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Endocrine Disorders (Pituitary)
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Endocrine Disorders (Pituitary)

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Pituitary Gland disorders which is part of Endocrine System.

Pituitary Gland disorders which is part of Endocrine System.

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Endocrine Disorders (Pituitary) Endocrine Disorders (Pituitary) Presentation Transcript

  • Disorders of the Hypothalmus & Pituitary
  • Endocrine System: Anatomy ENDOCRINE GLANDS  Pituitary  Adrenal  Thyroid  Parathyroid  Pancreas  Ovaries  Testes
  • Endocrine Glands: Hormone Messengers
  • Endocrine System: Functions       Maintenance & regulation of vital functions Response to stress & injury Growth & development Energy metabolism Reproduction Fluid, electrolyte, & acid-base balance
  • Endocrine Disorders  Pituitary / Hypothalmus       Obesity Pituitary adenoma Hypopituitarianism Diabetes insipidus Syndrome of Inappropriate Antidiuretic Hormone (SIADH)       ACTH Dependent ACTH Independent      Primary Secondary Adrenal Medulla Pheochromocytoma    Primary Hyperparathyroidism Secondary Hyperparathyroidism Familial (Benign) Hypocalciuric Hypercalcemia Hypercalcemia of Malignancy Hypoparathyroidism Pseudohypoparathyroidism Medullary carcinoma of the thyroid Thyroid  Adrenocortical Insufficiency (Addison’s Disease)    Cushing’s Syndrome  Parathyroid  Adrenal Cortex    Hyperthyroidism Hypothyroidism Goiter Thyroid nodules & Neoplasms Subclinical Thyroid disease Endocrine Pancreas      Type 1 diabetes mellitus Type 2 diabetes mellitus Insulinoma Glucagonoma Somatostatinoma
  • Hypothalamic-Hypophysial Portal System
  • Pituitary Gland        The master gland Located at the base of the brain Influenced by the hypothalamus Directly affects function of other endocrine glands Promotes growth of body tissue Influences water absorption by the kidney Controls sexual development and function
  • Pituitary Gland
  • Pituitary Gland Secretions  Anterior Lobe Production (adenohypophysis)          ACTH (adrenocorticotropic hormone) TSH (thyroid-stimulating hormone) STH (somatotropic growth-stimulating hormone) FSH (follicle-stimulating hormone) LH (luteinizing hormone) PRL (prolactin) GH (growth hormone) MSH (melanocyte-stimulating hormone) Posterior Lobe Production (neurohypophysis)   ADH (vasopressin, antidiuretic hormone) Oxytocin
  • Pituitary Disorders  Anterior Pituitary     Acromegaly Giantism Dwarfism Posterior Pituitary   Diabetes Insipidus SIADH (Syndrome of Inappropriate Secretion of Antidiuretic Hormone)
  • Pituitary Adenoma   Benign tumor Significant d/t    Clinical presentation r/t    Intracranial mass: headache, DI, vision changes Excess/deficiency of one or more pituitary hormones Size    Located in an enclosed space with very limited capacity to accommodate an expanding mass Arise from cells thatt secrete hormones, giving rise to hormone overproduction syndromes Microadenomas < 10 mm – more likely to present with c/o hormone excess than local mass effects Macroadenomas > 10 mm – more likely to experience mass effects which can impinge on optic chiasm producing visual impairments (bitemporal hemianopia) Etiology (type of tissue & specific secretion)     Oversecretion of growth hormone – Giantism & acromegaly Oversecretion of ACTH (and glucocorticoids) – Cushing’s disease Oversecretion of prolactin - Galactorrhea Oversecretion of TSH, LH, FSH by tumors is rare
  • Prolactinoma  Most common anterior pituitary disorder   Account for 60% of all primary pituitary tumors Symptoms   Galactorrhea in 30-80% of women & 33% of men Suppression of gonadal function    Women: Amenorrhea, irregular menses, menses with infertility, Men: decreased libido, partial or complete impotence or infertility Decreased bone density
  • GH-Secreting Adenoma  Giantism   occurs in childhood before the closure of the epiphyses of the long bones Acromegaly  Occurs in middle age, after the closure of the epiphyses of the long bones
  • Giantism or Gigantism  Assessment    Overgrowth of long bones Increased height in early adulthood Deterioration of mental & physical status
  • Clinical & Lab Findings in Acromegaly FINDING FREQ (%) Recent acral growth 100 Arthralgias 72 Excessive sweating 91 Weakness 88 Malocclusion 68 New skin tags 58 Hypertension 37 Carpal tunnel 44 ↑ FBG 30 Abnormal OGTT 68 ↑ heel pad thickness 91 ↑ serum PRL 16 ↑ serum phosphorus 48 ↑ sella volume 96
  • Acromegaly  Assessment              Large hands and feet Visual problems Headache Hyperglycemia Hypercalemia Deepened voice Thickening and protrusion of the jaw Increased hair growth Joint pain Diaphoresis Oily, rough skin Menstrual disturbances Impotence
  • ACTH-Secreting Pituitary Adenoma  Secretion of excess cortisol as a result of overproduction of ACTH by a pituitary adenoma     Most common cause of spontaneous Cushing’s disease Female to male ratio 8:1 Must be distinguished from effects caused by CRH or ACTH arising from outside the hypothalmus or pituitary gland and from adrenal adenomas or carcinomas S/S   Local mass effects Overproduction of cortisol
