Anterior pituitary disorders include hyperpituitarism and hypopituitarism. Hyperpituitarism is characterized by excessive secretion of pituitary hormones which can cause gigantism or acromegaly. Hypopituitarism is a deficiency of one or more anterior pituitary hormones and causes include infections, tumors, or surgery. Posterior pituitary disorders include diabetes insipidus, which is characterized by massive polyuria due to a lack of antidiuretic hormone or kidney insensitivity. Syndromes of inappropriate antidiuretic hormone cause persistent excretion of concentrated urine due to excessive antidiuretic hormone release.
Anterior pituitary disorders include hyperpituitarism and hypopituitarism. Hyperpituitarism is characterized by excessive secretion of pituitary hormones which can cause gigantism or acromegaly. Hypopituitarism is a deficiency of one or more anterior pituitary hormones and causes include infections, tumors, or surgery. Posterior pituitary disorders include diabetes insipidus, which is characterized by massive polyuria due to a lack of antidiuretic hormone or kidney insensitivity. Syndromes of inappropriate antidiuretic hormone cause persistent excretion of concentrated urine due to excessive antidiuretic hormone release.
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Anterior pituitary disorders include hyperpituitarism and hypopituitarism. Hyperpituitarism is characterized by excessive secretion of pituitary hormones which can cause gigantism or acromegaly. Hypopituitarism is a deficiency of one or more anterior pituitary hormones and causes include infections, tumors, or surgery. Posterior pituitary disorders include diabetes insipidus, which is characterized by massive polyuria due to a lack of antidiuretic hormone or kidney insensitivity. Syndromes of inappropriate antidiuretic hormone cause persistent excretion of concentrated urine due to excessive antidiuretic hormone release.
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HYPERPITUITARISM post-surgery nursing care ( maybe for life)
• May be due to over activity of the gland semi to high fowler’s Corticosteroids or the result of an adenoma position Levothyroxine • Characterized by: protect from infection Androgen/estrogen excessive serum concentration of and stressful situation Growth hormone pituitary hormone ( GH, AGH, PRL) Hormone morphologic and functional changes in replacement o Radiation: Indicated for larger the anterior pituitary Constant neurologic tumors checks o Surgery: • GROWTH HORMONE Monitor I&O to check trans-sphenoidal hypophysectomy HYPERSECRETION for diabetes Incipidus POSTERIOR PITUITARY DISORDERS • Gigantism – prior to closure of Encourage deep DIABETES INCIPIDUS epiphyses; proportional growth breathing but not coughing • Acromegaly – after closure of the • Characterized by massive polyuria due to Institute measures to epiphyses; disproportional growth either lack of ADH or rnal insensitivity prevent constipation • CLINICAL MANIFESTATIONS: • CENTRAL DI Watch out for CSF Arthritis - due to deficiency in ADH production leak Chest barreled shape • NEPHROGENIC DI Rough facial features HYPOPITUITARISM - due to defect in the kidney Odd sensations: hands and feet tubules that interferes with H2O Muscle weakness & fatigue • Deficiency of one or more anterior pituitary hormones absorption Enlargement of organs - polyuria is unresponsive to Growth of course hair • Causes: Infections/inflammatory disorsers ADH, which is secreted normally Amenorrhea; breast milk production Autoimmune diseases • DIAGNOSTIC Loss of vision; headaches Tumors Fluid deprivation test Impotence; increased Surgery/radiation theraphy Administration of desmopressin perspiration SIMMOND’S DISEASE 24-h urine collection for volume, glucose Snoring - Panhypopituitarism and creatinine - Complete absence of Serum for glucose, urea, nitrogen, calcium, • Management: pituitary hormones uric