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Endocrine Pituitary gland 5-2.

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Presentation on theme: "Endocrine Pituitary gland 5-2."— Presentation transcript:

1 Endocrine Pituitary gland 5-2

2 Hyperpituitarism What two hormones are affected with hyperpituitarism?

3 Hyperpituitarism hGH h ADH Adult Child
Acromegaly Child Gigantism h 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  i urine output  h fluid volume

5 SIADH - Etiology #1 Lung CA Other CA COPD

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

7 SIADH: S&S Hyponatremia Serum Osmolality < 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 Radiation Chemotherapy

9 SIADH: Rx Furosemide (Lasix) Action Nrs consideration Enhance diuresis
P Fluid & electrolyte panels I&O VS q day wt Need to know both names (generic and trade)

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

11 SIADH: Nrs. Dx Fluid Volume Excess

12 Hypopituitarism Definition Etiology i secretion of pituitary hormones
#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 Secondary Trouble w/ the Pituitary 
i Pituitary hormone Secondary Trouble somewhere else (not pituitary)  i pituitary hormone Usually hypothalmus

15 Hypopituitarism: Growth hormone
Dx: Dwarfism S&S (i 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 i libido Breast atrophy Male Weakness Impotence i libido Testicles soften & shrink

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

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

19 Hypopituitarism: Prolactin
S&S (i 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 i libido Cold intolerance Tx Administration of all Pit. hormones

22 Hypopituitarism: ADH Dx: Definition Diabetes Insipidus i ADH

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 i Serum osmolality h 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 P Electrolytes h Na+ intake VS

32 Mrs. Waterfall What would the name of this disorder be?
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 Why is Ms. Pealot not started on insulin?
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 Clinical Manifestations Anterior Pit. H/A
Visual problems Personality changes Dementation S&S of hypopituitarism

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

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