Pituitary Gland Flashcards
1
Q
Anterior Lobe Hormones - Thyroid-Stimulating Hormone (TSH)
A
-
Target Tissue
> Thyroid -
Action
> Stimulate synthesis & release of thyroid hormone (T3 &T4) - Thyrotropin
2
Q
Anterior Lobe Hormones - Adrenocorticotropic Hormone (ACTH)
A
-
Target Tissue
> adrenal cortex -
Action
> stimulates synthesis & release of corticosteroids & adrenocortical growth - Corticotropin
3
Q
Anterior Lobe Hormones - Luteinizing Hormone (LH)
A
-
Target Tissue
> ovary
> testis -
Actions
> stimulates ovulation & progesterone secretion
> stimulates testosterone secretion
4
Q
Anterior Lobe Hormones - Follicle-Stimulating Hormone (FSH)
A
-
Target Tissue
> ovary
> testis -
Actions
> stimulates estrogen secretion & follicle maturation
> stimulates spermatogensis
5
Q
Anterior Lobe Hormones - Prolactin (PRL)
A
-
Target Tissue
> mammary glands -
Action
> stimulates breast milk production
6
Q
Anterior Lobe Hormones - Growth Hormone (GH)
A
-
Target Tissue
> bone & soft tissue -
Action
> promotes growth through lipolysis, protein anabolism, & insulin antagonism
7
Q
Posterior Lobe Hormones - Antidiuretic Hormone (ADH)
A
-
Target Tissue
> kidney -
Action
> promotes water reaborption
8
Q
Posterior Lobe Hormones - Oxytocin
A
-
Target Tissue
> uterus & mammary glands -
Action
> stimulates uterine contractions and ejection of breast milk
9
Q
Pituitary Tumors
A
-
Most common cause of pituitary disorders; 95% are benign
> Pituitary (adenoma) tumors -
2 Types
> Secretory: secrete too much hormones, EX: tumor secretes TSH - hyperthyroidism
> Non-Secretory: cause extra pressure; does not secrete hormones, causes incrd ICP
10
Q
Posterior Pituitary Tumor
A
ADH deficiency or excess
11
Q
Anterior Pituitary - Hypopituitarism
A
-
Deficiency of one or more anterior pituitary hormones results in metabolic problems and sexual dysfunction
> TSH, ASTH, Estrogen, Progesterone - Growth hormone stimualtes liver
12
Q
Anterior Pituitary - Hyperpituiatrism
A
- Hormone oversecretion
-
Neurologic symptoms may occur
> compression of brain tissue (ICP) - Galactorrhea (spontaneous flow of breast milk), amenorrhea (absent menstrual period), and infertility can result
13
Q
Posterior Pituitary - Diabetes Insipidus
A
-
Deficiency of ADH
> excessive diluted urination; manis of dehydration & electrolyte imbalance -
Cause
> genetics
> brain surgery/trauma
> tumors
> renal problems
14
Q
Posterior Pituitary - Diabetes Insipidus: CMs
A
- Excessive thirst
-
Large vols of dilute urine
> avg. 250ml/hr - Low specific gravity (<1.005)
- Hypotension
-
Dehydration
> poor skin turgor, dry/cracked mucus membs - Incrd plasma osmolarity
- Incrd plasma sodium
- Urine output does not dcr when fluid intake dcrs
15
Q
Posterior Pituitary - Diabetes Insipidus: Treatment
A
-
Identify cause
> if genetic, life-long diagnosis
> may go away if due to brain swelling -
Replace Vasopressin (Desmopressin)
> replaces antidiuretic hormone (ADH); dcrs urination
16
Q
Posterior Pituitary - Syndrome of Inappropriate ADH (SIADH)
A
-
Excess ADH
> continues to be released when not needed -
Results in water retention, dilutional hyponatremia
> edema, dcrd serum sodium lvls, & fluid overload
> Sodium Is Always Down! (136-145mEq/L) -
Causes
> cancer/cancer therapy
> resp infections/impairment (pneum)
> cns disorders (stroke, hemorrhage, infection, trauma)
> drugs (SSRIs; -pine & -mide, NSAIDs, opioids)
> neuro surgery
17
Q
Posterior Pituitary - Syndrome of Inappropriate ADH (SIADH): CMs
A
- Neuro impairment
- Sodium < 115mEq/L
> confusion/ change in LOC
> lethargy
> headaches: can progress to dcrd responsiveness, seizures, coma
> hostility
> disorientatioon -
GI disturbances
> loss of appetite
> N/V
18
Q
Posterior Pituitary - Syndrome of Inappropriate ADH (SIADH): Treatment
