Endocrine

1. Endocrine Day 5-1 Pituitary Gland

2. Hypothalamus Description Attached to pituitary gland Infundibulum Brain Diencephalon

3. Hypothalamus Function Stimulate the pituitary to secrete its hormones

4. Pituitary Description �Master gland� Why? 9 hormones These 9 hormones influence many other endocrine glands and body systemsThese 9 hormones influence many other endocrine glands and body systems

5. Pituitary Description Size � pea Anterior lobe Adenohypophysis 7 hormones Posterior lobe Neurohypophysis 2 hormones

6. 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

7. Thyroid-stimulating Hormone Function Stim. thyroid growth Stim. secretion of thyroid hormones Stimulated by: Hypothalamus i T3 / T4 i Metabolism Cold temps Stress

8. Adrenocorticotropic Hormone (ACTH) Function Stim. adrenal cortex growth Stim. secretion of glucocorticoids Stimulated by: Hypothalamus Stress Hypoglycemia i glucocorticoids

9. Follicle-Stimulating Hormone (FSH) Function Gonadotropin Female Stimulated ovaries to mature Estrogen production Male Stim. Sperm production

10. Luteinizing Hormone (LH) Function Gonadotropin Female Stim. Ovulation Male Stim. testes to produce testosterone

11. Melanocyte-stimulating Hormone (MSH) Function h melanin

12. 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

13. Prolacting / Lactogenic Hormone Function Stim. breast development during pg Milk secretion p delivery

14. Posterior Pituitary Hormones Anti-diuretic Hormone (ADH) A.K.A: Vasopressin Oxytocin

15. 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

16. Oxytocin Function Stim. Uterine contractions Breast to release milk

17. Small Group Questions Are Gonadotropins? Cause increase synthesis of melanin? Cause ovulation? Cause water retention? In high levels causes increased BP?

18. Small Group Questions Increase protein synthesis? Increased metabolism of fatty acids for energy? Is also called vasopressin? Is also known as somatotropin? Is an insulin antagonist?

19. Small Group Questions 11. Secreted in response to cold temp and stress? Secreted in response to decreased BP? Secreted in response to decreased somatotropin? Secreted in response to hypoglycemia? Secreted in response to increased plasma osmolality?

20. Small Group Questions 16. Secreted in response to decreased glucocorticoids? Stim. Ovaries to mature and produce estrogen? Stim. sperm production? Stim adrenal cortex growth? Stim. breast development?

21. 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

22. Hyperpituitarism Definition h secretion of pituitary hormones Etiology Usually 20-40 yrs Tumor Usually GH or ADH

23. Hyperpituitarism Growth hormone Excess Affects Depends on age Epiphyses Epiphyses open (young) Gigantism

24. Gigantism Definition h GH before epiphyses closed Etiology Hyperplasia of anterior pituitary h in number of cells Can ? tumor

25. Gigantism Clinical manifestations Onset Infants / children > 8 feet Proportional overall growth Do not have strength that size implies

26. Gigantism Medical treatment Irradiation of anterior pituitary Removal of pit via surgery

27. Gigantism High Risk for: Heart failure Hypertension Thickened bones Osteoporosis Delayed sexual development

28. Gigantism Pharmacology IF pituitary is destroyed or removed Replace pituitary hormones

29. Gigantism Nursing interventions Listen Growth chart measurements Long beds

30. Hyperpituitarism Growth hormone Increased production Affects Depends on age Epiphyses Epiphyses closed (adult) Acromegaly

31. Acromegaly Definition h GH after epiphyses have closed Etiology 30-50 yrs Hyperplasia Tumor

32. Acromegaly Clinical S&S Gradual onset Hypertrophy Increase in volume of tissue d/t enlargement of existing cells �hulking� Enlarge jaw Thick tongue

33. Acromegaly Clinical S&S Tufted Thick fingers with tips like arrowheads

34. Acromegaly S&S Moist, weak, doughy handshake Heart, liver spleen enlarged Diaphoresis Oily, leathery skin Laryngeal hypertrophy

35. Acromegaly S&S Heat intolerance Weight gain Joint pain Hirsutism Excessive hairiness i libido Impotence Oligomenorrhea Infertility

36. Acromegaly: Medical Tx Diagnosis Hx S&S X-ray CT scan Lab h GH

37. Acromegaly: Medical Tx Prognosis ?? Cause i Life span DM ??? ?GH ? h Glucose levels ? h Insulin ? Stress pancreas ? DM type 2

38. Acromegaly: Medical Tx options Radiation Medication Surgery

39. Transsphenoid hypophysectomy Post-op care Nasal packing Check for drainage S&S infection Nuchal rigidity Pain control NO Coughing Straining Vomiting Sneezing

40. Transsphenoid hypophysectomy Post-op care Incentive spirometer No brush teeth x 2wks No lifting x 3 months

41. Acromegaly: Rx Bromocriptine mesylate (Parlodel) Action Inhibits GH (and prolactin) Nrs considerations Give c food S/E Drowsiness Stim. ovulation

42. Acromegaly: Nrs interventions HX S&S Glucose Gait changes Vital sign changes Jaw changes ? dysphagia

43. Which of the following statements about acromegaly is not true? Most cases are due to GH hypersecretion The diagnosis is usually obvious Patients may experience a gradual change in their voice Enlarged hands and feet are typical

44. All these comorbidities are common with acromegaly, except: Sleep apnea Insulin resistance Obesity Biventricular hypertrophy

45. Which of these treatments is best for a 35-year-old patient with a small pituitary adenoma? Octreotide Radiation Surgery Bromocriptine

46. Small group questions What hormonal disturbance causes acromegaly? 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?

47. 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?