In this week’s episode of NCLEX Ready, I’m doing something a bit different.
I’ll be answering a special request from one of our followers, Catherine A.
Catherine needed help on topics around endocrine diseases, and so, I decided why not make a whole episode of it?
So today, on behalf of Catherine, I’ll be breaking down everything you need to know about pituitary gland problems, which include hyperpituitarism, hypopituitarism, diabetes insipidus, and the syndrome of inappropriate antidiuretic hormone secretion (also known as SIADH).
Ready to learn more?
Tune in now!
What Is the Pituitary Gland?
Before we get into pituitary gland issues, we need to know exactly what the pituitary gland does for the body so that we know exactly how the body is affected when it’s not working properly.
The pituitary gland is part of the endocrine system, which consists of glands that create, store, and release hormones into the bloodstream. The pituitary gland is divided into the anterior pituitary and the posterior pituitary. They both have their own functions and hormone productions
The pituitary gland is located at the base of the brain and is regulated by the hypothalamus, which sends signals to it through hormones and nerve impulses.
We don’t give pituitary glands enough credit for regulating vital body functions. When we think about the hormones of the body, we don’t think of the pituitary gland that produces and releases these hormones. But after this episode, you will!
The Hormones of the Pituitary Glands
The hormones that the anterior lobe of the pituitary gland produces include ACTH, FSH, GH, LH, MSH, PRL, Somatotropic growth-stimulating hormone, and TSH.
The hormones that the posterior lobe of the pituitary gland produces include oxytocin and vasopressin, which is an antidiuretic hormone (ADH).
Quick NCLEX Pop Quiz:
Arnie is a nursing student that is studying for the NCLEX. He is quite stumped and wants to know which of the following hormones is produced by the posterior gland?
- ACTH
- GH
- Oxytocin
- TSH
Answer: The correct answer is oxytocin.
Rationale: Oxytocin is a hormone that is released from the posterior pituitary. ACTH, MSH, and TSH are hormones that are released by the anterior pituitary gland.
Let’s break this information down in a way you won’t feel too overwhelmed:
Oxytocin is involved in labor contractions during childbirth, breastfeeding, and sexual reproduction.
ACTH is short for adrenocorticotropic hormone, which tells the adrenal glands to produce cortisol. Cortisol is a hormone that affects the stress response, metabolism, and regulates the immune system.
GH is short for growth hormone, which stimulates growth in childhood.
TSH is short for thyroid-stimulating hormone, which stimulates the thyroid gland to produce thyroid hormones. Thyroid hormones regulate the body’s metabolism, energy, and nervous system.
Pituitary Gland Disorders
Hyperpituitarism and hypopituitarism occur when the anterior pituitary gland is affected. See how being in the FRONT of the pituitary gland can have its ups and downs? Hyper and hypo!
Diabetes insipidus and SIADH occur when the posterior pituitary gland or hypothalamus are affected. We can keep DI and SIADH in the BACK for now while we focus on hyperpituitarism and hypopituitarism for now.
Hypopituitarism
Knowing the hormones that affect the anterior pituitary will help you understand the common symptoms of hypopituitarism, which include growth hormone (GH) deficiency, thyroid-stimulating hormone (TSH) deficiency, adrenocorticotropic hormone (ACTH) deficiency, gonadotropin (FSH/LH) deficiency, and prolactin deficiency.
What can cause hypopituitarism? Tumors, trauma, encephalitis, autoimmunity, or a stroke. Any of these can affect the pituitary gland.
You can treat hypopituitarism with hormone replacement therapy to make up for the lack of hormones that the pituitary gland is not able to produce.
Hyperpituitarism
Hyperpituitarism, also known as acromegaly, occurs when there’s hypersecretion of growth hormones. This means that there’s too much growth hormone being produced by the anterior pituitary gland.
What can cause hyperpituitarism? It is usually due to a tumor, which is most of the time benign. The most common type of hyperpituitarism is caused by prolactinoma, which is a prolactin-producing tumor. Unexpected milk production can occur, menstrual functions and fertility can be affected in women, and erectile dysfunction or lack of libido are symptoms that are seen in men.
To treat hyperpituitarism, you have to suppress or block the growth hormone (GH). The patient may need radiation of the pituitary gland or stereotactic radiosurgery. Keep hypophysectomy (the removal of the pituitary tumor) in the back of your mind because this may be needed.
If the entire pituitary is removed, then the patient will not have a pituitary gland to secrete hormones, so ADH, cortisol, and thyroid hormones will need to be replaced for life. The hypophysectomy would be done via craniotomy or sublabial transsphenoidal approach.
As a nurse, you need to know the potential complications to watch out for after surgery. After a craniotomy, the nurse must watch out for intracranial pressure, bleeding, meningitis, and hypopituitarism.