A
- Treat cause
-
Fluid restriction
> 500-1000mL/24hrs - Diuretics
-
Hypertonic Saline (3%NaCl)
> bring Na lvls up while brining fluid lvl down
> alterations to Na lvls slowly -
Vasopressin receptor antagonists
> Vaptans: Tolvatan or Conivaptan - Provide safe envir’t, neuro checks q2-4
19
Q
Nursing Care for DI & SIADH
A
-
I&Os
> incrd intake equal to output for DI
> dcrd intake for SIADH; monitor for fluid overload -
Daily weights
> concern if more than 2.2lb (1kg) in 1 day - Blood chemistries
-
Electrolytes
> DI: sodium (high), plasma osmolarity (high)
> SIADH: sodium (low)
20
Q
Hyperpituitarism
A
Hormone oversecretion tht occurs w/ anterior pituitary tumors or tissue hyperplasia (tissue over growth)
21
Q
Hypopituitarism
A
Deficiency of 1 or more pituitary hormone
22
Q
Disorders of Anterior Pituitary (AP)
A
-
Gigantism
> growth hormone (GH) hypersecretion before puberty -
Acromegaly
> GH hypersecretion after puberty -
Dwarfism
> hyposecretion of GH
23
Q
Gigantism
A
- Too much GH
- Rare
- Affects height & girth
-
Most common cause:
> pituitary tumor = treatable -
CMs
> headahces
> vision probs
> nausea
> excessive sweating
> weakness
> insomnia
> delayed puberty
> irreg menstrual cycle
24
Q
Acromegaly
A
-
Pituitary adenoma
> benign tumor -
Onset of growth hormone hypersecretion after puberty
> slow pregression, changes unnoticed many yrs before diagnosis - Early detection essential to prevent irreversible enlargement of face, hands, feet
-
Slow Changes
> enlarged tongue, lips, nose, hands, feet, facial bone growth
> organ enlargement
> skeletal changes cannot be reversed
25
Dwarfism
- **Too little GH**
- Supplemental growth hormones if discovered early
- Not all types respond well to growth hormones
26
Anterior Pituitary - Diagnosis
- **H&P**
- **Visual acuity/visual field tests**
- **CT & MRI**
- **Lab**
> pituitary hormones & thyroid gland
- **Measurement of target organ hormones**
27
Anterior Pituitary - Medical Management
- **Remove/destroy tumor**
> surgery
> radiation therapy
- **Replacement hormones required after destruction**
- **Medications**:
> Bromocriptine (Parlodel)
> Octreotide (Sandostatin)
> these inhibit production/release of GH
28
Total Hypophysectomy - Complications
- **Transient DI**
> due to manipulation of posterior pituitary
- **Cerebral Spinal Fluid (CSF) leakage**
> observe for clear fluid from nose, halo sign
- **Also monitor for**:
> visual disturbances
> post op meningitis
> pneumocephalus (air in intracranial cavity)
> SIADH
29
Nursing: Pre-Op Teaching
- **Avoid actions tht incr ICP; cause pressure on surgical site leading to leak of CSF**
> vigorous coughing, blowing nose, sneezing
> sucking through straw
> bending over or straining during urination/defecation
- **Teach pt**
> deep breathing
> abt dressing & packing nose; don't mess w it
> nurse will check visual acuity often
> need for accurate I&Os (for DI & SIADH)
> HOB at least 30 degrees for 2 wks
30
Nursing: Post-Op Care
- **Monitor**
> neurologic checks including visual acuity & fields
> accurate I&Os
> incision/packing (keep dry)
> potential complications
- **HOB 30 degrees**
- **Mouth care q2-4hrs**
- **Cool vaporzer in room**
- **Hormones & glucocortiocoids as ordered**
31
Discharge Intructions
- **Avoid blowing nose, coughing, sneezing, drinking w straw, or bending over/straining for 4wks**
- **Report to surgeon**
> hunger, thirst, body swelling, mood swings, incrd urine output, weight loss (hormone deficiences)
> continual postnasal drip, nasal drainage, or excessive swallowing (CSF leak)
> pain w/ bending neck (meningitis)
> vision loss (damage to optic chiasm)
- Use only nasal meds/rinses as prescribed
- Keep f/u appt 1 wk after d/c
