pituitary gland

master gland

anterior pituitary gland

• Prolactin
• adrenocorticotropic hormone (ACTH)
• growth hormone (GH)
• Thyroid stimulating hormone (TSH)
• follicle-stimulating hormone (FSH)
• luteinizing hormone (LH)

posterior pituitary gland

• anti-diuretic hormone (ADH)
• oxytocin

disorders of the pituitary gland can include what?

tumors

hypofunction

hyperfunction

damage to gland

trauma

what are pituitary tumors described as?

benign pituitary adenoma.

• slow growing
• unclear etiology

signs and symptoms can be local or systemic for pituitary glands

Local symptoms

• headache
• visual disturbances with possible blindness

signs and symptoms can be local or systemic for pituitary glands

systemic symptoms

• vague and slow to process
• personality changes
• weakness
• fatigue

pituitary gland :

diagnosis

• complete history and physical exam
• MRI
• CT with contrast dye
• labs
• Ophthamlmologic exam

treatment for pituitary glands

• hormone therapy
• radiation
• surgery-transsphenoidal hypophysectomy

Hypophysectomy

post op and nursing care

• semi-folwers
• monitor vital sings closely
• through and frequent neuro checks: LOC, strength, visual changes, and mental status
• monitor for bleeding
• nasal drip pad will be placed: monitor the drainage-should be bloody/mucus

hyper function of the anterior pituitary gland: Acromegaly

• over secretion of growth hormone (GH)
• increase in bone size
• enlargement of facial features, hands, and feet

hyper function of anterior pituitary gland: gigantism

over secretion of GH in children

hyperfunction of anterior pituitary gland: Prolactin and gonadotropin (FSH&LH) hyper function

fertility issues

S/S of acromegaly

• change in ring size
• change in shoe size
• enlargement of nose, jaw, brow, hands, feet
• muscle weakness and joint pain

diagnosis for acromegaly

lab tests-hormone levels

acromegaly treatment

• aimed at cause
• medications
• hypophysectomy
• radiation

Sheehan syndrome

rare but serious postpartum hemorrhage

what does a decrease in growth hormones cause?

• leads to short stature
• results in bone breakdown and increased risk of osteoporosis
• metabolic problems

decrease in gonadotropins (FSH,LH)

• sexual dysfunction
• fertility problems
• testicular failure in men
• ovarian failure, amenorrhea in women

dwarfism

hypo secretion of GH during fetal development or childhood

• results in limited growth- congenital or from damage to the pituitary gland

posterior pituitary gland

• diabetes indipidus (DI)- decreased antidiuretic hormone (ADH)
• syndrome of inappropriate antidiuretic hormone (SIADH)- increased ADH

diabetes insipidus

(DI)

ETIOLOGY AND PATH.

• decrease production of antidiuretic hormone (ADH)
• excretion of copious amounts of urine

diabetes insipidus (DI)

signs and symptoms

• diuresis
• polydipsia
• weakness/fatigue
• sings of deficient fluid volume
• hypotension
• weight loss
• constipation
• poor skin tugor
• can lead to shock if untreated

diagnosis for DI

• h&p
• lab testing (CBC, CMP)
• urine specific gravity- low urine osomality, low specific gravity--> urine diluted
• plasma osmolality
• hyperosmolitiy- decreased water volume in the blood
• CT/MRI- check for tumor
• water deprivation test

DI

water deprivation test

used to determine whether the patient has DI

-test measures changes in body weight, urine output, and urine composition when fluids are withheld

treatment for DI

replacement of fluid and electrolytes

hormone therapy

SIADH

etiology and path

• opposite of DI
• excessive amounts of ADH produced
• fluid retention
• can be caused by a tumor

SIADH

S/S

• weight gain from water retention
• edema
• hyponatremia- can be less than 120 mEq/L
• decreased urine output
• high BP
• confusion
• seizures
• LOS
• muscle cramps and weakness

SIADH

Diagnosis

• simultaneous urine and serum osmolality tests- urine high, blood low
• CMP
• hyponatermia
• BUN decreased
• creatine clearance decreased
• CBC
• hgb and hct decreased

