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Hypothalamus & pituitary disorders and medications

Terms in this set (26)

Parathyroid hormones
when there is a decrease in calcium levels--> Parathyroid secretes PTH (parathyroid hormone)--> to increase bone resorption and increase serum calcium levels
Thyroid hormones
The hypothalamus releases TRH (thyrotropin-releasing hormone)--> it signals the anterior pituitary to secrete TSH (thyroid stimulating hormone)--> this stimulates the thyroid to release TH (Thyroid hormone)
Anterior Pituitary (Adenohypophysis) hormones
there are 6 main hormones that are released by the anterior pituitary;
1. ACTH (adrenocorticotropic horomone)--> sends signal to the adrenal cortex--> to secrete Aldosterone (mineralcorticoid), Cortisol, cortisone (glucocorticoid), and Testosterone (androgen). It also sends a signal--> to the adrenal medulla--> to secrete epinephrine and nor-epinephrine (non-essential)
2. TSH (thyroid-stimulating hormone)--> sends signal to the Thyroid--> secretes TH (thyroid hormone)
3. GH (growth hormone)--> send signal to the bone, muscle and tissue
4. Prolactin--> sends signal to the mammary glands
5. FSH (follicle stimulating hormone)--> sends signal to testes--> testosterone and to ovaries--> estrogen & progesterone
6. LH (leutenizing hormone)--> sends signal to testes--> testosterone and to ovaries--> estrogen & progesterone
Posterior pituitary (Neurohypophysis) hormones
1. ADH (anti-diuretic hormone)--> sends message to the kidneys to reabsorb water in the distal tubules
2. Oxytocin--> sends signals to the prostate, uterus & mammary glands
Adrenal gland disorders
The adrenal cortex secrets; aldosterone, cortisol, cortisone & testosterone
1. Disorder= Hypercrotisolism (Cushing's disease).
Drug therapy= anti-adrenal agents to decrease cortisol
2. Disorder= Hypocortisolism (Addison's disease)
Drug therapy= glucocorticoids
Anterior pituitary gland disorders
The anterior pituitary secretes GH, Prolactin, LH, FSH, ACTH, TSH.
1. Disorder= Acromegaly (too much GH in adults)
Drug therapy= Sandostatin, Somavert
2. Disorder= Small stature/ dwarfism (in children)
Drug therapy= Protropin, Genotropin, Mecasermin
Posterior pituitary gland disorders
The posterior pituitary secretes ADH & Oytocin
1. Disorder= DI (Diabetes Insipidus) (not enough ADH)
Drug therapy= Vasopressin, Desmopressin, Lypressin
Thyroid gland disorders
The thyroid secretes TH, T3, T4
1. Disorder= Graves Disease (too much TH)
Drug therapy= PTU, Tapazole
2. Disorder= Myexedema (adults) (not enough TH)
Drug therapy= T4
Graves disease manifestations
Goiter, exopthalamos, increased basal metabolism dute to increase Thyroid secretion
Myexedema manifestations
Dry, waxy , non-pitting edema, swollen lips, thick nose
Desmopressin indications
For acute Diabetes insipidus but not if it's caused by kidney disease (will make overload worse)
-is an ADH replacement
-Vasopressin analog
-reabsorbs water in the kidneys
- duration is 20hrs
-causes contraction of smooth muscle in the vascular system; the uterus, the GI tract, and the blood vessels
-give in the evening to mimic normal body rhythm
-tolerance occurs when taking desmopressin for less than 24hrs or by the IV route
-caution with children since they are more prone to water intoxication & hyponatremia
-give undiluted over 1 min
- fluids must be restricted & monitored after IV injection to prevent water intoxication
Desmopressin adverse effects
-water intoxication
-drowsiness
-headache
-listlessness
- convulsions & coma
-transient headache
-nausea
-mild abdominal pain
-cramping
-facial flushing
-hypertension
-pain & swelling at injection site
Adrenal gland hormones
-The adrenal gland weighs 2/10th of an oz
-it secretes 75-80% of epinephrine and the rest nor-epinephrine
-The Sympathetic division (fight or flight) of the ANS--> signals the adrenal medulla--> to secrete epinephrine . It also sends a signal to the adrenal cortex--> to secrete glucocorticoids, (cortisol is the most important and the most abundant) mineralcorticoids & gonatocorticoids (androgens)( Too much gonatocorticoids--> leads to hirstuism).
