Pituitary and Adrenal gland

side effects of adrenal gland hypofunction

loss of aldosterone and cortical action decreased glomerular filtration rate (because excretion of sodium and water) potassium, sodium, and water imbalances decreased body hair decreased gastric acid production

what is secreted by the adrenal cortex?

mineralocorticoids and glucocorticoids and sex hormones

suppression test

opposite of stimulation test diagnostic test for hyperpituitarism give IV glucose check GH levels at 30 minute intervals in a person with normal pituitary function, there will be a decrease in GH levels in a person with hyperpituitarism, the levels will not decrease

Surgical treatment for Cushing's

Adrenalectomy, hypophysectomy

order of gland stimulation

hypothalamus secretes CRH > pituitary secretes ACTH > adrenal secretes mineralocorticoids, glucocorticoids, androgens Hypothalamus secretes TRH > pituitary secretes TSH > thyroid secretes T3 and T4

problem with stimulation test

in children, they have a hard time overcoming the effects of this test (hypoglycemia)

symptoms of hyperpituitarism related to a growth hormone secreting tumor

increasing head size, thick lips, deep voice, enlarged feet and hands, barrel chest, joint enlargement and pain, excess sweating

treatment of secondary addison's disease

long term glucocorticoid therapy (prednisone)

Diagnostic test for pheochromocytoma

24-hour urine Looking for a byproduct of catecholamine metabolism This will be elevated

After receiving change-of-shift report about these four clients, which client does the nurse attend to first? A) Client with acute adrenal insufficiency who has a blood glucose of 36 mg/dL B) Client with diabetes insipidus who has a dose of desmopressin (DDAVP) due C) Client with hyperaldosteronism who has a serum potassium of 3.4 mEq/L D) Client with pituitary adenoma who is reporting a severe headache

A A glucose level of 36 mg/dL is considered an emergency; this client must be assessed and treated immediately. Although it is important to maintain medications on schedule, the client requiring a dose of desmopressin is not the first client who needs to be seen. A serum potassium of 3.4 mEq/L in the client with hyperaldosteronism may be considered normal (or slightly hypokalemic), based on specific hospital levels. The client reporting a severe headache needs to be evaluated as soon as possible after the client with acute adrenal insufficiency. As an initial measure, the RN could delegate obtaining vital signs to unlicensed assistive personnel (UAP).

What finding does the nurse expect to see in a client with hyperaldosteronism? A) Hypernatremia B) Hyperkalemia C) Metabolic acidosis D) Hypotension

A Hyperaldosteronism, or increased aldosterone levels, affect the kidney tubules and cause sodium retention with excretion of potassium and hydrogen ions. As a result, hypernatremia, hypokalemia, and metabolic alkalosis result. The client has elevated blood pressure, which may cause strokes, heart attacks, and kidney damage.

What clinical finding does the nurse expect in a client with reduced aldosterone secretion? A) Hyperkalemia B) Hyperglycemia C) Hypervolemia D) Hypernatremia

A Reduced aldosterone secretion causes potassium, sodium, and water imbalances. Potassium excretion is decreased causing hyperkalemia. Insufficiency of adrenocortical steroids causes problems through the loss of aldosterone and cortisol steroids. Impaired secretion of cortisol results in hypoglycemia. There is an increased excretion of sodium and water causing hyponatremia and hypovolemia.

A client with pheochromocytoma is admitted for surgery. What does the nurse do for the admitting assessment? A) Avoids palpating the abdomen. B) Monitors for pulmonary edema with a chest x-ray. C) Obtains a 24-hour urine specimen on admission. D) Places the client in a room with a roommate for distraction.

A The abdomen must not be palpated in a client with pheochromocytoma because this action could cause a sudden release of catecholamines and severe hypertension. The tumor on the adrenal gland causes sympathetic hyperactivity, increasing blood pressure and heart rate, not pulmonary edema. A 24-hour urine collection will already have been completed to determine the diagnosis of pheochromocytoma. A client diagnosed with a pheochromocytoma may feel anxious as part of the disease process; providing a roommate for distraction will not reduce the client's anxiety.

A client presents to the emergency department with a history of adrenal insufficiency. The following laboratory values are obtained: Na 130 mEq/L, K 5.6 mEq/L, and glucose 72 mg/dL. Which is the first request that the nurse anticipates? A) Administer insulin and dextrose in normal saline to shift potassium into cells. B) Give spironolactone (Aldactone) 100 mg orally. C) Initiate H2 blocker therapy with ranitidine for ulcer prophylaxis. D) Obtain arterial blood gases to assess for peaked T waves.

A This client is hyperkalemic. The nurse should anticipate a request to administer 20-50 units of insulin with 20-50 mg of dextrose in normal saline as an IV infusion to shift potassium into the cells. Spironolactone is a potassium-sparing diuretic that helps the body keep potassium, which the client does not need. Although H2 blocker therapy would be appropriate for this client, it is not the first priority. Arterial blood gases are not used to assess for peaked T waves associated with hyperkalemia; an electrocardiogram (ECG) needs to be obtained instead.

