AANN Core Curriculum, 7th Edition, Ch. 12 Neuroendocrine: Digital Version-Chapter 12

Chapter 12

Pdf Summary

The chapter reviews pituitary hormones, fluid and sodium regulation, and major neuroendocrine disorders. The anterior pituitary secretes growth hormone (GH), which supports bone and tissue growth; prolactin, which promotes lactation; thyroid-stimulating hormone (TSH), which stimulates thyroid hormone release; luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which regulate reproductive function; adrenocorticotropic hormone (ACTH), which stimulates adrenal cortical hormones; and melanocyte-stimulating hormone (MSH), involved in pigmentation and appetite. The posterior pituitary releases antidiuretic hormone (ADH), which promotes renal water reabsorption, and oxytocin, which supports uterine contractions and milk ejection.<br /><br />ADH and thirst help maintain fluid balance. Excess ADH causes SIADH, leading to water retention and hypotonic hyponatremia; cerebral salt wasting causes sodium loss, hyponatremia, and hypovolemia. Diabetes insipidus (DI), due to inadequate ADH or renal resistance to it, causes large volumes of dilute urine and can result in dehydration and hypernatremia. SIADH is commonly managed with fluid restriction, with other therapies selected according to cause and severity. Cerebral salt wasting is treated by restoring volume and sodium. DI management includes access to water, fluid replacement when needed, and desmopressin for central DI. Sodium correction must be carefully controlled to reduce the risk of osmotic demyelination.<br /><br />GH deficiency can impair growth in children and cause reduced energy, muscle mass, and bone density in adults; treatment may include recombinant GH. GH excess causes gigantism before growth-plate closure and acromegaly afterward; treatment may include surgery and medications. Adrenal insufficiency causes low cortisol, and sometimes aldosterone, with risks including hypotension, hypoglycemia, and electrolyte abnormalities; treatment involves hormone and fluid replacement, with stress dosing during illness. Cushing syndrome results from excess cortisol and may cause central weight gain, hypertension, hyperglycemia, fragile skin, and bone loss; treatment targets the source through surgery, radiation, or medication.<br /><br />Nursing priorities include neurological and vital-sign monitoring, strict intake and output, daily weights, and tracking serum and urine electrolytes and osmolality.

Keywords

pituitary hormones

growth hormone

antidiuretic hormone

SIADH

diabetes insipidus

cerebral salt wasting

sodium regulation

adrenal insufficiency

Cushing syndrome

neuroendocrine disorders