HORMONES Circulate via the bloodstream Secreted in minute amounts Inactivated or excreted by the liver or kidneys Alter the rate of physiological activities

Hormone REGULATION How do hormones turn on their release and turn off their release? Negative Feedback Hormone to Hormone Negative Feedback (or Complex Feedback) Nervous System Regulation

Negative Feedback serum Calcium Level PTH (parathyroid hormone) serum Calcium Level PTH

Hormone to Hormone Negative Feedback ↓ serum levels of thyroid hormones T3 and T4 Calls the hypothalamus and asks to release TRH TRH calls the Anterior Pituitary to release TSH (thyroid stimulating hormone  T3 and T4 Shuts off TRH, then TSH

Nervous System Regulation The hypothalamus and pituitary gland form a complex called the hypothalamic pituitary axis (HPA) which integrates communication from the nervous system to the endocrine system… Question…which hormones are released under times of stress???

Hormone Dysfunction Hypofunction-Too little Congenital defects Destruction of a gland that releases that hormone Aging Atrophy Hyperfunction- Too much Hyperplasia of that gland Tumors

Common Characteristics of Hormonal Disorders Non specific signs & symptoms ↑ or ↓ weight ↓ or ↑ appetite ↑ or ↓ sleep depression changes in hair, skin, personal appearance, mood, libido, etc.

Common Characteristics of Hormonal Disorders Specific Signs and Symptoms Polys Polyuria Polydipsia Polyphagia Exopthalmos in Hyperthyroidism Which celebs can you think of that have this condition?

PITUITARY GLAND Where is it located??? Name its’ 3 parts or sections. What hormones are secreted by the pituitary gland???

Pituitary Gland

ANTERIOR PITUITARY SECRETES 6+ HORMONES: ACTH (adrenocorticotropic hormone) release of cortisol in adrenal glands TSH (thyroid stimulating hormone) release of T3 & T4 in thyroid gland GH (growth hormone) stimulates growth of bone/tissue

FSH (follicle stimulating hormone) stimulates growth of ovarian follicles & spermatogenesis in males LH (lutenizing hormone) regulates growth of gonads & reproductive activities Prolactin promotes mammary gland growth and milk secretion

ANTERIOR HYPER PITUITARY DISORDERS What would happen if you had TOO MUCH secretion of prolactin? Too much release of Lutenizing Hormone (LH)?

ANTERIOR HYPER PITUITARY DISORDERS ETIOLOGY Primary: the defect is in the gland itself which releases that particular hormone that is too much or too little. Secondary: defect is somewhere outside of gland i.e. GHRH from hypothalamus TRH from hypothalamus

PITUITARY TUMORS 10% OF ALL BRAIN TUMORS What are the diagnostic tests to diagnose a pituitary tumor? tumors usually cause hyper release of hormones

ANTERIOR PITUITARY- HYPERfunctioning Sing along Sing along What would happen if you had too much growth hormone secretion??? Which goolish character on the Addam’s Family may have had too much GH secretion?

TOO MUCH GROWTH HORMONE GIGANTISM IN CHILDREN skeletal growth; may grow up to 8 ft. tall and > 300 lbs ACROMEGALY IN ADULTS enlarged feet/hands, thickening of bones, prognathism, diabetes, HTN, wt. gain, H/A, Visual disturbances, diabetes mellitus

GIGANTISM IN CHILDREN ACROMEGALY IN ADULTS

What assessment findings would the nurse document?

COLLABORATIVE INTERVENTIONS FOR PITUITARY TUMOR Medications Parlodel (bromocriptine) & Sandostatin (octreotide) to ________ & GH levels. Radiation therapy external radiation will bring down GH levels 80% of time

Transsphenoidal Hypophysectomy

Neurosurgery: procedure called “transsphenoidal hypophysectomy”; New Method New Method Most common method: incision is made thru floor of nose into the sella turcica.

Nursing Management Pre op hypophysectomy Anxiety r/t a. body changes b. fear of unknown c. brain involvement d. chronic condition with life long care Sharmyn

Sensory-perceptual alteration r/t a. visual field cuts b. diplopia secondary to pressure on optic nerve. Alteration in comfort (headache) r/t a. tumor growth/edema

Knowledge deficit r/t Post-op teaching pain control ambulation hormone replacement activity

Post operative care Post-op complications of hormone insufficiency: What would happen if you didn’t have enough ADH? What is that disorder called?

Other insuffciency: Decrease ACTH will require cortisone replacement due to decrease glucocorticoid production. Can you live without glucocorticoids????