SIADH

treatment

• correct underlying cause
• fluid restrictions (500-1000ml/day)
• sodium chloride po
• diuretics

the thyroid gland secretes what?

triiodothyronine (T3), thyroxine (T4), and calcitonin

goiter

• enlarged thyroid gland
• can be caused by iodine deficiency
• most common cause is an increase in TSH from lack of thyroid hormone production

S/S of goiter

• enlargement in front of neck.
• difficulty swallowing/breathing

hyperthyroidism

E&PATH

• overactive thyroid

graves disease

E&path

• autoimmune disorder affecting the thyroid gland
• causes hyperthyroidism
• immune system attacks the thyroid and causes it to make more

graves disease

S/S

• enlarged thyroid gland
• bulged eyes
• mood swings
• heat insensitivity
• anxiety
• temors

hyperthyroidism

S/S

• weight loss despite a good appetite
• nervousness/ anxiety/tremors/agitation
• tachycardia, palpations
• insomnia
• increased thirst and increased urination

hyperthyroidism-

radioactive iodine (ablation therapy)

• given orally
• destroys thyroid tissue
• collects in the thyroid and destroys the gland and cells with little effect on the rest of the body
• monitor for thyroid storm/ thyroid crisis

subtotal thyroidectomy

only a portion removed, so the remaining portion can still make hormones

total thryoidectomy

entire thyroid gland removed

thyroid malignancy

hyerpthyrpoidism

thyroidectomy pre-op care

• thorough assessment and baseline vital signs
• EKG, CXR, labs
• IV access

thyroidectomy post op care

• high fowlers portion for breathing and education of swelling
• keep head in neutral position to relieve tension
• do NOT hyperextend neck
• continuous vital sings - any increase in TPR/BP should be reported immediately

thyroid storm

AKA thyrotoxic crisis or thyrotoxicosis

SEVERE hyperthyroid state

• can result in death in as little as 2 hours
• can occur in patients with hyperthyroidism who are expecting another stressor/illness, or after thyroid surgery

thyroid storm

S/S

• hyperthyroid state symptoms
• apprehension, anxiety, restlessness
• Tachycardia
• tachypnea
• hypertension
• severly high temp- up to 106 degrees
• MONIOT VITAL SIGNS CONTINOUSLY AND CLOSELY

tREAMENT for thyroid storm

MUST BE IMMEDIATE

• reduced temp
• cooling blankets
• acetaminophen
• slow heart rate with cardiac medications
• administer sedatives to reduce anxiety, agitation, and restlessness

hypothyroidism

S/S

• weight gain
• joint pain
• slow HR
• fertility issues
• fatigue
• dry skin and brittle hair
• cold intolerance
• constipation
• non pitting edema

hypothyroidism treatment

replacement of thyroid hormone with levothyroxine (Synthroid)

life long therapy

myxedema coma

(hypothyroidism)

• life threatening medical emergency
• can occur due to abrupt withdrawal of hypothyroid treatment
• can occur due to increased stress/illness

myxedema coma

S/S

• bradycardia
• hypoventilation
• dizziness
• resp acidosis
• LOS
• hypotension

thyroiditis ACUTE

caused by an infection

treat with antibiotics

thryoiditis SUBACUTE

caused by a viral infection- respiratory

treat symptoms

thyroiditis CHRONIC

autoimmune- hashimotos thyroiditis

lifelong hormone replacement- levothyroxine

thyroiditis S/S

• enlargement of thyroid gland
• dysphagia

thyroiditis diagnosis

• lab testing (TSH, thyroid levels, radioactive iodine uptake testing)
• biopsy
• treatment goal___- reduce inflammation and prevent hypothyroidism

thyroid cancer

slow growing tumors

thyroid cancer S/S

• nodules noted on palpation
• fatigue
• weight changes
• difficulty swallowing or breathing
• voice changes
• fluctuating hormone levels

thyroid cancer diagnosis

• thyroid ultrasound
• iodine uptake studies
• fine-needles biopsies

thyroid cancer treatment

• thryoidectomy
• radioactive iodine ablation therapy