneys
 Alter the rate of physiological
activities

Hormone REGULATION

How do hormones turn on their release
and turn off their release?

Negative Feedback
Hormone to Hormone Negative
Feedback (or Complex Feedback)
Nervous System Regulation


Negative Feedback

serum Calcium Level

PTH (parathyroid hormone)

serum Calcium Level

PTH
Hormone to Hormone Negative
Feedback





↓ serum levels of thyroid hormones T3
and T4
Calls the hypothalamus and asks to
release TRH
TRH calls the Anterior Pituitary to
release TSH (thyroid stimulating
hormone
 T3 and T4
Shuts off TRH, then TSH
Nervous System Regulation


The hypothalamus and pituitary gland
form a complex called the
hypothalamic pituitary axis (HPA)
which integrates communication from
the nervous system to the endocrine
system…
Question…which hormones are
released under times of stress???
Hormone Dysfunction





Hypofunction-Too
little
Congenital defects
Destruction of a
gland that releases
that hormone
Aging
Atrophy



HyperfunctionToo much
Hyperplasia of
that gland
Tumors
Common Characteristics of
Hormonal Disorders

Non specific signs & symptoms





↑ or ↓ weight
↓ or ↑ appetite
↑ or ↓ sleep
depression
changes in hair, skin, personal
appearance, mood, libido, etc.
Common Characteristics of
Hormonal Disorders

Specific Signs and Symptoms
 Polys
 Polyuria
 Polydipsia
 Polyphagia
Exopthalmos in Hyperthyroidism
 Which celebs can you think of that have this
condition?

PITUITARY GLAND



Where is it located???
Name its’ 3 parts or sections.
What hormones are secreted by the
pituitary gland???
Pituitary Gland
ANTERIOR PITUITARY

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

FSH (follicle stimulating hormone)
stimulates growth of ovarian follicles &
spermatogenesis in males

LH (lutenizing hormone)
 regulates growth of gonads &
reproductive activities

Prolactin
promotes mammary gland growth
and milk secretion
ANTERIOR HYPER PITUITARY
DISORDERS

What would happen if you had TOO
MUCH secretion of prolactin?

Too much release of Lutenizing
Hormone (LH)?
ANTERIOR HYPER PITUITARY
DISORDERS

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

PITUITARY TUMORS



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


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

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, diabetes, HTN, wt. gain, H/A,
Visual disturbances, diabetes mellitus

GIGANTISM IN CHILDREN

ACROMEGALY IN ADULTS
What assessment findings would the nurse
document?
What assessment findings would the nurse
document?
COLLABORATIVE
INTERVENTIONS FOR PITUITARY
TUMOR


Medications
 Parlodel (bromocriptine) &
Sandostatin (octreotide) to
________ & GH levels.
Radiation therapy
 external radiation will bring down GH
levels 80% of time
Transsphenoidal
Hypophysectomy

Neurosurgery:
 procedure called “transsphenoidal
hypophysectomy”; New Method

Most common method: incision is
made thru floor of nose into the
sella turcica.
Nursing Management

Pre op hypophysectomy
 Anxiety r/t





a. body changes
b. fear of unknown
c. brain involvement
d. chronic condition with life long care
Sharmyn

Sensory-perceptual alteration r/t
a. visual field cuts
b. diplopia
 secondary to pressure on optic
nerve.

Alteration in comfort (headache) r/t
a. tumor growth/edema
Knowledge deficit r/t

Post-op teaching
 pain control
 ambulation
 hormone replacement
 activity
Post operative care

Post-op complications of hormone
insufficiency:
 What would happen if you didn’t have
enough ADH?
 What is that disorder called?
Other insuffciency:


Decrease ACTH will require cortisone
replacement due to decrease
glucocorticoid production.
Can you live without
glucocorticoids????
Other deficiency:


