Endocrine System: Pituitary Gland and Hormones - Nursing

ANTERIOR PITUITARY (ADENOHYPOPHYSIS) GROWTH HORMONE (SOMATOTROPIN) FUNCTIONS: ▪ Increase CHON synthesis ▪ Increase breakdown of fatty acids ▪ Increase blood glucose by decreasing glucose utilization – insulin antagonist HYPERSECRETION: ▪ Children: Gigantism ▪ Adult: Acromegaly HYP...

ANTERIOR PITUITARY (ADENOHYPOPHYSIS) GROWTH HORMONE (SOMATOTROPIN) FUNCTIONS: ▪ Increase CHON synthesis ▪ Increase breakdown of fatty acids ▪ Increase blood glucose by decreasing glucose utilization – insulin antagonist HYPERSECRETION: ▪ Children: Gigantism ▪ Adult: Acromegaly HYPOSECRETION: ▪ Young: Dwarfism ▪ Adult: Cachexia  PROLACTIN AKA: Mammotropic, Lactotropic, Luteotropic Hormone FUNCTIONS: ▪ Target: Breast & Gonads ▪ Necessary for breast dev’t & lactation ▪ Regulator of reproduction in males & females ▪ Maintains the corpus luteum & progesterone secretion HYPERSECRETION: ▪ Galactorrhea HYPOSECRETION: ▪ Absence of milk during lactation THYROID-STIMULATING HORMONE (TSH) FUNCTIONS: ▪ Target: Thyroid Gland ▪ Necessary for growth & functions of thyroid; control all functions ▪ Stimulates secretions & release of T3, T4, & Thyrocalcitonin HYPERSECRETION: ▪ Secondary Hypothyroidism HYPOSECRETION: ▪ Secondary Hyperthyroidism  ADRENOCORTICOTROPIC HORMONE (ACTH) FUNCTIONS: ▪ Target: Adrenal Cortex ▪ Necessary for growth & size of cortex ▪ Controls release of its hormones ▪ Minor role in release of mineralocorticoids HYPERSECRETION: ▪ Secondary Cushing Disorder HYPOSECRETION: ▪ Secondary Addison’s Disease  GONADOTROPINS FUNCTIONS: ▪ Target: Gonads ▪ Stimulates gametogenesis & sex steroid production 1. FOLLICLE-STIMULATING HORMONE (FSH) - stimulates dev’t of follicles & secretions of estrogen - Germinal Stimulating Hormone stimulates sperm producing cells in the testes 2. LUTEINIZING HORMONE (LH) - responsible for ovulation, dev’t of corpus luteum & progesterone secretion - Interstitial Cell Stimulating Hormone stimulates cell-producing testosterone  GONADOTROPINS HYPERSECRETION: ▪ Precocious puberty – Early puberty HYPOSECRETION: MALES: FEMALES: ▪ Small phallus & testicles ▪ Failure to develop breast ▪ No body hair growth ▪ No body hair growth ▪ Decrease libido ▪ No ovulation ▪ Impotence ▪ No menstruation ▪ Aspermia ▪ Infertility MELANOCYTE-STIMULATING HORMONE (MSH) FUNCTIONS: ▪ Target: Adrenal Cortex ▪ Affects pigmentation HYPERSECRETION: ▪ “Eternal Tan”, Bronze appearance of skin HYPOSECRETION: ▪ Albinism (Hypopigmentation) POSTERIOR PITUITARY (NEUROHYPOPHYSIS)  ANTIDIURETIC HORMONE (ADH) FUNCTIONS: ▪ Target: Kidney Tubular Cells ▪ “VASOPRESSIN” ▪ Increase water absorption; retains water HYPERSECRETION: ▪ Syndrome of Inappropriate Antidiuretic Hormone (SIADH) HYPOSECRETION: ▪ Diabetes Insipidus  OXYTOCIN FUNCTIONS: ▪ Target: Breast, Uterus ▪ Stimulate uterine contraction & breast milk ejection ▪ Stimulate prolactin release ▪ Stimulate fallopian tube contraction facilitating migration of sperm HORMONES TARGET TISSUE ACTION Promotes growth through GROWTH Bone & Soft tissue lipolysis, CHON anabolism, HORMONE insulin antagonism Stimulates lactation; PROLACTIN Mammary Gland mammary tissue growth Synthesis & release of TSH Thyroid thyroid hormones  TARGET HORMONES ACTION TISSUE Synthesis & release of ACTH Adrenal Cortex corticosteroids & adrenocortical growth GONADOTROPIN Stimulates estrogen secretion - FSH & follicle maturation; spermatogenesis Ovary & Testes - LH Stimulates ovulation & progesterone secretion; testosterone secretion MSH Melanocytes Provides pigmentation  TARGET HORMONES ACTION TISSUE VASOPRESSIN Promotes water (ADH) Kidneys reabsorption Uterus & Stimulates uterine OXYTOCIN Mammary contraction & ejection Glands of milk OTHER ENDOCRINE GLANDS DISORDERS OF THE PITUITARY