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A hormone is a chemical, synthesized within an organism, which alters the rate of cellular processes. Types: Steroid Protein Effects: Physiologic stability Hypophyseal Hormones (Pituitary) Pituitary Gland Located in sellaturcica of sphenoid bone attached to hypothalamus by infundibular stem. Lobes of Pituitary 1. Neurohypophysis (smaller) Posterior Direct link to hypothalamus. Stores and release two related hormones produced in hypothalamus 1. 2. ADH - ( Plasma osmolality + ( extra – cellular volume ( ADH ( Regulates Vasopressin – volume and concentration of urine. Clinical Syndromes: Diabetes Insipidus (( ADH) 2 ( to head injury, meningitis Symptoms: Therapeutic Agents: Route: SC, IM, Nasal Spray, IV Examples: Vasopressin (Pitressin) Desmopressin Acetate (DDAVP) Side effects/adverse effects: Contraindications: Coronary artery disease Chronic nephritis Uses 1. Diabetes 2. Abdominal distention 3. Esophageal Varices (vasopressor effect) Nursing Interventions Drink two glasses of water after each dose. Report sudden weight changes. Urine specific gravity levels ( replace fluids. Observe for water intoxication: (nausea, vomiting, confusion, drowsiness, headaches). Monitor sodium levels. Oxytocin (Released by Pituitary) Ejection of milk (galotogenic Action) Uterine Contraction (strong, rhythmic) Clinical Syndromes/Uses 1. Induction/enhancement labor 2. Postpartum uterine bleeding (atopy) 3. Management of abortion 4. Milk let down and/breast engorgement Anterior Pituitary (Adenahypophysis) Secretion of hormones controlled by hypothalamic regulatory hormones (factors) that are transported to the pituitary gland by the hypotalamohypophyseal portal system. (see attached diagram) Examples: Hypothalamic factors ( Pituitary “tropic” hormones ( target organ hormone FSH releasing factors ( FSH ( ovary Estrogen/progesterone NOTE: All adenohypophyseal hormones except GH (growth hormone) exert their effects on selective target organs, such as, adrenal cortex, thyroid gland or gonads. Clinical Syndromes (see chart) Hypopituitarism (pituitary insufficiency) results in a variety of syndromes related to target organ atrophy Etiology 1. 2. 3. Symptoms: Weakness, resistance to stress, cold, infection, sexual dysfunction (infertility amenorrhea), hypertension. Treatment: Replacement Therapy – give target gland hormone; ie, thyroxin, hydrocortisone, projesterone, estrogen Pituitary Dwarfism (( growth hormone), short stature but normal body proportions Therapeutic Agents Synthetic growth hormone Somatrem (humatrope, proptropin) Made by recombinant DNA Route: Given IM 3 x per week for 6 to 36 months Side Effects Injection site – pain, swelling Hypothyroidism, hypoglycemia Contraindications Nursing Interventions Hyperpituitarism – caused by tumor Gigantism 7 or 8 feet tall Acromegley Thickening of bones, face, hands, feet, overgrowth of mandible, separation of lower teeth Treatment Removal of tumor, irradiation. Some drugs that ( GH; such as: estrogen and parlodel. Thyroid Gland Thyroid Gland Two lobes on either side of larynx. Hollow spheres – store thyroglobablin (Hypothalamus) (Pituitary) (Thyroid) TSH Releasing Factor ( TSH ( Thyroglobulin( T3 (Triiodiothranine) + T4 (Thyroxin) Iodine – major component of T3 and T4 Thyroid stores enough thyroid hormone for 2 – 3 months Action 1. 2. Clinical Syndromes 1. ( in gland size due to goiter (iodine deficiency) thyroid cancer 2. Alteration in Secretion: Myxedema (Adult) Hypothyroidism ( thyroid hormone Etiology: Thyroiditis, thyroidectomy, irradiation, over treatment with antithyroids, pituitary deficiencies (( TSH) iodine deficiency Symptoms: ( Activity level, sensitivity to cold, obesity; ( perception of stimuli, thin hair, thickened boggy skin, slow mental processes *Reversible with replacement therapy Cretanism (child) (hypothyroidism) Therapeutic Agents: Synthetic hormones used more frequently. Synthyroid (T4) – synthetic PO, IM, IV (Levothyaoxine) drug of choice for replacement Tx Cytomel (T3) – synthetic – rapid acting (Liothyronine) Prolid – purified hog thyroid extract (Thyroglobulin) Action Incompletely understood. Probably binds to receptors on cellular surfaces to increase uptake of glucose and amino acids. Increase synthesis of RNA. Accelerated protein synthesis. Increase metabolic rate, gluconeogenesis Uses Replacement, goiter, adjunctive therapy in conjunction with radioactive iodine in thyroid cancer Side Effects/Adverse Effects: Due to excessive dosage are: palpitations, sweating, nervousness, heat intolerance, ie, symptoms of hyperthyroidism Contraindicated: Thyrotoxicosis, nephrosis, acute myocardial infraction Nursing Implications Prescribed for life – with adjustments at least seven years. Do not take two a day if a day is missed. Asses for hyp/hyper thyroid symptoms, growth charts for kids. Hyperthryoidism (Thyrotaxicoses) Graves Disease Etiology: Thyroid secreting tumors, overtreatment for hypothyroid, pituitary hyperactivity (( TSH), severe stress; ie, pregnancy Symptoms: Exopthalmos (eyeball swelling), increase metabolic rate, hyperactivity, sensitivity to heat, decrease rest and sleep, weight loss, potential respiratory difficulty, diarrhea. Treatment: Antithyroid drugs, subtotal