PITUITARY GLAND (hypophysis)

 Location: Below the hypothalamus/ base of the brain.

 How to remove: Hypophysectomy (Ectomy)
o Route: *mouth* Transsphenoidal (sinuses) hypophysectomy
 Most common symptom of bleeding after operation:
 Frequent swallowing
 Sphenoidal - Sinus - Swallowing (SSS)
 Master Gland of all of your hormones (almost all hormones) – indirect & direct effect

PARTS:
1. Anterior Pituitary Gland (APG) – Adenohypophysis
a. Produces Stimulating Hormones
i. TSH – Thyroid Stimulating Hormone – Thyroid Gland – T3& T4
ii. FSH – Follicle Stimulating Hormone
iii. ACTH – Adenocorticotropic Stimulating Hormones – Cortex – Corticosteroid
iv. MSH – Melanocyte Stimulating Hormone – Pigmentation of the skin
v. ICTH – Interstitial Cell Stimulating Hormone – Testosterone
vi. LH – Luteinizing Hormone – Stimulates Ovulation
vii. GH – Growth Hormone – stimulates growth of bones and muscles
2. Posterior Pituitary Gland (PPG) – Neurohypophysis
a. Function: Storage for what Hypothalamus produces
i. Oxytocin
Milk let down reflex (Milk Ejection)
Uterine Contraction (Induce Labor)
ii. Anti-Diuretic Hormone (ADH) – Vasopressin – Anti-Dehydration Hormone
 Conserves ALL FLUID
a. Water, saliva, tears, urine
b. Conserves fluids to the vascular area and Kidneys
3. Vasoconstrictor – Constricts your blood vessel to help retain fluid
 Blood Pressure Regulation
Fluid Compartments:
1. Vascular – where ADH acts
2. Cellular
3. Interstitial
2 Types of Dehydration
1. Vascular Dehydration – Affects circulation - systemic
2. Cellular Dehydration – Shrinks (cellular damage) – localize

Diabetes Insipidus (DI)

 Low Anti-Diuretic Hormone or No Anti-Diuretic Syndrome of Inappropriate (Increase) Anti-Diuretic
Hormone Hormone (SIADH)
 Polyuria (Increase Urine Output)  Increase Diuretic Hormone
 Polydipsia (Excessive Thirst)  Oliguria
 Water loss – Fluid Deficit  Water Retention
 Hypovolemia – Hypotension  Fluid Overload
 Weight loss  Jugular Vein Distention
 Vascular Dehydration  Hypervolemia
 Hypovolemic Shock  Hypertension
 Renal Failure  Weight Gain
 Diabetes Insipidus (DI) Syndrome of Inappropriate [increase] Anti-
Diuretic Hormone (SIADH)

Neurogenic – Hypothalamus / Posterior Pituitary  Leading cause: Pituitary Adenoma

Gland  Adenoma – Tumor (Benign)
 Low/ Absence production of ADH  Overproduction of ADH
 Most common type
Nephrogenic – Kidneys Clinical Manifestations:
 Increase resistance to ADH  Oliguria (<30cc/hr)
 Urine Concentration
Clinical Manifestations:  Fluid Overload
 Polyuria (Increase Urine)  Hypertension
 Polydipsia (Increase Thirst)  Hypervolemia
 NOT AN INSULTIN PROBLEM  Hemodilution
 Water loss/ Fluid loss  Jugular Vein Distention
 Hypovolemia  Weight Gain
 Hypotension  Dilutional Hyponatremia
 Weight loss  Seizures
 Diluted Urine  Hydronephrosis
 Hemoconcentration  Hemo diluted
 Prone for Shock  Hyponatremia
 Cause of death: Hypovolemic Shock Diagnostic Test:
 Renal Failure  CT scan / MRI (MRI usual)
 KFT – Kidney Function Test
Diagnostic Test:  Specific Gravity Test (Urinalysis) – to
 CT scan / MRI (MRI usual) check the ability of your kidney to
 Water Deprivation Test (Still Urinates) concentrate urine (SIADH - HIGH)
 BEST: Specific Gravity Test (Urinalysis) NORMAL: 1.010-1.030
– to check the ability of your kidney to  Serum Osmolality Test – checks blood
concentrate urine concentration
(DI - LOW)  EEG – Electroencephalogram
NORMAL: 1.010-1.030  Serum Electrolytes (Serum Na Level)
 Serum Osmolality Test – checks blood NORMAL: 135-145 meQ/L
concentration Management:
NORMAL: 285-295 mOsm/kg  Limit Fluids
 Kidney Function Test – to rule out  Diuretics – Furosemide (Lasix),
kidney problems Mannitol
Management:  Anti-Hypertension
 Hormonal Replacement Therapy of  Anti-convulsant
ADH – Vasopressin (IV) (FOR LIFE)  Seizure prec.
Intranasal (Desmopressin)  Radiation PRN
 Chlorpropamide (Diabenase) – Oral  Anti-Neoplastic PRN
Hypoglycemic Agent (OHA): stimulates  Sodium (Na) Replacement
hypothalamus ADH production/release  Drug Of Choice: DEMECLOCYCLINE –
 Hydration decreases the overproduction of ADH
 Monitor I&O
 Weight Daily *AM* (1kg-1000ml)
 Monitor and correct Electrolytes

Risk Factors: Risk Factors:

 Head Injury  Head Injury
 Aneurysm  Tumor
 Surgery
URINE: ↓ URINE: ↑
SERUM: ↑ SERUM: ↓