  • Hypopituitarism  Hypopituitarism   Panhypopituitarism     Addisonian crisis Diabetes insipidus Insidious onset from progressive destruction of pituitary gland by a nonsecreting tumor or subsequent to pituitary radiation therapy    Syndrome resulting from complete loss of all the hormones secreted by the pituitary gland Symptoms vary based on extent & duration of disease Acute onset secondary to infarction or trauma  life threatening conditions   Refers to the loss of one or more pituitary hormones c/o reproductive function d/t LH & FSH deficiency: amenorrhea in women; infertility or erectile dysfunction in men Non-specific c/o lethargy, altered bowel habits Other causes   Massive blood loss in childbirth – Sheehan’s syndrome Rare genetic conditions
  • Dwarfism  Description    The hyposecretion of growth hormone (GH) by the anterior pituitary gland Dwarfism occurs in childhood Assessment      Retarded physical growth Premature aging Low intellectual development Dry skin Poor development of secondary sex characteristics
  • Diabetes Insipidus   Syndrome of polyuria resulting from the inability to concentrate urine and conserve water as a result of the lack of vasopressin (antidiuretic hormone) Clinical presentation     Nocturia Enuresis Large volume of urine (10-20 L/day) Dehydration if unable to maintain fluid intake equal to fluid losses
  • Causes of Diabetes Insipidus  Central – defect in the synthesis or secretion of ADH  Hereditary     Autosomal dominant       Idiopathic Traumatic or postsurgical Neoplastic disease Ischemic or hypoxic disorder Granulomatous disease Infections Autoimmune disorder Hereditary  Acquired  Nephrogenic – loss of kidney’s ability to respond to ADH by retaining water  Acquired        Familial – 2 types Hypokalemia Hypercalcemia Postrenal obstruction Drugs: lithium Sickle cell trait or disease Amyloidosis Increased metabolic clearance of ADH  Pregnancy
  • Diabetes Insipidus  Description   The hyposecretion of antidiuretic hormone (ADH) & a deficiency of vasopressin Results in failure of tubular reabsorption of water in the kidneys  Assessment            Polyuria of 4 - 24 L per day Polydipsia Dehydration Decreased skin turgor, dry mucous membranes Inability to concentrate urine A low urinary specific gravity of 1.006 or less Fatigue Muscle pain & weakness Headache Postural hypotension Tachycardia
  • Causes of SIADH  Tumors      Bronchial carcinoma (small-cell) Other carcinomas (duodenum, pancreas, bladder, ureter, prostate) Leukemia, lymphoma Thymoma, sarcoma               Mass lesions: tumors, abscess, hematoma Infections: encephalitis, meningitis CVA Senile cerebral atrophy Hydrocephalus Trauma DTs Acute psychosis Demyelinating & degenerative disease Inflammatory disease      Infections: tuberculosis, pneumonia, abscess Acute respiratory failure Positive pressure ventilation Drugs  CNS disorders  Pulmonary disorders Vasopressin, desmopressin acetate Chlorpropamide Clofibrate Vincristin, vinblastine, TCAs, phenothiazines Idiopathic  Diagnosis of exclusion
  • Syndrome of Inappropriate Secretion of ADH (SIADH)  Description   A disorder of the posterior pituitary gland in which a continued release of the antidiuretic hormone (ADH) occurs Results in water intoxication  Assessment          Changes in LOC Mental status changes Weight gain Hypertension Signs of fluid volume overload Tachycardia Anorexia Nausea and vomiting Hyponatremia
  • Hyponatremia: Description    Serum sodium level < 135 meq/L Excessive sodium loss (without water) Excessive water gain (without sodium) Decreased serum osmolality    sodium shifts from ICF to ECF fluid shifts from ECF to ICF (cellular swelling) Most common electrolyte imbalance in hospital setting (3% prevalence)
  • Hyponatremia: Etiologies  Excessive sodium loss       Prolonged diuretic therapy Burns Excessive diaphoresis GI fluid loss: prolonged vomiting, NG suction, diarrhea, laxative abuse, repeated TWEs Renal disease Insufficient sodium intake or absorption   anorexia acute alcoholism  Excessive water gain    Adrenal insufficiency   excessive administration of water PO or IV (D5W) psychiatric disorders with compulsive water drinking low aldosterone compromises sodium reabsorption SIADH  dilutional hyponatremia d/t water retention
  • Hyponatremia: Manifestations   Na+     >125 asymptomatic =120-125 nausea, malaise, abd cramps =115-120 headache, lethargy, obtunded <110-115 seizures, coma, personality changes   I > O,  UO Lab values       urine specific gravity < 1.010  Cl< 100 mEq/L  Serum osmolality < 285 Weight gainno significant edema Fingerprinting over sternum *
  • Causes & Effects of Hyponatremia
  • Hypernatremia: Description    Serum sodium level > 145 meq/L Excessive sodium gain (without water) Excessive water loss (without sodium) Increased serum osmolality   fluid shifts from ICF to ECF (cellular shrinking) Most often a water problem  never occurs in alert pt with normal thirst and access to water
  • Hypernatremia: Etiologies  Water deprivation       unconscious debilitated infants Hypertonic tube feedings  without adequate fluids Insensible water losses      without water supplements Inadequately diluted baby formula High protein diet   Watery diarrhea Excessive admin of    3% saline sodium bicarbonate Diabetes Insipidus   burns hyperventilation heat stroke lack of ADH Near drowning in sea water
  • Hypernatremia: Manifestations   Dry sticky mucous membranes * Neurologic (CNS)       hyperactive DTRs disorientation agitation with stimulation hallucinations lethargy  coma Neuromuscular   muscle twitching convulsions   Extreme thirst * VS       T (low grade)  HR  BP Oliguria or anuria Lab values     ClUrine specific gravity > 1.015 Serum osmolality > 295
  • Causes & Effects of Hypernatremia
  • Isotonic Fluid Loss-Excess & Hyper/Hyponatremia