Final Exam - Endocrine Problems part 2 (Unit 12): Disorders of the Anterior Pituitary Gland Flashcards
What is Acromegaly ?
Excess secretion of Growth hormone (GH)
What is Acromegaly usually caused by ?
benign pituitary tumor (adenoma)
What does Acromegaly cause in adults ?
thickening of bones and soft tissues
What does Acromegaly cause in children ?
gigantism
What are Clinical Manifestations of Acromegaly ?
- Slow onset
- Enlargement of the hands/feet (hands and feet continue to grow into adulthood)
- Facial changes
- Tongue enlargement
- Sleep apnea
- Hypertrophy of the vocal cords (causes deeper voice)
- Skin leathery
- Proximal muscle weakness
Pt’s with Acromegaly have an increased risk for what ?
- Diabetes
- Cardiovascular disease
Why does having Acromegaly increase the risk for Diabetes ?
GH antagonizes the action of insulin, leading to hyperglycemia and possible DM
Why does having Acromegaly increase the risk for cardiovascular disease ?
GH mobilizes fats, leading to atherosclerosis
If GH levels do not fall, there is a diagnosis of what ?
Acromegaly
What is the Tx of choice for Acromegaly ?
Surgery
What is the medical term for the type of surgery used to Tx Acromegaly ?
Hypophysectomy
What is a Hypophysectomy ?
Removal of the entire pituitary gland
Hypophysectomy surgery leads to permanent loss of what ?
ALL pituitary hormones
Because of Hypophysectomy leads to permanent loss of all pituitary hormones, the pt. will need what ?
Hormone replacement throughout life
When performing surgery (Hypophysectomy) for Acromegaly, what approach do they use to access the anterior pituitary ?
Transsphenoidal Approach
Where is the incision made when using a Transsphenoidal approach for a Hypophysectomy surgery ?
Incision is made in the upper inner aspect of the lip, through the gums
Where should the HOB be placed for a post-op Hypophysectomy pt ?
Elevate HOB at 30 degrees AT ALL TIMES
Why do we want the HOB elevated to 30 degrees at all times for post-op Hypophysectomy pt’s?
- To avoid pressure on the area
- Decrease headache, a frequent post-op complication
What should we monitor in pt’s who are post-op from a Hypophysectomy ?
Neuro status (LOC, vision, etc)
What do we want pt’s to avoid post-op from a Hypophysectomy ?
Avoid vigorous coughing or straining to prevent CSF leak
To avoid straining in post-op Hypophysectomy pt’s, what might we put them on ?
Stool softners
What should you do with any clear nasal drainage from your pt who is post-op from a Hypophysectomy ?
Send to the lab to be tested for glucose
>30 mg/dL indicates CSF leak
What happens if a post-op Hypophysectomy pt has a CSF leak ?
It will usually resolve in 72hrs on its own. If not, need antibiotics
What should you avoid Post-op Hypophysectomy pt’s from doing ?
AVOID brushing teeth for 10 days
due to surgical incision of lip/gum
Post-op Hypophysectomy pt’s can develop what ? due to surgery ?
Diabetes Insipidious (DI)
- GET HOURLY URINE OUTPUT (to rule out DI)
What is Hypopituitarism ?
A rare disorder that involves a decrease in one or more pituitary hormones
(EX: ACTH (adrenocorticotropic hormone), TSH, FSH, LH, ADH)
What is the most common cause of Hypopituitarism ?
Pituitary tumor
But can also be from: infection, destruction of pituitary gland from trauma, radiation, or surgery
What is the Tx for Hypopituitarism ?
Surgical removal of the tumor or radiation
- Lifelong hormone replacement
