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
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
