Endocrine Slide 2 The pituitary gland is a tiny organ, the size of a pea, found at the base of the brain. As the “master gland” of the body, it produces many hormones that travel throughout the body, directing certain processes or stimulating (causing) other glands to produce other hormones. Treatments are based on which hormone is imbalanced • The pituitary gland makes or stores many different hormones. The following hormones are made in the anterior (front part) of the pituitary gland : Prolactin (PRL)- Prolactin stimulates breast milk production after childbirth. It also affects sex hormone levels from ovaries in women and from testes (testicles) in men, as well as fertility. Abnormalities will affect all this Excess PRL –hypogonadism (loss of secondary sexual characteristics), decreased gonadotropin hormones, galactorrhea, increased body fat, increased prolactin levels Growth hormone (GH) - GH stimulates growth in childhood and is important for maintaining a healthy body composition and well-being in adults. In adults, GH is important for maintaining muscle mass and bone mass. It also affects fat distribution in the body. Deficiency in GH= decreased bone density, pathological fractures, decreased muscle strength, Increased serum cholesterol levels Excess in GH= Acromegaly(enlargement of hands, face, feet) thickened lips, course facial features, increased head size, lower jaw protrusion, joint pain, barrel-shaped chest, hyperglycemia, sleep apnea, enlarged heart, lungs, liver Slide 8 • The clinical features of growth hormone (GH) excess. Robert Wadlow, the “Alton giant,” weighed 9 pounds at birth but grew to 30 pounds by the time he was 6 months old. By his first birthday, he had reached 62 pounds. At the time of his death at age 22 from cellulitis of the feet, he was 8 feet, 11 inches tall and weighed 475 pounds. Diagnosis= MRI Meds-dopamine agonists, sandostatin Most treatment is outpatient based unless surgical correction is necessary…then hospitalization is required Surgery- hypophysectomy- preoperative care = explain that nasal packing present for 2-3 days post surgery; it will be necessary to mouth breathe; patient will have a mustache dressing for 2-3 days; patient should not brush teeth, cough, sneeze, or blow the nose after surgery these activities will increase the intracranial pressure and potentially disrupt the suture line and delay healing. Slide 11 The transsphenoidal surgical approach to the pituitary gland. Selective adenomectomy leaves normal pituitary tissue undisturbed.
Intraoperatively- if the tumor cannot be resected endoscopically via transnasal approach then a craniotomy may be needed Post-operatively Neuro checks…concern w/ visual changes or LOC changes; decrease in extremity strength; observe for transient diabetes insipidus; CSF leaking; infection; and increase in ICP Teach the patient to report any postnasal dripping; test any drainage for glucose (indicates CSF) most CSF leaks resolve independently w bed rest see table 62-3 & 62-4 Adrenocorticotropin (ACTH)
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- Fall '18
- Allie Kotzian
- Cortisol, Pituitary adenoma