NURS 330 Week 2 Lecture (Exam 1)

• Anterior Pituitary gland secretes GH, PRL, LH, FSH, ACTH, and TSH
• Growth Hormone impacts the bones, muscles, and organs
• Prolactin impacts the breast
• Leutinizing hormone & follicle stimulating hormone impact the ovaries and testes
• ACTH impacts the adrenal cortex resulting in cortical hormones
• TSH impacts the thyroid gland resulting in thyroid hormones
• Posterior pituitary gland secretes ADH and oxytocin
• ADH or vasopressin impacts the kidneys
• Hypopituitarism is a deficiency in one or more pituitary hormones
• If one pituitary hormone is impacted, it is called selective hypopituitarism
• If multiple pituitary hormones are impacted, it is called panhypopituitarism
• When ACTH and TSH are at low levels, it is the most life threatening
• decreased LH and FSH result in sterility, amenorrhea, and infertility
• decreased GH results in decreased liver production of somatomedins
• Somatomedins maintain bone, cartilage, and tissues
• Hypopituitarism is caused by benign or malignant tumors, malnutrition, rapid loss of body fat, shock, head trauma, AIDS, PPH
• LH & FSH impact secondary sex characteristics when low
• Neurological symptoms seen with hypopituitarism include diplopia, decreased eye movement, and headaches
• Some labs measure the effect rather then the hormone level such as T3 and T4 being measured for thyroid conditions
• Main hypopituitarism interventions focus on replacing all the decreased hormone levels
• Gonadotropin deficiency in men is treated with androgen
• Androgen replacement is avoided in men with prostate cancer due to side effects including gynecomastia, acne, baldness, and prostate enlargement
• Gonadotropin deficiency in women is treated with HRT of estrogen and progesterone
• Growth Hormone deficiency involves SQ injections of growth hormone at night to mimic normal release
• Hyperpituitarism is over secretion of hormones due to anterior pituitary tumors or tissue hyperplasia
• Hyperpituitarism symptoms include vision changes, headaches, and increased ICP
• Prolactin is the most common change, inhibiting gonadotropins and sex hormones leading to galactorrhea, amenorrhea, and infertility
• Increased GH results in acromegaly with increased skin and skeletal thickness plus increased organ size
• Increased ACTH overstimulates the adrenal cortex resulting in Cushing's Disease
• Increased GH diagnosis is done via suppression testing where increased glucose suppresses GH
• Dopamine agonists stimulate dopamine receptors in the brain to stop GH and PRL
• Dopamine agonists include bromocriptine and cabergoline
• Bromocriptine should be given with meals to decrease side effects of orthostatic hypotension, headaches, nausea, abdominal cramps, and constipation
• Somatostatin analogs include octreotide and lanreotide
• GH receptor blockers include pegvisomant which block production of insulin-like growth factor (IGF)
• Radiation doesn't have immediate impacts and is not recommended for those with acromegaly
• Hypophysectomy is the removal of the pituitary gland and the most common treatment
• Post-op care of hypophysectomy includes nasal packaging plus no teeth brushing, coughing, sneezing, blowing nose, bending forward
• Post-op care of hypophysectomy requires monitoring neuro response, DI, CSF, leakage, increased ICP, and signs of infection
• Meningitis is a big concern post-op hypophysectomy with symptoms of headaches, fever, and nuchal rigidity