PITUITARY GLAND

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PITUITARY GLAND

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

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Pituitary Gland
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ANTERIOR PITUITARY

• SECRETES 6 HORMONES
• ACTH (adrenocorticotropic hormone)
• release of cortisol in adrenal glands
• TSH (thyroid stimulating hormone)
• release of T3 T4 in thyroid gland
• GH (growth hormone)
• stimulates growth of bone/tissue

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• FSH (follicle stimulating hormone)
• stimulates growth of ovarian follicles
  spermatogenesis in males
• LH (lutenizing hormone)
• regulates growth of gonads reproductive
  activities
• Prolactin
• promotes mammary gland growth and milk
  secretion

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ANTERIOR HYPER PITUITARY DISORDERS

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

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ANTERIOR HYPER PITUITARY DISORDERS

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

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PITUITARY TUMORS

• 10 OF ALL BRAIN TUMORS
• What are the diagnostic tests to diagnose a
  pituitary tumor?
• tumors usually cause hyper release of hormones

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ANTERIOR PITUITARY-HYPERfunctioning Sing along

• 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?

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TOO MUCH GROWTH HORMONE

• GIGANTISM IN CHILDREN
• skeletal growth may grow
• up to 8 ft. tall and gt 300 lbs
• ACROMEGALY IN ADULTS
• enlarged feet/hands, thickening of bones,
  prognathism, diabetes, HTN , wt. gain, H/A,
• Visual disturbances, diabetes mellitus

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• GIGANTISM IN CHILDREN
• ACROMEGALY IN ADULTS

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What assessment findings would the nurse document?
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What assessment findings would the nurse document?
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MEDICAL INTERVENTIONS FOR PITUITARY TUMOR

• Medications
• Parlodel (bromocriptine) to
• ________ GH levels.
• Radiation therapy
• external radiation will bring down GH levels 80
  of time

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Transsphenoidal Hypophysectomy
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• Neurosurgery
• procedure called transsphenoidal
  hypophysectomy New Method
• Most common method incision is made thru floor
  of nose into the sella turcica.

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Nursing Management

• Pre op hypophysectomy
• Anxiety r/t
• a. body changes
• b. fear of unknown
• c. brain involvement
• d. chronic condition with life long care
• Sharmyn

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

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Knowledge deficit r/t

• Post-op teaching
• pain control
• ambulation
• hormone replacement
• activity

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Post operative care

• Post-op complications of hormone insufficiency
• What would happen if you didnt have enough ADH?
• What is that disorder called?

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Other insuffciency

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

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Other deficiency

• in sex hormones can lead to infertility due
  to decrease production of ova sperm
• What were those hormones called again?-

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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

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Post-op CSF Leak where sella turcica was entered

• any clear rhinorrhea - test for glucose
• glucose CSF Leak
• Notify physician
• HOB 30 degrees
• Bedrest

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• CSF leak usually resolves within 72 hrs.
• If not - spinal taps done to decrease pressure

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Post op problems cont.

• Periocular edema/ecchymosis
• Headaches
• Visual field cuts/diplopia
• What is the most important nursing intervention
  for these problems????

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ANTERIOR PITUITARY-Hypofunction

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

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S S Anterior Pituitary Hypofunctioning

• GH
• FSH/LH
• Prolactin
• ACTH
• TSH

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Medical Management

• neurosurgery -- removal of tumor
• radiation - tumor size
• hormone replacement
• cortisol, thyroid, sex hormones

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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

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Posterior Pituitary(Neurohypophysis)

• Question??? What hormones are released by the
  posterior pituitary? _____ _____are released
  when signaled by hypothalamus

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ADH (Vasopressin)

• 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?

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Bonus Round...

• Under what conditions is ADH released???
• ADH has vasoconstrictive or vasodilation action???

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ANSWERS

• released in response to decrease blood volume,
  increase concentration of Na or other
  substances, pain, stress
• ADH has vasocontrictive properties

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Oxytocin

• Controls lactation stimulates uterine
  contractions
• Cuddle hormoneResearch links oxytocin and
  socio-sexual behaviors
  

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Posterior Hyper pituitary Disorders

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

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Think tank

• If you are having too much ADH... What would the
  clinical signs/symptoms be??

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Clinical manifestations-SIADH

• Weight gain or weight loss?
• or urine output?
• or serum Na levels?
• weakness
• muscle cramps
• H/A
• Diarrhea

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If hyponatremia worsens will develop neuro
manifestations

• lethargy
• decrease tendon reflexes
• seizures

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Diagnostic Tests-SIADH

• Serum Na lt135meq/l
• Serum osmolality lt275 OSM/kg H2O
• urine specific gravity
• or normal BUN

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Medical Treatment

• FLUID RESTRICTION
• LIMIT TO 1000ML/24HRS
• IV 3 NaCl to replace Na
• IF CHF -- Lasix (temporary fix)
• Treat underlying problem --Chemo, radiation
• Declomycin 600 po-1200mg/day
• to inhibit ADH

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Nursing Interventions-SIADH

• Fluid restriction may be as little as
  500-600ml/24hrs
• Daily weights...
• 1 lb. weight 500ml fluid retention
• Accurate I Os

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Nursing Management-SIADH

• F E imbalances
• fluid intake
• High risk for injury r/t complications of fluid
  overload (seizures)

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Posterior HypopituitaryADH disorders

• Diabetes Insipidus
• (too little ADH)
• What do you think the SS would be if you had too
  little ADH???

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Etiology

• 50 idiopathic
• a. central -- i.e. brain tumors
• b. nephrogenic - inability of tubules to respond
  to ADH

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Clinical Manifestations-DI

• Polydipsia
• Polyuria (10L in 24 hours)
• Severe fluid volume deficit
• wt loss
• tachycardia
• constipation
• shock

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Diagnostic Tests-DI

• or urine specific gravity
• or serum Na
• or serum osmolality
• Dehydration test
• 2 units of Vasopressin (ADH) mixed in saline
  administered over 2 hrs then check urine
  osmolality levels

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Medical Management-DI

• Identification of etiology, H P
• Tx of underlying problem
• DDAVP (nasal spray)
• Pitressin s.c. IM, nasal spray

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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