Term
| Anterior Pituitary Hormones |
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Definition
TSH-thyroid-stimulating hormone;
ACTH-adrenocorticotropic hormone or corticotropin;
LH-luteinizing hormone;
FSH-follicle-stimulating hormone;
PRL-prolactin;
GH-growth hormone;
MSH-melanocyte-stimulating hormone; |
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Term
| Posterior Pituitary Hormones |
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Definition
Vasopressin or ADH: antidiuretic hormone-promotes water reabsorption
oxytocin: stimulates uterine contractions and ejection of breast milk |
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Term
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Definition
| Usually one hormone is markedly decreased and the others somewhat decreased. |
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Term
| Deficiencies of what hormones are the most life threatening? |
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Definition
| Deficiencies of ACTH and TSH are the most life threatening. |
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Term
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Definition
| extremely rare for the anterior pituitary to stop making all hormones |
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Term
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Definition
| Hypopituitarism may be caused by tumors of the pituitary gland or hypothalamus, head trauma, brain tumor, radiation, brain surgery, stroke, or infections of the brain and the tissues that support the brain. Occasionally, hypopituitarism is due to uncommon immune system or metabolic diseases such as sarcoidosis, histiocytosis X, and hemochromatosis. |
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Term
| What accounts for 25-30% of pituitary adenomas |
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Definition
| prolactinomas--removal of this is one of the most common neurological surgeries |
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Term
| Signs and symptoms of Anterior hypopituitarism |
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Definition
Signs and symptoms depend on the cause and the hormone affected.
fatigue ,weakness, sensitivity to cold,
decreased appetite weight loss abdominal pain,
low blood pressure,headache, visual disturbances,
loss of armpit or pubic hair
in women: cessation of menstrual periods, infertility, or failure to lactate
in men: decreased libido, loss of body or facial hair
**REMEMBER THIS IS INSIDIOUS--it creeps up on you! |
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Term
| Hypopituitarism: Diagnosis |
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Definition
cranial CT scan or cranial MRI, revealing a tumor or abnormal mass in the pituitary gland;
Blood levels of serum luteinizing hormone (LH), serum follicle stimulating hormone (FSH), or serum thyroid stimulating hormone (TSH), decreased or normal;
serum testosterone serum estradiol (estrogen), serum cortisol, serum ACTH, levels, decreased;
T4 (thyroid hormone), decreased;
serum growth hormone (GH), decreased; |
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Term
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Definition
injecting agents that are known to stimulate secretion of specific pituitary hormones and then measuring the response;
if an agent is injected and you get a correct response, you know it's a production problem; if it's injected and don't get a correct response, it's a receptor problem |
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Term
| Hypopituitarism: Treatment |
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Definition
Removal of pituitary tumor;
Replacement of deficient hormones;
watch for halo sign to make sure there is no CSF leakage;
more severe HA when raised up head of bed, so they'll want to lay back down |
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Term
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Definition
Over secretion of hormones due to pituitary tumors or hyperplasia;
Benign adenomas are the most common;
If the tumor gets large enough it presses on brain tissue and causes visual changes, headache and signs of increased intracranial pressure |
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Term
| Growth Hormone Hypersecretion before puberty |
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Definition
leads to gigantism.
Usually caused by a pituitary tumor.
Causes organ overgrowth and pressure on pituitary and brain tissue. |
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Term
| Growth Hormone Hypersecretion after puberty |
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Definition
causes Acromegaly
Onset is insidious--slowly
An incidence of 3-4 cases per million people per year and a prevalence of 40-70 cases per million population.
This happens more commonly than giantism
After a prolactinoma, these growth hormone tumors are the most common
Remember it’s also happen internally—not just externally |
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Term
| Acromegaly: mortality rate and most common cause of death |
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Definition
| The mortality rate is 2-3 times that of the general population; The most common cause of death is cardiovascular and pulmonary complications. |
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Term
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Definition
| Successful treatment, with normalization of GH levels, may be associated with a return to normal life expectancy; bone doesn’t return to normal, but prevents further damage |
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Term
| does acromegaly happen more in men or women |
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Definition
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Term
| Acromegaly: signs and symptoms |
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Definition
Changes in appearance: thick oily skin, increased lip and nose size, protrusion of the lower jaw, increased head size, and increase head, hands and feet.
Joint enlargement with pain, kyphosis, and barrel chest.
