Transcript Caring for client`s with Endocrine DO.

Caring for client’s
with Endocrine DO.
Bakersfield College VN 86 PP #2
Pituitary Gland
• Pituitary disorders less common than other disorders
although can cause diverse and serious problems.
• Hyperpituitarism- excess production and secretion of one
or more hormones. Commonly causes oversecretion of
growth hormone.
• Hypopituitarism- lack of production of one or more of
the gland’s hormones
• Pituitary tumors usually cause both of these conditions.
Pituitary Gland Anterior
• Growth hormone is produced by the anterior lobe of the
pituitary gland. It stimulates growth of the long bones
• Excess secretion of GH prior to puberty and the closure
of the epiphyseal plates causes gigantism. These
patients can be over 7 foot tall.
• Dwarfism occurs when there is an inadequate production
of GH during childhood.
• During adulthood bones and connective tissue grow at a
slow rate and cause things like enlarged forehead and
protruding jaw. Hypersecretion during adulthood.
• Untreated: HTN, DM cardiac enlargement and failure.
Pituitary
• DX: MRI and CT show enlargement along with tumor.
• Labs show elevated growth hormone levels.
• Pituitary tumor treated with transphenoidal hypophysectomy
removal of the pituitary gland
• Irradiation of the pituitary tumor
• Drug therapy with Sandostatin (octreotide) decreases growth
hormone production does not reduce tumor size.
• Lifelong hormone replacement therapy needed.
Posterior Pituitary Gland
• Disorders of the posterior pituitary are caused by too much or
too little antidiuretic hormone (ADH).
• ADH regulates total body water by acting on the kidney to
retain or release water.
• Receptors in the Hypothalamus control the release of ADH in
response to serum osmolarity.
• Remember:
• When serum osmolarity increases ADH secretion increases
and renal water is reabsorbed, which decreases urine output.
• When serum osmolarity decreases (hyposmolarity)it
suppresses the release of ADH so urine output increases.
• Thus:
Diabetes Insipidus
• DI results from ADH insufficiency. Two types:
• 1. Neurogenic DI- results from damage to the pituitary gland
after head injury or cranial surgery.
• 2. Nephrogenic DI- kidneys fail to respond to ADH secretion
due to renal failure.
• Deficient supply of ADH causes a urinary output of 5 to 15
liters per day. Client develops polydipsia. If the patient can
not replace the water loss dehydration develops.
• Risk for hypernatremia.
• See manifestations:
DI
Diabetes insipidus diagnosis is based on presence of CM, risk
factors, water deprivation test see textbook.
• Treatment:
• Replace the water loss IV 0.45 NS
• ADH replacement therapy DDAVP or vasopressin
• Sodium restriction and thiazide diuretics for nephrogenic DI
SIADH
• Syndrome of inappropriate ADH secretion
• Results from excess production of ADH.
• Caused by lung tumor, head injury, pituitary surgery use of
barbiturates, anesthetics or diuretics.
• Excess production of ADH leads to water retention
hyponatremia and serum hyposmolarity.
• CM- decreases urine output and concentrated urine.
• Neurologic symptoms- cells in the brain swell as water moves
in.
• No edema in body, water is going to the extracellular spaces
SIADH
• Treatment- correcting the underlying cause, limit fluid intake so fluid
will go back into the cells.
• Diuretics such as lasix, with fluid restriction.
• Meds:
• Declomycin to promote urine producion
• Hypertonic saline.
• CM- see text
• Why fluid restriction?-prevents further dilution of the plasma and
sodium levels.
• Diuretics will help to decrease fluid volume excess
• Seizure precautions: low serum sodium levels can lead to seizures.
• Teaching- fluid restriction at home and medications. Video
Adrenal Gland Disorders
• Disorders involve either the adrenal cortex- secretes cortisol
and aldosterone.
• Or the Adrenal medulla- Releases epinephrine and
norepinephrine.
• Can cause physical, psychologic and metabolic alterations that
can be life threatening. Most common d/o are
• 1. Cushing’s syndrome, Addison’s disease and
pheochromocytoma.
Cushing’s Syndrome
• Chronic disorder in which the adrenal cortex produces
excessive amounts of the hormone cortisol.
• More common in women 30-50 yrs. May be caused by:
• Adrenal tumors
• Tumor of the pituitary gland which increases ACTH release
which stimulates the adrenal cortex to produce cortisol.
• Chronic glucocorticoid therapy- Where do we see this?
• Increased release of ACTH from certain tumors. Lung,
pancreatic.
Cushing’s Syndrome
• Too much cortisol/glucocorticoids result in changes in CHO
metabolism, protein and fat metabolism.
• Fat deposits
• Buffalo hump
• Moon face
• Muscle weakness and wasting
• Loss of collagen and connective tissue, thus poor wound
healing
• Thin skin with striae
• DM may occur.
• Osteoporosis compression fractures
• Hypertension, infection, peptic ulcers, depression, hirsutism.
Cushing’s Syndrome
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Treatment:
Surgery radiotherapy or medication
Pituitary adenoma- surgery
Radiation if inoperable tumor
Drug therapy when surgery is contraindicated.
DX test: increased plasma cortisol level / elevated 24 hour
urine test for 17 ketosteroids and 17 hydrocorticosteroids.
• Plasma ACTH levels are elevated when caused by pituitary
gland tumor
• Serum sodium and glucose levels are elevate in Cushing’s
Syndrome.
Cushing’s Syndrome
• If surgery indicated when adrenal cortex tumor.
• Usually only one adrenal gland is involved.
• If both taken the client will have to take lifelong corticosteroid
and mineralcorticoid replacement therapy.
• Addisonian crisis is risk after both glands removed.
• Radiation therapy when client has inoperable pituitary tumor
causing Cushing’s syndrome.
• Radioactive isotopes implanted into the pituitary gland.
Lifelong replacement of hormones
• See Nursing Care.
Addison’s Disease
• Most common form of adrenal cortex insufficiency.
• Women under age 60.
• Primary- Adrenal cortex hypofunction. Autoimmune response.
Which destroys the client’s own adrenal cortex.
• Secondary- Lack of pituitary ACTH.adrenalcorticotropic hormone
• DX: decreased serum levels of cortisol, atrophy of adrenal gland on
CT.
• Manifestations are slow CM when 90% gland destroyed.
• CM are from elevated ACTH levels and decreased aldosterone and
cortisol. Primary complication is Addisonian crisis.
• CM- See text
• Tx: early diagnosis, cortisol replacement, this can induce Cushing’s
syndrome. See textbook.
Addisonian Crisis
• Serious life threatening response to acute adrenal
insufficiency.
• Major stressors precipitate the condition.
• May occur in clients who abruptly withdraw corticosteroid
medications
• CM- hypotension, rapid weak pulse, extreme weakness,
confusion, altered K levels, cardiac dysrhythmias.
• TX: IV fluids, glucose, sodium glucocorticoids.
Adrenal Medulla Disorders
• Pheochromocytoma- benign tumor of the adrenal medulla.
• Middle aged adults
• Produces excessive amounts of catecholamines such as
epinephrine or norepinephrine.
• This stimulates the sympathetic nervous system which in turn
• Leads to dramatic rise in the systolic blood pressure!!
• 200/150.
• Can lead to stroke and MI
• DX: increased catecholamine levels in the blood.
• CT or MRI
• TX: Surgical removal; laparoscopic adrenalectomy
• NR; Blood pressure,adrenal hormone replacement therapy,
hypertension may be a problem chronic.