Hypophysis

Pituitary

Hypophysis = Pituitary
Pituitary
Pituitary
 Anterior Pituitary Disorders
These are the most common
disorders of the pituitary and
include
•Hypopituitarism
•Hyperpituitarism
•Local compression of brain
tissue by expanding tumor
masses
 Hypopituitarism
• Etiology and risk factors
1. Invasion- pituitary tumors, CNS tumors, carotid
aneurysmmost common
2. Infarction-postpartum necrosis (Sheehan’s
syndrome), pituitary apoplexy
3. Infiltration-sarcoidosis, hemochromatosis
4. Injury-head trauma, child abuse
5. Immunologic-lymphocytic hypophysitis
6. Iatrogenic-surgery, radiation therapy
7. Infectious-mycoses, tuberculosis, syphilis
8. Idiopathic-familial
9. Isolated-deficiency of an anterior pituitary hormone
(eg. GH, LH, FSH, TSH, ACTH-LPH, prolactin
 Hypopituitarism
• Pathophysiology-
– deficiency of one or more of the hormones produced by the
anterior lobe of the pituitary
• Clinical manifestations
– Short stature
– Sexual and reproductive disorders
– Hypothyroidism
– Secondary adrenocortical insufficiency
– Prolactin insufficiency
• Medical management-
– Treatment of choice= removal of causative factor and
permanent replacement of the target hormones
• Nursing management-
– focus on care of target organ
 Hyperpituitary
• Syndromes associated
– Cushing’s Syndrome
– Acromegaly
– Amenorrhea
– Galactorrhea
– Hyperthyroidism
– Hypergonadism (males)
Cushing’s Syndrome

46-1
 Acromegaly
•Clinical Manifestation
•Coarsening of
facial features
• Surgical
•Pathophysiology
Management
•Increased
•Transsphenoidal
growth
hypophysectomy
hormone
production
after
epiphyseal
plate closure
46-2
 Gigantism

Increased
growth
hormone
before
epiphyseal
plate
closure

46-3
 Hyperpituitary/
hyperprolactinemia
• Etiology and risk factors
• Pathophysiology
– Overproduction of porlactin and growth hormone by the
adenomas
• Clinical manifestations
– Abnormal growth patterns, galactorrhea
• Medical management-surgery
• Nursing management-
– emotional support, comfort throughout preoperative
period, physical and neurological assessment
Hyperpituitarism
• Treatment of choice
http://www.surgeryencyclopedia.com/Fi-La/Hypophysectomy.html
 Transsphenoidal
Hypophysectomy
• Frequent oral hygeine • Avoid coughing,
is needed- no sneezing, or activities
toothbrushing for 2 that cause a rise in
wks- use lubricant on intracranial pressure-
lips monitor ICP
 Transsphenoidal
Hypophysectomy
• Monitor UOP for • Monitor nasal
signs of Diabetes drainage for CSF
Insipidus: UOP greater leakage-may discern
than 200 ml/hr with by testing with
SG less than 1.005- dipstick for presence
monitor for hormonal of glucose (should be
insufficiencies negative if nasal
drainage)
 Transsphenoidal Hypophysectomy

• Monitor for meningitis

– Temperature elevation
– Severe headache
– Irritability
– Nuchal rigidity
 Transsphenoidal Hypophysectomy
• Monitor for adrenal insufficiency/
acute adrenal insufficiency/Addisonian Crisis
Prophylactic “stress” cortisol injections to enable better
tolerance of stress of surgery
Sudden penetrating pain in the back, abdomen, or legs
Depressed or changed mentation
Volume depletion (isotonic solution, volume expanders)
Hypotension*** (isotonic solution, vasopressors)
Loss of consciousness
Shock
Electrolyte imbalance*** (K+ - kaexylate Na-isotonic solution)

*** treat STAT or fatal ***

 Other Disorders
• Posterior lobe (neurophyseal disorders)
– ADH deficiency aka diabetes insipidus
• Excess ADH = SIADH or syndrome of inappropriate
ADH
• SIADH seen with lung cancer, head injuries, cranial
surgery, pituitary tumors, encephalitis, poliomyelitis,
myxedema
Posterior lobe (neurophyseal
disorders)
• Sexual disturbances
– excess secretion of LH/FSH from pituitary tumors can
produce sexual precocity in children
– Amenorrhea or galactorrhea in women
– Bromocriptine, a dopamine agonist, inhibits prolactin
secretion
Posterior lobe (neurophyseal disorders)

• Gondal disorders
– Testicular dysfunction (secondary to a
disorder of hypothalamic-pituitary function-
a gonadatropin deficiency, Kallmann’s
syndrome, abnormal maturation with midline
defects: cleft lip/palate, color blindness,
anosmia, ataxia)
 References
• Ackley, B. & Ladewig, G. (2006). Nursing Diagnosis Handbook: A
Guide to Planning Care, (7th ed.) St. Louis: Mosby
• Black, J. & Hawks, J (2005). Medical-Surgical Nursing: Clinical
Management for Positive Outcomes, (7th ed.), Philadelphia: W.B.
Saunders
• Hockenberry, M. (2003). Whaley & Wong’s Nursing Care of Infants and
Children, (7th ed)., St. Louis: Mosby
• Karch, A. (2006). Focus on Nursing Pharmacology (3rd ed.).,
Philadelphia: Lippincott
• Williams, S. & Schlenker, E. (2003). Essentials of Nutrition and Diet
Therapy, (8th ed.), St. Louis: Mosby