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AH2 Exam 3 > Pituitary Gland > Flashcards

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
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2
Q

Anterior Lobe Hormones - Adrenocorticotropic Hormone (ACTH)

A
  • Target Tissue
    > adrenal cortex
  • Action
    > stimulates synthesis & release of corticosteroids & adrenocortical growth
  • Corticotropin
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3
Q

Anterior Lobe Hormones - Luteinizing Hormone (LH)

A
  • Target Tissue
    > ovary
    > testis
  • Actions
    > stimulates ovulation & progesterone secretion
    > stimulates testosterone secretion
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4
Q

Anterior Lobe Hormones - Follicle-Stimulating Hormone (FSH)

A
  • Target Tissue
    > ovary
    > testis
  • Actions
    > stimulates estrogen secretion & follicle maturation
    > stimulates spermatogensis
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5
Q

Anterior Lobe Hormones - Prolactin (PRL)

A
  • Target Tissue
    > mammary glands
  • Action
    > stimulates breast milk production
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6
Q

Anterior Lobe Hormones - Growth Hormone (GH)

A
  • Target Tissue
    > bone & soft tissue
  • Action
    > promotes growth through lipolysis, protein anabolism, & insulin antagonism
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7
Q

Posterior Lobe Hormones - Antidiuretic Hormone (ADH)

A
  • Target Tissue
    > kidney
  • Action
    > promotes water reaborption
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8
Q

Posterior Lobe Hormones - Oxytocin

A
  • Target Tissue
    > uterus & mammary glands
  • Action
    > stimulates uterine contractions and ejection of breast milk
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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
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10
Q

Posterior Pituitary Tumor

A

ADH deficiency or excess

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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
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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
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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
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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
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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
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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
Q

Dwarfism

A
  • Too little GH
  • Supplemental growth hormones if discovered early
  • Not all types respond well to growth hormones
26
Q

Anterior Pituitary - Diagnosis

A
  • H&P
  • Visual acuity/visual field tests
  • CT & MRI
  • Lab
    > pituitary hormones & thyroid gland
  • Measurement of target organ hormones
27
Q

Anterior Pituitary - Medical Management

A
  • Remove/destroy tumor
    > surgery
    > radiation therapy
  • Replacement hormones required after destruction
  • Medications:
    > Bromocriptine (Parlodel)
    > Octreotide (Sandostatin)
    > these inhibit production/release of GH
28
Q

Total Hypophysectomy - Complications

A
  • 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
Q

Nursing: Pre-Op Teaching

A
  • 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
Q

Nursing: Post-Op Care

A
  • 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
Q

Discharge Intructions

A
  • 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

AH2 Exam 3 (12 decks)

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