Disorders of the Pituitary Gland

•    Anterior pituitary

•    Posterior pituitary

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Hyperfunction of anterior pituitary

•    Overproduction of GH usually result of benign pituitary adenoma (tumor)

Clinical Manifestations

•     Insidious symptoms in 3-4th decade

Diagnostic studies

•    Plasma levels of GH

•    MRI

•    CT

•    Ophthalmologic exam

Collaborative Care

•    Surgical Therapy: Transphenoidal microsurgery

•    Radiation Therapy

•    Adjunctive drug therapy    

Nursing assessment

•    Assess children for accelerated growth and development

•    Assess changes in hat, ring, glove, shoe sizes in adults

•    Signs of DM: polydipsia, polyuria, blurred vision, hyperglycemia

•    CV involvement: angina, hypertension, CHF

Nursing Diagnoses

•     Body image disturbance r/t enlargement of hands, feet, jaw, soft tissue

•     Fluid volume deficit r/t polyuria

•     Sleep pattern disturbance r/t soft tissue swelling

•     Sensory-perceptual alteration r/t visual defects secondary to enlarged pituitary gland

Nursing implementation: Pre-op transphenoidal hypophysectomy

•    Installation of bacitracin nose drops

•    Teaching

Post-op care

•    Elevate HOB 30 degrees at all times

•    Analgesics for headache

•    Mouth care every 4 hours

•    Avoid toothbrushing for 10 days

•    Monitor for complications: CSF leak or DI

CSF leaks

•    Assessment: nasal drainage with >30mgldl glucose.Persistent and severe generalized or supraobital headache

•    Intervention: HOB elevation, bedrest

Diabetes insipidus

•    Common transient post-op occurrence resulting from loss of ADH

Post radiation therapy

•    Assessment: VS, neuro checks, fluid status

•    Complications: headache, seizures, nausea, vomiting, pin site discomfort

•    Pin site care with peroxide and clean dressing

Hormone replacement

•    IT’S FOR LIFE!

•    Whether hypophysectomy or damaged gland

•    Loss of gonadotropins

Hypofunction of anterior pituitary

•    Primary hypo function may be result of developmental, autoimmune disorders, infections, tumors, vascular disease, or gland destruction.

•    The most common cause is tumor

•    Failure to secrete GH, gonadotropins, TSH, ACTH, and prolactin most common abnormality

Clinical Manifestations

•    Vary with degree and speed of onset of pituitary dysfunction

•    Related to the hyposecretion of target glands

•    Symptoms are nonspecific

Symptoms (Adult)

•     Weakness, fatigue, headache

•     Sexual dysfunction

•     Fasting hypoglycemia

•     Dry sallow skin

•     Diminished tolerance for stress

•     Poor resistance to infection

•     Orthostatic hypotension

•     Asymmetric visual field changes, possibly blindness

•     Apathy, mental slowness, delusions

Symptoms (Child)

•    Growth retardation

•    Growth normal for first 1-2 years then slows progressively

•    Intelligence is usually normal

 

Collaborative Care-Hypopituitarism

•    GH replacement therapy

•    Surgery or radiation for tumor removal

•    Permanent target gland hormone replacement

•    Nutrition

Nursing Management

•    Assessment and recognition of subtle signs and symptoms

•   STRESS

•    May first manifest after trauma or surgery

Hyperfunction posterior pituitary
SIADH

•    ADH is released in excess of indicated by plasma osmotic pressure

•    Various causes

Clinical manifestations

•     Increased renal tubular permeability and reabsorption of water

Diagnostic Studies

•    Simultaneous measurement of urine and serum osmolality

•    Decreased BUN, creatinine clearance, hemoglobin, and hematocrit

Collaborative Care

•    Goal: Restore normal fluid volume and osmolality

•    Fluid restriction 800-1000cc per day

•    Hypertonic saline solution

•    Drug therapy

Nursing assessment

•     Low UOP with high specific gravity

•     Sudden weight gain

•     Serum Na+ decline

•     Accurate hourly I & O, urine sp. gravity.

•     Daily weights

•     LOC

•     Signs and symptoms of hyponatremia q 2 h

•     Frequent VS plus heart and lung sounds

Nursing interventions

•    Fluid restriction

•    Position HOB flat or no more than 10% elevation

•    Side rails

•    Turn q2h, positioning, ROM

•    Seizure precautions

•    Assist with ambulation

•    Frequent oral hygiene

Hypofunction of posterior pituitary: Diabetes insipidus

•     Central DI occurs when any lesion of the hypothalmus, infundibular stem, or posterior pituitary interferes with ADH synthesis, transport or release

•     Other causes

Clinical manifestations

•     Central, neurogenic,nephrogenic, or psychogenic

•     Increased thirst (polydipsia)

•     Increased urination (polyuria)

Central DI

•    Occurs suddenly

•    Post-op has triphasic pattern

Collaborative Care

•    Maintenance of fluid and electrolyte balance

Nursing intervention

•     Fluid replacement

•     Urine glucose checks

•     Strict/accurate I&O

•     Daily weights

•     Urine specific gravity

•     Monitor for signs of hypertonic encephalopathy

•     Assess for complications of long-term DDAVP treatment