Disorders of anterior pituitary gland

Patho:

Symptoms

Diagnosis

Collaborative
care

Acromegaly (hyperpituitarism)
Overproduction of GH= overgrowth of
soft tissues, bones in hands, feet and
face
result of benign pituitary adenoma
joint pain
speech difficulties
apnea- tongue too big
visual disturbance
slanted forehead
protruding jaw
increase BP, HF- growing heart, not
enough CO
hypertrophy of soft tissues
enlargement of small bones
skin thick, leathery, oily
hyperglycemia

-increase serum somatotropin (GH)

- X-rays and MRI
-physical exam
-oral glucose challenge test, level does not
decrease
1. Surgery
-hypophysectomy
-edoscopic transsphenoid resection
Risks
-hemorrhage, CSF leak, infection, visual
changes, SIADH
Lifetime hormone replacement
-glucocorticoids
-thyroid hormones
-sex hormones
2. Radiation
-when surgery fails
-gamma knife
-lifetime of essential hormone replacement
necessary
3. Medication
-octreotide (sandostatin), decreases GH

Hypopituitarism
underproduction of one or more
pituitary hormones
usually GH and gonadotropins
pituitary tumor or destruction of
pituitary gland

GH:
- trunk obesity
- weakness/fatigue
- depression
Gonadotropins (FSH and LH)
- female: menstrual irregularity,
decrease breast size
- male: testicular atrophy, low
sperm count, impotence
Thyroid stimulating hormone
- hypothyroidism
- cold intolerance
- fatigue/depression
- weight gain
ACTH
- weakness/fatigue
- headache
- dry, pale skin
- delicate features
- hypoglycemia
- low infection resistance
Tumor and Increase intracranial pressure
- headache
- visual changes
- N/V
- seizures
Radiology:
- MRI, CT head (identify and rate
tumor
Labs
- hormone levels
Surgery or radiation therapy
Hormone therapy
- somatropin (omnitrope,
genotropin, humatrope) for GH
deficiency and long-term use.

Nurse
Management

Facts:

-SC injection 3X week

-frequent labs for dosing
Post Op
-HOB >30 degrees
-neuro assessment
-watch CSF drainage
-avoid increase intracranial pressure
(coughing, sneezing, straining)
-oral care- no tooth brushing for 10 days
- I&O- watch for large urine output (watching
for DI)
-medication for pain- mild analgesics
Radiation
-monitor for seizures, headaches, N/V
-pt will have head frame, pin site carefully
-I&O- watch for large urine output
rare

Same as hyper

Rare
Autoimmune
Infection
Trauma
Commonly:
-GH and Gonadotropins
- more common in African americans
-Lead to end-organ failure

Parathyroid problems
PTH:

-Regulates calcium/ phosphorus balance

-Stimulates calcium bone reabsorption & calcium reabsorption of the kidneys
-Activates vitamin D

Patho:

Hyperparathyroidism
-too much PTH
Primary:
- PTH r/t tumor

hypoparathyroidism
-too little PTH
-Rare
-genetic defects
-surgical damage/ removal

Secondary:
-reaction to prolonged hypocalcemia &
vitamin D deficiency
-chronic kidney disease

Manifestations

Diagnosis

Collaborative care

Nursing
Management

Tertiary
-hyperplasia of gland
-r/t kidney transplant & long term dialysis
-fatigue
-memory and concentration prob.
-insomia
-headache
-depression
-dysrhytmias, HTN
-kidney stones
-N/V/D
serum Calcium
> 10.2 mg/dL
Testing for both:
-pth levels
-serum Ca & phosphorus
-24 hr urine for calcium
-XRay (renal calculi)
Bone density test
Ct/MRI
Surgical
-complete removal
-indicated for calcium > 11mg/dL and
symptomatic
Nonsurgical:
-asymptomatic
-annual evaluation
-exercise program
-dietary management
Pharmacological- doesnt fix underlying
problem
-Biphosphonates (alendronate/Fosamax)
-phosphorus supplements
Monitor for tetany
-c/ o tingling in hands and mouth(early)
-spasms (late)
-IV calcium gluconate
Monitor I&O

-tetany
-Respiratory: stridor, bronchospasm
-dysrhythmias, hypotension
-seizures
-anxiety, irritability

serum Calcium
< 9.0 mg/dL

- treat acute complications

Iv calcium
-check IV first
-monitor EKG
-monitor for tetany

-encourage mobility
Nonsurgical care
-diet/exercise education

Education:
-long term drug therapy
-dietary/exercise
-calcium and vD supplements

Thyroid gland disorders

Thyroids:
-

function: convert iodine into thyroid hormones

pituitary glands secretes TSH
thyroid secretes:
o T3- regulates cell metabolism and growth
o T4- precursor to T3
o Calcitonin- regulates calcium levels

Patho:

Causes:

Complications:

Graves Disease
hyperthyroidsim
-Excessive hormone secretion and thyroid
enlargement
-autoimmune- antibodies to TSH receptors &
cause stimulation of T3 and T4
- iodine
-infection
-prolonged stress
-Thyrotoxicosis Thyroid storm
-stressors cause large amount of hormone
release (Surgery, infection, trauma)
-severe tachycardia, HF, seizures, NVD, coma
-FIRST sign is increase temperature

