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)
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
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
ANTERIOR PITUITARY
(adenohypophysis) 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: Cushings
Secondary: defect is somewhere outside
of gland
i.e. GHRH from hypothalamus
TRH from hypothalamus
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)
Anterior HYPERpituitary
Disorders
What would happen if you had TOO
MUCH secretion of prolactin?
Too much release of Lutenizing
Hormone (LH)?
Anterior Pituitary
HYPERfunctioning
What would happen if you had too
much growth hormone secretion???
Which goolish character on the
Addams Family may have had too
much GH secretion?
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, diabetes, HTN, wt. gain, H/A,
Visual disturbances, diabetes mellitus
GIGANTISM IN CHILDREN
ACROMEGALY IN ADULTS
What assessment findings would the nurse
document?
What assessment findings would the nurse
document?
Medical Interventions
for Pituitary Tumors
Medications
*Parlodel (bromocriptine) to
________ & GH levels.
Radiation therapy
external radiation will bring down GH
levels 80% of time
*Neurosurgery:
procedure called transsphenoidal
hypophysectomy; New Method
Most common method: incision is
made thru floor of nose into the
sella turcica.
Transsphenoidal
Hypophysectomy
Nursing Management &
Nursing Diagnosis
Pre op hypophysectomy
Anxiety r/t
body changes
fear of unknown
brain involvement
chronic condition with life long care
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
Nursing Management &
Nursing Diagnosis
Knowledge deficit r/t post-op teaching
pain control
ambulation
hormone replacement
activity
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
Post-op CSF Leak where sella
turcica was entered
any clear rhinorrhea - test for glucose
+ glucose = CSF Leak
Notify physician
HOB 30 degrees
Bedrest
Post op problems cont.
Periocular edema/ecchymosis
Headaches
Visual field cuts/diplopia
Post operative care
Post-op complications of hormone
deficiency:
What would happen if you didnt have
enough ADH?
What is that disorder called?
Other deficiency:
Decrease ACTH will require cortisone
replacement due to decrease
glucocorticoid production.
Can you live without
glucocorticoids????
Other deficiency:
in sex hormones can lead to
infertility due to decreased production
of ova & sperm
What were those hormones called
again?
Anterior Pituitary
HYPOfunction
Etiology (rare disorder) may be due to
disease, tumor, or destruction/removal of
the gland.
Diagnostic tests
CT Scan
Serum hormone levels
S & S Anterior Pituitary
HYPOfunctioning
GH
FSH/LH
Prolactin
ACTH
TSH
Medical Management
neurosurgery -- removal of tumor
radiation - tumor size
hormone replacement
cortisol, thyroid, sex hormones
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
Posterior Pituitary
(Neurohypophysis)
What hormones are released by the
posterior pituitary?
_____ & _____are released when
signaled by hypothalamus
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?
Bonus Round...
Under what conditions is ADH
released?
ADH has vasoconstrictive or
vasodilation action???
http://www.cvphysiology.com
Oxytocin
Controls lactation & stimulates uterine
contractions
Cuddle hormone
Research links oxytocin and socio-sexual
behaviors
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
Think tank:
If you have increased ADH secretion...
What would the clinical signs/symptoms
be?
Clinical manifestations-SIADH
Weight gain or weight loss?
or urine output?
or serum Na levels?
thirst
weakness
muscle cramps
H/A
Diarrhea
If hyponatremia worsens
development of neurological
manifestations
lethargy
decrease tendon reflexes
abdominal cramping, vomitting
coma
seizures
Diagnostic Tests-SIADH
Serum Na+ <134meq/l
Serum osmolality <280 OSM/kg H2O
urine specific gravity >1.005
or normal BUN
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
Nursing Interventions-SIADH
Fluid restriction
Daily weights
1 lb. weight = 500ml fluid retention
Accurate I & Os
Nursing Management-SIADH
F & E imbalances
fluid intake
High risk for injury r/t complications of
fluid overload (seizures)
Posterior HYPOpituitary
ADH Disorders
Diabetes Insipidus
(too little ADH)
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
Psychogenic
what is this?
Clinical Manifestations-DI
Polydipsia
Polyuria (10L in 24 hours)
Severe fluid volume deficit
wt loss
tachycardia
constipation
Shock
Diagnostic Tests-DI
or urine specific gravity
or serum Na
or serum osmolality
Diagnostic Tests - DI
Water deprivation test
Baseline weight, HR & BP
Labs?
Hold fluids for 8-16hrs
What is risk?
Dehydration test
2 units of Vasopressin (ADH) mixed in saline
administered over 2 hrs then check urine
osmolality levels
Medical Management-DI
Identification of etiology, H & P
Tx of underlying problem
Central
IV fluids?
DDAVP (oral, IV, nasal spray)
Pitressin s.c. IM, nasal spray
Chlorpropamide
Nephrogenic
Nursing Management-DI
Assess for F & E imbalances
High risk for sleep disturbances
Increase po/IV fluids
RF Injury (hypovolemic shock)
Knowledge deficit
High risk for ineffective coping