Other deficiency: in sex hormones can lead to infertility due to decrease production of ova & sperm What were those hormones called again?-

Incisional disruption after transsphenoidal hypophysectomy Avoid bending and straining X 2 months post transsphenoidal hypophysectomy, Use stool softeners Avoid coughing Saline mouth rinses Avoid toothbrushing for 7-10 days

Post-op CSF Leak where sella turcica was entered any clear rhinorrhea - test for glucose + glucose = CSF Leak >30mg/dl is positive for CSF leak Notify physician HOB 30 degrees Bedrest

CSF leak usually resolves within 72 hrs. Spinal drain may be placed to drain excess CSF If not - spinal taps done to decrease pressure

Post op problems Transsphenoidal Hypophysectomy (continued) Periocular edema/ecchymosis Headaches Visual field cuts/diplopia What is the most important nursing intervention for these problems????

ANTERIOR PITUITARY- Hypofunction 1. Etiology (rare disorder) may be due to disease, tumor, or destruction of the gland. Diagnostic tests CT Scan Serum hormone levels

S & S Anterior Pituitary Hypofunctioning GH FSH/LH Prolactin ACTH TSH

Collaborative Management neurosurgery -- removal of tumor radiation - tumor size hormone replacement cortisol, thyroid, sex hormones

Nursing Management Assessment of S & S of hypo or hyper functioning hormone levels Teaching-Compliance with hormone replacement therapy Counseling and referrals Support medical interventions

Posterior Pituitary (Neurohypophysis) Question??? What hormones are released by the posterior pituitary? _____ & _____are released when signaled by hypothalamus

ADH (Vasopressin) secreted by cells in the hypothalmus and stored in posterior pituitary acts on distal & collecting tubules of the kidneys making more permeable to H20 -- orvolume excreted?

Bonus Round... Under what conditions is ADH released??? ADH has vasoconstrictive or vasodilation action???

ANSWERS: released in response to decrease blood volume, increase concentration of Na+ or other substances, pain, stress ADH has vasocontrictive properties

Oxytocin Controls lactation & stimulates uterine contractions ‘Cuddle hormone’ Research links oxytocin and socio-sexual behaviors

Posterior Hyper pituitary Disorders SIADH (TOO MUCH ADH!!) Etiology: lung cancer, Ca duodenum/pancreas, head trauma, brain tumor, pulmonary disease, CNS disorders, drugs -- Vincristine, nicotine, general anesthetics, tricyclic antidepressants

Question: If you are having too much ADH... What would the clinical signs/symptoms be??

Clinical manifestations-SIADH Weight gain or weight loss? or urine output? or serum Na levels? muscle weakness muscle cramps H/A Vomiting, diarrhea

If hyponatremia worsens will develop neuro manifestations muscle twitching lethargy Confusion Cerebral edema seizures coma

Diagnostic Tests-SIADH Serum Na+ <135meq/l What is considered severe hyponatremia? < 120mEq/l Serum osmolality <275 OSM/kg H2O urine specific gravity

Collaborative Interventions ***FLUID RESTRICTION LIMIT TO 1000ML/24HRS IV 3% NaCl to replace Na IF CHF -- Lasix (temporary fix) Treat underlying problem --Chemo, radiation Declomycin 600 po-1200mg/day to inhibit ADH Tolvaptan (Samsca) ADH receptor antagonist

Nursing Interventions-SIADH Fluid restriction may be as little as ml/24hrs Daily weights... 1 lb. weight = 500ml fluid retention Accurate I & Os Seizure precautions Mouth care, why?

Nursing Management-SIADH F & E imbalances fluid intake High risk for injury r/t complications of fluid overload (seizures)

Posterior Hypopituitary ADH disorders Diabetes Insipidus (too little ADH) What do you think the S&S would be if you had too little ADH???

Etiology 50% idiopathic a. central -- i.e. brain tumors, head injury, brain surgery b. nephrogenic - inability of tubules to respond to ADH, common cause is due to side effect of Lithium c. Primary DI-due to excess water intake

Clinical Manifestations-DI Polydipsia Polyuria (10L in 24 hours) Severe fluid volume deficit wt loss tachycardia constipation shock

Diagnostic Tests-DI or urine specific gravity or serum Na or serum osmolality Dehydration test: 2 units of Vasopressin (ADH) mixed in saline administered over 2 hrs then check urine osmolality levels

Medical Management-DI Identification of etiology, H & P Tx of underlying problem DDAVP (nasal spray) Pitressin s.c. IM, nasal spray

Nursing Management-DI Assess for F & E imbalances Increase po/IV fluids RF Injury (hypovolemic shock) Knowledge deficit High risk for ineffective coping