adrenal medulla

• Pheochromocytoma


  Benign tumor in adrenal medulla
• Pheochromocytoma


  • High epinephrine and norepinephrine
  • Severe vasoconstriction
  • Hypertensive crisis — 180/120
  • Sudden death within 4 hours
• Management of pheochromocytoma


  1. Monitor blood pressure q15

  2. Administer medications

  3. Medication: Phentolamine Mesylate (Regitine) - fast acting vasodilator TIV

  4. Antidote: Dopamine – to increase BP
• Anterior Pituitary Gland


  Secretes TRF, ACTH RF, FSH RF, LH RF, GH, TSH, ACTH, FSH, LH
• Hypothalamus


  Secretes TRF, ACTH RF, FSH RF, LH RF
• Posterior Pituitary Gland


  Stores oxytocin and antidiuretic hormone
• Oxytocin


  Milk ejection, Uterine contraction
• Antidiuretic Hormone


  Water reabsorption
• Hyperpituitarism


  • Chronic progressive disease
  • Growth hormone secretion and tissue growth
  • Gigantism - whole body, bone not closed, happen in children
  • Acromegaly - only specific parts of the body grows, bone is closed already, growth hormone tends to focus in tissue
• Anterior pituitary adenoma


  Cause of hyperpituitarism
• Nursing Management of hyperpituitarism

  1. Assist with ROM - pts are not balanced

  2. Administer medications

  3. DOC: Sandostatin (Octreotide) - a synthetic somatostatin

  4. Surgery: Hypophysectomy - through nose, Removal of tumor

  5. Counseling
• Hypopituitarism


  • Dwarfism
  • Metabolic dysfunction
  • Sexual immaturity
  • Growth retardation
• Causes of hypopituitarism


  Tumor, infection/ inflammation, trauma
• Management of hypopituitarism


  Counseling
• Syndrome of Inappropriate Antidiuretic Hormone (SIADH)


  • Hypersecretion of ADH - water reabsorption
  • Characterized by excessive retention of water, Edema, Weight gain, Hypertension, Dilutional hyponatremia
• Management of SIADH


  1. Monitor fluid balance, I&O, weight, edema

  2. Diet: fluid and sodium restriction

  3. Main Therapy: Diuretics
• Diabetes Insipidus


  • Zero or no ADH — fluid volume deficit
  • Characterized by polyuria : 20L/ day, Dehydration, Constipation
• Nursing Intervention for Diabetes Insipidus

  1. Monitor fluid balance, I&O, weight, Skin turgor

  2. Maintain adequate hydration

  3. Medications, DOC: Desmopressin Acetate (Vasopressin)