Chapter 50Chapter 50

Pituitary and Adrenocortical Pituitary and Adrenocortical HormonesHormones

Pituitary GlandPituitary Gland

Anterior Pituitary Anterior Pituitary HormonesHormones Follicle-stimulating hormone (FSH)Follicle-stimulating hormone (FSH) Luteinizing hormone (LH)Luteinizing hormone (LH) Growth hormone (GH)Growth hormone (GH) Adrenocorticotropic hormone Adrenocorticotropic hormone

(ACTH)(ACTH) Thyroid-stimulating hormone (TSH) Thyroid-stimulating hormone (TSH)

(Chapter 51) (Chapter 51) Prolactin (not used medically)Prolactin (not used medically)

Growth HormoneGrowth Hormone

Also called somatotropic Also called somatotropic hormonehormone

Secreted by the anterior Secreted by the anterior pituitarypituitary

Regulates individual Regulates individual growthgrowth

Example—somatropin Example—somatropin Uses—children who fail to Uses—children who fail to

growgrow Adverse Reactions—failure Adverse Reactions—failure

to respond, to respond, hypothyroidism, insulin hypothyroidism, insulin resistance, joint swelling resistance, joint swelling and pain and pain

Contraindications to Contraindications to Growth HormonesGrowth Hormones

Nursing Nursing ConsiderationsConsiderations

Adrenocorticotropic Adrenocorticotropic Hormone: Hormone: Corticotropin (ACTH)Corticotropin (ACTH) Anterior pituitary hormoneAnterior pituitary hormone Stimulates adrenal cortex to Stimulates adrenal cortex to

produce and secrete produce and secrete glucocorticoidsglucocorticoids

Used to diagnosis adrenocortical Used to diagnosis adrenocortical function, multiple sclerosis, function, multiple sclerosis, thyroiditis, hypercalcemia (with thyroiditis, hypercalcemia (with cancer)cancer)

Many Adverse Many Adverse ReactionsReactions

Posterior Pituitary Posterior Pituitary HormonesHormones

Vasopressin and Vasopressin and

oxytocin (not discussed in this oxytocin (not discussed in this chapter)chapter)

VasopressinVasopressin

Examples—Examples—vasopressin vasopressin (Pitressin), lypressin (Pitressin), lypressin (Diapid), (Diapid), desmopressin desmopressin (DDAVP)(DDAVP)

Uses—diabetes Uses—diabetes insipidus, insipidus, postoperative postoperative abdominal distention, abdominal distention, dispel gas interfering dispel gas interfering with X-rayswith X-rays

Adverse ReactionAdverse Reaction

Adverse Reactions—Adverse Reactions—hypersensitivity reactions, hypersensitivity reactions, tremor, sweating, vertigo, tremor, sweating, vertigo, nausea, vomiting, water nausea, vomiting, water intoxicationintoxication

Nursing Nursing ConsiderationsConsiderations Assessment: vital signs, weight e-Assessment: vital signs, weight e-

lytes, abdominal girth, BS, urine lytes, abdominal girth, BS, urine specific gravityspecific gravity

Teaching: measure I & O, drink 2 Teaching: measure I & O, drink 2 glasses of water before taking glasses of water before taking drug, avoid alcohol, rotate drug, avoid alcohol, rotate injection sites, medical alert injection sites, medical alert identificationidentification

Adrenocortical Adrenocortical HormonesHormones

Glucocorticoids and mineralocorticoidsGlucocorticoids and mineralocorticoids

GlucocorticoidsGlucocorticoids Influence immune response; regulate glucose, fat Influence immune response; regulate glucose, fat

and protein metabolism, and antiinflammatory and protein metabolism, and antiinflammatory responseresponse

Act by entering target cells and binding to Act by entering target cells and binding to receptorsreceptors

Used as replacement therapy with adrenocorticol Used as replacement therapy with adrenocorticol insufficency, allergic conditions, collagen diseases insufficency, allergic conditions, collagen diseases (systemic lupus erythematosus, dermatologic (systemic lupus erythematosus, dermatologic conditions, rheumatic disorders, shock, etcconditions, rheumatic disorders, shock, etc

Examples : Desamethosone (Decadron), Examples : Desamethosone (Decadron), hydrocortisone (solu-cortef), methylprednisolone hydrocortisone (solu-cortef), methylprednisolone (solumedrol), and prednisone(solumedrol), and prednisone

Select Adverse Select Adverse Reactions Reactions

Many adverse reactions may occur:Many adverse reactions may occur:

ContraindicationsContraindications

Serious infectionsSerious infections TuberculosisTuberculosis Fungal or antibiotic resistant infectionsFungal or antibiotic resistant infections Caution with renal, hepatic, Caution with renal, hepatic,

hypothryoidism, ulcerative colitis, hypothryoidism, ulcerative colitis, diverticulitis, peptic ulcer, IBD, HTN, diverticulitis, peptic ulcer, IBD, HTN, osteoporosis, convulsive disorders, osteoporosis, convulsive disorders, diabetes, pregnancydiabetes, pregnancy