thyroidectomy or I-131 – radioactive iodine to destroy the thyroid tissue, iodine preparations Antithyroid Drugs Propylthiouracil (PTU) P.O. Methimazole (tapazole) P.O. Actions: Impair synthesis of T3 and T4 in the thyroid gland Initial treatment of choice before irradiation or throidectomy Effects delayed several weeks until stores of T3 and T4 are depleted Uses: Side Effects/Adverse Effects: Agranulocytosis (serious), itching, skin rash, epigastric distress, due to increase TSH size of thyroid Nursing Interventions: Iodine/Iodine Products Uses: Suppress hyperthyroidism and reduce size and vascularity of gland prior to surgery. Also Thyroid blocking agent in radiation emergency; i.e., Chernobyl Examples: Potassium Iodide SSKI (saturated solution of potassium iodide) Lugols solution (strong iodide solution) ** take orally through a straw – stains teeth Iodism  Side Effects: Metallic taste, gum soreness, increased salivation Nursing Interventions: Given adjunctive with antithyroid medication therapy. Teach symptoms hypo/hyper thryoidism. Unpleasant, salty taste – dilute in well chilled water, milk, juice. Omit iodized salt. Radioactive Iodide (I-131 (P.O.) Destroys small amount of thyroid tissue. Uses Patients unresponsive to antithyroid medication (over 30 years). Thyroid carcinoma. Half life – 1-8 days Thyroid function – decrease 2 -12 weeks Side Effects: Soreness in neck/pain swallowing, increase amount causes increase side effects. Nausea, vomiting, thin hair, bone marrow depression. Symptoms of hypothyroidism – patient will usually need replacement treatment. Communications: Nursing Interventions: drink 2000 cc/day X 2 weeks: coughing & expectoration X 24 hr: RISK TO OTHERS IS MINIMAL: for high does given to cancer patients, take FULL precautions: sign above bed, non pregnant personnel care for patient. PARATHYROID GLAND Small oval bodies (4 or 5) embedded in dorsal surface of thyroid gland. Parathyroid hormone (PTH)  released  in response to “! serum calcium (negative feedback mechanism) PTH + (thyroid) Calcitonin + Vit D ’! regulate Ca + Phosphate Metabolism Calcium (actions) Nerve and muscle function, cardiac activity, actions of cell membranes and clotting of blood PTH affects 3 target tissues Bone – bone resorption Kidneys – renal CA reabsorption, renal phosphate excretion GI – PTH + Vit D – CA reabsorption from small intestine Parathyroid Clinical Syndromes Hypoparathyroidism Accidental removal of parathyroid glands during thyroidectomy. Idiopathic – unknown cause Signs/Symptoms: Hypocalcemia “! Ca, ‘! Phosphate Symptoms: NOTE: A “! in Vit D, “! calcitonin or “! dietary calcium can also produce hypocalcemia with above symptoms. Therapeutic Agents: PTH  Vitamin D2 (calcirediol) & D3 + elemental calcium supplements (Example: Oscal) Diet therapy Side Effects Symptoms of hypercalcemia; i.e., muscle weakness, ‘! myocardial irritability, polyuria Nursing Implications Life long therapy ’! need good compliance Regular serum calcium levels Calcium inhibits tetracycline absorption Alert for renal calculi (kidney stones) Hyperparathyroidism 85% due to chief cell adenoma of parathyroid gland Symptoms: Hypercalcemia (‘! Ca) with vomiting, muscle weakness, constipation, sedation ’! cp,a NOTE: Hypercalcemia can also be caused by ‘! Vit D and hyperthyroidism. Treatment: Pagets Disease Excessive bone resorption (loss) and unorganized repair. Unknown etiology/familial tendency. Males over age 50 primarily. Symptoms: 1. 2. 3. 4. 5. Treatment: Calcitonin, etidrenate Therapeutic Agents Calcitonin (human/salmon) I.M. or S.C. lowers serum calcium and phosphate by bone resorption (loss) and ‘! kidney excretion , uses: Pagets disease, hypercalcemina, post menonpausal osteperosis. Side effects: Nausea, vomiting, flushing of face. Nursing Implications 1. 2. 3. Etidranate (P.O.) “! serum alkaline phosphatase levels and urinary hydroxyproline excretion. NOTE: Taken by mouth, “! allergic reaction and lower cost are advantageous over calcitonin. Uses: Paget, malignant tumor Side effects: Losst stools, nausea, + pain of Pagets. Nursing Implications: 1. 2. 3. 4. 5. Adrenal Gland (Steroid Hormones) Adrenal medulla and cortex function as 2 different endocrine glands Adrenal Medulla Sympathetic nervous system stem. ’! Epinephrine & Norepinepherine 80% 20% Catacholamines Action: Vasoconstriction Increased Blood Pressure Cardiac stimulation Chemical Disorder: Pheochromocytoma (chromaffin cell tumor) 90% benign, causes 1% of all cases of hypertension Treatment: removal of tumor Antihypertensive meds will not work because of the epinephrine levels. Once tumor is removed, the BP will go back to normal. Adrenal Cortex (steroid hormones secreted) Mineral corticoids Aldosterone CRH ’! ACTH ’! Adrenal Gland  (Hypothalamus) (pituitary) Glucocorticoids Cortisone Hydrocortisone  Sex Hormones  Estrogen Progesterone Testosterone Mineralcorticoids Aldosterone Actions: regulates electrolytes in the body, maintains a normal level of sodium in the blood; causes sodium reabsorption from urine; blood pressure control; regulates Potassium and Ph of blood. Clinical Disorders: Addisons Disease: decrease in adrenal corticosteroids and sometimes Aldosterone. 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