Pituitary and Adrenal Gland Disorders.docx - Pituitary and Adrenal Gland Disorders Pituitary Hormones Anterior Lobe TSH-Thyroid Stimulating Hormone

Pituitary and Adrenal Gland Disorders Pituitary Hormones  Anterior Lobe  TSH-Thyroid Stimulating Hormone  ACTH-Adrenocorticotropic Hormone  FSH-Follicle Stimulating Hormone  LH-Luteinizing Hormone  GH-Growth Hormone  Prolactin  Posterior Lobe  ADH-Anti-Diuretic Hormone  aka Arginine Vasopressin (AVP) or simply vasopressin  Oxytocin Anterior Pituitary Disorders  Acromegaly  GH  Overgrowth of soft tissues and bone

 6/1,000,000 Adults  Shortens life span 5-10 yrs  Clinical Manifestations  Enlarged Hand and Feet  Thickening of bony and soft tissue of the face  Leather, thick, and oily skin  Visual disturbances  Peripheral neuropathy  Headaches  Menstrual changes Acromegaly Diagnostic  H&P  Abnormal tissue growth  Increase in hat, ring, glove, shoe size  Growth Factor levels  Oral glucose tolerance test (OGTT)  Growth Hormone response to oral glucose challenge  MRI/CT with contrast Acromegaly Treatment  Surgery (Hypophysectomy)  Treatment of Choice  Transsphenoidal Approach  Permanent Loss of Pituitary Hormones  Target organ hormone replacement for lifetime  Radiation Therapy  Used when surgery failed to produce complete remission/high risk surgery candidate  Offered in combo with drug therapy  Drug Therapy  Used for inadequate response to/cannot be treated with surgery or radiation therapy  Most common medication is octreotide (Sandostatin) given IM. Reduces GH levels within norm range Nursing Management- Surgical  Post-Surgical  Head of Bed 30 degrees  Neuro Assessment  Pupillary Response, Speech Patterns, Extremity Movement and Strength  Q 4hr Mouth Care, No teeth brushing for 10 days  Hemorrhage  Avoid Coughing, Sneezing, or Straining

 CFS (glucose test) Nursing Management- Radiation  Stereotactic Radiosurgery  Specialized Radiation Neuro ICU  Headaches, Seizures, Nausea, Vomiting  Pin Site Care  Diabetes Insipidus (Loss ADH)  Infertility (FSH, LH)  Increased Risk for Colon Polyps and Colorectal Cancer Nursing Management-Medication  Octreotide (Sandostatin) lowers GH  Subcutaneous three times a week  Dopamine agonist reduces secretion of GH  Combination Drugs  Hormonal Therapy  Life Long Therapy  ADH  Cortisol  Thyroid Hypopituitarism  Selective Hypopituitarism verses Panhypopituitarism  Causes  Pituitary tumor  Autoimmune disorders  Infections  Pituitary Infarction (Sheehan Syndrome)  Destruction of Pituitary (trauma, radiation, surgery)  Anterior pituitary hormone deficiency = end organ failure.  Life Threatening Hypopituitarism Clinical Manifestations  Vary with the Pituitary dysfunction.  Headache, visual changes, anosmia, seizures  Growth hormone deficiency  Truncal obesity  Decreased muscle mass  Decreased energy  Reduced exercise capability.