Adrenal gland disorders; Hyperaldosteronism
-too much aldosterone--> causes hyptertension, hypernatremia & hypokalemia
-is due to adrenal tumor
Glucocorticoids secreted by the adrenal cortex
- Cortisol, Corticosterone, & cortisone
- they affect the metabolism of every cell, & prepare the body for long-term stress
-they increase blood glucose by inhibiting insulin secretion & promoting gluconeogenesis (the synthesis of carbohydrates from lipids & protein sources)
-they increase protein breakdown & lipids--> and use as energy
-they supress inflammatory & immune responses
-they increase sensitivity of vascular smooth muscle to norepinephrine & angiotensin II
-they increase bony matrix breakdown--> can lead to bone demineralization
-they increase bronchodilation by making it sensitive to SNS
Pathophysiology of Corticosteroids
the control of corticosteroids begins with CRF (corticotrophin releasing factor) in the hypothalamus--> sends a signal to the anterior pituitary--> secretes ACTH (Adrenocorticotrophic Hormone)--> this sends a signal to the adrenal cortex--> secretes glucocorticoids ( cortisol)--> to the blood stream--> when cortisol is increased in the blood, the negative feedback is sent to the hypothalamus--> the pituitary shuts off the further release of cortisol.
Adrenal cortex disorders; Adrenocortical insufficiency (Addisons disease)
-Is caused by diminished secretion of corticosteroids from the adrenal cortex, or not enough ACTH from the anterior pituitary to signal the adrenal cortex to produce corticosteroids.
-Use Cosyntropin medications= it resembles ACTH and is used to diagnose the cause. If it is adrenal gland or if it is from the pituitary.
-The rise in plasma cortisol means that the adrenal cortex is reacting to ACTH secretion
-If there is no rise in cortisol, then it means that the adrenal cortex is unresponsive to the ACTH and the problem is in the adrenal cortex itself.
Manifestations of Adrenocortical insufficiency (Addisons disease)
- hypoglycemia
-fatigue
-hypotension
-increased skin pigmentation
- GI disturbances
-decrease plasma cortisol
Primary adrenocortical insufficiency (Addisons disease)
-decreased glucocorticoid, decreased mineralcorticoids
-caused by atuoimmune destruction of both glands
Secondary adrenocortical insufficiency (addisons disease)
-due to sodden withdrawal of glucocorticoids, infection, trauma or cancer
manifestations of acute adrenocortical insufficiency
- nausea, vomiting, lethargy, confusion, & coma
-Give hydrocortisone= patients taking glucocorticoids should also take mineralcorticoids (Florinef)
Hydrocortisone
-short acting to increase cortisol levels
- has mineralcorticoid activity--> causes an increase in sodium, & fluid retention
-can mask infection & resultant delay in antibiotic therapy
-give with food
-estrogen potentiates the effects
-diuretics increase the risk of hypokalemia
*Adverse Effects= signs of cushing's disease, insomnia, anxiety, headache, vertigo, confusion, & depression, hypertension, tachycardia, PUD if long term
*caution= DM, osteoporosis, psychoses, liver disease, hypothyroidism
Glucocorticoid interactions with other meds
*antidiabetic agents= decreases effectiveness since glucocorticoids increase BG
*Ulcerogenic drugs= NSAIDs & Aspirin= can increase PUD
*Non-potassium sparing diuretics= cause hypocalcemia, and hypokalemia
*Long term effects of glucocorticoids= immune & inflammatory suppression, may mask existing infection, PUD when combined with NSAIDs, fractures due to Osteoporosis, Nervous, moody, hallucinations, increase suicidal ideation, cataracts, open-angle glaucoma, hyperglycemic effects--> glucose intolerance, hyperlipidemia, abnormal fat deposits, hypocalcemia, hypokalemia, hypernatremia, fluid retention, weight gain (similar to increase ACTH in cushings), edema, muscle wasting, weak, fatigue.
Cushing's syndrome
occurs when high levels of glucocorticoids are in the body for a long time
-hypersecretion can be due to increase ACTH or adrenal tumors
-high mortality rate
*manifestations= adrenal atrophy, osteoporosis, hypertension, increase risk of infection, delayed wound healing, mood and personality changes, psychologically dependent on drug, acne, PUD, general obesity, redistribution of fat, moon face, buffalo hump
Metyrapone (Metopirone)
is an antiadrenal drug, is used to determine pituitary gland function levels of ACTH & glucocotricoids.
-are measured to determine if the adrenal glands responded to the inhibiting action of metyrapone
-also used to treat cushing's disease to decrease ACTH
Ketoconazole (Nizoral)
Preferred drug for patients with cushing's disease who need long-term therapy
-rapidly blocks the synthesis of glucocorticoids lowering serum levels
-not for pregnant women
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