If a sublabial transsphenoidal surgery has been performed, then the nurse needs to watch out for cerebrospinal fluid leak, infection, diabetes insipidus, and hypopituitarism.
Quick NCLEX Pop Quiz:
Arnie is a nursing student, who has been stumped on the difference between the anterior pituitary gland and the posterior pituitary gland. Help him out by choosing which of the following pituitary gland disorders is caused by a damaged posterior pituitary gland.
- Diabetes insipidus
- Hyperpituitarism
- Hypopituitarism
- Hyperparathyroidism
Answer: The correct answer is diabetes insipidus.
Rationale: Diabetes insipidus is caused by damage to the posterior pituitary gland or hypothalamus when there is too little ADH being secreted.
Hyperpituitarism and hypopituitarism are caused by damage to the anterior pituitary gland.
Cushing syndrome is caused by damage to the adrenal cortex when there is an excess of cortisol production.
Hyperparathyroidism is caused by hypersecretion of the parathyroid hormone (PTH).
Diabetes Insipidus (DI)
Diabetes insipidus and diabetes mellitus can get mixed up easily. Know that diabetes insipidus occurs when there is too little ADH being produced by the posterior pituitary gland. This means the kidney tubules are not able to reabsorb water. You must keep this in mind when it comes to diabetes insipidus because you will be able to answer NCLEX questions properly with this key fact.
This can be caused by stroke, trauma, or surgery. There is central diabetes insipidus, where there is a decrease of ADH being produced. Then, there is nephrogenic diabetes insipidus, where ADH production is actually fine, but the kidneys are not responding to the production of ADH.
Postural hypotension can occur. Are you wondering what is the difference between postural hypotension and orthostatic hypotension? It’s your lucky day because there is no difference. They both mean the same thing, when the blood pressure drops when the patient transitions from a sitting or lying position to an upwards position. Dizziness, lightheadedness, or even fainting can occur.
If postural hypotension can occur, the nurse must make sure to provide a safe environment and observe for potential complications. Kidneys regulate blood pressure so this will help you put two and two together.
Electrolytes must be monitored because dehydration can occur with diabetes insipidus. The client may report excessive thirst. Because the kidneys cannot conserve water properly, excessive urine production and excess thirst can occur. IV hypotonic saline may be administered to account for the excess urine production.
Low urinary specific gravity, fatigue, polydipsia, excess urine productions are all seen in someone that is diagnosed with diabetes insipidus.
To treat diabetes insipidus, you can administer Vasopressin.
Quick NCLEX Pop Quiz:
Arnie is a nursing student, who is learning about pituitary gland disorders. Which of the following disorders is caused by a hyposecretion of ADH that is caused by the posterior pituitary gland?
- Hyperparathyroidism
- Hyperpituitarism
- SIADH
- Diabetes insipidus
Answer: The correct answer is diabetes insipidus.
Rationale: Diabetes insipidus occurs when there is a hyposecretion of ADH.
SIADH occurs when there is a hypersecretion of ADH.
Hyperpituitarism occurs when there is a hypersecretion of growth hormones.
Hyperparathyroidism is a hypersecretion of the parathyroid hormone (PTH).
Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)
SIADH is short for Syndrome of Inappropriate Antidiuretic Hormone Secretion, which occurs when there is an excess amount of ADH being produced. Remember that SIADH occurs when there is damage to the posterior pituitary gland or the hypothalamus.
Cerebral edema or seizures can occur, which means seizure precautions should be implemented. The nurse must observe for increased intracranial pressure signs and symptoms.
Antidepressants, antipsychotics, and even chemotherapeutic agents can cause SIADH. After brain surgery, the nurse should watch out for SIADH as a complication.
Fluid volume overload, level of consciousness changes, weight gain, hypertension, low urinary output, concentrated urine, and hypertension are all signs and symptoms to watch out for. Note that in diabetes insipidus, the nurse must observe for postural hypotension and how SIADH is the opposite, in which the nurse should watch out for hypertension.
Low serum sodium concentration can also be seen in SIADH. This is why fluids may be restricted for patients with chronic SIADH to 1000 mL/day or less. This is often the first step a physician will take to increase serum sodium levels.
If IV fluids are administered, then the nurse must observe for signs and symptoms of fluid volume overload. Salt tablets, loop diuretics, and potassium replacements may be given. This is done to cautiously correct sodium levels and promote water excretion.
SIADH can be caused by medications, cancer, or infections. Once the underlying cause is addressed, then SIADH may be corrected.
A doctor may prescribe Vasopressin antagonists to decrease overproduction of ADH. Remember that vasopressin is administered for diabetes insipidus, in which it is given for hyposecretion of ADH production. So vasopressin antagonists can be given for hypersecretion of ADH production.
I discuss all of this in more depth in the episode above, so make sure to give it a listen when you can!
