Ch 48 Pituitary and adrenal disorders Flashcards
Posterior pituitary secretes what
Antidiuretic hormone (ADH), or vasopressin Oxytocin
Posterior pituitary(smaller lobe) is also known as
neurohypophysis
What causes hyperpituitarism
excess production of one or more of the anterior
pituitary hormones
Common factor of the hyperpituitarism is:
presence of a pituitary adenoma
Hyperpituitarism can lead to:
Growth hormone and prolactin often in excess
Overproduction of growth hormone can lead to
Gigantism or acromegaly
Increased growth hormone without closed epiphysis plate causes what?
Makes the patient get taller leading to gigatism
Overproduction of prolactin causes
Prolactinemia
When the patient gets a tumor causing growth hormone to be released, it can no longer affect the epiphysis plate so it makes the bones wider and leads to:
Acromegaly
More common than gigantism
Acromegaly
Most patients with acromegaly
have pituitary macroadenomas that secrete excess growth hormone
GH production occurs AFTER epiphyseal closure so bones increase in thickness and width instead of longitudinal growth
Acromegaly
what systems in the body does patients with acromegaly affect in patients
Cerebrovascular, gastrointestinal, nervous system and gastro-urinary system.
Assessment of acromegaly
Enlargement of the jaw, forehead, nose, tongue, and teeth, hands, and feet.
A soft doughy, damp handshake is characteristic of this disorder
Assessment of acromegaly
Assess for a deep, hollow sounding voice
Assess for hemianopsia and loss of visual acuity
Assessment of acromegaly
If surgery, determine what patient knows and expects
Remember to talk with them about body changes that are NOT reversible
If enlarged tongue assess respiratory alterations
Intervention of acromegaly
Disturbed Body Image
Activity Intolerance
Chronic Pain
Ineffective Therapeutic Regimen Management
Post operative nursing care for acromegaly
STRICT Intake and output because the patient is at risk for DI or SIADH
Hypophysectomy
Surgery for acromegaly
Post-operative nursing care of hypophysectomy
Neurologic status and vision must be monitored closely with particular attention to level
of consciousness, pupil size and equality, and vital signs.
Inspect nasal packing.
Signs and symptoms of infection
Hypopituitarism
Inadequate secretion of GH occurs during preadolescence
Dwarfism (attainment of a maximum height that is 40% below normal) as a result of
Hypopituitarism
If growth has been completed and some pathologic process impairs
the function of the pituitary, this can lead to
Panhypopituitarism
In this situation all hormones of the anterior pituitary are usually affected
Hypopituitarism
What is SIADH
Blood = dilute
Decreased serum sodium
Decreased serum osmolality
SIADH
Excess ADH secretion increases renal tubular permeability and reabsorption of
water into the circulation, resulting in excess extracellular fluid volume,
reduced plasma osmolality, increased glomerular filtration rates, and
decreased sodium levels.
Diabetes Insipidus
Blood = concentrated
Increased serum sodium
Increased serum osmolality
Diabetes Insipidus
Urine = dilute
Decreased urine sodium
Decreased urine osmolality
What happens during diabetes insipidus
ADH deficiency leads to little or no water reabsorption
Which causes dilute urine formed in the more proximal parts of the nephron to be excreted essentially unchanged.
This loss of solute free water causes mild dehydration, a rise in plasma osmolality, and the stimulation of thirst
SIADH
Urine =- CONCENTRATED
Increased sodium
Increased urine osmolality
Addison’s disease
Adrenal insufficiency
(Adrenal Insufficiency)
Decreased production of cortisol
Alters metabolism, decreases stress tolerance, emotional lability occurs in which condition?
Addison’s disease
(Aldosterone deficiency)
Urinary loss of sodium, chloride, and water leading to dehydration and electrolyte imbalances occurs in what condition?
Addison’s disease
(Androgen deficiency)
Loss of secondary sexual characteristics occurs in what condition?
Addison’s disease
