Endocrine Disorders: Posterior Pituitary
Problems, Diabetes Insipidus, SIADH,
Diabetes Mellitus, Meds
ADH
Increases permeability of renal tubules, causing increased water reabsorption and urine
concentration
Diabetes insipidus
Dry inside, decreased ADH (or renal resistance to ADH), increased UOP. Urine diluted,
decreased specific gravity, decreased osm, decreased na and k. Concentrated serum osm,
increased osm, increased na and k
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Causes of DI
Defect in hypothalamus or pituitary gland or result of trauma/radiation/cranial surgery, Inherited
or renal tubules do not respond to ADH, and drug induced- lithium
Water deprivation test
Simple and most reliable, no water for 2-3 hours if they still have to pee indicates DI (increased
plasma osm should reduce UOP if not indicates DI)
, vasopressin test
Tests to see if administration of subcutaneous vasopressin increases urine specific gravity. If
vasopressin causes increase in urine specific gravity, this is indicative of central cause -->
neurogenic diabetes Insipidus. (i.e. issue with pituitary gland)
DI SSA
polyuria (may have abrupt onset of inc uop up to 18 L/day), polydipsia (excessive H20 intake),
inc HR, dec BP, inc serum osm, HA, muscle weakness, fatigue, dehydration, poor skin turgor,
dry mucous membranes, wt loss, dizzy, constipation, urine clear.
DI interventions
restrict foods with diuretic effect (caffeine, alcohol, lemon), encourage oral intake of fluids, add
bulk and fruit juices to dec constipation, prescribed diet, bed rails up to promote safety,
meticulous skin and oral care, electrolyte replacement, assess turgor and mm, monitor VS, i/o,
specific grav, daily wt
desmopressin
ADH agonist (inc ADH to dec UOP), nasal, IV, oral
carbamazepine
tegretol, inc natural levels of desmopressin/vasopressin
vasopressin
pitressin,
SIADH
Soaked inside, increased ADH, decreased UOP
causes of SIADH
malignant tumors (oat cell lung cancer), increased intrathoracic pressures (positive pressure
ventilation), head injury, meningitis, CVA, trauma, stress, pain, drug induced
Early SSA SIADH
Headache, anorexia, muscle cramps, weakness, weight gain, don't want to eat because feel full