Transcript Pituitary and Adrenal Gland Dysfunction

Chapter 19
Care of Patients with
Pituitary and Adrenal Gland
Problems
Disorders of the Anterior Pituitary
Gland
 Target tissue
 Thyroid, adrenal cortex, ovary, testes, uterus, mammary
glands and kidney
 Either excess or deficiency
 Pathologic condition within the gland or hypothalmic
dysfunction
 Two to focus on:
 Hyperpituitarism
 Hypopituitarism
Anterior Pituitary Gland
 Hyper-secretion and or secretion
 Pituitary Tumor
 Pituitary hyperplasia
 Benign adenoma (most common)
 Pressure on the optic nerve
 Excess GH, ACTH, prolactin (PRL) or TSH
Hypopituitarism
 Deficiency of one or more anterior pituitary hormones
results in metabolic problems and sexual dysfunction.
 Panhypopituitarism—decreased production of all of the
anterior pituitary hormones.
 Most life-threatening deficiencies—ACTH and TSH.
 Deficiency of gonadotropins.
 Growth hormone
 Proportionate dwarfism
Cause of Hypopituitarism
 Benign or malignant tumors
 Anorexia nervosa
 Shock or severe hypotension
 Head trauma
 Brain tumors or infection
 Congenital
Patient-Centered Collaborative
Care
 Assessment
 Interventions include:
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Replacement of deficient hormones
Androgen therapy for virilization; gynecomastia can occur
Estrogens and progesterone
Growth hormone
Hyperpituitarism
 Hormone oversecretion occurs with pituitary tumors or
hyperplasia
 Genetic considerations
 Pituitary adenoma
Gigantism
 Gigantism is the onset of growth hormone hypersecretion
before puberty.
Acromegaly
 Growth hormone hypersecretion after puberty
 Surgical Intervention
 Transsphenoidal or transfrontal removal of the pituitary gland
 http://www.youtube.com/watch?v=Ebhf1qKVA9A
Patient-Centered Collaborative
Care
 Assessment
 Nonsurgical management:
 Drug therapy- to reduce GH secretion or the effects on tissues
 Somatostatin analogues
 Dopamine agonists
 Growth hormone antagonist
 Radiation
 Gamma knife procedure
 Usually one time treatment
Surgical Management
Postoperative Care
 Monitor neurologic response
 Assess for postnasal drip
 HOB elevated
 Assess nasal drainage
 Avoid coughing early after surgery
 Assess for meningitis
 Hormone replacement
 Avoid bending
 Avoid strain at stool
Postoperative Care
 Avoid toothbrushing
 Numbness in the area of the incision
 Decreased sense of smell
 Vasopressin
Diabetes Insipidus
 Water metabolism problem caused by an antidiuretic
hormone deficiency (either a decrease in ADH synthesis or
an inability of the kidneys to respond to ADH)
 Diabetes insipidus is classified as:
 Nephrogenic
 Neurogenic
Patient-Centered Collaborative
Care
 Assessment
 Most manifestations of DI are related to dehydration
 Increase in frequency of urination and excessive thirst
 Dehydration and hypertonic saline tests used for diagnosis
of the disorder
 Urine diluted with a low specific gravity (<1.005)
DI: Interventions
 Oral chlorpropamide
 Desmopressin acetate
 Early detection of dehydration and maintenance of
adequate hydration
 Lifelong vasopressin therapy for patients with permanent
condition of diabetes insipidus
 Teach patients to weigh themselves daily to identify weight
gain
Syndrome of Inappropriate
Antidiuretic Hormone Secretion
(SIADH)
 Vasopressin is secreted even when plasma osmolarity is low
or normal.
 Feedback mechanisms do not function properly.
 Water is retained, resulting in hyponatremia (decreased
serum sodium level).
SIADH: Patient-Centered
Collaborative Care
 Assessment:
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Recent head trauma
Cerebrovascular disease
Tuberculosis or other pulmonary disease
Cancer
All past and current drug use
SIADH: Interventions
 Fluid restriction
 Drug therapy—diuretics, hypertonic saline, demeclocycline
 Monitor for fluid overload
 Safe environment
 Neurologic assessment
Adrenal Gland Hypofunction
 Adrenocortical steroids may decrease as a result of
inadequate secretion of ACTH
 Dysfunction of the hypothalamic-pituitary control
mechanism
 Direct dysfunction of adrenal tissue
Effect of Insufficiency of
Adrenocortical Steroids
 Loss of aldosterone and cortical action
 Decreased gluconeogenesis
 Depletion of liver and muscle glycogen
 Hypoglycemia
 Reduced urea nitrogen excretion
 Anorexia and weight loss
 Potassium, sodium, and water imbalances
Addison’s Disease
 Primary
 Secondary:
 Sudden cessation of long-term high-dose glucocorticoid
therapy
Acute Adrenal
Insufficiency/Addisonian Crisis
 Life-threatening event in which the need for cortisol and
aldosterone is greater than the available supply
 Usually occurs in a response to a stressful event
Patient-Centered Collaborative
Care
 Assessment
 Clinical manifestations
Assessment
 Psychosocial assessment
 Laboratory tests
 Imaging assessment
Adrenal Gland Hyperfunction
 Hypersecretion by the adrenal cortex results in Cushing’s
syndrome/disease, hypercortisolism, or excessive androgen
production
Pheochromocytoma
 Hyperstimulation of the adrenal medulla caused by a tumor
 Excessive secretion of catecholamines
Hypercortisolism (Cushing’s
Disease)
 Etiology
 Incidence/prevalence
 Patient-centered collaborative care
 Assessment:
 Clinical manifestations—skin changes, cardiac changes,
musculoskeletal changes, glucose metabolism, immune
changes
Hypercortisolism
Cushing’s Disease
 Psychosocial assessment
 Laboratory tests—blood, salivary and urine cortisol levels
 Imaging assessment
Hypercortisolism: Nonsurgical
Management
 Patient safety
 Drug therapy
 Nutrition therapy
 Monitoring
Hypercortisolism: Surgical
Management
 Hypophysectomy
 Adrenalectomy
Community-Based Care
 Home care management
 Health teaching
 Health care resources
Hyperaldosteronism
 Increased secretion of aldosterone results in
mineralocorticoid excess.
 Primary hyperaldosteronism (Conn's syndrome) is a result
of excessive secretion of aldosterone from one or both
adrenal glands.
Patient-Centered Collaborative
Care
 Assessment
 Most common issues—hypokalemia and elevated blood
pressure
Interventions
 Adrenalectomy
 Drug therapy
 Glucocorticoid replacement
 When surgery cannot be performed—spironolactone
therapy
Pheochromocytoma
 Catecholamine-producing tumors that arise in the adrenal
medulla
 Tumors produce, store, and release epinephrine and
norepinephrine
Patient-Centered Collaborative
Care
 Assessment
 Interventions:
 Surgery is main treatment.
 After surgery, assess blood pressure.