Endocrine Pituitary gland 5-2

Hyperpituitarism What two hormones are affected with hyperpituitarism? GH ADH

Hyperpituitarism hGH h ADH Adult Child Acromegaly Child Gigantism h ADH Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Definition Excess ADH What does ADH do? Causes kidneys to reabsorb water  i urine output  h fluid volume

SIADH - Etiology #1 Lung CA Other CA COPD

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

SIADH: S&S Hyponatremia Serum Osmolality < 130 Normal 135-145 meq/dl Muscle cramps Weakness Serum Osmolality Decreased Blood leaks into brain  Brain swelling  Lethargy, seizures, coma Deathmosis

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

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)

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

SIADH: Nrs. Dx Fluid Volume Excess

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

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

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

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

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

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

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

Hypopituitarism: Prolactin S&S (i prolactin) Absent postpartum lactation

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

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

Hypopituitarism: ADH Dx: Definition Diabetes Insipidus i ADH Vasopressin

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

Hypopituitarism: Diabetes Insipidus Clinical manifestations Polyuria Sp. gravity of urine i Serum osmolality h Na+ levels Hypernatremia > 145

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

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

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

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

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

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

Hypopituitarism: Diabetes Insipidus Nrs. Dx Fluid Volume Deficit Nursing interventions I&O P Electrolytes h Na+ intake VS

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?

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?

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?

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?

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

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