acid, potassium and sodium. o Medication: Bromocriptine CACHEXIA • MANAGEMENT: cabergoline - most prominent feature CENTRAL DI -dopamine agonist follows destruction of the Desmopressin, lypressin GH pituitary by surgery, infection, (intranasal) hypersecretion and injury or tumor Vassopresine tannate in oil (IM) prolactinoma SHEEHAN’S SYNDROME NEPHROGENIC DI Ocreotide -post partum pituitary necrosis Indomethacin sematostatin - a complication of delivery -hydrochlorothiazide -GH results from severe blood loss and -desmopressin hypersecretion hypovolemia -amiloride • CLINICAL MANIFESTATIONS: Clofibrate chlorpropamide o Radiation: Indicated for larger tumors HYPO-thermia, glycemia, tension o Surgery: Loss of vision, strength, libido & secondary sexual characteristics trans-sphenoidal hypophysectomy • MANAGEMENT • Increased basal metabolic rate o Use for pregnant women and patients who have refused surgery or RA1 SYNDROME OF INNAPROPRIATE ADH • CAUSES: treatment • Disorder due to excessive ADH o Grave’s disease o During pregnancy, PTU is DOC. release o Initial manifestation of o 1% of infants born to mothers on • CLINICAL MANIFESTATION thyroiditis antithyroid theraphy will be hypothyroid Persistent excretion of concentrated o TSH-screening pituitary o WOF agranulocytosis urine tumor RAI (131I), K or Na iodide, SSKl (Lugol’s) Signs of fluid overload o Toxic adenoma Adjuct to other anti-thyroid drugs in preparation Hyponatremia for thyroidectomy o Factitious thyrotoxicosis LOC changes- increased ICP Treatment for thyroroxic crisis o Amiodarone theraphy • DIAGNOSTIC Inhibits release and synthesis of TH Low serum sodium CLINICAL MSNIFESTATION o GI Hypermotility MEDICATIONS: Low serum osmolality o Rapid weight loss Digitalis,proprandol (inderal)Phenobarbital High urine osmolality Well balance, high calorie diet with vitamin and High urine sodium excretion o Apphrehension Normal renal function mineral supplement o Volume deficit;voracious appetite • MANAGEMENT Subtotal or total thyroidectomy o Exopthalmos; erratic menses NURSING IMPLICATION Maintain fluid balance o Systolic BP elevated;sweating o NPO post midnight MIOW Fluid restriction o TSH decreased in primary o Initial dose: Loop diuretic disease o Urine and saliva slightly radioactive Lithium or democlocycline o Increased in secondary disease o 24h vomitus highly radioactive x 6-8h Maintain Na balance TYROID STORM/ THYROTOXIC CRISIS Increased Na intake o Institute full radiation precations o Marked delirium Emergency treatment of 3% NaCl o Instruct the patient to use appropriate o Severe tachycardia followed by furosimide disposal methods when coughing and Excessive rapid correction of o Vomiting expectorating hyponatremia: central pontine myelinolysis o Diarrhea o Dilute oral doses in water or fruit juices THROID DISORDERS o Dehydration and give witm meals to prevent gastric • Function test o High fever irritation Fine needle aspiration biopsy -occurs in patient with exsisting but o LUGOL’s Solution -Sampling of thyroid tissue to detect unrecognized thyrotoxicosis, stressful o Decreased vascularity of thyroid malignancy. Initial test for evaluation of illness, thyroid surgery,RAI gland thyroid masses o Discoloration of the teeth provide NURSING INTERVENTION Increased systemic adrenergic activity straw for the patient when drinking o Determine whether the patient has severe hypermetabolism o Encourage for increased H2O taken medications or argents that MANAGEMENT intake contains iodine because they may o Anti-thyroid drugs o May caused tyrotoxic crisis alter the test results o Prophylthiouracil (PTU); HYPOTHYROIDISM o Assess allergy to iodine or shellfish methimazole o State of low serum thyroid hormone in the o For scans, tell patient that radiation o Blocks thyroid hormones blood resistance to TH is only minimal synthesis Autoimmune HYPERTHYROIDISM Developmental Dietary o Decreased all body function o Phenitoin