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PITUITARY GLAND

PITUITARY GLAND. Where is it located??? Name its’ 3 parts or sections. What hormones are secreted by the pituitary gland???. Pituitary Gland. Anterior Pituitary (adenohypophysis). SECRETES 6+ HORMONES: ACTH (adrenocorticotropic hormone) aka (corticotrphin)

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PITUITARY GLAND

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  1. PITUITARY GLAND • Where is it located??? • Name its’ 3 parts or sections. • What hormones are secreted by the pituitary gland???

  2. Pituitary Gland

  3. Anterior Pituitary(adenohypophysis) • SECRETES 6+ HORMONES: • ACTH (adrenocorticotropic hormone) • aka (corticotrphin) release of cortisol in adrenal glands • TSH (thyroid stimulating hormone) • aka (thyrotropin) release of T3 & T4 in thyroid gland • GH (growth hormone) • aka (somatotropin) stimulates growth of bone/tissue

  4. ANTERIOR PITUITARY(adenohypophysis) • FSH (follicle stimulating hormone) stimulates growth of ovarian follicles & spermatogenesis in males • LH (lutenizing hormone) regulates growth of gonads & reproductive activities • Prolactin • aka (luteotropin/mammotropin) promotes mammary gland growth and milk secretion

  5. Positive vs Negative Feedback Mechanisms • Give some examples of • Negative • Positive

  6. Anterior HYPERpituitary Disorders • ETIOLOGY • Primary: the defect is in the gland itself which releases that particular hormone that is too much or too little. • Example: • Secondary: defect is somewhere outside of gland i.e. GHRH from hypothalamus TRH from hypothalamus

  7. Pituitary Tumors • 10% OF ALL BRAIN TUMORS • What are the diagnostic tests to diagnose a pituitary tumor? • Tumors usually cause hyper release of hormones (Recall all hormones)

  8. Anterior HYPERpituitary Disorders • What would happen if you had TOO MUCH secretion of prolactin? • Too much release of Lutenizing Hormone (LH)?

  9. Anterior PituitaryHYPERfunctioning • What would happen if you had too much growth hormone secretion???

  10. 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, HTN, wt. gain, H/A, visual disturbances, diabetes mellitus, enlargement of the heart and liver

  11. GIGANTISM IN CHILDREN • ACROMEGALY IN ADULTS

  12. What assessment findings would the nurse document?

  13. Medical Interventions for Pituitary Tumors • Medications • *Parlodel (bromocriptine) to ________ & GH levels. • Radiation therapy • external radiation will bring down GH levels 80% of time

  14. *Neurosurgery: • procedure called “transsphenoidal hypophysectomy” • Most common method: incision is made thru floor of nose into the sella turcica.

  15. Transsphenoidal Hypophysectomy

  16. Nursing Management &Nursing Diagnosis • Pre op hypophysectomy • Anxiety r/t • body changes • fear of unknown • brain involvement • chronic condition with life long care

  17. Nursing Management &Nursing Diagnosis • Sensory-perceptual alteration r/t visual field cuts • diplopia • secondary to pressure on optic nerve. • Alteration in comfort (headache) r/t tumor growth/edema

  18. Nursing Management &Nursing Diagnosis • Knowledge deficit r/t post-op teaching • pain control • ambulation • hormone replacement • activity

  19. Incisional disruption after transsphenoidal hypophysectomy Avoid bending and straining X 2 months post transsphenoidal hypophysectomy, Use stool softeners Avoid coughing Saline mouth rinses No toothbrushes for 7-10 days

  20. Post-op CSF Leak where sella turcica was entered any clear rhinorrhea - test for glucose + glucose = CSF Leak Notify physician HOB 30 degrees Bedrest

  21. Post op problems cont. Periocular edema/ecchymosis Headaches Visual field cuts/diplopia Meningitis

  22. Post operative care Post-op complications of hormone deficiency: What would happen if you didn’t have enough ADH? What is that disorder called?

  23. Other deficiency: • Decrease ACTH will require cortisone replacement due to decrease glucocorticoid production. • Can you live without glucocorticoids????

  24. Other deficiency: • in sex hormones can lead to infertility due to decreased production of ova & sperm • What were those hormones called again?

