Msquiz

• Cause of Hyperpituitarism:

  • Pituitary tumor or pituitary hyperplasia
• Hyperpituitarism is a progressive disease marked by excess production and secretion of one or more anterior pituitary gland hormones
• Hormones involved in Hyperpituitarism:

  • Prolactin (PRL)
  • Symptoms: irregular or absent menses, difficulty in becoming pregnant, decreased libido
• Growth Hormone (GH) excess secretion leads to tissue overgrowth

  • Gigantism: begins before puberty, proportional overgrowth of all body tissues, person is abnormally tall
  • Acromegaly: occurs after epiphyseal plate closure, causes bone thickening, transverse bone growth, visceromegaly
  • Overgrowth of bone and soft tissue in hands and feet causes clients to buy increasingly larger rings, gloves, and shoes
• Adrenocorticotropic Hormone (ACTH) leads to Cushing's Syndrome

  • Diagnostic tests: Immunoradiometric assay shows increased plasma GH level
  • CT scan and MRI determine presence and extent of pituitary lesion
• Surgical Management for Hyperpituitarism:

  • Transsphenoidal hypophysectomy (Removal of the pituitary gland)
  • Post-surgery care: monitor dressing for signs of cerebrospinal fluid leakage, observe for "halo sign" on dressing, avoid valsalva, administration of synthetic thyroid hormone, ADH, and sex hormones
• Medical Management for Hyperpituitarism:

  • Pituitary radiation
  • Medications: bromocriptine (Parlodel) and octreotide (Sandostatin) inhibit GH synthesis and decrease tumor size
• Nursing Management for Hyperpituitarism:

  • Provide emotional support for altered body image
  • Perform or assist with ROME to promote maximum joint ability
  • Monitor for manifestations of meningitis (Kernig's and Budzinski's signs)
• Hypopituitarism is a complex syndrome caused by a deficiency of hormones secreted by the anterior pituitary gland
• Causes of Hypopituitarism:

  • Tumor
  • Pituitary Ischemia
  • Congenital defects
  • Partial or total hypophysectomy
  • Radiation therapy
  • Chemical agents
  • Head injury
• Manifestations of Hypopituitarism are apparent if 75% of the gland is dysfunctional

  • Panhypopituitarism (Simmond's Disease) is the total absence of all pituitary secretions
• Diagnostic Tests for Hypopituitarism:

  • Immunoradiometric Assay shows decreased plasma levels of some or all pituitary hormones
  • Pituitary Challenge with TRH
• Management for Hypopituitarism:

  • Hypophysectomy
  • GH administration to children
  • Symptomatic treatment depending on the end organ response
• Diabetes Insipidus (DI) is a disorder of the posterior lobe of the pituitary gland characterized by a deficiency of antidiuretic hormone or vasopressin
• Types of Diabetes Insipidus:

  • Neurogenic DI: results from a disruption of the hypothalamus and pituitary gland
  • Nephrogenic DI: renal tubules are not sensitive to ADH
• Causes of Diabetes Insipidus:

  • Neurogenic DI: hypophysectomy, head trauma, brain tumor, radiation of pituitary gland, CNS infection
  • Nephrogenic DI: failure of renal tubules to respond to ADH, medications like Lithium Carbonate and demeclocycline, renal failure
• Manifestations of Diabetes Insipidus:

  • Extreme polyuria, polydipsia, polyphagia, fatigue, severe dehydration, severe hypotension
• Hyperpituitarism is a progressive disease marked by excess production and secretion of one or more anterior pituitary gland hormones
• Diagnostic Tests for Diabetes Insipidus:

  • Urinalysis shows very dilute urine with low specific gravity
  • Water Deprivation Test reveals inability of kidneys to concentrate urine
• Causes of Hyperpituitarism:

  • Pituitary tumor or pituitary hyperplasia
• Management for Diabetes Insipidus:

  • Replace ADH with Desmopressin Acetate, Lypressin, Vasopressin
  • Ensure adequate fluid replacement
  • Identify and correct underlying intracranial pathology
• Hormones involved in Hyperpituitarism:

