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NUR 146 Lecture > Week 3- Pituitary > Flashcards

Week 3- Pituitary Flashcards

1
Q

Describe the pituitary gland the hormones it secretes

A
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2
Q

Explain the effects the hormones have on its target organs and cells

A
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3
Q

LECTURE OBJECTIVE - EXPLAIN THE EFFECTS HORMONES HAVE ON ITS TARGET ORGANS/CELLS

Describe Oxytocin

Posterior/Anterior?
What does it do?
What stimulates its release?

A

Posterior Pituitary
Stimulated by positive feedback system
Helps during childbirth

  • Stimulates uterine contraction
  • Release of milk during lactation
  • “Bonding hormone”
  • Positive feedback system
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4
Q

LECTURE OBJECTIVE - EXPLAIN THE EFFECTS HORMONES HAVE ON ITS TARGET ORGANS/CELLS

Vasopressin / Antidiuretic Hormone / ADH

Posterior/Anterior?
What does it do?
What stimulates its release?

A

Posterior Pituitary

Stimulated by increased osmolality (Blood/fluid is too thick, ADH is released to hold onto water) OR low blood pressure

  • Causes kidneys to reabsorb water
  • Results in increased blood volume –> increase BP
  • Causes vasoconstriction –> increased BP
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5
Q

Anterior Pituitary Gland

A

Hypothalamus sends hormones to APG, then APG sends tropic hormones out

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6
Q

LECTURE OBJECTIVE - EXPLAIN THE EFFECTS THE HORMONES HAVE ON ITS TARGET ORGANS AND CELLS

Growth Hormone

Anterior/Posterior?
What does it do?
What stimulates its release?

A

Produced by Anterior Pituitary Gland

Function:
- Stimulates bone growth
- Promotes protein synthesis
- Tissue repair
- Cell regeneration

Stimulated by:
- GHRH (Growth Hormone Releasing Hormone) from hypothalamus

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7
Q

LECTURE OBJECTIVE - EXPLAIN THE EFFECTS THE HORMONES HAVE ON ITS TARGET ORGANS AND CELLS

Thyroid Stimulating Hormone (TSH)

Anterior/Posterior?
What does it do?
What stimulates its release?

A

Tropic Hormone
Produced by Anterior Pituitary

Function:
- Stimulates thyroid gland to produce thyroid hormones

Stimulated by:
- TRH from hypothalamus

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8
Q

Adrenocorticotropic Hormone (ACTH)

A

Produced by Anterior Pituitary, stimulation from hypothalamus

Function:
- Stimulates adrenal cortex to produce cortisol

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9
Q

Follicle Stimulating Hormone (FSH)

A

Tropic Hormones
Produced by Anterior Pituitary, stimulation from hypothalamus

Function:
- Stimulates development of sperm and eggs

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10
Q

Luteinizing Hormones (LH)

A

Tropic Hormone
Produced by anterior pituitary, stimulation from hypothalamus

  • Stimulates production of testosterone and estrogen
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11
Q

Prolactin

A

Non-Tropic
Produced by Anterior Pituitary, stimulation from hypothalamus

Function:
- Milk production

(Oxytocin stimulates release of milk)

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12
Q

Diabetes Insipidus

A

Deficiency of ADH
Results in excretion of large amount of highly dilute urine and extreme thirst

-“No ADH, so the patient loses a lot of water in urine”
-“Think ‘dry inside’ i.e. no water”

Causes:
Neurogenic:
- Trauma
- Brain tumor
-Radiation
Nephrogenic:
- Inadequate response of renal tubules to ADH
- Renal disease
- Drug toxicity

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13
Q

What are the clinical manifestations of Diabetes insipidus?

