Study Notes on Pituitary and Adrenocortical Hormones - Corticosteroids (Glucocorticoids)

Chapter 41: Pituitary and Adrenocortical Hormones - Corticosteroids (Glucocorticoids)

Key Terminology

  • Corticosteroids: Hormones produced by the adrenal cortex; effective for various medical conditions.
  • Glucocorticoids: A subset of corticosteroids, including prednisone, that affect metabolism and immune response.
  • Mineralocorticoids: Hormones that regulate sodium and potassium levels in the body.
  • Gonadotropins: Hormones that stimulate the gonads (ovaries and testes).

Vasopressin (ADH)

  • Definition: A posterior pituitary hormone that regulates water reabsorption in the kidneys.
  • Function: Secreted to conserve water in responses to dehydration (e.g., severe vomiting, diarrhea, or low fluid intake).
  • Mechanism: Promotes water retention; urine becomes concentrated as water moves into the bloodstream.
Clinical Use
  • Diabetes Insipidus: Caused by a lack of vasopressin due to pituitary removal or failure. Symptoms include:
    • Dramatically increased urination (up to 10L in 24 hours)
    • Excessive thirst
  • Medications:
    • Desmopressin (DDAVP): A synthetic derivative used in treating nocturnal enuresis (bedwetting) and central diabetes insipidus.
    • Routes of administration include: tablet, subcutaneous (SQ), intramuscular (IM), intravenous (IV), and nasal spray.
Nursing Interventions
  • Monitor:
    • Intake and output (I&O)
    • Weight changes
    • Blood pressure (BP)
    • Electrolytes
  • Be aware of adverse effects:
    • Abdominal cramps, nausea (decreased with water administration)
    • Possible water intoxication, leading to drowsiness, confusion, headache, convulsions, and coma.

Growth Hormone (GH)

  • Also known as: Somatotropic hormone; regulates growth until adulthood.
  • Synthetic Form: Somatotropin; used to promote skeletal growth in children with GH deficiency.
  • Administration: Needs to be before the closure of the bone epiphyses (growth plates); ineffective post-closure.
  • Considerations: Monitor height, weight, and potential body image issues.
  • Routes: IM administration 3-6 times per week, often at bedtime.

Glucocorticoids

  • Functions:
    • Regulate immune response, glucose, fat, and protein metabolism.
    • Mediate anti-inflammatory responses.
  • Uses: Treatment for adrenocortical insufficiency, allergic reactions, lupus, dermatological conditions, etc.
  • Adverse Reactions (primarily with long-term use):
    • Fluid and electrolyte imbalances
    • Musculoskeletal (MS) disturbances
    • Cardiovascular (CV) disturbances
    • Gastrointestinal (GI) disturbances
    • Neurological, dermatological, and endocrine disturbances.
Administration Guidelines
  • Dosage Timing: Daily oral doses typically given at 9:00 am to mimic normal adrenal function.
  • Monitoring: Watch for signs of infection and changes in mental status, especially with long-term therapy.
  • Important Considerations:
    • Do not abruptly stop corticosteroids, especially after long-term use, to avoid adrenal crisis due to suppressed system.
    • Complications of long-term use include:
    • Increased risk for infections
    • Blood glucose level imbalances
    • Mood disturbances (e.g., depression, lethargy, weight gain).

Nursing Process

Assessment
  • Initial Assessment: Record vital signs and assess disease involvement.
  • Ongoing Assessment: Continuously monitor vital signs and track adverse effects.
Planning
  • Expected Outcomes: Optimal response to therapy; support of patient needs concerning adverse reactions; understanding of therapeutic regimen.
Implementation
  • Adjustment for Stress: Increased doses may be needed during stress (surgery, illness).
  • Diabetic Patients: Frequent monitoring of blood glucose levels.
  • Adrenal Insufficiency Management: Monitor temperature or signs of infection; manage acute pain and excess fluid volume.

Cushing’s Syndrome

  • Definition: A hormonal disorder caused by excessive cortisol.
  • Signs/Symptoms: Moon face, buffalo hump, striae, oily skin, acne, osteoporosis, and truncal obesity.
Nursing Management
  • Assess Emotional State: Address body image disturbances.
  • Monitor Mental Status: Document mental changes, as corticosteroids can affect cognition and emotions.

Patient Education

  • Educate about:
    • Importance of adhering to prescribed therapy (short-term, alternate-day, long-term).
    • Tapering doses when discontinuing therapy (over 7-10 days).
Evaluation
  • Effectiveness of Therapy: Therapeutic effects are achieved without severe adverse reactions; patients understand and comply with the regimen.

Anterior Pituitary Hormones

  • Important Pituitary Hormones:
    • Thyroid-stimulating hormone (TSH)
    • Adrenocorticotropic hormone (ACTH)
    • Luteinizing hormone (LH)
    • Follicle-stimulating hormone (FSH)
    • Growth hormone (GH)
    • Prolactin

Corticosteroids Overview

  • Types:
    • Glucocorticoids (prednisone, hydrocortisone)
    • Mineralocorticoids (aldosterone).
  • Functions: Affect metabolism, immune response, and stress management.
  • Common Drugs:
    • Glucocorticoids: Cortisol, corticosterone, cortisone; effects include increased glucose level, reduction of inflammation, and immune suppression.
    • Mineralocorticoids: Primarily regulate sodium retention and potassium excretion.

Side Effects of Corticosteroids

  • Physical Changes: Thinning hair, moon face, buffalo hump, increased body and facial hair, weight gain, muscle atrophy, and bruising.
  • Bodily Functions Impacted: Anti-inflammatory actions, regulation of metabolism, and immune responses can be altered.

Precautions and Monitoring

  • Monitor for weight gain, infections, hyperglycemia, muscle and bone loss, cataracts, and dosage adjustment during stress.
  • Tapering Off: Slowly reduce dosage when ending treatment to avoid withdrawal symptoms and risks of adrenal crisis.

Final Notes

  • Life-long Treatment: Some conditions (e.g., Addison’s disease) will require ongoing corticosteroid therapy with careful management of dosages and monitoring for adverse effects.