Endocrine-disorders1.pdf

Care of the client with endocrine disorders Disorders of the pituitary gland Two main reasons for pituitary gland disorders ⩥ Hyperactivity ⩥ Hypoactivity 5 Parts involved Hyperactivity Hypoactivity Gigantism Acromegaly Anterior Pituitary Cushing’s disease Dwarfism Acromicria Simmond’s disease Poste...

Care of the client with endocrine disorders Disorders of the pituitary gland Two main reasons for pituitary gland disorders ⩥ Hyperactivity ⩥ Hypoactivity 5 Parts involved Hyperactivity Hypoactivity Gigantism Acromegaly Anterior Pituitary Cushing’s disease Dwarfism Acromicria Simmond’s disease Posterior Pituitary Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Diabetes insipidus 6 Gigantism ⩥ A pituitary disorder due to hyperactivity/ excessive secretion of growth hormone, which is also known as somatotropin characterized by: ⊳ Excess growth of the body ⊳ Average height is approximately 7-8 feet 7 Causes ⩥ Hypersecretion of GH in childhood or in preadult ⩥ Tumor of acidophilic cells of the anterior pituitary ( the gland makes more growth hormones than the body needs) 8 Signs and symptoms ⩥ Huge stature: 7 or 8 feet height ⩥ Headache due to the tumor of the pituitary ⩥ Very large hands and feet ⩥ Thick toes and fingers ⩥ A prominent jaw and forehead ⩥ Coarse facial features ⩥ Weakness ⩥ Insomnia and other sleep disorders 9 Signs and symptoms ⩥ Visual disturbances ⩥ Diabetes and hyperthyroidism ⩥ Delayed puberty in both boys and girls ⩥ Irregular menstrual periods in girls 10 Diagnostic tests ⩥ Blood test to measure levels of growth hormones ⩥ MRI scan of the gland ⩥ Insulin-like growth factor 1 (IGF-1), which is produced by the liver ⩥ OGTT: Normally, growth hormone levels will drop after eating or drinking glucose. If patient’s levels remain the same, it means his body is producing too much GH. ⊳ Normal: GH level of less than 1 ng/mL 11 Treatment ⩥ Goal: to stop or slow the production of GH ⩥ Somatostatin analogs such as octreotide (Sandostatin) or long-acting lanreotide ⩥ Surgery: ⊳ Hypophysectomy –removing the tumor is the preferred treatment for gigantism ⊳ Radiation therapy Used when surgery and medication fail 12 Hypophysectomy ⩥ Removal of the pituitary tumor through transsphenoidal surgery 13 Care for the client undergoing intracranial surgery ⩥ Neurologic assessment ⩥ Monitor intake and output, and check daily weight ⩥ Check clear nasal drainage for glucose ⩥ Encourage deep breathing, but not coughing ⩥ Measures to prevent constipation ⩥ Maintain client in a position no lower than semiFowler’s position 14 Acromegaly ⩥ Anterior pituitary disorder characterized by: ⊳ Abnormal growth of the hands, feet and face caused by overproduction of growth hormone by the pituitary gland ▪ Enlargement, thickening and broadening of bones particularly the extremities of the body 15 Signs and symptoms ⩥ Striking features are protrusion of: Supraorbital ridges Broadening of nose Thickening of lips Thickening and wrinkles formation on forehead ⊳ Prognathism (lower jaw) ⊳ ⊳ ⊳ ⊳ 16 Signs and symptoms ⩥ Kyphosis ⩥ Scalp is thickened and thrown into folds ⩥ Overgrowth of body hair ⩥ Visceral organs are enlarged 17 Signs and symptoms ⩥ Thyroid, parathyroid and adrenal glands show hyperactivity ⩥ Hyperglycemia and glucosuria ⩥ Hypertension ⩥ Headache ⩥ Visual disturbance –bitemporal hemianopia (vision is missing in the outer half of both the right and left visual field) 18 Treatment ⩥ The same as gigantism 19 dwarfism ⩥ Pituitary disorder in children characterized by stunted growth. 20 Causes of dwarfism ⩥ Reduction in the GH in infancy or early childhood ⩥ Deficiency of GH releasing hormone from the hypothalamus ⩥ Atrophy of acidophilic cells in the adenohypophysis ⩥ Tumor of chromophobes: nonfunctioning tumor, compresses and destroys the normal cells ⩥ Panhypopituitarism 21 ⩥ ⩥ ⩥ ⩥ ⩥ Signs and symptoms Stunted skeletal growth Maximum height approximately 3 feet Head becomes slightly larger in relation to the body Mental activity is normal without any deformity Reproductive system is not affected due to lack of GH but in Panhypopituitarism, puberty is not obtained due to the lack of gonadotropin hormone. 22 Types of Dwarfism ⩥ Laron dwarfism (abnormal GH secretagogue receptors in liver) ⩥ Psychogenic dwarfism (stress dwarfism) ⩥ Dwarfism in dystrophia adiposogenitals (Frohlich syndrome) 23 Acromicria ⩥ Rare disease in adults characterized by the atrophy of the extremities of the body 24 25 causes ⩥ Deficiency of GH in adults ⩥ Secretion of GH decreases in the following conditions: ⊳ Deficiency of GH releasing hormone ⊳ Atrophy of acidophilic cells in the anterior pituitary ⊳ Tumor of chromophobes ⊳ Panhypopituitarism 26 Signs and symptoms ⩥ Atrophy and thinning of extremities (major symptoms) ⩥ Associated with hypothyroidism ⩥ Hyposecretion of adrenocortical hormone ⩥ Person becomes lethargic and obese ⩥ Loss of sexual function 27 Simmonds disease ⩥ Rare pituitary disease: weakness and wasting of the body due to severe chronic illness. ⩥ Also called as cachexia ⩥ Occurs mostly in Panhypopituitarism ⩥ Atrophy of the cells and organs that are normally stimulated by pituitary hormones 28 causes ⩥ Tumor ⩥ Presses on the optic nerve and surrounding brain structures ⩥ Complication of pregnancy Postpartum hypopituitarism or postpartum gland necrosis 29 Signs and symptoms emaciation Developing a senile decay Loss of hair The skin on face becomes dry and wrinkled ⩥ Asthenia (muscular weakness) ⩥ Low BMR ⩥ hypoglycemia ⩥ ⩥ ⩥ ⩥ 30 Treatment ⩥ Lifetime hormonal therapy ⊳ ACTH, TSH, thyroid hormones, adrenal hormones or sex hormones 31 Nursing care of clients with hypopituitarism ⩥ Importance of adhering to medical regimen on a long term basis ⩥ Allow ample time to verbalize feelings ⩥ Provide adequate rest periods 32