ATI: Chapter 77 - Pituitary Disorders Flashcards
The _____ gland (hypophysis) is known as the master gland due to its regulation of many bodily functions.
pituitary
Located underneath the hypothalamus, at the base of the skull, the pituitary gland is regulated by the _______.
hypothalmus
The hypothalamus is divided into two lobes; anterior (_______) and posterior (_______), which secrete regulatory hormones.
adenohypophysis
neurohypophysis
The hormones associated with the posterior pituitary are produced in the ________ and stored in the posterior pituitary, where they are released into the circulation as needed.
hypothalamus
Anterior Pituitary hormones (6)
Thyroid stimulating hormone (TSH) Adrenocorticotropic hormone (ACTH) Luteinizing hormone Follicle stimulating hormone Prolactin Growth Hormone (GH)
FLATPG
Thyroid stimulating hormone stimulates the ______.
thyroid gland
The thyroid stimulating hormone is released from the ______ pituitary gland.
anterior
Adrenocorticotropic hormone (ACTH) stimulates the adrenal glands to secrete _________.
glucocorticoids
Luteinizing hormone in women stimulate maturation of ______ and _____.
ova and ovulation
Luteinizing hormone in men stimulate ______.
sperm production
Prolactin stimulates ______ production during lactation.
breast milk
Growth hormone (GH) stimulates protein synthesis and growth of ________
muscle and bone
Posterior pituitary hormones (2)
antidiuretic hormone (ADH) vasopressin Oxytocin (OT)
Antiduiuretic hormone (ADH) (vasopressin): increases re-absorption of water in the ______.
kidneys
Oxytocin (OT) stimulates ______ of uterus following delivery.
contraction
Oxytocin (OT) stimulates ejection of _____ during lactation.
breast milk
Altered function of the pituitary gland can be caused by disease of the pituitary gland or the ________, trauma, tumor, or vascular lesion.
hypothalamus
Hyperfunction or hypofunction of the anterior and posterior pituitary gland can occur ______ of one another.
independently
Over secretion of ACTH from the anterior pituitary gland in results in ________.
Cushing’s disease
Over secretion of GH results in ______ in children and _______ in the adult client.
gigantism
acromegaly
In the adult client, acromegaly manifests as ______ of body parts without affectign the client’s height.
enlargement
Under secretion of GH in children results in ______.
dwarfism
Insufficient secretion of hormones in the anterior pituitary typically affects all the hormones, termed _________.
panhypopituitarism
Panhypopituitarism affects the target organs of the hormones produced in the anterior pituitary, including the thyroid, _______, and gonads.
adrenal cortex
A deficiency of ____ causes diabetes insipidus (DI),
ADH
Diabetes insipidus is characterized by the excretion of a large quantity of _______.
diluted urine
Excessive secretion of ADH causes _______.
SIADH
In SIADH, the ____ retain water, urine output decreases, and extracellular fluid volume is increased.
kidneys
Posterior pituitary disorders result in fluid and ______.
electrolyte imbalances
_______is characterized by excess growth hormone in adults, which causes an increase in size of body parts but not height.
Acromegaly
Manifestations of acromegaly are widespread, including overgrowth of _____; bones of the forehead, jaw, feet and _____; and enlargement of organs including the liver and the heart.
skinhands
If acromegaly is untreated can cause hypertension, _______, and heart problems.
diabetes mellitus
Onset of _____ is gradual and can progress for years before becoming noticeable
acromegaly
Risk Factors for acromegaly
age (adulthood) benign tumors (pituitary adenoma)
Acromegaly expected findings
severe headaches visual disturbances (diplopia, decreased visual acuity) thick lips with coarse facial structures joint pain decreased libido enlarged hands and feet hyperglycemia barrel-shapped chest lower jaw protrusion increasing head size change in voice characteristics change in menstrual pattern sleep apnea increases in intracranial pressure (decreased LOC, pupillary changes, sever hypertension, widened pulse pressure, bradycardia, seizures)
Growth hormone level is measured as a baseline and following administration of _______, typically 0.5 g/kg or 1000 g with a growth hormone suppression test. Elevated glucose levels are expected to suppress GH; however, clients who have ______ will show only a slight decrease or no decrease at all in GH levels.
glucose
acromegaly
For a growth hormone suppression test you need to obtain baseline GH and glucose levels, administer prescribed glucose, obtain GH and blood levels at ____, _____, and _____ minutes after glucose administration.
10, 60, 120 minute
Clients should receive nothing but water for ___ to _____ hours preceding the growth hormone suppression test.