Excessive sweating, hyperglycemia.
Airway narrowing, enlarged heart lung and liver.** |
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Term
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Definition
Serum GH levels: Inability to suppress serum GH during an oral glucose tolerance test (OGTT) is the criterion standard for diagnosing GH excess.
Serum IGF-1 concentrations
Serum insulin like growth factor-binding protein-3 levels
CT or MRI |
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Term
| Acromegaly: Medical treatment |
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Definition
Somatostatin analogs (Octreotide):adverse effects are nausea, abdominal pain, diarrhea, and increased incidence of gallstones, reduce effects of cyclosporine; drugs are insulin, oral hypoglycemics, beta-blockers, and calcium channel blockers.;
Dopamine agonists (eg, bromocriptine):Adverse effects include nausea, vomiting, abdominal pain, arrhythmias, nasal stuffiness, orthostatic hypotension, sleep disturbances, and fatigue; caution in renal or hepatic disease |
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Term
| Surgical Treatment of Acromegaly |
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Definition
Surgical removal of tumor.
Post op: Usually in neuro-ICU first 24 hr
Monitor: vitals, vision, mental status, level of consciousness;
Watch for “halo sign” for CNS fluid leakage |
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Term
| Acromegaly: Post surgery teaching |
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Definition
| Pt to report post nasal drip. Avoid coughing, sneezing or blowing the nose early after surgery as it can cause increase pressure and CSF leakage.; watch for halo sign |
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Term
| Posterior Pituitary Hypofunction causes... |
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Definition
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Term
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Definition
| A water metabolism problem caused by an ADH deficiency or an inability of the kidneys to respond to ADH |
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Term
| Key Features of Diabetes Insipidus |
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Definition
| Inability to concentrate urine leads to polyuria with excessive fluid loss and dehydration, dilute urine, increased thirst, hypotension, tachycardia, irritability, decreased LOC, lethargy and coma; there will be a rise hemoglobin and hematocrit and BUN |
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Term
| What is the greatest danger for patients with Diabetes Insipidus? |
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Definition
| The greatest danger for these pts is dehydration! b/c they’re going to completely dry out |
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Term
| Diabetes Insipidus: Assessment |
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Definition
24 hour I & O: Urine output must exceed 4 L to diagnosis diabetes insipidus.; 24 hr. urine output will usually be between 4 and 30 L/day.;
"water deprivation" or dehydration test: measure urine output, specific gravity, osmolarity and weight hourly.;
CT or MRI scans |
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Term
| What happens if you withhold water from pts with diabetes insipidus? |
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Definition
| they will continue to put out huge amounts of water; the body isn't saving itself/conserving what they need |
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Term
| Treatment of diabetes insipidus |
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Definition
Oral chlopropamide (Diabinese)(can cause hypoglycemia;
Vasopressin nasal sprays;
Daily weights;
Drink fluids equal to urine output;
Wear med alert
Hormone treatment is lifelong!!! |
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Term
| SIADH: Posterior Pituitary Hyperfunction |
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Definition
| syndrome of inappropriate antidiuretic hormone- too much vasopressin (ADH) is put out even when plasma osmolarity is low--drowning b/c not putting any fluids out! |
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Term
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Definition
Malignancies Pulmonary: pneumonia/pneumothorax;
CNS: trauma, infection, strokes;
Drugs: opioids, general anesthesia |
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Term
| What is the most important electrolyte to watch? |
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Definition
| Sodium-it can get below 115 mEq/L |
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Term
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Definition
GI disturbances: N/V, loss of appetite
Water retention, hyponatremia (especially if Na fall below 115 mEq/L) and fluid shifts leads to lethargy, headaches delirium, decreased LOC, seizures and coma.