Multiple drug interactions-Table 50-2, Multiple drug interactions-Table 50-2, page 525page 525

MineralocorticoidsMineralocorticoids

Aldosterone and Aldosterone and desoxycorticosteronedesoxycorticosterone

Act to conserve sodium and Act to conserve sodium and increase potassium excretion increase potassium excretion

Deficiencies result in a loss of Deficiencies result in a loss of sodium and retention of potassiumsodium and retention of potassium

Used a replacement therapy for Used a replacement therapy for deficiency deficiency

MineralocorticoidsMineralocorticoids

Adverse ReactionsAdverse Reactions Edema, hypertension, CHF, Edema, hypertension, CHF,

enlargement of the heart, enlargement of the heart, increased sweating, allergic skin increased sweating, allergic skin rash, hypokalemia, muscular rash, hypokalemia, muscular weakness, headache, weakness, headache, hypersensitivity reactionshypersensitivity reactions

Nursing Process for Nursing Process for Patients Receiving Patients Receiving CorticosteroidsCorticosteroids

Long term therapyLong term therapy

Nursing Nursing Considerations, contConsiderations, cont Administration of corticosteroids several Administration of corticosteroids several

times a day in as little as one week results in times a day in as little as one week results in shutting off the pituitary release of ACTH shutting off the pituitary release of ACTH because there are always high levels of because there are always high levels of glucocorticoids in the plasma. Without ACTH, glucocorticoids in the plasma. Without ACTH, the adrenals fail to manufacture the adrenals fail to manufacture glucocorticoids which can lead to acute glucocorticoids which can lead to acute adrenal insufficiency (life threatening)adrenal insufficiency (life threatening)

May be ordered alternate day therapy:May be ordered alternate day therapy:

Nursing DiagnosesNursing Diagnoses

Chapter 51Chapter 51

Thyroid and Antithyroid DrugsThyroid and Antithyroid Drugs

Thyroid Gland Thyroid Gland

Thyroid GlandThyroid Gland

Secretes hormones thyroxine (TSecretes hormones thyroxine (T44) ) and triiodothyronine (Tand triiodothyronine (T33))

Iodine is an essential element in Iodine is an essential element in hormone productionhormone production

Activity regulated by thyroid-Activity regulated by thyroid-stimulating hormone (TSH)stimulating hormone (TSH)

Two Diseases Related Two Diseases Related to Hormone-to Hormone-Producing ActivityProducing Activity

HypothyroidismHypothyroidism

HyperthyroidismHyperthyroidism

Thyroid HormonesThyroid Hormones

Example—levothyroxineExample—levothyroxine Act to increase metabolic rateAct to increase metabolic rate Uses—replacement therapy in hypothyroidism, Uses—replacement therapy in hypothyroidism,

euthyroid creation, thyrotoxicosiseuthyroid creation, thyrotoxicosis Adverse Reactions—palpitations, tachycardia, Adverse Reactions—palpitations, tachycardia,

nervousness, headache, insomnia, diarrheanervousness, headache, insomnia, diarrhea Contraindicated with recent MI, ThyrotoxicosisContraindicated with recent MI, Thyrotoxicosis Used with caution with Addison’s diseaseUsed with caution with Addison’s disease Replacement therapy may take several weeks Replacement therapy may take several weeks

or begin in 48 hours or begin in 48 hours

Patient TeachingPatient Teaching

Antithyroid DrugsAntithyroid Drugs

Also called thyroid antagonists; Also called thyroid antagonists; used to treat hyperthyroidism and used to treat hyperthyroidism and before surgery to decrease before surgery to decrease bleeding tendency bleeding tendency

Antithyroid DrugsAntithyroid Drugs

Examples—methimazole (Tapazole), Examples—methimazole (Tapazole), propylthiouracil (PTU)propylthiouracil (PTU)

Action—inhibit thyroid hormone Action—inhibit thyroid hormone manufacturemanufacture

Used to manage hyperthryoidismUsed to manage hyperthryoidism Adverse Reactions—agranulocytosis, Adverse Reactions—agranulocytosis,

hay fever, sore throat, skin rash, fever, hay fever, sore throat, skin rash, fever, headache, nausea, vomiting, headache, nausea, vomiting, paresthesiasparesthesias

Iodine (Lugol’s Iodine (Lugol’s solution)solution)

Radioactive IodineRadioactive Iodine

Used to treat hyperthyroidism Used to treat hyperthyroidism and thyroid cancer and thyroid cancer

Nursing considerationsNursing considerations

Patient TeachingPatient Teaching

Isolation/quarantined for specified Isolation/quarantined for specified days (3-5 days)days (3-5 days)

Avoid pregnant women for 2 Avoid pregnant women for 2 weeksweeks