Exam 4 - Endo Flashcards
where is the pituitary gland located
base of the brain
the pituitary gland is aka
the master gland
primary vs. secondary pituitary adenoma
primary: localized
secondary: metastasized
functional vs. nonfunctional pituitary adenoma
function: creating too little or too much hormone
nonfunctional: not secreting hormones but still causing issues
pituitary adenomas are usually ___ and ___ growing
benign; slow
anterior pituitary gland secretes these 6 hormones
GH
ACTH
LH
FSH
prolactin
TSH
posterior pituitary gland secretes these 2 hormones
ADH
Oxytocin
only definitive way to know whether someone has cancer
biopsy
stimulation test
med is given to stimulate the secretion of a hormone
gland should capable of secreting the hormone
suppression test
excess hormone is administered
the gland should be able to suppress the extra hormone
3 types of treatment for pituitary adenoma
meds: shrink growth, reduce hormone production (may not be effective)
transsphenoidal/hypophysectomy
radiation
least invasive pituitary adenoma treatment
transsphenoidal/hypophysectomy
what is a transsphenoidal/hypophysectomy
cut into the back of the nose, tool removes the growth
stereotactic is still ____
radiation; it is a high 1 time dose of radiation
acromegaly is caused by an overproduction of which hormone?
GH
too much GH in children is called ___
gigantism
excess GH beings before the end of puberty (when growth plates close)
too much GH before plates close cause children to grow tall
in which ages is acromegaly commonly seen
4th-5th decade
what changes occurs in acromegaly
skeletal thickening, enlargement, and decalcification
overgrowth of soft tissue and bones (hands, feet, nose, chin)
s/sx of acromegaly
muscle weakness
joint pain
deep voice
HA
visual disturbances
shortened life expectancy
change in menstrual cycle
galactorrhea (50% of women)
DM 2
HTN
acromegaly risk factor
genetics
appropriate nursing dx for acromegaly
risk for fractures r/t bone decalcification
acromegaly goals
meds to suppress or block GH
meds for joint pain
prepare for radiation or hypophysectomy
emotional support
how to Dx acromegaly
GH suppression test
IGF-1
OGTT (oral glucose tolerance test)
MRI, CT, XR
eye exam (eval optic nerve)
what is administered for a GH suppression test
glucose
glucose is supposed to suppress GH
how often are labs drawn for GH suppression test
10 minutes
1 hour
2 hour
what is needed prior to GH suppression test
baseline glucose level
can a pt eat before GH suppression test
No
hypophysectomy postop education
no straining
no heavy lifting
do not bend at the waist
do not blow nose, cough, or sneeze
do not brush teeth
x2 weeks
hypophysectomy postop nursing interventions
neuro checks
monitor packing (bleeding, CSF: glucose test, yellow ring)
no less than semi-fowlers
encourage deep breathing with mouth open (no coughing)
med education (will be on rest of their life)
monitor for meningitis (fever, photosensitivity, petechia, nuchal rigidity)
2 adrenal gland disorders
Addison
Cushing
3 adrenal cortex hormones
mineralocorticoid (aldosterone)
glucocorticoid (cortisol)
androgens (testosterone)
2 adrenal medulla hormones
epi
norepi
Addison vs. Cushing
A: deficient secretion
C: over secretion
ACTH regulates which 2 hormones
glucocorticoids (cortisol)
androgens (testosterone)
___ is regulated by the amount of K+ is in the body
mineralocorticoid (aldosterone)
glucocorticoids is a part of which feedback loop
Negative
Primary vs. secondary Addison
P: autoimmune; unknown cause
S: surgery removal, illness, meds
does Addison effect some or all 3 hormones
all 3 are affected
Addison s/sx
weakness, fatigue
liable mood
weight loss
anorexia
hyperpigmentation (d/t increase ACTH)
orthostatic hypotension (d/t low fluid volume)
hyponatremia
hyperkalemia
salt craving
dehydration
hypoglycemia
N/V/D
depression
decrease sex drive
decrease menses
hair loss
hair is fine, thin
life threatening emergency caused by insufficient ACTH hormones or sudden, sharp decrease in hormones
Addisonian crisis/Acute Adrenal Insufficiency
Addisonian crisis/Acute Adrenal Insufficient is triggered by
stress
sudden WD from corticosteroid therapy
—review meds on admission!
s/p adrenal surgery
sudden pituitary gland destruction
SALT LOSS re: addisonian crisis s/sx
S low Na
A anorexia
L lethargy
T decrease tendon reflex
L limp muscles
O orthostatic hypotension
S eventually seizures
S stomach cramps
Addisonian crisis replacement therapy
Bolus NS with Dextrose
hydrocortisone (glucocorticoid + mineralocorticoid properties)
salt
treat underlying cause
Florinef (mineralocorticoid)
Addisonian crisis nursing interventions
monitor VS
electrolyte imbalance
daily weight
corticosteroid administration
protection, monitor for infection
avoid extreme temps and stressors
how to Dx Addisons
assess s/sx
serum cortisol (low)
serum ACTH (high)
serum glucose
serum Na, K+
leukocytosis
CT, MRI
stimulation test
when should serum cortisol and ACTH lab be drawn for Addisons dx
early morning
stimulation test for Addisons
ACTH infused, glucocorticoid (cortisol) measured (should not go up)
when are labs drawn for stimulation test re: Addisons
q30 minutes x2
glucocorticoid (cortisol) measured, should not go up
Addison’s diet
low K+
high Na
Addison’s medications
Florinef (monitor for HTN; fluid volume excess)
Prednisone (monitor BGL)
Hydrocortisone (take with food to prevent GI distress)
Addison’s home care/education
lifelong treatment
med alert bracelet
emergency prefilled hydrocortisone or dexamethasone on hand
stress management
avoid infection
mineralocorticoids in AM
glucocorticoids: 2/3 in AM; 1/3 in PM
when to call HCP
–HTN, weight gain, fluid overload, low BGL, increased fatgiue
Cushing disease vs. Cushing syndrome
Disease: tumor
Syndrome: d/t long term corticosteroid use
s/sx of Cushings
weight gain (most common)
buffalo hump
central obesity
purple striae
moon faced
hyperglycemia
muscle wasting
osteoporosis
fragile skin
hirsutism
virilization
infections
ecchymosis
HTN
depression
acne
Cushing diagnostic labs
CBC
CMP
-BGL: elevated
-K+, Ca: low
Salivary free cortisol level for diagnosis of Cushing is drawn when
late evening
Dexamethasone suppression test for Cushing is administered in the ___ and labs are drawn in the ___
evening; morning
Cushings diet
high protein
high potassium
low calorie/carb
low Na
calcium + D
medications for Cushing suppression
ketoconazole (Nixoral)
aminogluethimide (Cytadren)
ketoconazole considerations
anti-fungal
large doses supress adrenal cortex activity
may cause liver failure
cytraden considerations
temporarily suppresses adrenal cortex activity
start in hospital
usually no more than 3 months
S/E: N/V
bisphosphonates are given to Cushing pts to prevent ___
osteoporosis
S/E: HA
Cushing pre op care
control BGL, HTN, K+
high protein diet
Cushing postop care
high dose Solu-Cortef (hydrocortisone)
monitor VS, wound, bleeding, infection
Cushing postop critical period
24-48 hours
must report changes in VS or UOP
Cushing daily weight changes to be reported
2# in 24 hours
3# in 1 week
postop cushing diet
high calorie
high salt
**opposite of preop
corticosteroid therapy effects on the body
anti-inflammatory
immunosuppression
maintain normal BP
carb + protein metabolism