Nursing
management

Patho

Myxedema Coma
hypothyroidism
- loss of brain function as result of
severe longstanding hypothyroidism
-labs may be normal but stressor
results in coma state
-infection
-depressant drugs
-cold exposure
-trauma
- temperature, BP, RR
-lethargy, sluggishness, drowsiness
Check for: hypoventilation,
hyponatremia, hypoglycemia,
hypotension, subabnormal body
temp.
-mechanical vent.
-continuous CV monitoring
-Iv thyroid hormone replacement
-IV fluid replacement
-monitor core temps

- FIRST SIGN is increase temperature

ICU interventions:
- medication administration/edu
-CV monitoring
-oxygen
-calm, quiet environment
-promote rest
-replace fluid and electrolytes
Exopthalmos:
-HOB>30 degrees
-artificial tears
-salt restrictions
Disorders: goiter, thyroiditis, nodules (malignant or benign), hyperthyroidism,
hypothyroidism, cancer, graves disease, myxedema

Hyperthyroidism
tigger
-Increase thyroid hormone synthesis
&release
-women 20-40 years old

Hypothyroidism
Eeyore
- decrease thyroid hormone= decrease metabolic
rate
- more common in women

Causes:
-Graves Disease*most common
-thyroiditis
-toxic goiter
-pituitary tumor
-excess iodine intake
-thyroid cancer
Symptoms

Diagnosis

Collaborative
care/treatment

Nursing
management

-diaphoresis
-brittle nails
-bounding pulse
-murmur
-goiter
-weight loss
-tremors
-diarrhea
-menstrual changes
-Exopthalmos (eye protrusion
-Heat intolerance
-acropachy- clubbing of fingers
-Thyroidtoxicosis***
-Decrease TSH
-increase Free T4
-ultrasound
-RAIU- Dx for graves, 95% uptake of
iodine
-biopsy
Treatments
-beta blockers
-iodine
-anti-thyroid medications:
propylthiouricil, tapazole
-surgery or radiation
At risk patients:
-female
-smoker
-20-40 years old
Dietary instructions:
-increase calories, protein, carbs
-avoid high fiber (diarrhea)
-avoid caffeine (restlessness)
Preoperative medications:
-slow down thyroid
-take iodine through a straw after
meals
General Pre-Op:
-leg exercises
-pain scale
-support head when turning
-neck exercises as instructed
-talking may be difficult for short
period
Post op after thyroidectomy:
-oxygen
-suction

Primary:
- Destruction or abnormal function of
thyroid tissue
Secondary:
- Pituitary disease (decrease TSH),
hypothalamus dysfunction (decrease TRH)
-global iodine deficiency
-U.S- autoimmune disease
- hair distribution
-edema
-brittle nails
-menstrual disturbances
-constipation
-weight gain
-memory problems
-cold intolerance
-dry skin

Diagnostic:
-TSH
-Free T4
-Thyroid antibody(autoimmune)
-lipid panel
Thyroid Replacement:
- Levothyroxine
- Life-long
- Empty stomach in AM
- Monitor labs
Diet:
- Promote weight loss
Teaching:
-get exercise
-increase fiber
-encourage comfortable, warm environment
-skin care: lotions
-avoid sedatives
-Minimize constipation
-reduce caloric intake until medication takes
effect (4-6 weeks)
-monitor for symptoms of hyperthyroidism

-tracheostomy tray
Interventions:
- Assess every 2 hours: airway,
neck swelling, frequent
swallowing, incision problems,
blood or drainage
- Semi-fowlers-support neck
- Monitor vital signs and assess
for TETANY (twitching, tingling,
trousseau, chvostek)
- Pain management
Discharge teaching:
- Monitor thyroid hormone
levels
- Reduce calories to prevent
weight gain
- Encourage regular exercise
- Avoid extreme heat

Goiter
Patho

Cause:
- Hyper or hypo
- Lack of dietary iodine
- Hashimotos thyroiditis
Types:
- Nontoxic: not related to
malignancy or inflammation,
- Nodular: hormone secreting
nodules graves disease,
function independently of TSH

Symptoms
Diagnosis

-TSH and T4 levels are measured to

associate with normal thyroid function,
hyperthyroid, or hypothyroid

Collaborative
care/ treatment

-prevent further enlargement

- surgery
-thyroid hormone therapy

Nurse
management

thyroiditis

Inflammation of thyroid gland

Causes:
- Subacute: viral
- Acute: bacterial/fungal
Hashimotos thyroiditis:
- Common cause of goiters
- Autoimmune: antibodies destroy thyroid
tissue
- Most affected: Caucasian females w/ fa
history

- Abrupt onset of jaw, throat, ear pain

- Fever, chills, fatigue
- thyroid antibodies (TPO) measured
- T3 and T4 levels elevate in subacute, actue, a
silent but then become depressed
- Hashimotos- t3 and t4 are low, TSH is high
- antibiotics for bacterial
- surgical drainage
-NSAIDS- symptoms
-corticosteroids- severe pain
-beta-blockers: CV symptoms r/t hyperthyroidis
- Patient teaching for disease process
- Not abruptly stopping meds
- If pt has hashimotos at increased risk o
addisons, pernicious anemia, or graves
disease