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Critical Care > Pituitary Dysfunction > Flashcards

Pituitary Dysfunction Flashcards

1
Q

Which physiologic functions do hormones regulate?

A

Energy production
Temperature regulation
Fluid and electrolyte balance
Stress response
Sexual development

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2
Q

Which organs rely on the hormones secreted by the pituitary gland?

A

Parathyroids
Thyroid
Adrenals
Pancreas
Testes
Ovaries

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3
Q

Hormones produced in the anterior pituitary

A

*TSH (thyroid stimulating hormone)
*ACTH (adrenal corticotropic)
LH
FSH
PRL
*GH (growth hormone)
MSH

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4
Q

Hormones produced by the posterior pituitary

A

*Vasopressin (ADH)
Oxytocin

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5
Q

How is hormone secretion in the pituitary gland regulated?

A

Endo and neuro systems work together to regulate hormone balance through negative feedback mechanism:
Decreased hormone levels stimulate production
Increased hormone levels inhibit production

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6
Q

Etiology of hypopituitarism

A

Hypophysectomy (removal of pituitary gland)
Pituitary tumors
Severe malnutrition (anorexia nervosa)
Shock or severe hypotension (Sheehan’s syndrome)

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7
Q

S/S of hypopituitarism

A

Secondary adrenocortical insufficiency
Hypothyroidism
Deficient growth hormone
Sexual and reproductive disorders:
Men: decreased facial/body hair, libido, impotence
Women: decreased pubic/axillary hair, libido, breast atrophy

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8
Q

Diagnostics for hypopituitarism

A

CT scan / MRI to look for tumor
Draw hormone levels (one will be very low while other likely not as low)

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9
Q

Interventions for hypopituitarism

A

Medical: remove cause, replace hormones
Nursing: assessment of organs involved
Patient problems: body image disturbance, sexual dysfunction, ineffective individual coping

*Removal of pituitary gland = lifelong hormone replacement

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10
Q

Two types of hyperpituitarism

A

Gigantism
Acromegaly

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11
Q

What is gigantism?

A

Excess GH in children, resulting in overgrowth of long bones

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12
Q

What is acromegaly?

A

Excess GH in adults, resulting in increased bone thickness and hypertrophy of soft tissue

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13
Q

Causes of hyperpituitarism

A

Benign pituitary adenoma (GH secreting tumor)
Prolactinomas (form of pituitary tumor)
ACTH secreting tumor
Tumors secreting gonadotropin or TSH

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14
Q

Effects of hyperpituitarism

A

Rapid growth of all body tissue
Full blown DM (from over-secretion of ACTH)
Destruction of pituitary causing hypopituitarism (tumor encroaches on gland and ruins it)
Pressure on optic nerve causing blindness

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15
Q

S/S of hyperpituitarism

A

Headaches
Diplopia/blindness
Goiter
Enlargement of organs
*Broad hands and feet
*Increased ring and shoe size
Thickening of skull
*Protruding of supraorbital ridges
*Coarse facial features
*Prognathism
Arthritic changes
DM
Enlarged, but weak skeletal muscles
Lethargy/fatigue
*Deepening voice
Thickened heel pads

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16
Q

Diagnostics for hyperpituitarism

A

Plasma hormone levels
CT scan
MRI
Angiography

17
Q

Patient problems for hyperpituitarism

A

*Body image disturbance r/t altered physical appearance
Sexual dysfunction r/t loss of libido, infertility, impotence

18
Q

Interventions for hyperpituitarism

A

*Surgery = #1 tx
Medication therapy
Radiation therapy

19
Q

What is the surgery for hyperpituitarism?

A

Transsphenoidal hypophysectomy

Incision in upper lip with long scissors to cut out pituitary gland. Pt will be on hormone replacement for life

20
Q

Where is ADH produced?