Decreased tendon reflexes, tachycardia and hypothermia. |
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Term
| Why do you need to watch their BP continuously even if they're on anti-HTN meds? |
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Definition
| because their BP will continually increase even with medication |
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Term
| SIADH: Treatment/Monitoring |
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Definition
Fluid restriction- As low as 500 mL/24 hr;
I & O, daily weights- weight gain of 2 lbs per day troubling, 1 Kg wt. = 1 L fluid.;
Diuretics- may cause more Na loss;
Use saline in all IVs- hypertonic saline is rarely used because it can cause fluid shifts and heart failure;
Demeclyocycline (Declomycin)-rarely used (don't take with antiacids or milk |
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Term
| Adrenal cortex produces what? |
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Definition
| cortisol, aldosterone, and androgens |
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Term
| what does the adrenal medulla produce? |
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Definition
| norepinephrine and epinephrine |
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Term
| Adrenal Hypofunction: ADDISON'S Disease |
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Definition
also called adrenal insufficiency, or hypocortisolism.;
May result from inadequate ACTH through the hypothalamic-pituitary control system or dysfunction of adrenal gland tissue. |
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Term
| Primary Causes of adrenal hypofunction |
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Definition
affects about 1 in 100,000 people;
About 70 percent of reported cases of Addison's disease are caused by autoimmune disorders: tuberculosis, AIDS, hemorrhage, metastatic cancer |
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Term
| Secondary Causes of adrenal hypofunction |
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Definition
| Pituitary tumors, high dose pituitary radiation, or an abrupt stop of long term glucocorticoid therapy; these will cause probs but won’t affect aldosterone output; more common than primary |
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Term
| Adrenal Hypofunction: Key features |
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Definition
Usually begins gradually: chronic, worsening fatigue, muscle weakness, joint pain, loss of appetite, wt. loss, N/V, diarrhea, salt cravings.;
Irritability and depression;
Anemia, orthostatic hypotension,hypoglycemia, hyponatremia, hypercalcemia and hyperkalemia |
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Term
| Addisonian Crisis: Life threatening event--What can cause it? |
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Definition
| Usually when someone with adrenal insufficiency experiences a stressor such as surgery, severe infection, or trauma |
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Term
| Addisonian Crisis: Life threatening event--what can it lead to? |
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Definition
| to severe hypotension, hyponatremia and hyperkalemia: weakness, confusion, cardiac arrhythmias,shock, coma |
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Term
| Adrenal Hypofunction: Testing for Primary |
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Definition
| low serum cortisol, low blood glucose, hyponatremia, hyperkalemia, increased BUN, (elevated eosinophils and ACTH in primary disease). |
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Term
| Adrenal Hypofunction: Testing for Secondary |
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Definition
| Secondary disease also has low serum ACTH, ACTH stimulation test results in increased cortisol levels |
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Term
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Definition
CT, MRI, skull X-ray, or angiography to detect tumors or atrophy.;
Urinary testing for glucocorticoid metabolite 17-hydroxycortico-steroid |
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Term
| Nursing Interventions for Adrenal Hypofunction |
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Definition
Maintain fluid balance-daily wt., I & O;
Monitor for cardiac problems;
Manage electrolyte imbalances;
Monitor for and manage hypoglycemia;
Administer gluccocorticoids and aldosterone as ordered.(may carry dexamethanon pen);
Teach patient to wear medic alert, hormonal replacement is lifelong and what to do incase of sick days of stressors. |
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Term
| Adrenal Hyperfunction: Hypersecretion of the adrenal gland results in: |
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Definition
Hypercorticalism: Cushing’s syndrome, Cushing’s Disease (also known as Hyperadrenocorticism);
Hyperaldosteronism;
Excessive androgen production |
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Term
| Hypercorticalism: Cushing's Disease |
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Definition
| Caused by endogenous cortisol secretion by pituitary or adrenal adenomas or lung, GI or pancreatic malignancies |
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Term
| Hypercorticalism: Cushing’s syndrome |
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Definition
| Caused by administration of Glucocorticoids or ACTH as an anti-inflammatory in treatment of asthma, transplants, autoimmune diseases or allergic responses. |
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Term
| Manifestations of Cushing’s |
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Definition
Fat redistribution and weight gain: moon face, buffalo hump, obesity;
Muscular atrophy, thin skin, striae;
Increased risk for infections
Osteoporosis with spontaneous fracture;
Hypertension, increased risk for DVT, edema, bruising.;
Sleep disturbances, decreased memory.
Weakness, fatigue;
Increased glucose and possible DM;
Changes in menses, libido and secondary sex characteristics.