A
  • Extreme Polyuria (excess urination
  • Extreme polydipsia (Thirst)
  • Dehydration
  • Hypotension –> hypovolemic shock
  • Weight loss, Anorexia
  • Urine output does NOT decrease by limiting fluid
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14
Q

Diagnostic tests / Labs regarding Diabetes Insipidus

A

Labs
- Hypernatremia (excess sodium in blood)
- Hyperosmolarity (loss of water –> solutes in blood)

Urinalysis
- Dilute, pale urine; Specific gravity 1.001 - 1.005
- Low urine osmolality (<200)

Fluid deprivation test
- Frequent monitoring of vitals, terminate test if unstable vitals
- “If we deprive fluid, urine output should decrease in healthy person”
Trial of Synthetic Vasopressin
- Differentiates neurogenic vs. nephrogenic

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15
Q

How to treat Diabetes Insipidus

A

Maintain fluid balance

Neurogenic DI:
- Pharmacologic therapy
- Desmopressin (Synthetic ADH)

Nephrogenic DI:
- Desmopressin will be ineffective
- Low salt diet
- Pharmacologic: Hydrochlorothiazide, indomethacin

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16
Q

Desmopressin (DDAVP)

A

Synthetic Vasopressin

Indications:
-Diabetes insipidus (neurogenic)
- Nocturnal enuresis (bed-wetting)

  • Mimics the actions of endogenous ADH

Side effects

17
Q

Syndrome of Inappropriate ADH (SIADH)

A

Excessive amount of ADH
Excessive fluid retention
“SI = soaked inside”

Causes:
- Often non-endocrine causes
- Malignant cells synthesize ADH
- Direct stimulation of posterior pituitary

18
Q

Manifestations of Syndrome of Inappropriate ADH (SIADH)

A

Small amounts of concentrate urine

Fluid Volume Excess:
- Tachycardia, hypertension
- JVD, Anasarca (General Edema)
- Rales

Dilutional Hyponatremia:
- Lethargy, Weakness, muscle cramps

19
Q

Labs / Diagnostics for SIADH

A

Diagnostics:
Serum sodium <120 mEq/dl
- Plasma Osmolality <275 mOsm/kg

20
Q

Treatment for SIADH

A

Treat underlying cause

Correction of dilutional hyponatremia

Meds:
- Serum albumin replacement
- Sodium replacement

21
Q

Anterior Pituitary Disorders:
Neoplasias / Tumors

A

Usually benign

s/s:
Headache
Visual disturbances
Galactorrhea
Plus endocrine symptoms r/t excess hormone secretion

22
Q

Diagnostic tests for Pituitary tumors

A

Detailed history and physical
Visual acuity exam
CT or MRI
Serum hormone levels

Medical Management:
- Hypophysectomy
- Radiation Therapy
- Medication management

23
Q

Treatment for Pituitary Tumor

A

Surgical Therapy

Hypophysectomy:
- Removal of entire pituitary gland
- Patient needs lifetime hormone replacement
- Incision via nose

Tran sphenoidal Microsurgery:
- Microsurgical approach
- Preserves normal pituitary tissue

24
Q

Post-Op Hypophysectomy Care

A

Maintain HOB >30 degrees

Avoid increase in intracranial pressure:
- Coughing, sneezing, vomiting
- Vigorous hair brushing, drinking with straw
- Bending at waist

Potential transient diabetes insipidus:
- Monitor urine output; notify PCP if urine output is >100mL/hr

25
Q
A
26
Q

Hypopituitarism

A

Hyposecretion

27
Q

Treatment for hypopituitarism

A

Hormone Replacement Therapy

28
Q

Gigantism

A

D/t an excess in GH prior to closure of growth plates
Elongated long bones

Cause:
Eosinophilic tumor

29
Q

Acromegaly

A

Excessive growth hormones after closure of epiphyseal plates
Abnormal growth of “short” bones

Complications:
High risk for diabetes and hypercholesterolemia

30
Q

Clinical manifestations of acromegaly

A

Hands, feet, facial bones, sternum
Coarse features
- Deep, hoarse voice
- Muscle weakness, osteoporosis, osteoarthritis
- Barrel chest

31
Q

Diagnostic tests for acromegaly

A
  • Growth hormone suppression test
  • Radiography
  • Oral glucose tolerance test
32
Q
A
33
Q
A

NUR 146 Lecture (5 decks)

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