Neuroendocrine System:Pituitary HormonesHypothalamus

Part of the CNSPituitary gland

Anterior pituitary (adenohypophysis)Posterior pituitary (neurohypophysis)

Together, govern all bodily functionsHormonesNegative feedback loop

Pituitary DrugsAnterior pituitary drugs

corticotropinsomatotropin

Posterior pituitary drugsvasopressin

somatremsomatrem octreotideoctreotide

desmopressindesmopressin

UsesReplacement therapy to make up for

hormone deficiencyDrug therapy to produce a specific hormone

response when a hormone deficiency is present

Diagnostic aids to determine hypofunction or hyperfunction of a specific hormonal function

Mechanism of Action

Differs depending on the drugEither augments or antagonizes the natural

effects of the pituitary hormones

Indicationscorticotropin

Stimulation of release of cortisol from adrenal cortex

Used to diagnose, but not treat, adrenocortical insufficiency

Multiple sclerosisCorticotropin insufficiency caused by long-term

corticosteroid use

Indications (cont’d)somatropin and somatrem

Recombinantly made growth hormone (GH)Stimulate skeletal growth in patients with

deficient GH, such as hypopituitary dwarfism

Indications (cont’d)octreotide (Sandostatin)

Carcinoid tumors secrete VIP (vasoactive intestinal polypeptide)

VIP causes profuse, watery diarrheaOctreotide reduces this severe diarrhea,

flushing, and potentially life-threatening hypotension that may occur with a carcinoid crisis

Unlabeled use: Control bleeding in esophageal varices

Indications (cont’d)vasopressin and desmopressin

Used in the treatment of diabetes insipidusUsed in the treatment of various types of

bleeding, especially GI bleedingdesmopressin is useful for:

Hemophilia A Type I von Willebrand’s disease

Adverse EffectsCorticotropin: Sodium retention, hypokalemia, hyperpigmentation, convulsions, euphoria, psychosis

Vasopressin: High BP, headache, flushing

Nursing ImplicationsObtain thorough nursing assessment,

medication historyAssess for contraindications specific to

each drugAssess medication history for possible

interactions

Nursing Implications (cont’d)corticotropin

IM, SC, IV forms, and gel and repository formsFollow directions carefully for administrationMaintain adequate hydrationSodium and potassium intake should be

decreasedAvoid vaccinations during drug therapy

Nursing Implications (cont’d)Provide specific instructions for nasal spray

forms of lypressin and vasopressinRotate injection sitesDrugs should not be discontinued abruptlyDo not take OTC products without checking

with health care provider

Nursing Implications (cont’d)Parents of children who are receiving

growth hormones should keep a journal reflecting the child’s growth

Nursing Implications (cont’d)Monitor for therapeutic responses

Corticotropin should eliminate pain associated with inflammation and produce increased comfort and muscle strength in patients with multiple sclerosis

Somatropin should increase growth in childrenDesmopressin, vasopressin should reduce severe thirst

and decrease urinary outputOctreotide should reduce symptoms of carcinoid crisis

Monitor for adverse effects