Posterior

Pituitary
Disorders
1
Diabetes Insipidus
and SIADH
Disorders Associated with ADH
ADH Anti-Diuretic Hormone
(Vasopressin)
Produced in hypothalamus
2
Stored in the posterior pituitary gland
Acts on the renal collecting tubules &
results in water reabsorption
Diabetes Insipidus (DI)
Pathophysiology
Deficiency in synthesis or release of antidiuretic
hormone (ADH)
Excess water losses
3
Excess water losses
Neurogenic versus nephrogenic
NeurogenicADH deficiency
Nephrogenickidneys insensitive to ADH
Secondary causes
Excessive intake (IV or PO)
DI: Etiology Neurogenic
Trauma to pituitary or hypothalamus
Head trauma, hypophysectomy, tumor
4
DI: Etiology Nephrogenic
Chronic Renal disease
Drugs (alcohol, phenytoin, lithium)
5
DI: Clinical Signs
High urine output; low specific gravity
Thirst
Dehydration
6
Dehydration
Central nervous system signs of volume
depletion
DI Assessment Clinical Picture of
Dehydration
Polyuria 5-40L/24 hr
Urine pale & dilute
Polydipsia Thirst
Polyphagia
Hypovolemia
hypotension, skin
turgor, dry MM,
tachycardia, wt loss,
CVP & PCWP
7
Polyphagia
Dehydration
Constipation
Thick secretions
CVP & PCWP
Confusion
Restlessness
Seizures
Coma
DI: Diagnostics
Serum Na - >145 mEq/L (due to loss of
fluid)
8
fluid)
ADH - (neurogenic); (nephrogenic
kidneys insensitive to ADH);
Dilute urine with specific gravity - <1.005
DI: Interventions
Fluids; assess for hypovolemia
ADH replacement (neurogenic)
vasopressin (DDAVP)
9
Side effects: HA, nausea, mild
abdominal cramps
Note: watch for overload
DI: Interventions
Nephrogenic (kidneys insensitive to ADH)
Thiazide diuretics
Sodium restriction
10
Syndrome of Inappropriate Secretion of
Antidiuretic Hormone (SIADH)
Pathophysiology
Excess ADH
Plasma hypo-osmolality
11
SIADH: Etiology
Malignancy
Pulmonary disorders Lung CA, TB,
COPD, Pneumonia, Mech Ventilation
12
Central nervous system trauma, brain
tumors
SIADH: Assessment Clinical
Picture of Water Intoxication
CV: wt gain, HTN,
RAP>10, PCWP>12,
Neuro: confusion,
restlessness, lethargy,
GI: N/V/A, BS,
muscle cramps
Resp: tachypnea,
dyspnea, adventitious
13
restlessness, lethargy,
diff concentrating, HA,
seizures, coma
Renal: dark urine,
UOP
dyspnea, adventitious
sounds, frothy pink
sputum
SIADH: Assessment - Lab
Serum Na: <135 mEq/L (dilutional)
Serum Osmolality: <275 mOsm/Kg H2O
Serum ADH: elevated
14
Serum ADH: elevated
Urine Na: >20 mEq/L
SIADH Interventions
Fluid restriction (800 to 1000 mL/day)
Diet liberal in sodium
If needed, hypertonic saline and diuretics
(Lasix)
15
(Lasix)
Monitor intake and output, specific gravity,
weights