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Basic Medical And Surgical Nursing > Disorders Of The Pituitary Gland > Flashcards

Disorders Of The Pituitary Gland Flashcards

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1
Q

What is acromegaly?

A

Acromegaly is a rare condition in which there is too much growth hormone. This causes various symptoms which slowly develop over several years.
The most noticeable symptoms are that the hands and feet become larger and features of the face may become more prominent.

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2
Q

What causes acromegaly?

A

It is usually caused by a small non cancerous growth(tumor) in the pituitary gland.

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3
Q

What are the signs and symptoms of acromegaly?

A
  • skin may thicken (particularly on the face) and become more greasy and sweaty.
  • Changes to the face may include: thickened lips and nose, thickening of your scalp, your jaw becoming more prominent.
  • Teeth grows apart or teeth don’t meet properly anymore when you bite your teeth together.
  • Vocal cords thicken which may cause voice to deepen.
  • Enlarged tongue.
  • Thickening of cartilage may cause joint pain and arthritis in various joints.
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4
Q

How can acromegaly be diagnosed?

A
  • A blood test to measure the level of IGF-1 and growth hormone
  • Glucose tolerance test. Taking glucose should lower the blood level of growth hormone. However, if there is acromegaly, the growth hormone level remains high.
  • A magnetic resonance imaging (MRI) scan can show the size of any tumour.
  • Eye and visual tests can assess if the tumour is pressing on the optic nerve.
  • If one is confirmed as having acromegaly, other tests will be needed to see if the tumour is causing a lack or excess of other hormones made by the pituitary gland.
  • Other tests may include chest X-ray, electrocardiogram (ECG), CT Scan
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5
Q

What are the treatment options for acromegaly?

A
  • The aim of treatment is to reduce the amount of growth hormone in the blood back to normal and to reduce the size of an enlarged tumour.
  • Surgical treatment
  • Drugs like Somatostatin analogues (octreotide and lanreotide) and Dopamine agonists (such as cabergoline, bromocriptine and quinagolide)
  • Radiotherapy
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6
Q

What are the nursing diagnosis for acromegaly?

A

Disturbed Body Image related to anxiety over thickened skin and enlargement of face, hands, and feet.
Ineffective Coping related to change in appearance.
Disturbed Sensory Perception
Disturbed Sleeping Pattern related to soft tissue swelling
Fluid Volume Deficit
Anxiety related to change in appearance
Knowledge Deficit

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7
Q

What is Cushing syndrome?

A

Cushing’s syndrome develops when the level of a glucocorticoid in the body is too high over a long period of time.
Too much glucocorticoid can occur from an exogenous (prednisolone) or endogenous source(cortisol).

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8
Q

What are the causes of Cushing syndrome

A

Consumption of lot of alcohol (which makes too much cortisol. The cortisol level goes back to normal if drinking alcohol stops), severe depression make too much cortisol.

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9
Q

What are the functions of cortisol in the body?

A

Cortisol is vital for life. It has several functions including:
•Helping to regulate blood pressure.
•Helping to regulate the immune system.
•Helping to balance the effect of insulin to keep the blood sugar level normal.
•Helping the body to respond to stress.

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10
Q

Signs and symptoms of Cushing disease

A
  • Obesity , Facial puffiness , Facial hair in women, High blood pressure.
  • Muscle weakness, Thin skin which bruises easily, Purple/pink stretch marks (striae) may appear.
  • Aches and pain, Mood swings.
  • Lack of sex drive (loss of libido).
  • Periods may become irregular, or stop, in women.
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11
Q

How can Cushing syndrome be diagnosed ?

A
  • A test to measure the amount of cortisol in urine
  • Blood suppression test: After ingestion of the drug dexamethasone, a high blood cortisol level helps to confirm Cushing’s syndrome.
  • A night-time blood test or saliva test to measure the level of cortisol. The level of cortisol should be low after you go to sleep and a high level is abnormal.
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12
Q

How can Cushing syndrome be managed?

A
  • The treatment options depend on the cause. For example:
  • If a tumor in an adrenal gland is the cause, an operation to remove it will cure the condition.
  • For adrenal hyperplasia , both adrenal glands may need to be removed. Patient will then need to take lifelong replacement therapy of certain adrenal hormones.
  • Other tumors in the body which make ectopic ACTH may be able to be removed, depending on the type of tumor, where it is, etc.
  • Medication to block the production or effects of cortisol may be an option.
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13
Q

What are prolactinomas?

A
  • A prolactinoma occurs when some of the cells in the pituitary gland (the ones producing prolactin) multiply more than usual to form a small growth (tumour) in the pituitary gland.
  • The prolactinoma makes too much prolactin and this can cause symptoms.
  • Prolactinomas occur both in men and in women. Prolactinomas occur most often in women aged 20-50 years, but they can occur at any age.
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14
Q

What are the signs and symptoms of prolactinomas

A

Women may have:
•Irregular periods or no periods.
•Reduced fertility.
•Reduced sex drive.
•Galactorrhoea.
Men may have:
•Reduced fertility.
•Difficulty having an erection (erectile dysfunction).
•Reduced sex drive (libido).
•Breast enlargement (called gynaecomastia).
•Very rarely, leakage of milk from the breasts.