See chart 66-13 |
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Term
| Cushing’s: Diagnostic Assessment |
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Definition
Elevated plasma cortisol levels- try and get the sample at the same time each day as levels normally fluctuate;
ACTH levels may be elevated;
Increased glucose, and sodium;
Decreased serum calcium and potassium and lymphocyte count;
also causes increased WBCs--don't be alarmed, but do notify dr.;
Urine for free cortisol and metabolites- Done as a 24 hr. collection. Urine Ca+, K+, and glucose will be elevated.;
Dexamethasone suppression tests for Cushing’s disease.;
In normal subjects giving dexamethasone will suppress cortisol secretion. |
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Term
| Radiologic exams for Cushing's |
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Definition
X-rays of skull, chest and abdomen.;
Angiography;
Nuclear scans;
CT scans;
MRI;
Ultrasonography |
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Term
| Nonsurgical Management of Cushing's |
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Definition
Treat the clinical manifestations such as: hypernatremia, hypokalemia, hyperglycemia and hypertension.;
Protect from injury: falls, fractures and skin tears.;
Prevent infection;
Provide education; |
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Term
| Surgical Management of Cushing's |
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Definition
Removal of pituitary adenoma-Most common cause of Cushing's.; Surgical cure rate of 85-90%;
Will need replacement steroids;
Adrenalectomy- Usually done laproscopically; Will need lifelong steroid replacement |
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Term
| Surgical Management of Cushing's: Pre operative |
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Definition
| Pre Op: Correct electrolyte imbalances and monitor for dysrhytmias |
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Term
| Surgical Management of Cushing's: Post-Op |
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Definition
| Monitor vitals and I&O, Monitor urine output, daily wt. and electrolyte levels; Pt. may need immediate glucocorticoid replacement therapy |
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Term
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Definition
| Excessive secretion of aldosterone |
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Term
| What is hyperaldosteronism usually caused by? |
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Definition
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Term
| What does excess aldosterone lead to? |
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Definition
| Na+ retention and K+ and hydrogen ion loss |
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Term
| Symptoms of hyperaldosteronism |
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Definition
| high BP***; HA, muscle weakness, fatigue, intermittent paralysis, numbness and nocturia; also, watch for signs of K+ depletion such as numbness and tingling |
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Term
| Hyperaldosteronism: signs and test |
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Definition
Low serum potassium level;
Abdominal CT scan that shows adrenal mass;
Elevated plasma and urine aldosterone levels;
Low plasma renin activity;
ECG that shows abnormalities associated with low potassium levels |
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Term
| Hyperaldosteronism: Interventions |
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Definition
Surgical removal of adenoma: surgery is not done until potassium levels are normal.;
Spironolactone (Aldactone): potassium sparing diuretic. (will need liver tests b/c it's hard on liver)
Watch for hyperkalemia. Avoid K+ supplements. Teach patient signs of hyponatremia such as dry mouth or lethargy. |
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Term
| What type of replacement therapy will be needed if only one adrenal gland is removed? |
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Definition
| Will need temporary replacement therapy, but it will eventually compensate |
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Term
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Definition
| a tumor of the adrenal gland that causes excess release of epinephrine and norepinephrine |
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Term
| What does a pheochromocytoma cause? |
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Definition
| Causes sporadic attacks of sympathetic stimulation lasting minutes to hours. |
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Term
| Pheochromocytoma: signs and symptoms |
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Definition
Severe headache;
Palpitations;
Rapid heart rate;
Sweating – can be profuse;
Flushing / heat intolerence;
Chest pain ;
Abdominal pain –may cause nausea and vomiting;
Nervousness/ Irritability ;
Decreased appetite /Loss of weight |
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Term
| What should you NOT do in pts with pheochromocytoma? |
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Definition
DO NOT palpate the abdomen in these patients as it can cause a sudden release of catacholamines and cause a hypertensive crisis.
Also, tricyclics, glucagons and foods with tyramine can also cause a HTN crisis |
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Term
| Diagnosis of Pheochromocytoma |
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Definition
Adrenal biopsy;
An MRI or CT of abdomen that shows adrenal mass;
24 hr. urine collection for VMA (vanilylmandelic acid), metanephrine and catecholamines;
Clonidine suppression test (Clonidine reduces the catecholemine levels in normal people, but will remain same in people with pheochromocytoma |
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Term
| Pheochromocytoma: Interventions |
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Definition
Surgical removal of the tumor is the main treatment.;
Monitor and stabilize blood pressure before and after surgery.; Start with alpha blockers and then beta blockers.;
Do not palpate the abdomen.;
Provide adequate hydration and nutrition. |
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Term
| What could happen if a beta blocker is used before alpha blockade is achieved? (Pheochromocytoma) |
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Definition
| may cause a rebound in BP |
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