6 to 8 hours
Diagnostic Procedures for Acromegaly (3)
xrays of the skull
CT or MRI of the head
Cerebral angiography
________ identify abnormalities of the sella tircica, the location of the pituitary gland within the skull associated with acromegaly.
x-rays of the skull
______ or _______ of the head identify soft tissue lesions associated with acromegaly.
CT or MRI
__________ is used to evaluate for the presence of vascular malformation or aneurysms with acromegaly.
cerebral angiography
Hypophysectomy is the removal of the _________ through an endoscopic transnasal (most common) or oronasal (transsphenoidal) approach. If these approaches do not provide access to the tumor, a craniotomy is indicated.
pituitary gland
Preop to a hypophysectomy instruct the client not to brush his teeth, blow his nose, or _______ postoperatively. These actions can increase intracranial pressure.
bend at the waist
Prior to hypophysectomy assess ______ related to physical manifestations of disorder.
self-concept
Postoperative to hypophysectomy monitor _______ status.
neurological
Postoperative to hypophysectomy monitor drainage to __________.
mustache dressing (drip pad)
Postoperative to hypophysectomy notify the provider of the presence of glucose in the ________, which is an indication of leakage of cerebrospinal fluid).
drainage
Postoperative to hypophysectomy maintain the client in a _________ position.
high-fowlers
Postoperative to hypophysectomy monitor _______, especially greater output than intake (DI)
fluid balance
Postoperative to hypophysectomy encourage deep breathing exercises, but limit ______ as this increases intracranial pressure and can cause a leak of ________.
coughing cerebrospinal fluid (CSF)
Postoperative to hypophysectomy assess for manifestations of _____.
meningitis.
Postoperative to hypophysectomy administer _______.
replacement hormones
________ (bromocriptine mesylate, cabergoline) inhibit the release of GH.
Dopamine agonists
Instruct the client to notify the provider immediately if _____, dizziness, or watery nasal discharge occurs while taking bromocriptine. This can indicate cardiac dysrhythmia, coronary artery spasms, or _______>
chest pain
leakage of CSF
_______ (octreotide, lanreotide) inhibit GH release.
somatostatin analogs
________ (pegvisomant) prevents GH receptor activity and blocks production of insulin-like growth factor.
growth hormone receptor blocker
_______ therapy shrinks pituitary tumor over a period of time.
radiation
Hormone replacement therapy will be _____ after a hypophysectomy.
lifelong
Avoid activities that increase _______ after a hypophysectomy.
intracranial pressure
Report ______ or increased swallowing after a hypophysectomy.
postnasal drip
Rinse mouth frequently to minimize effects of ________ after a hypophysectomy.
mouth breathing
Use ______ and flossing to clean teeth. Avoid brushing teeth due to risk of trauma to the operative site after a hypophysectomy.
oral rinses
Consume a diet high in fiber to minimize ______ to defecate after a hypophysectomy.
straining
________ results from a deficiency of ADH, which is secreted by the posterior lobe of the pituitary gland (neurohypophysis).
Diabetes insipidus (DI)
Decreased ADH reduces the ability of the distal renal tubules in the kidneys to collect and concentrate urine, resulting in excessive diluted urination, ______, electrolyte imbalance, and excessive fluid intake.
excessive thirst
Types of Diabetes Insipidus
Primary
Secondary
Nephrogenic
Drug-Induced
______ diabetes insipidus is a lack of ADH production or release; caused by defects in the hypothalamus or pituitary gland.
primary
_____ diabetes insipidus is a lack of ADH production or release; caused by infection, tumors, in or near the hypothalamus or pituitary gland, _______, or brain surgery.
Secondary
head trauma
________ diabetes insipidus is inherited; renal tubules do not react to ADH.
nephrogenic
_________ diabetes insipidus is when lithium carbonate or demeclocyline can alter the way the kidneys respond to ADH.
drug-induced
Clients who have a head injury, tumor or lesion, surgery or irradiation near or around the pituitary gland or infection (meningitis, encephalitis) are risk factors for _______.
diabetes insipidus
Clients who are taking _______ or demeclcycline are at risk for diabetes insipidus.
lithium carbonate
Older adult clients are at higher risk for dehydration due to lower water content of the body, decreased thirst response, decreased ability of the __________, increased use of diuretics, swallowing difficulties, or inadequate food intake. (Risk factor for DI)
kidneys to concentrate urine
An expected finding of DI includes ______ (abrupt onset of excessive urination, urinary output of 4 to 30 L/day of dilute urine): failure of the renal tubules to collect and reabsorb water.
polyuria
An expected finding of DI is _______, excessive thirst, consumption of 2 to 20 L/day.
polydipsia
Other expected findings of DI includes fatigue, nocturia, and ______.
dehydration
An expected finding of DI is dehydration, as evidenced by extreme thirst, weight loss, _____, headache, constipation, and dizziness.
muscle weakness
Physical assessment findings of Diabetes Insipidus
Sunken eyes tachycardia hypotension loss or absence of skin turgor dry mucous membranes dry mucous membranes weak, poor peripheral pulses decreased cognition
