PPT_Chapter_31.ppt - Pituitary and Adrenocortical Hormones Chapter 31 Copyright \u00a9 2013 Wolters Kluwer Health | Lippincott Williams Wilkins Pituitary

PPT_Chapter_31.ppt - Pituitary and Adrenocortical Hormones...

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Unformatted text preview: Pituitary and Adrenocortical Hormones Chapter 31 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pituitary The pituitary gland secretes hormones that regulate growth, metabolism, the reproductive cycle, electrolyte balance, and water retention or loss. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Anterior Pituitary Hormones • Gonadotropins – Follicle-stimulating hormone (FSH) – Luteinizing hormone (LH) • Growth hormone – somatropin • Adrenocorticotropic hormone • Thyroid-stimulating hormone (TSH) • Prolactin Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Actions of Gonadotropins • Gonadotropins influence the secretion of sex hormones, the development of secondary sex characteristics, and the reproductive cycle in both men and women • Menotropins and urofollitropins – purified preparations extracted from the urine of postmenopausal woman – Induce ovulation and pregnancy – In men, induce the production of sperm Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Actions of Gonadotropins Clomiphene Synthetic nonsteroidal compound that binds to estrogen receptors, decreasing the number of available estrogen receptors and causing the anterior pituitary to increase section of FSH and LH Chorionic gonadotropin Extracted from human placentas Actions are identical to those of the pituitary LH Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pituitary Gland and Hormones Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Uses of Gonadotropins Menotropins Induce ovulation and pregnancy Used with human chorionic gonadotropin in women to stimulate follicles for in vitro fertilization In men, induce the production of sperm Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Uses of Gonadotropins Follitropin alfa and beta Used to induce ovulation and pregnancy in anovulatory women Used to develop multiple follicles for in vitro fertilization In men, used to induce spermatogenesis Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Uses of Gonadotropins Urofollitropin Used to induce ovulation and pregnancy in women with polycystic ovarian disease and to stimulate multiple follicular development in anovulatory women for in vitro fertilization Lutropin Used with follitropin alfa in the initial treatment cycle Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Uses of Gonadotropins Clomiphene Used to induce ovulation in anovulatory women Chorionic gonadotropin Used to induce ovulation in anovulatory women Used for the treatment of prepubertal cryptorchidism In men, used to treat selected cases of hypogonadotropic hypogonadism Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions of Gonadotropins Menotropins Headache Abdominal enlargement Cramps and/or fullness Abdominal pain Nausea Ovarian hyperstimulation Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions of Gonadotropins Urofollitropin Mild to moderate ovarian enlargement Abdominal discomfort Nausea Headache Hot flashes Irritation at the injection site Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions of Gonadotropins Follitropin Enlarged abdomen Abdominal pain Breast pain in women Flatulence Nausea Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions of Gonadotropins Clomiphene Vasomotor flashes Abdominal discomfort Ovarian enlargement Blurred vision Nausea Vomiting Nervousness Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions of Gonadotropins Chorionic gonadotropin Headache Irritability Restlessness Fatigue Edema Precocious puberty Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contraindications, Precautions, and Interactions of Gonadotropins Contraindications: hypersensitivity Gonadotropin: patients with high gonadotropin levels, thyroid dysfunction, adrenal dysfunction, abnormal bleeding, ovarian cysts, or organic intracranial lesion Chorionic gonadotropin, choriogonadotropin alfa, clomiphene, follitropins, lutropin, menotropins, urofollitropin: pregnancy Clomiphene: liver disease, abnormal bleeding of undetermined origin, or ovarian cysts Chorionic gonadotropin: precocious puberty, prostatic cancer, androgen-dependent neoplasm Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contraindications, Precautions, and Interactions of Gonadotropins Precautions: Clomiphene and chorionic gonadotropin: patients with epilepsy, migraine headaches, asthma, cardiac or renal dysfunction, lactation Interactions No known clinically significant with gonadotropins Follitropins: serious pulmonary and vascular complications Multiple births with gonadotropin use Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Management Issues with Gonadotropins Administered on an outpatient basis Thorough medical history and physical exam Lab and diagnostic tests for ovarian function and tubal patency Pelvic exam may be performed Examined every other day during treatment and at 2week intervals to detect excessive ovarian stimulation (hyperstimulation syndrome) Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Management Issues with Gonadotropins • Gonadotropin injections – Given in the health care provider’s office or clinic – Administered subcutaneously or IM because they are destroyed by the GI tract • Urofollitropin – May cause pain and irritation at the injection site – Sites should be rotated – Previous sites should be examined for redness and irritation Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Educating the Patient and Family About Gonadotropins Keep all appointments Adverse reactions should be reported Menotropins and follitropins Educate on the possibility of multiple births and birth defects before beginning therapy Use a calendar to track treatment schedule and ovulation Report bloating, abdominal pain, flushing, breast tenderness, and pain at injection site Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Educating the Patient and Family About Gonadotropins Clomiphene Take as prescribed for 5 days Do not stop taking until course is completed Notify health care provider if: bloating, stomach or pelvic pain, jaundice, blurred vision, hot flashes, breast