12. Endocrine.rtf - Endocrine Hypothalamus and Pituitary...

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Endocrine Hypothalamus and Pituitary Axis Hypothalamus and Pituitary Axis Hypothalamus-Pituitary axis Forms structural and functional basis neuroendocrine system HPA produce hormones that affect many body functions Thyroid, adrenal, and reproductive Hypothalamus Hypothalamus Connected to pituitary gland Hypothalmic releasing hormones regulate the release of hormones from anterior pituitary Control secretion of hormones Neurosecretory cells regulate release of antidiuretic hormone (ADH) and oxytoxin Examples of Hypothalmic Hormones Examples of Hypothalmic Hormones These hormones will target the anterior pituitary to either release or inhibit hormones o Tyroitropin RH o Gonadotropin RH o Growth HRH
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o Cordicotropin RH o Prolactin inhibiting factor o Prolactin RH Anterior Pituitary Review of hormones secreted Thyroid stimulating hormone (TSH) Adrenocortiocotropic hormone (ACTH) Follicle stimulating hormone (FSH) and Leutenizing hormone (LH) Prolactin Growth hormone (GH) Diseases of the Anterior Pituitary Hyperpituitarism: Acromegaly (adults) gigantism (children) Increased production of Growth Hormone Abnormal growth of hands and feet Overgrowth of bones and soft tissues Problem begins after epiphyseal closure
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Cardiomegaly Increased bulk Enlargement of tongue o Speech difficulties o Sleep apnea Nursing Management Nursing Management Assessment s/s abnormal tissue growth What kind of assessment questions would you expect to ask a patient suspected of having acromegaly? o Changes in what? Hat, ring, glove, shoe size changes- r/t tissue expansion- slow changes Often changes are so slow that patients are unaware Clinical Manifestations Skin becomes leathery, thick and oily Peripheral neuropathy Visual disturbances due to pressure in brain
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Hyperglycemia ( GH antagonized action of insulin ) ( glucose intolerance w/ prolonged excessive GH ) Increased rate of atherosclerosis ( increased free fatty acids levels d/t GH immobilization of stored fat for energy ) Heart disease ( atherosclerosis, left ventricular hypertrophy, angina pectoris, and HTN ) Diagnostic Studies Diagnostic Studies Oral Glucose Tolerance Test (OGTT) -2 hr OGTT ( oral glucose tolerance test ) with 75 gram glucose given ( if BS is >200 after 2 hrs, problem! ) GH is inhibited by glucose In acromegaly the GH levels will not decease with increased glucose loads CT, MRI with contrast What meds do we give is someone has elevated BUN, CR? o Mucomist - clears dye through the kidneys; given before, during and after, and the next day. Smells like sulfer (rotten eggs). Given to chronic renal failure patients around time of angiogram o Look at BUN/Creatinine!! High levels may indicate a need for this drug.
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