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





Avoid bending and straining X 2
months post transsphenoidal
hypophysectomy,
Use stool softeners
Avoid coughing
Saline mouth rinses
Avoid toothbrushing for 7-10 days
Post-op CSF Leak where sella
turcica was entered



any clear rhinorrhea - test for glucose
+ glucose = CSF Leak
>30mg/dl is positive for
CSF leak
 Notify physician
 HOB 30 degrees
 Bedrest



CSF leak usually resolves within 72
hrs.
Spinal drain may be placed to drain
excess CSF
If not - spinal taps done to decrease
pressure
Post op problems
Transsphenoidal
Hypophysectomy (continued)



Periocular edema/ecchymosis
Headaches
Visual field cuts/diplopia
 What is the most important nursing
intervention for these
problems????
ANTERIOR PITUITARYHypofunction


1. Etiology (rare disorder) may be due to
disease, tumor, or destruction of the
gland.
Diagnostic tests


CT Scan
Serum hormone levels
S & S Anterior Pituitary
Hypofunctioning





GH
FSH/LH
Prolactin
ACTH
TSH
Collaborative Management

neurosurgery -- removal of tumor

radiation -

hormone replacement

tumor size
cortisol, thyroid, sex hormones
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)
Question??? What hormones are
released by the posterior pituitary?
_____ & _____are released when
signaled by hypothalamus
ADH (Vasopressin)


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...

Under what conditions is ADH
released???

ADH has vasoconstrictive or
vasodilation action???
ANSWERS:


released in response to decrease blood
volume, increase concentration of Na+
or other substances, pain, stress
ADH has vasocontrictive properties
Oxytocin

Controls lactation & stimulates uterine
contractions

‘Cuddle hormone’
Research links oxytocin and socio-sexual
behaviors
Posterior Hyper pituitary
Disorders


SIADH (TOO MUCH ADH!!)
Etiology: lung cancer, Ca
duodenum/pancreas, head trauma,
brain tumor, pulmonary disease, CNS
disorders, drugs -- Vincristine,
nicotine, general anesthetics,
tricyclic antidepressants
Question:

If you are having too much ADH... What
would the clinical signs/symptoms be??
Clinical manifestations-SIADH


Weight gain or weight loss?
or
urine output?
or





serum Na levels?
muscle weakness
muscle cramps
H/A
Vomiting, diarrhea
If hyponatremia worsens will
develop neuro manifestations






muscle twitching
lethargy
Confusion
Cerebral edema
seizures
coma
Diagnostic Tests-SIADH

Serum Na+ <135meq/l

What is considered severe hyponatremia?
< 120mEq/l

Serum osmolality <275 OSM/kg H2O

urine specific gravity
Collaborative Interventions

***FLUID RESTRICTION






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
Tolvaptan (Samsca) ADH receptor
antagonist
Nursing Interventions-SIADH






Fluid restriction may be as little as 500600ml/24hrs
Daily weights...
1 lb. weight = 500ml fluid retention
Accurate I & Os
Seizure precautions
Mouth care, why?
Nursing Management-SIADH

F & E imbalances


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

50% idiopathic
 a. central -- i.e. brain tumors, head
injury, brain surgery
 b. nephrogenic - inability of tubules
to respond to ADH, common cause is
due to side effect of Lithium
 c. Primary DI-due to excess water
intake
Clinical Manifestations-DI



Polydipsia
Polyuria (10L in 24 hours)
Severe fluid volume deficit
 wt loss
 tachycardia
 constipation
 shock
Diagnostic Tests-DI
or

or
or

urine specific gravity
serum Na
serum osmolality
Dehydration test:

2 units of Vasopressin (ADH) mixed in saline
administered over 2 hrs then check urine
osmolality levels
Medical Management-DI




Identification of etiology, H & P
Tx of underlying problem
DDAVP (nasal spray)
Pitressin s.c. IM, nasal spray
Nursing Management-DI





Assess for F & E imbalances
Increase po/IV fluids
RF Injury (hypovolemic shock)
Knowledge deficit
High risk for ineffective coping
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