  • Prolactin (PRL)
  • Symptoms: Irregular or absent menses, Difficulty in becoming pregnant, Decreased Libido
• Causes of SIADH:

  • Often nonendocrine origin, caused by ectopic production of ADH
  • Bronchogenic carcinoma, head injury, lesions in the brain involving the hypothalamus, medications, and nicotine
• Growth Hormone (GH) excess secretion leads to tissue overgrowth

  • Gigantism: Begins before puberty, causes proportional overgrowth of all body tissues, person is abnormally tall
  • Acromegaly: Occurs after epiphyseal plate closure, causes bone thickening, transverse bone growth, visceromegaly, overgrowth of bone and soft tissue in hands and feet
• Manifestations of SIADH:

  • Fluid volume excess, headache, fatigue, weight gain without edema, small amounts of concentrated amber-colored urine
• Adrenocorticotropic Hormone (ACTH) leads to Cushing's Syndrome

  • Diagnostic Tests: Immunoradiometric assay shows increased plasma GH level
  • CT scan and MRI determine presence and extent of pituitary lesion
  • Surgical Management: Transsphenoidal hypophysectomy (Removal of the pituitary gland)
• Diagnostic Tests for SIADH:

  • High urine osmolality, high specific gravity, low serum osmolality, decreased hematocrit, BUN, serum sodium
• Nursing Management for SIADH:

  • Monitor fluid balance, neurological status, and vital signs
  • Implement safety measures to prevent falls due to hyponatremia
• Post-surgery care:

  • Patients have nasal packing and a "mustache dressing" to collect drips, monitor for signs of cerebrospinal fluid leakage
  • CSF contains glucose, observe for "halo sign" on dressing, avoid valsalva, sneezing, blowing of the nose
  • Administration of synthetic thyroid hormone, ADH, and sex hormones, effects include amenorrhea and gonads shrinking
• Thyroid Gland produces hormones: Thyroxine (T4), Triiodothyronine (T3), Thyrocalcitonin or Calcitonin
• Thyroid hormone controls cellular metabolic activity

  • Iodine is essential for hormone synthesis
• Medical Management:

  • Pituitary radiation
  • Medications: bromocriptine (Parlodel) and octreotide (Sandostatin) inhibit GH synthesis and decrease tumor size, side effect: Hypotension
• Thyroid Tests:

  • Eclia: method of testing for thyroid hormones
  • Irma (Ria): specific, sensitive, and accurate method for T3 and T4
• Nursing Management for Hyperpituitarism:

  • Provide emotional support for altered body image
  • Perform or assist with ROME to promote maximum joint ability
  • Monitor for manifestations of meningitis (Kernig's and Budzinski's signs)
• Hyperthyroidism is a disorder with excessive circulating thyroid hormone accelerating metabolism
• Hypopituitarism is a complex syndrome caused by a deficiency of hormones secreted by the anterior pituitary gland

  • Marked by metabolic dysfunction, sexual immaturity, or growth retardation
  • Signs and Symptoms apparent if 75% of the gland is dysfunctional
  • Panhypopituitarism (Simmond's Disease) is the total absence of all pituitary secretions
• Types of Hyperthyroidism:

  • Graves' Disease: excessive output of normal thyroid hormones
  • Toxic adenoma/Colloid Adenomatous Goiter: benign enlargement of thyroid tissue
  • Thyrotoxicosis Factitia: from chronic ingestion of thyroid hormone
  • Subacute Granulomatous Thyroiditis: virus-induced, painful condition
• Nursing Management for Hyperthyroidism:

  • Monitor for signs of thyroid storm
  • Provide emotional support and education on medication compliance
• Causes of Hypopituitarism:

  • Tumor
  • Pituitary Ischemia
  • Congenital defects
  • Partial or total hypophysectomy
  • Radiation therapy
  • Chemical agents
  • Head injury
• Manifestations of Diabetes Insipidus:

  • Extreme Polyuria of diluted urine with low specific gravity
  • Polydipsia
  • Polyphagia
  • Nocturia
  • Fatigue
  • Severe Dehydration