1. Endocrine
Pituitary gland
5-2

2. Hyperpituitarism What two hormones are affected with hyperpituitarism?GH
ADH

3. Hyperpituitarism hGH h ADH Adult Child
Acromegaly
Child
Gigantism
h ADH
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

4. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Definition
Excess ADH
What does ADH do?
Causes kidneys to reabsorb water 
i urine output 
h fluid volume

5. SIADH - Etiology #1
Lung CA
Other CA
COPD

6. SIADH – S&S Water retention Urine Edema Wt gain Concentrated
Sp. gravity h

7. SIADH: S&S Hyponatremia Serum Osmolality < 130
Normal meq/dl
Muscle cramps
Weakness
Serum Osmolality
Decreased
Blood leaks into brain 
Brain swelling 
Lethargy, seizures, coma
Deathmosis

8. SIADH: Medical treatment
Tx underlying disorder
Resolve fluid volume excess
Restrict H2O
Promote H20 voiding
Sodium replacement
Radiation
Chemotherapy

9. SIADH: Rx Furosemide (Lasix) Action Nrs consideration Enhance diuresis
P Fluid & electrolyte panels
I&O VS
q day wt
Need to know both names (generic and trade)

10. SIADH: Rx Demeclcycline hydrochloride (Declomycin)
Action
Enhances Na+ retention
Fludrocortisone (Florinef)
Nrs. Consideration
Fluid restriction

11. SIADH: Nrs. Dx
Fluid Volume Excess

12. Hypopituitarism Definition Etiology i secretion of pituitary hormones
#1 Tumor
Congenital defects
Pituitary infarction
Pituitary surgery
Pituitary CA

13. Hypopituitarism
Clinical manifestations are slow to appear & are not really apparent until 75% of the pituitary is destroyed

14. Hypopituitarism: Primary Secondary Trouble w/ the Pituitary 
i Pituitary hormone
Secondary
Trouble somewhere else (not pituitary) 
i pituitary hormone
Usually hypothalmus

15. Hypopituitarism: Growth hormone
Dx:
Dwarfism
S&S (i GH)
Apparent by 6 months
Delayed puberty
Growth rate ½ unto 4 ft.
Body proportions = normal
Accel. aging

16. Hypopituitarism: FSH & LH
Female
Amenorrhea
Infertility
i libido
Breast atrophy
Male
Weakness
Impotence
i libido
Testicles soften & shrink

17. Hypopituitarism: TSH Severe growth retardation (even w/ tx)
S&S (i TSH)
Think slow
Lethargy
Bradycardia
Slow thoughts
Cold intolerance

18. Hypopituitarism: ACTH
Handle stress
S&S (i ACTH)
Fatigue
Wt loss
Anorexia
Depigmentation of skin
V/S when stressed
Fever
Hypotension

19. Hypopituitarism: Prolactin
S&S (i prolactin)
Absent postpartum lactation

20. Hypopituitarism: Simmond’s Disease
AKA
Panhypopituitarism
Definition
Total absence of all pit. hormones
Etiology
Surgery
Infection
Injury
Tumor

21. Hypopituitarism: Simmond’s Disease
Clinical Manifestations
Wt loss
Gen. debility
Weak
i libido
Cold intolerance Tx
Administration of all Pit. hormones

22. Hypopituitarism: ADH Dx: Definition Diabetes Insipidus i ADH
Vasopressin

23. Hypopituitarism: Diabetes Insipidus
Etiology
Injury to pituitary or hypothalamus
Pregnancy
Medication use
Lithium
Lasix
Kidney not respond to ADH

24. Hypopituitarism: Diabetes Insipidus
Clinical manifestations
Polyuria
Sp. gravity of urine i
Serum osmolality h
Na+ levels
Hypernatremia
> 145

25. Hypopituitarism: Diabetes Insipidus
Extreme thirst
Cold beverages
Wt. loss
Dizziness
Constipation
Fatigue

26. Hypopituitarism: Diabetes Insipidus
Complications
Hypovolemia
Circulatory collapse
Unconsciousness
CNS damage
Prognosis
OK (w/ fluid)

27. Hypopituitarism: Diabetes Insipidus
Medical treatment
Fluid replacement
Replace hormone
ADH/Vasopressin
Fix underlying cause

28. Hypopituitarism: Diabetes Insipidus Rx
Desmopressin acetate (Stimate)
Action
Synthetic ADH
Route
Parenteral
Nasal
Nrs. Considerations
Clear nasal passage

29. Hypopituitarism: Diabetes Insipidus Rx
Vasopressine (Pitressin)
Action
ADH hormone
Route
Parenteral
Nasal
S/E
Increased BP

30. Hypopituitarism: Diabetes Insipidus Rx
If D.I. is due to kidney
More ADH not help

31. Hypopituitarism: Diabetes Insipidus
Nrs. Dx
Fluid Volume Deficit
Nursing interventions
I&O
P Electrolytes
h Na+ intake VS

32. Mrs. Waterfall What would the name of this disorder be?
2. What is causing the elevated ADH levels?
3. What other lab values would coincide with this disorder?

33. Mrs. Waterfall
4. What nursing diagnosis is appropriate for this disorder?
5. What interventions would you as a nurse start with this diagnosis?
6. What medications would you expect the doctor to order?

34. Ms. Pealot Why is Ms. Pealot not started on insulin?
2. What hormonal irregularity causes diabetes insipidus?
3. What can cause diabetes insipidus?
4. Besides polyuria & polydipsia, what other clinical manifestations would you expect?

35. 5. What dx tests would confirm the dx of diabetes insipidus?
6. What nrs. dx would best apply to Ms. Pealot?
7. What nrs. interventions would you implement?
8. What doctors order would you expect to see?

36. Pituitary Tumors Definitions Clinical Manifestations Anterior Pit. H/A
Visual problems
Personality changes
Dementation
S&S of hypopituitarism

37. Pituitary Tumors Medical treatment Rx Remove tumor Radiation
Cryohypophysectomy Rx
Hormone replacement