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Endocrine Day 5-1 Pituitary Gland Hypothalamus • Description – Attached to pituitary gland • Infundibulum – Brain • Diencephalon Hypothalamus • Function – Stimulate the pituitary to secrete its hormones Pituitary • Description – “Master gland” – Why? – 9 hormones Pituitary • Description – Size – pea – Anterior lobe • Adenohypophysis • 7 hormones – Posterior lobe • Neurohypophysis • 2 hormones Anterior Pituitary Hormones • Thyroid-stimulating hormone (TSH) • Adrenocorticothropic hormone (ACTH) • Follicle-stimulating hormone (FSH) • Luteinizing Hormone (LH) • Melanocyte-stimulationg hormone (MSH) • Growth Hormone (GH) Somatoropin • Prolactin / Lactogenic hormone Thyroid-stimulating Hormone • Function – Stim. thyroid growth – Stim. secretion of thyroid hormones • Stimulated by: – – – – – Hypothalamus i T3 / T4 i Metabolism Cold temps Stress Adrenocorticotropic Hormone (ACTH) • Function – Stim. adrenal cortex growth – Stim. secretion of glucocorticoids • Stimulated by: – – – – Hypothalamus Stress Hypoglycemia i glucocorticoids Follicle-Stimulating Hormone (FSH) • Function – Gonadotropin – Female • Stimulated ovaries to mature • Estrogen production – Male • Stim. Sperm production Luteinizing Hormone (LH) • Function – Gonadotropin – Female • Stim. Ovulation – Male • Stim. testes to produce testosterone Melanocyte-stimulating Hormone (MSH) • Function – h melanin Growth Hormone (GH) Somatotropin • Function – Stim. Growth – Stim. Protein sysnthesis – h serum glucose levels • Insulin-antagonist • Stimulated by: – – – – – Hypothalmus i growth hormone Stress Exercise Hypoglycemia Prolacting / Lactogenic Hormone • Function – Stim. breast development during pg – Milk secretion p delivery Posterior Pituitary Hormones • Anti-diuretic Hormone (ADH) – A.K.A: Vasopressin • Oxytocin Anti-diuretic Hormone (ADH) Vasopressin • Function – Stim. H2O retention – i urine output – h H2O in serum/body • Stimulated by: – – – – – h Serum Osmolality i BP Stress Pain Exercise Oxytocin • Function – Stim. Uterine contractions – Breast to release milk Small Group Questions 1. Are Gonadotropins? 2. Cause increase synthesis of melanin? – 3. Cause ovulation? 4. Cause water retention? 5. In high levels causes increased BP? Small Group Questions 6. 7. 8. 9. 10. Increase protein synthesis? Increased metabolism of fatty acids for energy? Is also called vasopressin? Is also known as somatotropin? Is an insulin antagonist? Small Group Questions 11. Secreted in response to cold temp and stress? 12. Secreted in response to decreased BP? 13. Secreted in response to decreased somatotropin? 14. Secreted in response to hypoglycemia? 15. Secreted in response to increased plasma osmolality? Small Group Questions 16. Secreted in response to decreased glucocorticoids? 17. Stim. Ovaries to mature and produce estrogen? 18. Stim. sperm production? 19. Stim adrenal cortex growth? 20. Stim. breast development? Small Group Questions 21. Stim. Testes to produce testosterone? 22. Stim secretion of glucocorticoids? 23. Stim. secretion of thyroid hormone 24. Stim. Thyroid to grow 25. Stim uterine contractions Hyperpituitarism • Definition – h secretion of pituitary hormones • Etiology – Usually 20-40 yrs – Tumor – Usually GH or ADH Hyperpituitarism Growth hormone Excess • Affects – Depends on age – Epiphyses • Epiphyses open (young) – Gigantism Gigantism • Definition – h GH before epiphyses closed • Etiology – Hyperplasia of anterior pituitary – h in number of cells – Can tumor Gigantism • Clinical manifestations – Onset • Infants / children – > 8 feet – Proportional overall growth – Do not have strength that size implies Gigantism • Medical treatment – Irradiation of anterior pituitary – Removal of pit via surgery Gigantism • High Risk for: – – – – – Heart failure Hypertension Thickened bones Osteoporosis Delayed sexual development Gigantism • Pharmacology – IF pituitary is destroyed or removed • Replace pituitary hormones Gigantism • Nursing interventions – Listen – Growth chart measurements – Long beds Hyperpituitarism • Growth hormone – Increased production • Affects – Depends on age – Epiphyses • Epiphyses closed (adult) – Acromegaly Acromegaly • Definition – h GH after epiphyses have closed • Etiology – 30-50 yrs – Hyperplasia – Tumor Acromegaly • Clinical S&S – Gradual onset – Hypertrophy • Increase in volume of tissue d/t enlargement of existing cells – “hulking” • Enlarge jaw • Thick tongue Acromegaly • Clinical S&S – Tufted • Thick fingers with tips like arrowheads Acromegaly • S&S – Moist, weak, doughy handshake – Heart, liver spleen enlarged – Diaphoresis – Oily, leathery skin – Laryngeal hypertrophy Acromegaly • S&S – – – – Heat intolerance Weight gain Joint pain Hirsutism • Excessive hairiness – i libido • Impotence • Oligomenorrhea • Infertility Acromegaly: Medical Tx • Diagnosis – – – – – Hx S&S X-ray CT scan Lab • h GH Acromegaly: Medical Tx • Prognosis – ?? Cause – i Life span – DM ??? • • • • • ↑GH h Glucose levels h Insulin Stress pancreas DM type 2 Acromegaly: Medical Tx options • Radiation • Medication • Surgery Transsphenoid hypophysectomy • Post-op care – Nasal packing • Check for drainage – – – – S&S infection Nuchal rigidity Pain control NO • • • • Coughing Straining Vomiting Sneezing Transsphenoid hypophysectomy • Post-op care – Incentive spirometer – No brush teeth x 2wks – No lifting x 3 months Acromegaly: Rx Bromocriptine mesylate (Parlodel) • Action – Inhibits GH (and prolactin) • Nrs considerations – Give c food • S/E – Drowsiness – Stim. ovulation Acromegaly: Nrs interventions • • • • • • HX S&S Glucose Gait changes Vital sign changes Jaw changes dysphagia Which of the following statements about acromegaly is not true? A. Most cases are due to GH hypersecretion B. The diagnosis is usually obvious C. Patients may experience a gradual change in their voice D. Enlarged hands and feet are typical All these comorbidities are common with acromegaly, except: A. Sleep apnea B. Insulin resistance C. Obesity D. Biventricular hypertrophy Which of these treatments is best for a 35-yearold patient with a small pituitary adenoma? A. Octreotide B. Radiation C. Surgery D. Bromocriptine Small group questions 1. What hormonal disturbance causes acromegaly? 2. 2. What signs and symptoms might you expect to see Mrs. Gandios exhibit? 3. What 2 dx tests might have been performed to dx Mrs. Grandios? Small Group Questions 4. What med. Tx do you expect to be implements with Mrs. Grandios? 5. What complications might you assess or monitor for with Mrs. Grandios? How would you assess for this? 6. Mrs. Grandios was prescribed Parlodel. What would you tell her about this medication?