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Hypothalamus & Pituitary Gland
Disorders
24
Nursing
Undergraduate 3
07/10/2012

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Cards

Term

Endocrine Disorders usually develop from...

 

Definition
  • Excess of a specific hormone
  • Deficiency of a specific hormone
  • Receptor defect
Term
Anterior Pituitary Gland
Definition
  • Hypopituitarism - selective or pan
  • Hyperpituitarism
Term
Hypopituitarism
Definition

Most life threatening = ACTH & TSH deficiencies (cause decrease in adrenal and thyroid hormones)

Term

Hypopituitarism

 

 

Causes

Definition
  • Head trauma
  • Radiation or surgery of the head and brain
Term
Sheehan's Syndrome
Definition
  • Pituitary infarction due to postpartum hemorrhage
  • Usually immediate but can occur several years later
  • Hx is IMPORTANT - birth in the last few years?
  • Pituitary naturally gets larger during pregnancy
Term

Hypopituitarism

 

 

Assessment

Definition

Neurologic Manifestations - VISION changes with tumor growth

Skull x-ray for changes in sella turcica (where pituitary gland sits)

 

Term

Hypopituitarism

 

 

Clinical Manifestations

Definition

ACTH deficiency:

  • Decreased serum cortisol
  • Hyponatremia
  • Hypoglycemia
  • Trouble maintaining BP

TSH deficiency:

  • Decreased serum thyroid hormone
  • Decreased libido
  • (Hypothyroidism s/s)

GH deficiency:

  • Decreased bone density

 

Term

Hyperpituitarism

 

 

Pituitary adenoma

Definition

Most common cause of hyperpituitarism

A benign tumor in one or more tissues w/in anterior pituitary

May be enclosed or invasive (if sella turcica involved)

PRL-secreting tumors = most common type of pituitary adenoma

Term

Hyperpituitarism

 

 

GH

Definition

Acromegaly

Early detection essential

Some changes reversible with tx - skeletal changes are permanent

Term

Hyperpituitarism

 

 

Excess ACTH

Definition

Overstimulates adrenal cortex - sugar, salt, sex

Leads to dvlpmt of Cushing's disease:

  • Moon face
  • Extremity muscle wasting
  • Loss of bone density
  • HTN
  • Hyperglycemia
  • Hyperpigmentation
Term

Hyperpituitarism

 

 

PRL

Definition

Occurs in both sexes; think pregnancy?

CMs:

  • Hypogonadism
  • Decreased gonadotropin lvls
  • Galactorrhea
  • Increased body fat
  • Increased serum prolactin
Term

Hyperpituitarism

 

 

Excess TSH

Definition

Increased metabolism

S/S of hyperthyroidism

Term

Hyperpituitarism

 

 

Assessment

Definition
  • Skull x-rays for sella turcica changes
  • Suppression testing
    • Determines functioning of neg feedback control (ex - high blood glucose levels suppress release of GH - if they do not drop, abnormal test)
Term

Hyperpituitarism

 

 

Interventions

Definition
  • Radiation therapy - not useful immediately, may take several years
  • Dopamine agonists - catecholamines will try to reset neg. feedback system
  • Hypophysectomy - most common tx
    • Pt in semi-sitting position
    • Endoscopic transnasal approach
    • Transsphenoidal approach
    • Craniotomy - if tumor can't be reached using either approach
Term

Hyperpituitarism

 

 

Transsphenoidal surgical approach

Definition
Incision above upper lip - gland through sphenoid sinus - muscle graft from thigh to support area and prevent CSF leakage - nasal package inserted and mustache dressing applied
Term

Hyperpituitarism

 

 

Care after hypophysectomy

Definition
  • Neuro checks
  • I/O - b/c we've messed with ADH (posterior pituitary)
  • Deep breathing - NO coughing!
  • Do NOT blow nose or sneeze
  • No brushing teeth until incision heals (use dental floss or mouth wash)
  • No bending at waist for any reason
  • Monitor nasal drip pad - watch for CSF
  • Prevent constipation and any straining
  • Teach self admin of prescribed hormones
Term
Posterior Pituitary
Definition
  • Disorders usually r/t deficiency or excess of ADH
  • Independent of anterior pituitary problems
  • Diabetes insipidus - ADH deficiency
  • SIADH - ADH excess
Term

Hypopituitarism (Posterior)

 

 

Diabetes Insipidus

 

 

 

Definition

Insufficient ADH

Lg volumes of dilute urine (3-6 L)

Drug induced poss - Lithium carbonate

Output does NOT decrease with intake decrease

Term

Diabetes Insipidus

 

 

Assessment

Definition
  • Polydipsia, polyuria
  • 24 I/O - don't restrict fluid
  • If greater than 4 L and greater than volume ingested
Term

DI

 

 

Interventions

Definition
  • Partial ADH deficiency = Diabinese PO
    • Increases action of existing ADH
  • Severe ADH deficiency = DDAVP
    • Oral or nasal
    • Severe dehydration - IV or IM
      • IV form 10X stronger than oral form
Term

DI

 

 

Pt Education

Definition
  • Permanent DI patients on lifelong DDAVP or vasopressin therapy
  • Daily weights
  • S/S of water toxicity - persistent h/a, acute confusion, seizures
  • Weight gain or water toxicity - CALL 911
  • Med alert bracelet
Term

Hyperpituitarism (Posterior)

 

 

SIADH

Definition
  • Excess ADH
  • Water retained = dilutional hyponatremia & fluid overload
Term

SIADH

 

 

Assessment

Definition
  • Water retention - NO dependent edema
  • Hypothermia
  • Radioimmunoassay of ADH
  • Hyponatremic
Term

SIADH

 

 

Interventions

Definition
  • Restrict fluid intake (as low as 500-600 mL/24 hrs)
  • Monitor for fluid overload
  • Seizure precautions
  • Neuro checks
  • Administer SAMSCA (PO) - vasopressin antagonist, excretes water w/o sodium loss
    • ONLY administere in hospital!!!
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