GLAND ANTERIOR LOBE 1. HYPOPITUITARISM - results from deficiency of one or more pituitary hormones, which may occur as a result of the effects of disease in the hypothalamic center that controls the release of pituitary hormones, or from problems directly involving the pituitary glands. ❑ CAUSES: Tumor, Trauma, Surgical Removal, Irradiation, Congenital  Diseases of Hypopituitarism  DWARFISM - stunted growth (within 1st yr of life) - Normal size at birth - Appears chubby and lacks muscular dev’t - Puberty is delayed TREATMENT Successful if treated in the 1st 3 years of life Hormone Replacement Therapy (HRT) a. SOMATREM (Protropin) b. SOMATROPIN (Humatrope)  CACHEXIA – state of poor health & malnutrition - severe weight loss, muscular weakness, anorexia, severe depression, acidosis, toxemia CAUSE: atrophy of PG OTHER S/SX: emaciation, premature aging, atrophy of genitals, loss of 2nd sex charac., low BMR NSG DX: Nutrition, Risk for Infection, Altered Body Image TREATMENT: Symptomatic  HYPOGONADISM - changes in secondary sex characteristics (do not enter normal puberty) - WOMEN: amenorrhea, breast atrophy & infertility are common - MEN: small testes & phallus, decrease libido, aspermia, impotence TREATMENT: Replacement on missing hormone HRT: 1. CLOMID (F) 2. ANDROGEN (M) NSG DIAGNOSIS: Altered Body Image GENERAL ASSESSMENT: 1. Hemianopsia; headache (if due to tumor) 2. Weight loss, emaciation 3. Hair loss 4. Impotence 5. Amenorrhea 6. Hypometabolism (hypothyroidism) 7. Adrenal Insufficiency MEDICAL MANAGEMENT: Surgical removal of tumor Radiation HRT (Hormonal Replacement Therapy) Hypophysectomy – surgical removal of the pituitary gland via TRANSSPHENOIDAL HYPOPHYSECTOMY (Endoscopic Transnasal Approach) 🡪 incision is made under the upper lip  Nursing Intervention: ✔ Provide care to patient undergoing hypophysectomy or radiation therapy if indicated. ✔ Provide patient and discharge planning concerning: ❑ HRT ❑ Importance of follow-up  CRANIOTOMY TRANSSPHENOIDAL HYPOPHYSECTOMY 1. Increased ICP 1. CSF leakage 2. Bleeding 2. Infection 3. Meningitis 3. Hypopituitarism 4. Hypopituitarism 2. HYPERPITUITARISM – hyperfunction of anterior pituitary resulting in oversecretion of one or more of the anterior pituitary hormones CAUSES: ✔Benign pituitary adenoma ✔Hyperplasia of pituitary tumors ✔Prolactinomas (prolactin – secreting tumors) – accounts for 60 – 80% of all pituitary hormones  ACROMEGALY (adults) ▪ Begins between 2nd to 4th decade of life ▪ It occurs after epiphyseal closure; following which the bones grow wider and thicker ▪ Extremities are enlarged ▪ Lower jaw 🡪 lengthen & bridge of the nose becomes broader ▪ Softer tissue of the hands & feet is enlarged & takes on a coarse appearance ▪ Spade-like 🡪 large feet & hands ▪ “Are you buying large size of shoes?”  GIGANTISM (children) Starts when bones grow longitudinally and subsequently results in a generalized overgrowth of skeleton & soft tissue. As a result, a marked increase is noted in HEIGHT & SIZE. Characterized by excessive growth of long bones accompanied by muscular weakness. Assessment: Neurologic Hemianopsia/ Blindness/ Visual Disturbances Headache Somnolence Signs of increased ICP Behavior changes, seizures Disturbance in appetite, sleep, temperature regulation & emotional balance due to HYPOTHALAMIC involvement  Diagnostic Test: Skull x-ray, CT scan & MRI Endocrine Changes: Irregular menses, anovulatory periods, oligomenorrhea, amenorrhea Infertility Galactorrhea - ↑ prolactin Dyspareunia, vaginal mucosal atrophy Decreased vaginal lubrication, decreased libido & impotence Reduced sperm count, infertility & gynecomastia (males) Medical Management: Surgery – TRANSSPHENOIDAL HYPOPHYSECTOMY Radiation Pharmacotherapy ▪ Sandostatin – chemotherapeutic agent, ↓ GH ▪ Bromocriptine Mesylate (Parlodel) – used to lower growth hormone & prolactin levels Nursing Interventions: Monitor for hyperglycemia & cardiovascular problems (HPN, angina, CHF) & modify care accordingly Provide physiologic support & acceptance for alterations in body image Provide care of patients undergoing hypophysectomy or radiation therapy if indicated  Nursing Interventions Post Transsphenoidal Hypophysectomy 1. Keep head of bed elevated. 