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Med-Surg Nursing Chapter 65
Care of Patients with Pituitary and Adrenal Gland Problems
74
Nursing
Undergraduate 2
11/19/2013

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Term
Vasopressin
Definition
Anti-diuretic hormone (ADH), secreted by the posterior pituitary
Term
Anterior pituitary gland
Definition
Also known as adenohypophysis. Disorders can result from primary problems arising within the gland itself, or secondary problems in the hypothalamus that change function.
Term
Hypopituitarism
Definition
Deficiency of one or more anterior pituitary hormones, resulting in metabolic problems and sexual dysfunction
Term
Panhypopituitarism
Definition
Rare condition in which production of all of the anterior pituitary hormones is decreased
Term
Gonadotropins
Definition
Hormones (FSH and LH) that stimulate the ovaries and testes to produce sex hormones
Term
Osteoporosis
Definition
Fragile bones, caused by GH deficiency
Term
Amenorrhea
Definition
Absence of menstrual periods, caused by gonadotropin deficiency
Term
Dysparenunia
Definition
Painful intercourse, caused by gonadotropin deficiency
Term
Diplopia
Definition
Double vision
Term
Deficient Growth Hormone Manifestations
Definition
Decreased bone density
Pathologic fractures
Decreased muscle strength
Increased serum cholesterol levels
Term
Deficient Gonadotropins Manifestations
Definition
Women
-Amenorrhea
-Anovulation
-Low estrogen levels
-Breast atrophy
-Loss of bone density
-Decreased axillary and pubic hair
-Decreased libido
Men
-Decreased facial hair
-Decreased ejaculate volume
-Reduced muscle mass
-Loss of bone density
-Decreased body hair
-Decreased libido
-Impotence
Term
Deficient TSH Manifestations
Definition
Decreased thyroid hormone levels
Weight gain
Intolerance to cold
Scalp alopecia
Hirsutism
Menstrual abnormalities
Decreased libido
Slowed cognition
Lethargy
Term
Deficient Adrenocorticotropic Manifestations
Definition
Decreased serum cortisol levels
Pale, sallow complexion
Malaise and lethargy
Anorexia
Postural hypotension
Headache
Hypoglycemia
Hyponatremia
Decreased axillary and pubic hair
Term
Deficient Vasopressin Manifestations
Definition
Diabetes insipidus
-Greatly increased urine output
-Low urine specific gravity
-Hypovolemia
-Increased plasma osmolarity
-Increased thirst
-Output does not increase with fluid intake
Term
Management of hypopituitarism
Definition
Focuses on replacement of deficient hormones
Term
Virilization
Definition
Presence of male secondary sex characteristics
Term
Gynocomastia
Definition
Male breast tissue development
Term
Thrombosis
Definition
Formation of blood clots in deep veins. Risk is increased during estrogen therapy.
Term
Hyperpituitarism
Definition
Hormone oversecretion that occurs with pituitary tumors or tissue hyperplasia.
Term
Adenoma
Definition
Benign tumor of one or more tissues within the anterior pituitary. Most common cause of hyperpituitarism.
Term
Galactorrhea
Definition
Breast milk production
Term
Acromegaly
Definition
Excessive growth that occurs after puberty. Caused by overproduction of GH.
Term
Gigantism
Definition
Excessive growth that occurs before puberty.
Term
Hyperglycemia
Definition
Elevated blood glucose levels. Can be caused by high GH levels.
Term
Arthralgias
Definition
Joint pain. Caused by high GH levels.
Term
PRL Hypersecretion
Definition
Results in sexual dysfunction and menstrual changes.