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15
Q

How can prolactinomas be diagnosed?

A
  • A blood sample can check the level of prolactin in the blood.
  • Eye tests will assess if the tumour is pressing on the optic nerve
  • Scans like MRI, CT scan
  • A bone density scan may be advised for some patients, to check whether they are at risk of ‘thinning’ of the bones (osteoporosis), which is a possible complication
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16
Q

How can prolactinomas be managed?

A
  • For a small prolactinoma, if symptoms are not too troublesome then one option is just to monitor the situation. This means having regular blood tests and possibly scans. If symptoms get worse or the prolactinoma seems to be growing, treatment can be started whenever necessary.
  • If one is choosing the no-treatment option, patient may be advised to take oestrogen hormones (for women) or testosterone hormones (for men). This can help to prevent ‘thinning’ of the bones (osteoporosis).
  • Medication such as dopamine agonists are called bromocriptine, cabergoline or quinagolide
17
Q

What is diabetes insipidus

A
  • Diabetes insipidus is a condition in which the ability to control the balance of water within the body is not working properly.
  • The kidneys are not able to retain water and this causes passage of large amounts of urine.
  • Because of this, patient become more thirsty and want to drink more
18
Q

What are the types of diabetes insipidus

A

•It can be of two types: cranial and nephrogenic

Cranial diabetes insipidus
•Cranial D.I occurs when the brain produces or releases a reduced amount of ADH. ADH (vasopressin).
•ADH usually helps the kidneys to concentrate urine. If less ADH is released, one will pass an increased volume of dilute urine.
•Cranial diabetes insipidus can occur if the hypothalamus or pituitary gland is damaged. This causes a reduction in production and release of ADH

Nephrogenic diabetes insipidus
•In nephrogenic diabetes insipidus, ADH is still being released by the brain but the kidneys become resistant to the effects of ADH. This means that ADH is not able to work properly to allow kidneys to concentrate urine which causes
•Passage of large amounts of diluted urine (polyuria).
•Becoming excessively thirsty and so drinking more (polydipsia).
•Nephrogenic diabetes insipidus is very rare. it can result from:
•chronic kidney disease.
•High concentration of lithium in the blood

19
Q

What are the symptoms of diabetes insipidus

A
  • Passing large volumes of urine. Passage of between 3 and 20 litres of urine per day.
  • Passing urine frequently (up to every half an hour) during the day.
  • Getting up to pass urine frequently during the night.
  • Feeling excessively thirsty, despite the fact that you seem to be drinking lots of fluids.
  • Dehydration. Severe dehydration is a medical emergency and immediate medical attention is needed.
  • Symptoms of dehydration can include:
  • Headaches.
  • Dry mouth, lips and tongue.
  • Dry skin, dizziness.
  • Light-headedness.
  • Muscle cramps.
  • Weakness.
  • Confusion.
20
Q

How can diabetes insipidus be diagnosed

A
  • Blood and urine tests
  • A water deprivation test
  • Antidiuretic hormone test
  • Imaging tests such as MRI
21
Q

How can diabetes insipidus be managed?

A 
Administration of ADH and its derivatives 
- Vasopressin (pitressin)
IM,effective for 24 to 72 hrs
Vial should be warmed and shaken vigorously before administering to mix active components settled at the bottom of the vial.
-Lypressin (Diapid nasal spray)
Absorbed through nasal mucosa
Duration of action 4 to 6 hours
May cause chronic nasal irritation
22
Q

What is hypopituitarism

A

Hypopituitarism is a rare condition in which there’s a lack (deficiency) of one, multiple or all of the hormones made by the pituitary gland

Hypopituitarism can occur from disorders of or damage to your pituitary gland or hypothalamus

23
Q

What are the types of hypopituitarism

A
  • There are three different kinds of hypopituitarism based on the number of hormones that are lacking (deficient):
  • Isolated pituitary deficiency: One pituitary hormone is affected and lacking.
  • Multiple pituitary hormone deficiency: Two or more pituitary hormones are affected and lacking.
  • Panhypopituitarism: All pituitary hormones are affected and lacking.

TYPES…
•Based on the cause of it and how the pituitary gland and its hormones are affected:
•Primary hypopituitarism: Caused by damage to or disorders of the pituitary gland.
•Secondary hypopituitarism: Caused by damage to or disorders of the hypothalamus.
•Idiopathic hypopituitarism: The cause can’t be determined.
•The symptoms of hypopituitarism depend on which pituitary hormone(s) are affected and deficient (lacking).

