Week 2 Endocrine Anatomy and

Physiology review & Pituitary

Disturbances

Ann MacLeod, MPH, BScN, RN

Agenda
 General Anatomical Overview
 Endocrine vs Exocrine
 Classes of Hormones
• proteins
• steroids
 Positive and negative feedback mechanisms
 Pituitary disturbances
Endocrine system
 Functions as chemical communication &
control
 slower than the nervous system
 may target one type of cells or many

 Glands secrete hormones into the blood

stream, not into a duct like the exocrine glands
Hormone secreting glands of the endocrine system
 Classification of Hormones
Protein hormone Steroid
e.g. insulin hormone
e.g. estrogen,
hydrocortisone
Action Bind to cell surface Pass through lipid
activates cyclic AMP cell membrane to
“second messenger” link to cell DNA
which regulate other to mRNA increase
enzymes action e.g.
estrogen on breast
tissue
Protein Hormones
Steroid Hormones
Feedback mechanisms
 Negative
• elevated blood levels of substance ( sugar )
• gland releases hormone (insulin)
• hormone works to decrease the levels of the
substance ( sugar transferred intracellularly
with help of insulin)
• blood levels are decreased (sugar ) 
pancreas ceases to produce insulin
Feedback mechanisms
 Positive
• elevated blood levels of substance (oxytocin)
• gland (pituitary) releases hormone (oxytocin )
• hormone works to further increase the levels of
the substance (oxytocin stimulates the pituitary
to increase more oxytocin release during
labour)
Disturbances
Hypersecretion
• Tumors, genetic disorders
Hyposecretion
• Target cells damaged
• Receptors on target cells malfunctioning
• damaged gland due to age, injury, genetics
see table in handout or pg 1030 in Brunner
Hypothalmus affects Pituitary
Anterior Pituitary: Hypothalmus secretes releasing
hormones for the following:
TSH Thyroid  growth
ACTH Adrenal cortex  homeostasis
FSH ovary/seminiferous  sexual dev’p
LH ovary & egs/testes estrogrogen/ testosterone fertile
GH all organs  blood glucose used for growth
(somatotropin)
Prolactin Breast tissue  milk production
Hypothalmus affects Pituitary
 Posterior Pituitary directly stimulated by
neurohormones released from the
hypothalmus
ADH(vasopressin)  kidney  H2O
retention/diuresis

Oxytocin  milk ducts and uterine muscle 

contraction
Posterior
pituitary
Pituitary Gland
Disturbances of the Anterior
Pituitary : Hyposecretion
Hypopituitarism
 May result from the pituitary gland itself or
from a disease of the hypothalmus however,
the result is the SAME
 may occur d/t radiation to the head and
neck, trauma, tumors, vascular lesions
Dwarfism
 Hypo secretion of GH, TSH, FSH, LH, ACTH
 metabolic dysfuction
 sexual immaturity
 growth retardation
 causes: tumors, congenital defects, pit.
Ischemia, radiation, surg, brain injury,
chemical agents
Dwarfism
 May be perm. Or reversible, the gland may
be 75% dysfunctional before you see
findings
Assessment:
 Delayed puberty  Loss of libido
 obesity  decreased body temp
 fine scant hair  decreased resistance to
 small bones colds and infection
 small stature
 delayed growth
according to scales
Disturbances of the Anterior
Pituitary : Hypersecretion

  ACTH Cushings’s syndrome ( cover

during adrenal cortex discussion)
  GH acromegaly & giantism
Assessment findings
 Excessive growth of  Skin is warm, moist,
bones and soft tissues coarse and oily
 enlargment of facial
features, tongue, and
viscera
Diagnostic
Tests
 Skull x-ray may show enlarged pituitary
gland
 CT/MRI: shows thick long bones
 Blood work: may indicate Increased
prolactin, GH, and ACTH
 urine: hypo: decreased cortisol,
gonadotropin, decreased GH
Management:
 Hormone replacement therapy is nec. For
hyposecretion that isn’t r/t pit. Tumours
 Hormone suppression therapy for hormone
secreting tumors
 ie. Parlodel: inhibits the synthesis and
release of ant. Pit. Hormones by the gland
Surgery
 Hypophysectomy: Rx. Of choice for
pituitary tumors
 transphenoidal: entry is gained through the
inner aspect of upper lip through the
sphenoid sinus
Post -op hypophysectomy
 Monitor LOC  Avoid nose blowing,
 measure I+O HT: may lose sense of
smell
 assess for hemorrhage
inspect nasal packing
 monitor for edema
for blood and CSF  watch for addisons
 monitor for excess disease and thyroid
swallowing problems
(hemorrhage)  replacement hormones
are for life
Posterior Pituitary lobe
hyposectretion
 Diabetes insipidus: deficient production of
vasopressin, kidneys excrete large amounts
of urinedue to trauma, tumors infections or
renal tubules don’t respond to ADH
Posterior Pituitary lobe
hyposectretion Assessment &
Management
 Urine SG 1.001-1.005 4-40 litres
 Desmopressin DDAVP synthetic
vasopressin (nasal spray)
 IM Vasopressin