2. Maintain nasal packing in place and reinforce when needed. 3. Provide frequent oral care. 4. Instruct to avoid activities that will increase ICP. 5. Assess signs of increased ICP and Signs of CSF leakage. 6. Report output above 900ml/2 hours or specific gravity less than 1.004 7. Give analgesic for mild headache. 8. Administer CORTICOSTEROIDS as scheduled or other HRTs POSTERIOR LOBE  DIABETES INSIPIDUS (DI) Characterized by a deficiency in ANTIDIURETIC HORMONE (ADH), which makes it possible for the body to concentrate urine CAUSES: ▪ Head trauma ▪ Brain tumor ▪ Surgical removal/ irradiation of PG ▪ CNS infection (meningitis) ▪ Failure of renal tubules to respond to ADH  3 Classical Signs Of DI: 1. Polyuria - 5 to 20 L/day (about 4 gallons) 2. Polydipsia - 2 to 20 L/day (cold water) 3. Diluted Urine - SG of 1.001 to 1.004 (water-like) SPECIFIC GRAVITY – is the ratio of the density of a substance to that of a standard substance (water). Clinical Manifestations: Excretion of excessive amount of urine. Severe dehydration Constipation Poor skin turgor Increased serum Na (hypernatremia) Diagnostic Test: FLUID DEPRIVATION TEST - do not give the client any fluids for 8 to 12 hours. ▪ (+) DI = large volume & diluted UO ▪ N = less amount & concentrated UO Treatment: GOALS 1. To replace ADH (long term) 2. Adequate fluid replacement 3. Correct the underlying cause  TREATMENT: 1. Vasopressin Replacement (DESMOPRESSIN / DDAVP) - synthetic form, severe & chronic DI with fewer adverse effects, long term use 2. Clofibrate - hypolipidemic agent but has anti-diuretic effect 3. Chlorpropamide (Diabinese) & Thiazides - potentiates the action of ADH; for mild DI only  Nursing Interventions: 1. Maintain fluid & electrolyte balance by: ✔ Maintaining adequate fluid intake ✔ Monitoring specific gravity and I & O accurately ✔ Evaluate urine specific gravity for changes ✔ Assess hydration status – WEIGHING DAILY 2. Assist the client to understand implication of the condition: ✔ DI secondary to other problems is usually 🡪 self-limiting (temporary) ✔ If chronic deficiency 🡪 require long term ADH replacement  SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE (SIADH) A condition in which there is a continued release of ADH, regardless of level of plasma osmolarity CONDITIONS THAT PRECIPITATE SIADH: ▪ Trauma (head injuries), Tumor ▪ Bronchogenic cancer ▪ CNS disorder – direct stimulation of PG ▪ Medication-induced – it increases sensitivity or renal tubules to circulating ADH Clinical Manifestations: Low urine output with weight gain & no obvious edema at first Water intoxication manifested by mental confusion Muscular cramps (Dilutional) HYPONATREMIA, HYPOCALCEMIA Seizures, coma 🡪 due to decreased Na to less than 120 meq/L Treatment: Eliminate/Treat the underlying cause. LIMIT the fluid intake IVF: NORMAL SALINE Diuretics except LOOP DIURETICS Potassium supplement  Nursing Interventions: 1. Monitor for urine output with increased specific gravity 2. Evaluate weight gain or loss 3. Maintain fluid restriction 4. Evaluate serum K & Na levels 5. Frequent neurologic assessment for cerebral edema 6. Monitor v/s & cardiac status due to change in Ca ions 7. Provide safe environment – watch out for seizure & coma 8. DOC: DEMECLOCYCLINE (Declomycin) - induce water reabsorption by inhibiting ADH & produce diuresis