Term
Hyperpituitarism Testing
Definition
Imaging assessment
-Skull x-rays
-CT scans
-MRI scans
Suppression testing
-GH levels
Term
PRL Hyperfunction Key Features
Definition
Hypogonadism
Decreased ganodtropin levels
Galactorrhea
Increased body fat
Increased serum prolactin levels
Term
GH Hyperfunction (Acromegaly)Key Features
Definition
Folding of the scalp skin
Thickened lips
Coarse facial features
Increasing head size
Protrusion of the lower jaw
Deepening of the voice
Tufting of the fingertips
Enlarged hands and feet
Joint enlargement and pain
Kyphosis and backache
Barrel-shaped chest
Excessive sweating
Hyperglycemia
Airway narrowing
Sleep Apnea
Enlarged heart, liver, and lungs
Term
ACTH Hyperfunction (Cushing's Disease) Key Features
Definition
Elevated plasma cortisol levels
Weight gain
Truncal obesity
Moon face
Extremity muscle wasting
Loss of bone density
Hypertension
Hyperglycemia
Purple striae
Acne
Thin, easily damaged skin
Hyperpigmentation
Term
TSH Hyperfunction Key Features
Definition
Elevated plasma TSH levels
Elevated plasma thyroid hormone levels
Weight loss
Tachycardia and dysrhythmias
Heat intolerance
Increased GI motility
Fine tremors
Term
LH and FSH Hyperfunction Key Features
Definition
Men
-Elevated LH and FSH levels
-Hypogonadism or hypergonadism
Women
-Normal LH and FSH levels
Term
Hypophysectomy
Definition
Surgical removal of the pituitary gland and tumor
Term
Neurohypophysis
Definition
Disorders of the posterior pituitary gland, and are related to a deficiency or excess of ADH (Vasopressin)
Term
Diabetes Inipidus (DI)
Definition
Water metabolism problem caused by ADH deficiency
Term
Polyuria
Definition
Excessive water loss through urination
Term
Nephrogenic diabetes insipidus
Definition
Inherited disorder, in which the kidney tubules do not respond to the actions of ADH, which results in poor water reabsorption by the kidneys.
Term
Primary diabetes insipidus
Definition
Caused by a defect in the hypothalamus or pituitary gland, resulting in a lack of ADH production or release.
Term
Secondary diabetes insipidus
Definition
Can result from tumors in or near the hypothalamus or pituitary gland, head trauma, infectious processes, surgical procedures, or metastatic tumors.
Term
Drug related diabetes insipidus
Definition
Usually caused by lithium carbonate and demeclocycline. These drugs interfere with the kidneys response to ADH.
Term
Diabetes Insipidus Manifestations
Definition
Hypotension
Decreased pulse pressure
Tachycardia
Weak peripheral pulses
Hemoconcentration
Increased urine output
Poor skin turgor
Dry mucous membranes
Increased sensation of thirst
Irritability
Decreased cognition
Hyperthermia
Lethargy to coma
Ataxia
Term
Syndrome of inappropriate antidiuretic hormone (SIADH, Schwartz-Bartter Syndrome)
Definition
Problem in which vasopressin is secreted even when plasma osmolarity is low or normal
Term
Causes of SIADH
Definition
Malignancies
-Small cell lung cancer
-Pancreatic, duodenal, and GU carcinomas
-Thymoma
-Hodgkin's lymphoma
-Non-hodgkin's lymphoma
Pulmonary Disorders
-Viral and bacterial pneumonia
-Lung abscesses
-Active TB
-Pneumothorax
-Chronic lung diseases
-Mycoses
-Possitive pressure ventilation
CNS Disorders
-Trauma
-Infection
-Tumors
-Strokes
-Porphyria
-Systemic lupus erythematosus
Drugs
-Exogenous ADH
-Chlorpropamide
-Vincristine
-Cyclophosphamide
-Carbamazepine
-Opiods
-Trcyclic antidepressants
-General anesthetics
Term
Hyponatremia
Definition
A decreased serum sodium level. Occurs in SIADH.
Term
Signs of increased fluid overload
Definition
Bounding pulse
Increasing neck vein distension
Crackles in lungs
Increasing peripheral edema
Reduced urine output
(Monitor every 2 hours in SAIDH)
Term
Adrenal Crisis
Definition
Acute adrenocortical insufficiency. Life-threatening manifestations may appear without warning.
Term
Gluconegenesis
Definition
Making glucose from proteins
Term
Hypoglycemia
Definition
Low blood glucose levels
Term
Acute adrenal insufficiency (Addison's Crisis)
Definition
A life threatening event in which the need for cortisol and aldosterone is greater than the available supply
Term
Adrenal insufficiency (Addison's Disease)
Definition
Classified as primary or secondary.