A

Hypothalamus and stored in/released from posterior pituitary gland

21
Q

Function of ADH

A

AKA vasopressin
Acts of renal collecting tubules and results in water reabsorption

22
Q

Disorders associated with ADH

A

Diabetes insipidus
SIADH

23
Q

What is diabetes insipidus?

A

Deficiency in synthesis or release of ADH
Excess water losses

24
Q

Two types of DI and what causes each?

A

Neurogenic: ADH deficiency
Nephrogenic: kidneys insensitive to ADH (can’t respond to it)

25
Q

What causes neurogenic DI?

A

Trauma to pituitary or hypothalamus (to head/brain)
Ex: craniotomy sometimes causes acute DI, will go away after swelling goes down

26
Q

What causes nephrogenic DI?

A

Chronic renal disease
Drugs (alcohol, phenytoin, lithium)

27
Q

*S/S of DI
Major concern?

A

Clinical picture of DEHYDRATION:
Polyuria: 5-40L per 24 hr
Urine pale and dilute
*Hypovolemia/shock = major concern
Dehydration:
- thirst
- constipation
- thick secretions

28
Q

Diagnostics of DI

A

Serum osmolality >295 mOm/kg of water
*Serum Na >145 mEq/L
Dilute urine with decreased specific gravity and osmolality <100

29
Q

Main issues with DI that need to be treated

A

Dehydration
Hormone deficiency

30
Q

Treatment for DI

A
  • First: replace fluid that is lost (primarily water) so need to replace with D5W (added sugar is scooped up by cells if enough insulin and water is left)
    BUT: if pt is shocky, will use NS instead
  • Next: ADH (aka vasopressin) replacement (if neurogenic)
    Can be given SQ, IV, nasal spray, but usually IV in c.c.

Note: watch for fluid overload (*JVD)

31
Q

Side effects of vasopressin administration

A

HA
Nausea
Mild abdominal cramps

32
Q

Patho of SIADH

A

Excess ADH unrelated to plasma osmolality
Due to failure in negative feedback mechanism

Leads to plasma hypoosmolality which leads to fluid retention and ascites

33
Q

What can cause SIADH?

A

Malignancy (ex: NSCLC b/c these cells release ADH)
Pulmonary disorders (TB, COPD, pneumonia)
CNS trauma, tumors
Drugs (if you suspect SIADH and can’t find another cause, need to look at pt’s drugs)

34
Q

S/S of SIADH

A

*Will have clinical picture of water intoxication aka fluid volume overload:

CV: *weight gain, HTN, RAP>10, PCWP>12
*Edema
Neuro: decreased LOC, HA, seizures, coma
Renal: *dark urine, *decreased UOP
GI: N/V/A, decreased bowel sounds, muscle cramps
Respiratory: tachypnea, dyspnea, *frothy pink sputum

35
Q

Lab values for SIADH

A

Decreased serum osmolality
Increased urine osmolality

*Serum NA: <135
*Serum osmolality: <275 mOsm/Kg H2O
Serum ADH: elevated
Urine Na: >20 mEq/L

36
Q

*SIADH interventions and nursing care

A

*Fluid restriction (800-1000 mL/day)
*Diet liberal in sodium
*then, if serum Na <110 mEq/L, hypertonic saline and diuretics (Lasix) (need to react fast b/c water is pulled from tissues and cells)

Intake and output
Specific gravity
Weights
Mouth care

37
Q

How should a nurse develop a schedule for fluid administration for a pt being treated for SIADH?

A

Develop schedule for 800 mL/day restriction (this is less than 2 quarts)
Know how many mL are allowed for AM shift and PM shift, document and post this so everyone can see

38
Q

What changes might need to be made regarding med administration for a pt being treated for SIADH?

A

May need to switch from IV to tube administration of meds due to fluid restriction

39
Q

How can you ensure that at pt being treated for SIADH doesn’t ingest additional fluids?

A

Good education for patient and family about how important fluid restriction is
Post fluid restriction guidelines for that pt where everyone can see

Critical Care (35 decks)

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