ACROMEGALY

RISK FACTORS

- AGE - BENIGN TUMORS (PITUITARY ADRENOMA)

CLIENT EDUCATION

- HORMONE REPLACEMENT THERAPY WILL BE LIFELONG - AVOID ACTIVITIES THAT CAN CAUSE INCREASE ICP - REPORT POSTNASAL DRIP OR INCREASED SWALLOWING - RINSE MOUTH FREQUENTLY - AVOID BRUSHING TEETH... USE ORAL RINSE AND FLOSSING TO CLEAN TEETH - HIGH-FIBER DIET

NURSING CARE

● Assess self-concept related to physical manifestations of disorder. ● Instruct the client regarding medications or other treatment options.

THERAPEUTIC PROCEDURES

- HYPOHYSECTOMY - RADIATION THERAPY

MEDICATIONS

Dopamine agonists (bromocriptine mesylate, cabergoline) inhibit the release of GH. CLIENT EDUCATION: Notify the provider immediately if chest pain, dizziness, or watery nasal discharge occurs while taking bromocriptine. This can indicate cardiac dysrhythmia, coronary artery spasms, or leakage of CSF. Somatostatin analogs (octreotide, lanreotide) inhibit GH release. Growth hormone receptor blocker (pegvisomant) prevents GH receptor activity and blocks production of insulin-like growth factor.

WHAT IS ACROMEGALY?

Excess growth hormone in adults, which causes an increase in size of body parts but not height. ● Manifestations are widespread, including overgrowth of the skin; bones of the forehead, jaw, feet and hands; and enlargement of organs including the liver and the heart. ● If left untreated, acromegaly can cause hypertension, diabetes mellitus, and heart problems. ● Onset is gradual and can progress for years before becoming noticeable.

LABORATORY FINDINGS

GROWTH HORMONE SUPPRESSION TEST: Elevated glucose levels are expected to suppress GH; however, clients who have acromegaly will show only a slight decrease or no decrease at all in GH levels. NURSING ACTIONS: ● Obtain baseline GH and glucose levels. ● Administer prescribed glucose. ● Obtain GH and blood glucose levels at 10, 60, and 120 min after glucose administration. CLIENT EDUCATION: Consume nothing but water for 6 - 8 hr preceding the test.

DIAGNOSTIC TESTS

X-rays of the skull: Identify abnormalities of the sella turcica, the location of the pituitary gland within the skull. CT or MRI of the head: Identify soft tissue lesions. Cerebral angiography: Evaluate for the presence of vascular malformation or aneurysms.

EXPECTED FINDINGS

● Severe headaches ● Visual disturbances (diplopia, decreased visual acuity) ● Thick lips with coarse facial structures ● Joint pain ● Decreased libido ● Enlarged hands and feet ● Hyperglycemia ● Barrel-shaped chest ● Lower jaw protrusion ● Increasing head size ● Change in voice characteristics ● Change in menstrual pattern ● Sleep apnea ● Increases in intracranial pressure (decreased LOC, pupillary changes, severe hypertension, widened pulse pressure, bradycardia, seizures)