Pituitary Gland Disorders

1. Description: Hyposecretion of one or more of the pituitary hormones caused by tumors,trauma, encephalitis, autoimmunity, or stroke

2. Hormones most often affected are growth hormone (GH) and gonadotropic hormones (luteinizing hormone, follicle-stimulating hormone), but thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), or
antidiuretic hormone (ADH) may be involved.

a. Mild to moderate obesity (GH, TSH)

b. Reduced cardiac output (GH, ADH)

c. Infertility, sexual dysfunction (gonadotropins, ACTH)

d. Fatigue, low blood pressure (TSH, ADH, ACTH, GH)

e. Tumors of the pituitary also may cause headaches and visual defects (pituitary is located near the optic nerve).

a. Provide emotional support to the client and family.

b. Encourage the client and family to express feelings related to disturbed body image or sexual dysfunction.

c. Client may need hormone replacement for the specific deficient hormones.

d. Client education is needed regarding the signs and
symptoms of hypofunction and hyperfunction related to insufficient or excess hormone replacement

1. Description

a. Hypersecretion of growth hormone by the anterior pituitary gland in an adult; caused primarily by pituitary tumors

b. Leads to conditions such as acromegaly and Cushing’s disease

2. Assessment

a. Large hands and feet

b. Thickening and protrusion of the jaw

c. Arthritic changes and joint pain

d. Visual disturbances

e. Diaphoresis

f. Oily, rough skin

g. Organomegaly

h. Hypertension

i. Dysphagia

j. Deepening of the voice

a. Provide emotional support to the client and family, and encourage the client and family to express feelings related to disturbed body image.

b. Provide frequent skin care.

c. Provide pharmacological and nonpharmacological interventions for joint pain.

d. Prepare the client for radiation of the pituitary gland if prescribed.

e. Prepare the client for hypophysectomy if planned.

C. Hypophysectomy (pituitary adenectomy, transsphenoidal pituitary surgery)

a. Removal of the pituitary tumor via craniotomy or transsphenoidal (endoscopic transnasal) approach (latter approach is preferred because it is associated with fewer complications)

b. Complications for craniotomy include increased intracranial pressure, bleeding, meningitis, and hypopituitarism.

c. Complications for the transsphenoidal surgery include cerebrospinal fluid leak, infection, and hypopituitarism.

a. Initiate postoperative care similar to craniotomy care.

b. Monitor vital signs, neurological status, and level of consciousness.

c. Elevate the head of the bed.

d. Monitor for increased intracranial pressure.

e. Monitor for bleeding.

f. Instruct the client to avoid sneezing, coughing, and blowing the nose.

g. Monitor for signs of temporary diabetes insipidus or syndrome of inappropriate antidiuretic hormone resulting from ADH disturbances.

h. Monitor intake and output, and avoid water intoxication.

i. Administer glucocorticoids and other hormone replacements as prescribed.

j. Administer antibiotics, analgesics, and antipyretics as prescribed.

k. Instruct the client in the administration of prescribed medications.

1. Description

a. Hyposecretion of ADH caused by stroke or trauma, or may be idiopathic

b. Kidney tubules fail to reabsorb water.

a. Polyuria of 4 to 24 L/day

b. Polydipsia

c. Dehydration (decreased skin turgor and dry mucous membranes)

d. Inability to concentrate urine

e. Low urinary specific gravity, 1.006 or lower

f. Fatigue

g. Muscle pain and weakness

h. Headache

i. Postural hypotension that may progress to vascular collapse without rehydration

j. Tachycardia

a. Monitor vital signs and neurological and cardiovascular status.

b. Provide a safe environment, particularly for the client with postural hypotension.

c. Monitor electrolyte values and for signs of dehydration.

d. Maintain client intake of adequate fluids.

e. Monitor intake and output, weight, serum osmolality, and specific gravity of urine.

f. Instruct the client to avoid foods or liquids that produce diuresis.

g. Vasopressin tannate (Pitressin) or desmopressin acetate
(DDAVP, Stimate) may be prescribed; these are used when the ADH deficiency is severe or chronic.

h. Instruct the client in the administration ofmedications as prescribed; DDAVP may be administered by injection, intranasally, or orally.

i. Instruct the client to wear a Medic-Alert bracelet.

E. Syndrome of inappropriate antidiuretic hormone (SIADH)

a. Excess ADH is released, but not in response to the body’s need for it.

b. Causes include trauma, stroke, malignancies (often in the lungs or pancreas), medications, and stress.

c. The syndrome results in water intoxication and hyponatremia.

a. Signs of fluid volume overload

b. Changes in level of consciousness and mental status changes

c. Weight gain

d. Hypertension

e. Tachycardia

f. Anorexia, nausea, and vomiting

g. Hyponatremia

a. Monitor vital signs and cardiac and neurological status.

b. Provide a safe environment, particularly for the client with changes in level of consciousness or mental status.

c. Monitor intake and output and obtain weight daily.

d. Monitor fluid and electrolyte balance.

e. Monitor serum and urine osmolality.

f. Restrict fluid intake as prescribed.

g. Administer diuretics and IV fluids (usually normal saline or hypertonic saline) as prescribed; monitor IV fluids carefully because of the risk for fluid volume overload (IV solutions containing water are contraindicated because of the risk of water intoxication).

h. Medications that inhibit ADH-induced water reabsorption and produce water diuresis may be prescribed.

UNIT X The Adult Client With an Endocrine Disorder