24
Q

What are the symptoms of a lack of growth hormones (GH)

A
  • Hypoglycemia (low blood sugar).
  • An abnormally small penis (micropenis) in babies assigned male at birth.
  • Slow growth or no growth.
  • Short height (stature).
  • Missing or delayed sexual development during puberty.
  • Fatigue.
  • Reduced sense of wellbeing.
  • Decreased sexual function and sexual interest.
  • Higher amount of body fat, particularly around the waist.
  • Sensitivity to heat and cold.
  • Decreased muscle mass.
  • Decreased strength and stamina when exercising
25
Q

What are the symptoms of a lack of thyroid stimulating hormone(TSH)

A
  • Decreased muscle tone.
  • Low body temperature (hypothermia).
  • A bulging belly.
  • A hoarse cry.
  • Fatigue.
  • Dry skin and thinning hair.
  • Constipation.
  • Weight gain.
  • Muscle weakness.
  • Sensitivity to cold temperatures.
  • Depression.
26
Q

What are the symptoms of a lack of follicle stimulating hormone and luitenizing hormones(FSH & LH)

A

micropenis.
•cryptorchidism.
•Absent breast development and testicular enlargement.
•Loss of interest in sex (low sex drive).
•Fatigue.
•Infertility.
•Erectile dysfunction.
•Decreased facial or body hair.
•Loss of interest in sex (low sex drive).
•Fatigue.

27
Q

What are the symptoms of a lack of adrenocorticotropic hormone(ACTH)

A
  • Hypoglycemia (low blood sugar).
  • The rate of weight gain is significantly lower than average (failure to thrive).
  • Seizures.
  • Yellowing skin (jaundice).
  • Fatigue.
  • Unexplained weight loss.
  • Low blood pressure (hypotension).
  • Nausea and vomiting.
  • Hypoglycemia (low blood sugar).
  • Confusion.
28
Q

What are the symptoms of a lack of prolactin and oxytocin

A
  • Symptoms of a lack of prolactin
  • The main symptom of prolactin deficiency is a lack of breast milk production after giving birth.
  • Symptoms of a lack of oxytocin
  • Symptoms of oxytocin deficiency include:
  • Breast milk flow issues after childbirth.
  • Difficulty bonding with your baby after birth.
  • Lack of empathy.
  • Difficulty interacting with others.
29
Q

What are the symptoms of a lack of anti diuretic hormone (ADH) or vasopressin

A 
Vomiting.
•Unexplained episodes of fever.
•Excessive crying.
•Weight loss.
•Constipation.
•Very wet diapers.
•Difficulty with toilet training.
•Bedwetting.
•Getting tired easily.
•Frequent urination.
•Extreme thirst.
30
Q

What are the causes of hypopituitarism

A
  • In some cases, healthcare providers can’t determine the cause. This is called idiopathic hypopituitarism.
  • In general, these three main factors can cause hypopituitarism:
  • Something is putting pressure on (compressing) the pituitary gland or hypothalamus e.g pituitary adenomas, brain tumors
  • There’s damage to the pituitary gland or hypothalamus e.g surgery, radiation, head trauma
  • Having a rare condition or a condition that rarely causes hypopituitarism e.g bacteria meningitis and genetic mutations.
31
Q

What are the diagnostic investigations for hypopituitarism

A
  • Hormone level blood tests
  • Hormone stimulation tests
  • Insulin tolerance test
  • Osmolality tests for blood and urine
  • MRI (magnetic resonance imaging) scans
  • Brain CT (computed tomography) scan
32
Q

What are the treatment options for hypopituitarism

A
  • Hormone replacement therapy: Hormone replacement therapy aims to restore the deficient pituitary hormone(s) to normal levels.
  • Surgery: Pituitary adenomas can cause hypopituitarism. People who have pituitary adenomas may undergo surgery to remove the adenoma.
  • Radiation therapy: Some pituitary adenomas can be treated using radiation therapy.
33
Q

What is the prognosis for hypopituitarism

A
  • It depends on four factors:
  • age at the onset (beginning) of hypopituitarism.
  • The cause of the hypopituitarism.
  • How much the affected hormone(s) are lacking.
  • How the body responds to treatment.
  • In most cases, people with hypopituitarism require close, lifelong monitoring of their hormones and symptoms.
34
Q

Nursing diagnosis for hypopituitarism

A
  1. Disturbed Body Image related to changes in body structure and function of the body due to deficiency of gonadotropin and growth hormone deficiency.
  2. Ineffective individual coping related to the chronicity of the disease condition.
  3. Low Self-Esteem related to changes in body appearance.
  4. Disturbed Sensory perception (visual) related to impaired transmission of impulses as a result of suppression of tumor on the optic nerve.
  5. Anxiety related to threat or change in health status.
  6. Self care deficit related to the decrease in muscle strength.
  7. Risk for impaired skin integrity (drought) related to declining hormonal levels.

Basic Medical And Surgical Nursing (2 decks)

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