NUR 420 Endocrine Disorders Lecture Notes

Feedback System
 Levels of hormones are regulated by hypothalamus, which sends commands
to pituitary to increase or decrease secretion of hormones depending on
levels in body
Disorders of Anterior Pituitary: Growth Hormone Excess
 Almost always caused by benign pituitary adenoma (tumor growing out of
tissue)
 Presents as giantism (children) and acromegaly (adults)
o Giantism: onset of growth hormone hypersecretion before puberty;
longitudinal growth
o Acromegaly: hypersecretion after puberty; enlargement of facial
features, hands, feet, joints; broadening growth
 1st line surgical management
o Transsphenoidal Microsurgery or hypophysectomy : surgery done
through the upper lip and floor of the nose to remove tumor
 Lifelong PO hormone replacement if entire gland is removed
 Post-op:
 Raise HOB, avoid bending over (puts stress on suture)
 No teeth brushing
 No coughing or nose blowing
 Deep breathing is ok for pneumonia prevention
 No use of straws (can break suture line)
 Monitor neuro status (CSF leak) and watch for meningitis
(intense headache, fever, neck stiffness, buccal rigidity)
 CSF leak manifests as headache
 If pt. notes feeling drip in back of throat, don't
assume its post nasal drip. Test it with dexa strip to
show sugar
 Collaborative intervention
o Radiation therapy secondary treatment if removal is not completely
successful/ piece left behind
 Sometimes used to reduce tumor size prior to surgery so it's
easier to remove
o Drug therapy
 Octreotide (Sandostatin) to decrease growth hormone levels
 Dopamine agonist to suppress GH secretions
 PO hormone replacement taken if needed
Disorders of Anterior Pituitary: Hypopituitarism
 Caused by pituitary tumor with symptoms specific to hormone not being
secreted
 Treated with lifelong hormone replacement for damaged gland
Disorders of Posterior Pituitary: Syndrome of Inappropriate Antidiuretic Hormone
(SIADH)
 Antidiuretic Hormone (ADH) is made in hypothalamus and stored in posterior
pituitary; function is to regulate water balance and osmolarity (how much
water body needs and when to get rid of it)
o Released by posterior pituitary when plasma osmolality is too high
(when blood thicker than urine)
 Inappropriate ADH -> water intoxication

, o ADH released despite normal or low plasma osmolality; diuresis not
happening naturally and body is holding onto water
o More common in older adults
o Characterized by
 Holding onto fluid so no/ decreased urine output
 Really concentrated urine even with increased fluid volumes
 Serum hypoosmolality (blood very thin and diluted)
 Dilutional hyponatremia: sodium levels plummet and put pt. at
seizure risk
 Hyponatremia s/s: muscle cramps, n&v, abdominal
cramps, seizures
 ;Pituitary increases levels of ADH -> this increases renal tubule
permeability to water (kidneys pulling water instead of releasing to bladder) -
> increased water reabsorption -> low urine volume, increased hyperosmolar
urine (concentrated, thick), increased urine sodium -> increased blood
volume (from water reabsorption back into body), increased serum
hypoosmolality (thin), dilutional hyponatremia occurs which causes
aldosterone (salt) secretion, which causes more water retention -> n&v,
irritability, confusion, disorientation, seizure
 Causes
o Cancer, particularly small cell cancer of lungs
o Disorders of central nervous system (head injury)
o Drug therapy: chemo, general anesthesia
o Hypothyroidism (untreated)
o COPD/ lung infection/ mechanical ventilation
o CVA, brain tumor
 Diagnostic studies
o Serum sodium levels diluted; lower then 134
 Seizure risk
o Serum osmolality (thickness of blood) lower than 280 (should be 280-
295)
o Urine specific gravity (weight of urine compared to water) higher than
1.030 (should be 1.010- 1.025/1.030)
o Serum osmolality less than urine osmolality (urine thicker than blood)
 Collaborative interventions
o If sodium higher than 125, restrict fluids and hope it balances out
 Provide ice chip and hard candies if thirsty
o If sodium less than 120, provide hypertonic (3%) saline solution (salty
fluids, to raise sodium levels)
o Diuresis to release water
 Watch potassium
o Daily weight to monitor progress
o Strict I&O
 Urine output will increase as problem is corrected
o Safety interventions since they'll be confused from hyponatremia and
can have seizure
o Demeclocycline (Declomycin) taken PO for chronic SIADH to block
effects of ADH on renal tubules
 Decreases the absorption