Term
Causes of primary Addison's Disease
Definition
Idiopathic disease
Tuberculosis
Metastatic cancer
Fungal lesions
AIDS
Hemorrhage
Gram-negative sepsis
Adrenalectomy
Abdominal radiation therapy
Drugs and toxins
Term
Causes of secondary Addison's Disease
Definition
Pituitary tumors
Postpartum pituitary necrosis
Hypophysectomy
High-dose pituitary radiation
High-dose whole-brain radiation
Term
Adrenal insufficiency key features
Definition
Muscle weakness
Fatigue
Joint/muscle pain
Anorexia
Nausea/vomiting
Abdominal pain
Bowel changes
Weight loss
Salt craving
Vitiligo
Hyperpigmentation
Anemia
Hypotension
Hyponatremia
Hyperkalemia
Hypercalcemia
Term
Adrenal gland laboratory test levels
Definition
Sodium
-Normal = 136-145 meq/L
-Hypofunction = Decreased
-Hyperfunction = Increased
Potassium
-Normal = 3.5-5.0 meq/L
-Hypofunction = Increased
-Hyperfunction = Decreased
Glucose
-Normal = 70-115 mg/dL
-Hypofunction = Normal to decreased
-Hyperfunction = Normal to increased
Calcium
-Normal = 9-10.5 mg/dL (total)4.5-5.6 mg/dL (ionized)
-Hypofunction = Increased
-Hyperfunction = Decreased
Bicarnonate
-Normal = 23-30 meq/L
-Hypofunction = Increased
-Hyperfunction = Decreased
BUN
-Normal = 10-20 mg/dL
-Hypofunction = Increased
-Hyperfunction = Normal
Cortisol
-Normal = 5-23 mcg/dL (AM)3-13 mcg/dL (PM)
-Hypofunction = Decreased
-Hyperfunction = Increased
Term
Hypercortisolism
Definition
Hypersecration by the adrenal cortex
Term
Hyperaldosteronism
Definition
Excessive mineralocorticoid production
Term
Pheochromocytoma
Definition
A tumor in the adrenal medulla, that causes hyperstimulation and results in excessive secretion of catecholamines
Term
Conditions causing increased cortisol secretion
Definition
Cushing's Disease
-Bilateral adrenal hyperplasia
-Pituitary adenoma increasing the production of ACTH
-Malignancies
-Adrenal adenomas or carcinomas
Cushing's Syndrome
-Therapeutic use of ACTH or glucocortidoids for treatment of
---Asthma
---Autoimmune disorders
---Organ transplantation
---Cancer chemotherapy
---Allergic responses
---Chronic fibrosis
Term
Cushing's Disease
Definition
Endogenous Secretion. Pituitary and/or adrenal.
Term
Cushing's Syndrome
Definition
Exogenous Administration. Caused by drug therapy for another problem.
Term
Hirsutism
Definition
Increased hair growth
Term
Oligomenorrhea
Definition
Scant or infrequent menses
Term
Striae
Definition
Stretch marks
Term
Hypercortisolism key features
Definition
Fat redistribution
-Moon face
-Buffalo hump
-Truncal obesity
Weight gain
Hypertension
Increased risk for thrombosis
Frequent dependent edema
Capillary fragility
Muscle atrophy
Osteoporosis
Thinning skin
Striae
Increased pigmentation
Increased risk for infection
Decreased immune function
Decreased inflammatory responses
Manifestations of infection
Term
Hypophysectomy
Definition
Removal of the pituitary gland
Term
Adrenalectomy
Definition
Removal of the adrenal gland
Term
Hyperaldosteronism
Definition
Increased secretion of aldosterone with mineralcorticoid excess
Term
Primary Hyperaldosteronism (Conn's syndrome)
Definition
Results from excessive secretion of aldosterone from one or both adrenal glands, usually caused by a benign adrenal adenoma.
Term
Secondary Hyperaldosteronism
Definition
Excessive secretion of aldosterone is caused by high levels of angiotensin II that are stimulated by high plasma renin levels.
Term
Nocturia
Definition
Excessive urination at night. Caused by hyperaldosteronism
Term
Polydipsia
Definition
Excessive fluid intake. Caused by hyperaldosteronism
Term
Paresthesias
Definition
Sensations of numbness and tingling. Caused by hyperaldosteronism
Term
Spirinolactone Treatment
Definition
Increases potassium levels to prepare the patient for adrenal surgery.
Term
Pheochromocytoma
Definition
Catecholamine-producing tumor that arises in the adrenal medulla
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