discomfort, headache, nausea, vomiting May take up to three courses of therapy After three regimens, therapy may be considered unsuccessful Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Actions of Growth Hormone Also called somatotropic hormone Secreted by anterior pituitary Regulates the growth of the individual until early adulthood or the time when the person no longer grows taller in height Available synthetically as somatrem and somatropin Identical to growth hormone Recombinant DNA products Produce skeletal growth in children Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Uses of Growth Hormone Administered to children who have not grown because of a deficiency of pituitary growth hormone Must be used before closure of bone epiphyses Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions of Growth Hormone Antibodies to somatropin may develop in a small number of patients, resulting in a failure of the drug to produce growth Also may experience: Hypothyroidism Insulin resistance Swelling Joint pain Muscle pain Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contraindications, Precautions, and Interactions of Growth Hormone Contraindications: Somatropin: patients with known hypersensitivity to somatropin, sensitivity to benzyl alcohol, epiphyseal closure, underlying cranial disease Precautions: Thyroid disease, diabetes Interactions: Excessive amounts of glucocorticoids Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Management Issues with Growth Hormone Thorough physical exam and lab and diagnostic tests are performed before therapy Vital signs, height, and weight recorded before beginning drugs Height and weight measured and recorded at each visit Bone age is monitored to be sure therapy is stopped when growth plates seal Periodic testing of growth hormone levels, glucose tolerance, and thyroid functioning Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Educating the Patient and Family About Growth Hormone • Educate parents about the therapeutic regimen • Child’s parents need to thoroughly understand the drug program • Drug is to be given at bedtime • Educate parent on proper administration technique • Keep all appointments • Child may begin to grow suddenly and have an increase in appetite • Report lack of growth, symptoms of diabetes, or symptoms of hypothyroidism Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adrenocorticotropic Hormone Actions of Corticotropin Corticotropin is an anterior pituitary hormone that stimulates the adrenal cortex to produce and secrete adrenocortical hormones, primarily the glucocorticoids Cosyntropin is a synthetic version of corticotropin Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Uses of Corticotropin Corticotropin and cosyntropin are used for diagnostic testing of adrenocortical function. Corticotropin may also be used for the management of acute exacerbations of multiple sclerosis, nonsuppurative thyroiditis, and hypercalcemia associated with cancer. Corticotropin is also used as an anti-inflammatory and immunosuppressant drug when conventional glucocorticoid therapy has not been effective. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions to Corticotropin Allergic Especially in patients with allergic response to proteins manifesting as dizziness, nausea and vomiting, shock, and skin reactions Cardiovascular Hypertension, necrotizing angiitis, CHF CNS Convulsions, increased intracranial pressure with papilledema, pseudotumor cerebri, headache, vertigo Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions to Corticotropin Dermatologic Impaired wound healing, thin fragile skin, petechiae and ecchymoses, facial erythema, increased sweating, suppression of skin test reactions, acne, hyperpigmentation Electrolyte disturbances Sodium retention, fluid retention, potassium loss, hypokalemic alkalosis, calcium loss Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions to Corticotropin • Endocrine – Menstrual irregularities; development of cushingoid state; suppression of growth in children; secondary adrenocortical and pituitary unresponsiveness, particularly in times of stress, as in trauma, surgery, or illness; decreased carbohydrate tolerance; manifestations of latent diabetes mellitus; increased requirements for insulin or oral hypoglycemic agents in diabetics; hirsutism Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions to Corticotropin GI Peptic ulcer with possible perforation and hemorrhage, pancreatitis, abdominal distention, ulcerative esophagitis Metabolic Negative nitrogen balance caused by protein catabolism Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions to Corticotropin Ophthalmic Posterior subcapsular cataracts, increased intraocular pressure, glaucoma with possible damage to optic nerve, exophthalmos Miscellaneous Abscess, loss of stimulatory effect resulting from prolonged use of ACTH Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contraindications, Precautions, and Interactions of Corticotropin Contraindications Patients with adrenocortical insufficiency or hyperfunction, scleroderma, osteoporosis, recent surgery, history of current peptic ulcer, CHF, systemic fungal infections, ocular herpes simplex, scleroderma, hypertension, sensitivity to pork or pork products Avoid any vaccinations with live virus Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contraindications, Precautions, and Interactions of Corticotropin Precautions Patients with diabetes, diverticulosis, renal insufficiencies, myasthenia gravis, tuberculosis, hypothyroidism, cirrhosis, nonspecific ulcerative colitis, heart failure, seizures, febrile infections, children Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contraindications, Precautions, and Interactions of Corticotropin Interactions Amphotericin B Diuretics Insulin Oral antidiabetic drugs Barbiturate Anticholinesterase drug Live vaccines Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Management Issues with Corticotropin May mask signs of infection Report any symptoms of sore throat, cough, fever, malaise, sores that do not heal, redness or irritation of the eyes May have decreased resistance and inability to localize infection Skin should be observed daily for signs of infection, especially at injection site Do not allow visitors who have an infectious illness Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Management