hypothalamus/pituitary glands and disorders Flashcards
what does the hypothalamus do
- regulates secretion of both anterior and posterior pituitary hormones
- synthesizes oxytocin and ADH and transports these hormones to posterior pituitary for storage
what are the two pathways from the hypothalamus to the pituitary
- neural stalk: path to the posterior pituitary
- pituitary portal blood syatem pathway: uses blood flow from hypothalamus to get to the anterior pituitary
what are the three distinct sections of the pituitary
- anterior (adenohypophysis)
- posterior (neurohypophysis)
- pars intermedia (little dividing wall, kinda useless)
what are the anterior hormones
- follicle stimulating hormone (FSH)
- luteinizing hormone (LH)
- prolactin (PRL)
- adrenocorticotropic hormone (ACTH)
- thyroid stimulating hormone (TSH)
- growth hormone (GH)
what are the posterior pituitary hormones
- vasopressin (ADH)
- oxytocin
are pituitary tumors slow growing or speedy fast growing
slow growing and benign
whats the difference between primary and secondary pituitary tumors
primary: actual gland affected
secondary: something else is causing it
whats the difference between a functional and nonfunctional pituitary tumor
functional: things work as normal with sx
nonfunctional: shutting off or an excess of hormones
what are some clinical manifestations of pituitary tumors
HA, vision changes, endocrine disorders, change in LOC
describe assessment and diagnostic findings for pituitary tumors
- energy level changes, GI issues, strength, skin/hair changes, visual acuity
- CT, MRI to show tumor
- check hormone levels
whats used for medical management of pituitary tumors
surgery -> anterior or posterior or both
describe hypophosectomy
- done transsphenoidally
- nose packed after for three days: watch drainage and test for sugar (indicates CSF leak)
- keep HOB elevated, monitor neuro status, BP, and sugar
- have to replace cortisol and TH, especially if anterior pituitary taken out
- monitor for diabetes insipidus
- deep breathe hourly but dont cough bc you can disturb incision
- gentle oral care
- monitor for sx of meningitis (stiff neck, HA, photophobia)
describe the etiology and pathophysiology of hypopituitarism
- deficient secretion of GH, TSH, FSH, LF, and ACTH
- complication of radiation therapy
- tumor, congenital defects, pituitary ischemia
- 75% of gland dysfunctional before symptoms
what are some therapeutic interventions for hypopituitarism
- cortisol replacement
- thyroid replacement
what are some nursing interventions for hypopituitarism
- monitor for diabetes insipidus
- monitor for gonadal failure and loss of secondary sex organs
name two posterior pituitary disorders
- diabetes insipidus
- SIADH
describe diabetes insipidus
- deficiency of ADH (inability to conserve water)
- hypernatremia, cells like raisin bc its all in the bloodstream
- piss up to 18L/day
- happens a lot w trauma to the head
describe SIADH
- excessive amounts of ADH
- hold on to fluid
- cells swell like a grape
- hyponatremia
describe the etiology and pathophysiology of diabetes insipidus
- neurogenic causes: trauma to head, tumor, herpes encephalitis
- infections of CNS
- nephrogenic: kidneys arent responding to ADH, no concentrating piss, low specific gravity
- drugs can cause it: lithium, hypercalcemia, hypothalamus defects
what are some clinical manifestations of diabetes insipidus
- CV: hypotension, tachycardia, weak peripheral pulses, hemoconcentration (increased H&H and BUN)
- renal: increased UO (>250 ml/hr), dilute urine (low specific gravity - 1.001-1.005)
- integumentary: poor skin turgor, dry mucus membranes
- neuro: polydipsia, craving cold water, signs of dehydration and hypernatremia (irritability, lethargy to coma, ataxia)
whats used in the assessment and diagnostic findings of diabetes insipidus
- fluid deprivation (hold fluids for 8-12 hours)
- 25hr fluid I+O
- decreased plasma levels of ADH
- increased plasma and decreased urine osmolality
- trial of desmopressin and IV fluids
whats used for the medical management of diabetes insipidus
- antidiuretic hormone replacement (DDAVP, pitressin, lipressin)
- if renal cause: indomethacin and aspirin
- treat underlying cause if possible
- give fluids to replace the loss and correct Na+ levels
- increase oral fluids
- chlorpropramide (antidiabetic) and thiazide diuretics (makes piss more concentrated)
whats included in nursing management of diabetes insipidus
- I&O
- weigh daily
- specific gravity of urine
- monitor fluid and electrolyte status
- monitor response to ADH replacement
- educate on proper med techniques (i.e. nasal sprays, injections)
- advise patient to avoid alcohol because it suppresses ADH secretion
- wear medical alert bracelet
what are some causes/risk factors of SIADH
- disorders of lungs (bronchogenic carcinoma, severe pneumonia, pneumothorax)
- CNS disorders (head injuries, hemorrhage, brain surgery/tumor, infection)
- malignant tumors (malignant cells release ADH)
- meds (vincristine, antidepressants, nicotine, thiazide diuretics)
what are some clinical findings associated with SIADH
- HA
- N/V
- diarrhea
- anorexia
- mental sluggishness
- changes in LOC - lethargy
- dminished deep tendon reflexes
- hyponatremia
- weight gain
- VS: increased HR and hypothermia
- increased specific gravity
describe the medical management of SIADH
- treat underlying cause
- fluid restriction
- sodium restriction
- medications like diuretics
whats included in nursing care of SIADH
- I&O
- daily weight
- fluid restriction
- urine and blood chemistries
- monitor neurologic status (high risk for seizures, reduce overstimulation, prevent water intoxication)
- low sodium -> 3% saline -> pulls water from cells to blood to be excreted
