DI vs SIADH Gail L Lupica PhD, RN, CNE

Pituitary Disorders The pituitary gland plays a vital role in the body’s ability to maintain homeostasis. Pituitary disorders involve an excess or deficiency in one or more of the pituitary hormones. The Hypothalamus controls many Pituitary functions. It signals to the pituitary to release or inhibit hormone secretion.

The Pituitary gland (hypophysis) Posterior (these hormones are synthesized in the hypothalamus And stored in the posterior pituitary) 1. Anti-diuretic hormone (ADH): renal distal tubules become more permeable to water, causing a reabsorbtion (also has a vasopressor effect in high doses) (alcohol inhibits ADH secretion) 2. Oxytocin: uterine/lactation/fertilization 3. Melanocyte stimulating Hormone

Diabetes Insipidus and stored in the posterior pituitary ADH is synthesized in the hypothalamus and stored in the posterior pituitary 1. ADH: renal distal tubules become more permeable to water, causing a reabsorbtion (also has a vasopressor effect in high doses) (alcohol inhibits ADH secretion)

Diabetes Insipidus (DI) Anti diuretic hormone is suppressed from the post pituitary. The patient therefore diureses. What will you see? Copious urine output! High serum sodium > 145 Why? Low urine specific gravity 1.001-1.005 Why? What kind of problems do you think would prompt this?

DI- treat, Nsg Dx Treat underlying cause May give exogenous ADH (nasally, IV, po) Give IV fluid resusitation/replacement I & O What is your PRIMARY Nursing Diagnosis?

Syndrome of Inappropriate Anti-diuretic hormone (SIADH) Occurs when there is over secretion of ADH from the posterior pituitary ADH ADH ADH ADH ADH ADH ADH ADH ADH ADH ADH ADH ADH ADH ADH ADH

SIADH What will you see? The body is NOT diuresing. Therefore fluid is reabsorbed into the vascular space Pt will be oliguric. Serum sodium will be very low (< 135). Why? Specific gravity of urine will be high. Why? (Pt suffers from symptoms of a dilutional hyponatremia)