Issues with Corticotropin May cause alterations in the psyche Report any behavior changes Anxiety is decreased with understanding of the regimen Patients with diabetes may require a dosage adjustment of their insulin or oral hypoglycemic medication Notify health care provider if experience headache, seizure, abdominal pain, muscle weakness, marked fluid retention Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Educating the Patient and Family About Corticotropin Report any adverse reactions Avoid contact with people who have infections Report any symptom of an infection immediately Patients with diabetes should monitor blood glucose or urine because dosage adjustment of insulin or oral hypoglycemic may be necessary Notify health care provider if experience a marked weight gain, swelling in the extremities, muscle weakness, persistent headache, visual disturbances, or behavior change Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Posterior Pituitary Hormones • Produces two hormones – Vasopressin – antidiuretic hormone – Oxytocin Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Actions of Vasopressin Vasopressin and its derivative desmopressin regulate the reabsorption of water by the kidneys Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Uses of Vasopressin Treatment of diabetes insipidus, a disease resulting from failure of the pituitary to secrete vasopressin or from surgical removal of the pituitary Vasopressin is also used for the prevention and treatment of postoperative abdominal distention and to dispel gas interfering with abdominal x-rays Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Reactions of Vasopressin Local or systemic hypersensitivity reactions Tremor, sweating, vertigo, nausea, vomiting, abdominal cramps, water intoxication Managing adverse reactions of vasopressin Patient should take with two glasses of water and be told that symptoms will clear soon Skin blanching, abdominal cramps, and nausea Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Contraindications, Precautions, and Interactions of Vasopressin Contraindications: Patients with chronic renal failure, increased blood urea nitrogen, allergy to beef or pork proteins Precautions: History of seizures, migraine headache, asthma, CHF, vascular disease, perioperative polyuria Interactions Lithium, heparin, norepinephrine, alcohol, carbamazepine, clofibrate, fludrocortisone Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Management Issues with Vasopressin Before therapy, measure blood pressure, pulse, respiratory rate, weight Serum electrolyte levels and other lab test may be ordered Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Management Issues with Vasopressin • Before administering vasopressin for relief of abdominal distention: – Take blood pressure, pulse, and respiratory rate – Measure patient’s abdominal girth Administered IM Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Management Issues with Vasopressin Desmopressin Administered orally, intranasally, subcutaneously, or IV Oral dose must be individualized for each patient Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Management Issues with Vasopressin Managing fluid volume Diabetes insipidus causes the patient to void a large volume of urine at frequent intervals during the day and throughout the night. This is accompanied by the need to drink large volumes of fluids because the patient is continually thirsty. If patient has limited ability, water should be readily available. Reassure the patient that symptoms will be reduced or eliminated with drug therapy. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Educate the Patient and Family About Vasopressin Drink one or two glasses of water immediately before taking the drug Measure the amount of fluids consumed daily Measure the amount of urine passed daily Do not drink alcohol Rotate injection sites Wear a medical alert tag Contact health care provider if experience: significant increase or decrease in urine output, abdominal cramps, blanching of the skin, nausea, signs of inflammation or infection at injection sites, confusion, headache, drowsiness Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Adrenocortical Hormones Adrenal gland Located on the superior surface of each kidney Secretes several hormones: Glucocorticoids Mineralocorticoids Small amounts of sex hormones Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Actions of Glucocorticoids Influence or regulate functions such as the immune response, the regulation of glucose, fat and protein metabolism, and control of the anti-inflammatory response Enter target cells and bind to receptors Examples: cortisone, hydrocortisone, prednisone, prednisolone, triamcinolone Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Uses of Glucocorticoids Replacement therapy for adrenocortical insufficiency Treat allergic reactions Treat collagen diseases (e.g., systemic lupus erythematosus) Treat dermatologic conditions Rheumatic disorders Shock As anti-inflammatories and immunosuppressants to suppress inflammation and modify the immune response Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Uses of Glucocorticoids Collagen diseases Lupus erythematosus, acute rheumatic carditis, systemic dermatomyositis Dermatologic diseases Pemphigus, bullous dermatitis, herpetiformis, severe erythema multiforme, exfoliative dermatitis, mycosis fungoides, severe psoriasis, severe seborrheic dermatitis, angioedema, urticaria, various skin disorders such as lichen planus or keloids Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Uses of Glucocorticoids – Allergic states • Control of severe or incapacitating allergic conditions not controlled by other methods, bronchial asthma, contact dermatitis, atopic dermatitis, serum sickness, drug hypersensitivity reactions – Ophthalmic diseases • Severe acute and chronic allergic and inflammatory processes, keratitis, allergic corneal marginal ulcers, herpes zoster of the eye, iritis, iridocyclitis, chorioretinitis, diffuse posterior uveitis, optic neuritis, sympathetic ophthalmia, anterior segment inflammation Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Uses of Glucocorticoids Respiratory disease Sarcoidosis, berylliosis, fulminating or disseminating pu...
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