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Endocrine Pituitary gland 5-2. Hyperpituitarism What two hormones are affected with hyperpituitarism? – GH – ADH.

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Presentation on theme: "Endocrine Pituitary gland 5-2. Hyperpituitarism What two hormones are affected with hyperpituitarism? – GH – ADH."— Presentation transcript:

1 Endocrine Pituitary gland 5-2

2 Hyperpituitarism What two hormones are affected with hyperpituitarism? – GH – ADH

3 Hyperpituitarism  GH – Adult Acromegaly – Child Gigantism  ADH – Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

4 Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Definition – Excess ADH What does ADH do? – Causes kidneys to reabsorb water  –  urine output  –  fluid volume

5 SIADH - Etiology #1 – Lung CA Other CA COPD

6 SIADH – S&S Water retention – Edema – Wt gain Urine – Concentrated – Sp. gravity 

7 SIADH: S&S Hyponatremia – < 130 – Normal meq/dl – Muscle cramps – Weakness Serum Osmolality – Decreased – Blood leaks into brain  – Brain swelling  – Lethargy, seizures, coma – Deathmosis

8 SIADH: Medical treatment Tx underlying disorder Resolve fluid volume excess – Restrict H2O – Promote H20 voiding Sodium replacement

9 SIADH: Rx Furosemide (Lasix) Action – Enhance diuresis Nrs consideration –  Fluid & electrolyte panels – I&O – VS – q day wt

10 SIADH: Rx Demeclcycline hydrochloride (Declomycin) – Action Enhances Na+ retention Fludrocortisone (Florinef) – Action Enhances Na+ retention Nrs. Consideration – Fluid restriction

11 SIADH: Nrs. Dx Fluid Volume Excess

12 Hypopituitarism Definition –  secretion of pituitary hormones Etiology – #1 Tumor – Congenital defects – Pituitary infarction – Pituitary surgery – Pituitary CA

13 Hypopituitarism Clinical manifestations are slow to appear & are not really apparent until 75% of the pituitary is destroyed

14 Hypopituitarism: Primary – Trouble w/ the Pituitary  –  Pituitary hormone Secondary – Trouble somewhere else (not pituitary)  –  pituitary hormone – Usually hypothalmus

15 Hypopituitarism: Growth hormone Dx: – Dwarfism S&S (  GH) – Apparent by 6 months – Delayed puberty – Growth rate ½ unto 4 ft. – Body proportions = normal – Accel. aging

16 Hypopituitarism: FSH & LH Female – Amenorrhea – Infertility –  libido – Breast atrophy Male – Weakness – Impotence –  libido – Testicles soften & shrink

17 Hypopituitarism: TSH Severe growth retardation (even w/ tx) S&S (  TSH) – Think slow – Lethargy – Bradycardia – Slow thoughts – Cold intolerance

18 Hypopituitarism: ACTH ACTH – Handle stress S&S (  ACTH) – Fatigue – Wt loss – Anorexia – Depigmentation of skin – V/S when stressed Fever Hypotension

19 Hypopituitarism: Prolactin S&S (  prolactin) – Absent postpartum lactation

20 Hypopituitarism: Simmond’s Disease AKA – Panhypopituitarism Definition – Total absence of all pit. hormones Etiology – Surgery – Infection – Injury – Tumor

21 Hypopituitarism: Simmond’s Disease Clinical Manifestations – Wt loss – Gen. debility – Weak –  libido – Cold intolerance Tx – Administration of all Pit. hormones

22 Hypopituitarism: ADH Dx: – Diabetes Insipidus Definition –  ADH Vasopressin

23 Hypopituitarism: Diabetes Insipidus Etiology – Injury to pituitary or hypothalamus – Pregnancy – Medication use Lithium Lasix – Kidney not respond to ADH

24 Hypopituitarism: Diabetes Insipidus Clinical manifestations – Polyuria Sp. gravity of urine –– Serum osmolality –– Na+ levels –– – Hypernatremia – > 145

25 Hypopituitarism: Diabetes Insipidus Extreme thirst – Cold beverages Wt. loss Dizziness Constipation Fatigue

26 Hypopituitarism: Diabetes Insipidus Complications – Hypovolemia – Circulatory collapse – Unconsciousness – CNS damage Prognosis – OK (w/ fluid)

27 Hypopituitarism: Diabetes Insipidus Medical treatment – Fluid replacement – Replace hormone ADH/Vasopressin – Fix underlying cause

28 Hypopituitarism: Diabetes Insipidus Rx Desmopressin acetate (Stimate) Action – Synthetic ADH Route – Parenteral – Nasal Nrs. Considerations – Clear nasal passage

29 Hypopituitarism: Diabetes Insipidus Rx Vasopressine (Pitressin) Action – ADH hormone Route – Parenteral – Nasal S/E – Increased BP

30 Hypopituitarism: Diabetes Insipidus Rx If D.I. is due to kidney – More ADH not help

31 Hypopituitarism: Diabetes Insipidus Nrs. Dx – Fluid Volume Deficit Nursing interventions – I&O –  Electrolytes –  Na+ intake – VS

32 Mrs. Waterfall 1.What would the name of this disorder be? 2.2. What is causing the elevated ADH levels? 3. What other lab values would coincide with this disorder?

33 Mrs. Waterfall 4. What nursing diagnosis is appropriate for this disorder? 5. What interventions would you as a nurse start with this diagnosis? 6. What medications would you expect the doctor to order?

34 Ms. Pealot 1.Why is Ms. Pealot not started on insulin? 2.2. What hormonal irregularity causes diabetes insipidus? 3. What can cause diabetes insipidus? 4. Besides polyuria & polydipsia, what other clinical manifestations would you expect?

35 5. What dx tests would confirm the dx of diabetes insipidus? 6. What nrs. dx would best apply to Ms. Pealot? 7. What nrs. interventions would you implement? 8. What doctors order would you expect to see?

36 Pituitary Tumors Definitions – Anterior Pit. Clinical Manifestations – H/A – Visual problems – Personality changes – Dementation – S&S of hypopituitarism

37 Pituitary Tumors Medical treatment – Remove tumor – Radiation – Cryohypophysectomy Rx – Hormone replacement


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