disorders of the pituitary gland

CHAPTER 56
ENDOCRINE SYSTEM
Disorders of the Pituitary Gland
PG. 947

Acromeg aly (Hype rpituitaris m):

A condition in which an over secretion of GH
(gro wth hormone ) occurs after the epiphyses
of the long bones have sealed

Results of hyperplasia (increase in the number
of cells) or a tumor of the anterior pituitary.
S/S of Acromegaly

S/S: coarse features, a huge lower jaw, thick
lips, a thickened tongue, a bulging forehead, a
bulbous nose, and feet (fig 56-1)

The heart, liver, and spleen may be enlarged.
Despite enlarged tissues, muscle weakness is
common, and hypertrophied joints may become
painful and stiff

Osteoporosis of the spine and joint pain
develop.
Acromegaly
Medical Management

Treated by surgical removal of the pituitary
gland or by radiation therapy with consequent

destruction of the pituitary.

Even if the disease is arrested successfully,
physical changes are irreversible.

If the tumor is removed or destroyed by
radiation therapy, replacement therapy with
thyroid hormone, corticosteroids, and sex
hormones is necessary
Simmond’s Disease
(Panhypopituitarism) PG. 949

Simmond’s dis e as e is a rare disorder caused
by destruction of the pituitary gland followed
by an absence of pituitary hormonal activity.

Events such as postpartum emboli, surgery,
tumor, and TB can destroy pituitary function.
S/S Simmond’s Disease

The gonads and genitalia atrophy.

S/s of hypothyroidism, hypoglycemia, and
adrenal insufficiency are apparent.

The client ages prematurely and becomes
extremely cachectic.
Medical Management

Administration of substitute hormones for the

glands that depend on the pituitary for
stimulation.

If untreated, the disease is fatal.

Assess the client’s mental status, emotional
state, energy level, and appetite.
Diabetes Insipidus pg 950

An endocrine disorder that develops when there
is insufficient antidiuretic hormone (ADH) from
the posterior pituitary gland.

Can be caused by head trauma that damages
the pituitary and by primary or metastatic brain
tumors.
S/S

Urine output for a 24 – hour period may be as high as 20
liters (20,000 mL)

The urine is dilute, with a specific gravity of 1.002 or
less.

The excretion of urine cannot be controlled by limiting
the intake of fluids

The need for drinking and voiding frequently limits
activities


Weakness, dehydration, and weight loss develop.
Medical Management

Desmopressin (DDAVP) nasal solution and
lypressin (Diapid) nasal spray are synthetic
drugs with ADH activity that reduce the urine
output to 2 to 3 L/24 hours.

IV fluids if unable to take po.
Syndrome of Inappropriate
Antidiuretic Hormone Secretion

SIADH—characterized by renal reabsorption of
water rather than its normal excretion.

Causes include lung tumors, central nervous
system disorders, brain tumors, CVA, head
trauma, and drugs such as vasopressin, general
anesthetic agents,m oral hypoglycemics, and
tricyclic antidepressants.

Continued release of ADH results in ↑ fluid
volume and hyponatremia.
S/S

Water retention, HA, muscle cramps, and
anorexia develop.

As the condition becomes more severe,
nausea, vomiting, muscle twitching and

changes in the LOC occur.
Medical Management

Treatment is aimed at eliminating the
underlying cause

Osmotic diuretics, such as mannitol and loop
diuretics, including lasix, help to correct water
retention. Severe hyponatremia is treated
with IV administration of a 3% hypertonic
sodium chloride solution.
Nursing Management

S/s of fluid overload: confusion, dyspnea,
pulmonary congestion, hypertension

S/s of hyponatremia: weakness, muscle
cramps, anorexia, nausea, diarrhea, irritability,
HA, and weight gain without edema.
Disorders of the Thyroid Gland
PG. 951

Thyroid disorders include hyperthyroidism,
thyrotoxic crisis, hypothyroidism, thyroid
tumors, and endemic and multinodulal goiters.
Hyperthyroidism

Also called Graves disease, Basedow’s
disease, thyrotoxicosis, or exophthalmic goiter.


May be autoimmune or inherited disease.

Symptoms are from mild to severe

Restless despite feeling fatigued and weak,
highly excitable, and constantly agitated

Fine tremors of the hands occur, resulting in
unusual clumsiness ( 56-4)
Graves Disease
Hyperthyroidism

Cannot tolerate heat, and experience an
increased appetite with weight loss.

Diarrhea also occurs.

Visual changes, such as blurred or double
vision, can develop.

Exophthalmos, seen in client with sever
hyperthyroidism, is due to enlargement of
muscle and fatty tissue that surrounds the rear &
sides of the eyeball

S/s in Table 56-1 PG 952
Hyperthyroidism
Medical Management

Antithyroid drugs are given to block the

production of thyroid hormone.

Potassium iodide (Lugol’s solution) is prescribed
in combination with an antithyroid drug.

Antithyroid medications should be avoided
during pregnancy because they can induce
hypothyroidism, or cretinism, in the fetus.
Nursing Management

Monitor heart rate and BP

Record sleep pattern and daily weight

May take several weeks before thyroid
medication effective.

If radioactive iodine is used to destroy thyroid
tissue, tell the client that it does not seriously
affect other tissues.
Radioactive Iodine
Thyrotoxic Crisis

An abrupt form of hyperthyroidism that is a life-
threatening event.

Thought to be triggered by extreme stress,
infection, diabetic ketoacidosis, trauma,
toxemia of pregnancy, or manipulation of a
hyperactive thyroid gland during surgery or

physical examination.
Thyrotoxic Crisis

S/S: Temperature may be as high as 106 F

Pulse rate is rapid, and cardiac arrhythmias
are common

Persistent vomiting

Extreme restlessness with delirium

Chest pain

dyspnea