  25. Anterior PituitaryHYPOfunction • Etiology (rare disorder) may be due to disease, tumor, or destruction/removal of the gland. • Diagnostic tests • CT Scan • Serum hormone levels

  26. S & S Anterior Pituitary HYPOfunctioning • GH • FSH/LH • Prolactin • ACTH • TSH

  27. Medical Management • neurosurgery -- removal of tumor • radiation - tumor size • hormone replacement • cortisol, thyroid, sex hormones

  28. 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

  29. Posterior Pituitary(Neurohypophysis) What hormones are released by the posterior pituitary? _____ & _____are released when signaled by hypothalamus

  30. ADH (Vasopressin/AVP) • 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?

  31. Normal Lab Values r/t ADH • Serum osmolality 285-295mOsm/L • Serum Na 135-145mEq/L • Urine Specific Gravity 1.010-1.025 some texts 1.020-1.030 • Urine Osmolality 500-800mOsm • Urine Na 15-240mEq/L/day

  32. Bonus Round... • ADH has vasoconstrictive or vasodilation action??? • Under what conditions is ADH released?

  33. http://www.cvphysiology.com

  34. Oxytocin • Controls lactation & stimulates uterine contractions • ‘Cuddle hormone’Research links oxytocin and socio-sexual behaviors

  35. Posterior HYPERpituitary Disorders • SIADH (TOO MUCH ADH!!) • small cell lung cancer, Ca duodenum/pancreas, trauma, pulmonary disease, CNS disorders • drugs -- Vincristine, nicotine, general anesthetics, tricyclic antidepressants

  36. Think tank: • If you have increased ADH secretion... What would the clinical signs/symptoms be?

  37. Clinical manifestations-SIADH • Weight gain or weight loss? • or urine output? • or serum Na levels? • thirst • weakness • muscle cramps • H/A • Diarrhea

  38. If hyponatremia worsens development of neurological manifestations: LATE signs • lethargy • decrease tendon reflexes • abdominal cramping, vomitting • coma • seizures

  39. Diagnostic Tests-SIADH • Serum Na+ <134meq/l • Serum osmolality <280 OSM/kg H2O • urine specific gravity >1.005 • or normal BUN

  40. Medical Treatment • ***FLUID RESTRICTION • Stop drugs causing issue • LIMIT TO 1000ML/24HRS • may be as little as 500-600ml/24hrs • IF CHF -- Lasix (temporary fix) • What do watch for? • Treat underlying problem • Chemo, radiation • demeclocycline (Declomycin) & Lithium • 600 po-1200mg/day to inhibit ADH

  41. Nursing Interventions-SIADH • Fluid restriction • Daily weights • 1 lb. weight = 500ml fluid retention • Accurate I & Os

  42. Nursing Management-SIADH • F & E imbalances • fluid intake • High risk for injury r/t complications of fluid overload (seizures)

  43. Posterior HYPOpituitaryADH Disorders Diabetes Insipidus (too little ADH)

  44. Etiology of DI • 50% idiopathic • Central (aka. neurogenic) • usually occurs suddenly • head trauma, brain tumors, infection • Nephrogenic • inability of tubules to respond to ADH • drug therapy, renal damage, heredity

  45. Clinical Manifestations-DI • Polydipsia • Polyuria (10L in 24 hours) • Severe fluid volume deficit • wt loss • tachycardia • constipation • Shock

  46. Diagnostic Tests-DI • or urine specific gravity orserum Na orserum osmolality

  47. Diagnostic Tests - DI Water deprivation test Urine output >4000ml/24hr ----- fluid restrict at start of test <4000ml/24hr ---- fluid restrict at midnight Baseline weight, HR & BP Labs? Hold fluids for 6hrs (usually 6am-12noon) Hourly urine monitoring for urine SG, osmolality & volume Draw sample for plasma osmolality when urine osmolality increases <30mOsm/kg When plasma osmolaity is >288mOsm/kg, pt is deydrated --- admin vasopressin 5 units of Vasopressin (ADH) Subq Obtain urine osmolality 30-60minutes after injection Discontinue test if pt weight drops >2kg at any time

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