Hyperpituitarism

1. Definition - anterior pituitary secretes too much growth hormone and/or ACTH

2. Etiology
1. usually caused by benign neoplasm
2. growth hormone overproduction: acromegaly
3. ACTH overproduction leads adrenal gland to overproduce cortisone: Cushing's syndrome

3. Findings
1. may see signs of increased ICP
2. acromegaly: excess longitudinal bone growth
3. prognathism
4. coarse facial features
5. prominent forehead and orbital ridge
6. large, broad, spade-like hands
7. arthritis, kyphosis


4. Diagnostics
a. history and physical exam
b. computerized tomogram (CT) scan
c. plasma hormone levels: increased growth hormone, ACTH
5. Management
a. expected outcome: remove tumor and restore hormonal balance
b. surgical removal of tumor
c. irradiation of gland
d. pharmacologic: growth hormone suppressant: bromocriptine (parlodel)

6. Nursing interventions
a. provide
i. care of the client with increased ICP
ii. care of the client undergoing surgery
iii. care of the client undergoing radiation therapy
iv. emotional support
b. assess for signs of diabetes insipidus, since removal of a pituitary tumor may injure the posterior pituitary glands and decrease antidiuretic hormone (ADH) secretions
c. teach client that treatment usually produces hypopituitarism so lifelong hormone replacement therapy with regular check-ups are required

Hypopituitarism

1. Definition - underactivity of the front (anterior) pituitary gland
a. classifications of pituitary tumors
i. functioning: hormone present in insufficient quantities
ii. non-functioning: hormone absent

2. Etiology - most common cause: neoplasms, usually benign

3. Findings - result from hormone deficiency (hypogonadism)
a. hypogonadism, female:
i. amenorrhea
ii. infertility
iii. decreased libido
iv. breast and uterine atrophy
v. loss of axillary and pubic hair
vi. vaginal dryness
b. hypogonadism, male
i. decreased libido
ii. impotence
iii. small, soft testicles
iv. loss of axillary and pubic hair
c. hypothyroidism (because pituitary regulates thyroid glands by thyroid stimulating hormone (TSH))
d. hypoadrenalism (because pituitary regulates adrenal glands by ACTH production)
e. may see signs of increased intracranial pressure (ICP)


4. Diagnostics
a. history and physical exam
b. neuro-ophthalmological exam
c. x-rays of pituitary fossa
d. radioimmunoassays of anterior pituitary hormones
e. computerized tomogram (CT) scan

5. Management
a. expected outcome: hormone deficiency corrected
b. hormone replacement therapy
i. corticosteroid therapy
ii. thyroid hormone replacement
iii. sex hormone replacement
c. surgical removal of tumor

6. Nursing interventions
a. provide for
i. care of the client with increased ICP
ii. care of the client undergoing surgery
b. monitor for desired effects of administered medications as ordered
c. provide emotional support with referral to support groups
d. teach client
i. medications desired effects and side effects
ii. need for lifelong hormone replacement therapy and regular checks of serum levels

CARE OF THE CLIENT WITH INCREASED INTRACRANIAL PRESSURE

1. Monitor neuro vital signs as ordered
2. Maintain fluid restriction as ordered
3. Raise head of bed at 30-45 degrees
4. Prevent any activities that increase ICP such as straining at stool, coughing, vomiting, any restrictive clothing around neck, neck rotation, flexion, extension, anxiety
5. Observe for herniation syndrome
6. Monitor intracranial pressure
7. Administer oxygen as ordered
8. Seizure precautions

Diabetes insipidus

1. Posterior pituitary gland makes too little antidiuretic hormone (ADH). Body loses too much water in the urine; plasma osmolality and sodium levels increase.

2. Etiology can include tumor, trauma, inflammation, or psychogenic causes.

3. Findings
a. excessive thirst (polydipsia)
b. polyuria: as much as 20 liters per day with specific gravity below 1.006
c. nocturia
d. signs of dehydration
e. constipation
4. Diagnostics
a. water deprivation tests: inability to concentrate urine
b. osmotic stimulation
c. administration of vasopressin (pitressin) or desmopressin acetate (stimate)
d. computerized tomogram (CT) scan

5. Management
a. expected outcomes: to correct underlying cause and restore hormonal balance
b. pharmacotherapy
i. desmopressin acetate (stimate)
ii. vasopressin (pitressin) - antidiuretic hormone
iii. lypressin (diapid)
iv. chloropropamide (chloronase)
v. clofibrate (claripex)
vi. carbamazapine (mazepine)
c. IV fluid replacement therapy
d. surgical removal of tumor

6. Nursing interventions
a. monitor for findings of dehydration; measure urine; specific gravity
b. administer medications as ordered
c. monitor fluids and give IV fluids as ordered
d. measure intake and output
e. weigh client daily
f. care of the client with increased ICP
g. care of the client undergoing surgery
h. teach client
i. to record intake and output
ii. about medications and side effects
iii. to check urine specific gravity
iv. the need to wear disease identification jewelry

ANTIPARASITICS

Action: interferes with parasite metabolism and reproduction

Examples
a. anthelmintics: mebendazole (Vermox), piperazine (Vermizine) (illustration )
b. amebicides: chloroquine HCL (Aralen), metronidazole (Flagyl)
c. antimalarials: chloroquine HCL (Aralen), quinine sulfate (Quinamm)

Use: kills parasites, helminths (pinworm and tapeworm), protozoa (amebiasis and malaria)

Adverse effects
a. anthelmintics: GI upset, CNS disturbances, skin rash, headache
b. amebicides: GI upset, blood dyscrasias, skin rash, CNS disturbances
c. antimalarials: GI upset, blood dyscrasia, visual disturbances

Nursing interventions
a. administer medication with food
b. monitor vital signs, blood work during therapy
c. use safety precautions if CNS disturbances manifested
d. teach client to prevent further infection
e. with antimalarials: frequent visual examinations, urine may turn rust colored