or laxative abuse Iodine o Decreased v/s CLINICAL MANIFESTATION Oncologic o Precipitating Factors: o Constipation Drugs induce Acute illness o Apathy Iatrogenic Rapid withdrawal to medication o Lordosis Nonthyroidal anesthesia o Cardiac dysthemia Endocrine Thyroidectomy o Upset GI tract o COMMON CAUSES: Opiod use o Low energy level Increased BP o Autoimmune hypothyroiditis aka MANAGEMENT SYMPTOMS hashimoto disease Prevention o Increased calcium o Failure of the hypothalamus Prophylaxis o Increased parathyroid hormone o Failure of the pituitary gland Hormonal replacement MANAGEMENT o Inborn errors of EH synthesis Levothyroxine (syncroid) o Decreased calcium intake o History of thyroidectomy Liothyronine (cytomel) o Increased phosphorus intake o Expose to radiation Liothrix (thyrolar) Doses increased every 2-3 weeks o Calcitonin o Antithyroid theraphy o Surgery to remove adenoma o COMMON CAUSE: iron Watch out for: o Chest pain o Furosemides Deficiency o Biphosponates CLASSIFICATIONS o Palpitation o Profuse sweating HYPOPARATHYROIDISM o CRETINISM – in infants and Auto immune young children o Nervousness o Drink meds at exact time each Injury to the parathyroid theraphy o LYMPHOCYTIC Ischemic thyroid surgery THYROIDITIS – self limiting day CLINICAL MANIFESTATION and appears after 6 yrs of o May develop insomia if taken at Dypsnea, dysrrhytmia age and peak during night Extremities tingling adolescent o Monitor bp and apical pulse Fhotophobia o HYPOTHYROIDISM W/O o If pulse morethan 100 bpm-stop Increased bone density MYXEDEMA- mild thyroid NURSING IMPLICATION Cramps; chvostek sign failure common in older o Low calorie Trousseau sign; tetany children and adult o Warm environment MANAGEMENT CLINICAL MANIFESTATION o Stool softener o IV calcium gluconate-drug of choice Dry brittle hair, dry course skin o Maintain patent airway o Oral calcium salts Edema in periorbital HYPERPARATHYROIDISM o Vit d supplementation Reduce BMR Primary o Elevated serum phosphate Apathy, anorexia, anemia o Single adenoma o Low calcium Increased weight, intolerance to food o Genetic disorders Lethargy, loss of libido o Trousseau & chvostek sign o Multiple endocrine neoplasias o Elevated serum phosphate Enlarged tongue Secondary Drooling saliva o Low calcium o Rickets TSH increased in primary o Akalosis/arrhythmias o Vit. D deficiency Decreased in secondary o Narrowing of airways o Chronic renal failure MYXEDEMA COMA o Irritability o Cramps o Monitor Weight and glucose o Parathormone injection o 24h urine specimen collection o High calcium diet-spinach o Bronze skin discoloration o Low phosphate o Avoid stress PHEOCHROMOCYTOMA o Avoid contacts Adrenal tumor CUSHING SYNDROME Increased epinephrine and norepinephrine Enlargement of adrenal gland Tumor in the adrenal corex which is Increased stimulation responsible for the regulation of BP CLINICAL MANIFESTATION Buffalo hump CLINICAL MANIFESTATION Unusual behavior Headache Facial features; moon facesfat; trunkal Anxiety obesity Nausea ACTH is elevated Eye disturbances Loss of muscle mass Sever hypertension Over extended skin Dilate blood vessels by nitroprussside Hypertension, hypernatrimia Monitor bp Urinary cortisol elevated Monitor I & o Menstrual irregularity Fluid replacement Pourosity of the bone Decreased environment stimulation MANAGEMENT Stress o Remove steroids Maintain dosage of steroids o Irradiation Follow up check up o Hypophesectomy ADDISON’S DISEASE o Adrenalectomy Hyposecretion of adenocortical hormones o DRUGS Idiophatic atrophy o Cyproheptadine SIGNS AND SYMPTOMS (perjactine) o Weakness o Nysodrine o Excess stress o Aminoglutethamine o Anorexia, vomiting, nausea ( cytadrin) o Low sodium o Monitor V/S o Decreased potassium o Monitor I & O o Decreased bp o Stress reduction MANAGEMENT o Replacement of hormones:hydrocortisone o Increased carbohydrate and protein o Potassium o Sodium o Monitor v/s 4x a day o Monitor I & O