What manifestations should the nurse expect to find in a client with Cushing's syndrome? Select all that apply. A) Moon face B) Truncal obesity C) Barrel-shaped chest D) Loss of bone density E) Enlarged hands and feet

A, B, D The client with Cushing's syndrome has increased total body fat which is redistributed, producing moon face and truncal obesity. Depletion of nitrogen and mineral loss leads to loss of bone density. The client with acromegaly has a barrel-shaped chest and enlarged hands and feet due to an excess of growth hormone.

What manifestation does the nurse expect to find during the assessment of a client with pheochromocytoma? Select all that apply. A) Profuse sweating or diaphoresis B) Excessive urination at night C) Increased abdominal pressure D) Sensation of numbness and tingling E) Intermittent episodes of hypertension

A, C, E A pheochromocytomais a tumor that produces, stores, and releases epinephrine and norepinephrine.These stimulate adrenergic receptors and have a widerange of adverse effects mimicking the action of thesympathetic nervous system. Manifestations include profuse diaphoresis and increased abdominal pressure during intermittent episodes of hypertension. Excessive urination at night and sensation of numbness and tingling are observed in the client with hyperaldosteronism.

client has been diagnosed with pheochromocytoma. Which factors can trigger a hypertensive crisis? Select all that apply. A) Increased abdominal pressure B) Low-sodium diet C) Potassium supplements D) Foods high in tyramine E) Palpation of the abdomen

A, D, E Factors that trigger a hypertensive crisis in a client with pheochromocytoma include increased abdominal pressure, intake of foods high in tyramine such as aged cheese and red wine, and palpation of the abdomen. These actions stimulate a sudden release of catecholamines and trigger severe hypertension. The client should consume a low-sodium diet and take potassium supplements before surgery for early-stage hypoaldosteronism.

Pheochromocytoma

Adrenal medulla problem Catecholamine producing tumors that arise in the adrenal medulla Tumors produce, store, and release epi and norepi

Most common cause of cushings syndrome

Adrenal tumor

Surgery for pheochromocytoma

Adrenalectomy

diagnostic test for adrenal gland hypofunction

ACTH stimulation test

Medications for pheochromocytoma

Alpha blocker before surgery (effective against norepi) After alpha, beta blockers are given to control tachycardia

What can lead to hypertensive crisis in pheochromocytoma?

Anesthetic agents during surgery, manipulation of adrenal gland during surgery

Nursing postop care for adrenalectomy and hypophysectomy

Assess for shock, I&O, daily weight, have a parenteral dose of corticosteroids available in case patient is NPO

The client is taking fludrocortisone (Florinef) for adrenal hypofunction. The nurse instructs the client to report which symptom while taking this drug? A) Anxiety B) Headache C) Nausea D) Weight loss

B A side effect of fludrocortisone is hypertension. New onset of headache should be reported, and the client's blood pressure should be monitored. Anxiety is not a side effect of fludrocortisone and is not associated with adrenal hypofunction. Nausea is associated with adrenal hypofunction; it is not a side effect of fludrocortisone. Sodium-related fluid retention and weight gain, not loss, are possible with fludrocortisone therapy.

Which finding does the nurse identify as contributing to the potential for infection in the client with hypercortisolism? A) Increased serum sodium level B) Decreased lymphocyte count C) Increased blood glucose level D) Decreased serum potassium level

B Excess cortisol reduces the number of circulating lymphocytes and increases the risk for infection. The client should restrict sodium intake due to increased serum sodium levels to prevent fluid overload. Glucose metabolism is disturbed by hypercortisolism and the client's fasting blood glucose is increased. The client also has decreased serum potassium level. Dysrhythmias can occur from potassium imbalance.

What are the most common features of acromegaly? A) Moon face B) Thickened lips C) Fine tremors D) Acne

B Overproduction of GH in adults results in acromegaly. The onset may be gradual with slow progression and may be noticed as thickened lips, coarse facial features, increasing head size and lower jaw protrusion. Moon face is related to Cushing's disease. Fine tremors are associated with excessive thyroid stimulating hormone and acne is associated with hyperproduction of adrenocorticotropic hormone (ACTH).

A client presents to the emergency department with acute adrenal insufficiency and the following vital signs: P 118 beats/min, R 18/min, BP 84/44 mm Hg, pulse oximetry 98%, and T 98.8° F oral. Which nursing intervention is the highest priority for this client? A) Administering furosemide (Lasix) B) Providing isotonic fluids C) Replacing potassium losses D) Restricting sodium

B Providing isotonic fluid is the priority intervention because this client's vital signs indicate volume loss that may be caused by nausea and vomiting and may accompany acute adrenal insufficiency. Isotonic fluids will be needed to administer IV medications such as hydrocortisone. Furosemide is a loop diuretic, which this client does not need. Potassium is normally increased in acute adrenal insufficiency, but potassium may have been lost if the client has had diarrhea; laboratory work will have to be obtained. Any restrictions, including sodium, should not be started without obtaining laboratory values to establish the client's baseline.

What precautions must a client, who has had a hypophysectomy, take to prevent intracranial pressure (ICP)? A) Bend at the waist to pick up objects. B) Consume high-fiber foods and drink plenty of fluids. C) Cover the mouth when coughing and sneezing. D) Perform deep breathing exercises.

B The client who has undergone a hypophysectomy should consume high-fiber foods and drink plenty of fluids to increase peristaltic movement and reduce the risk of ICP by straining during bowel movements. The client should avoid bending from the waist to pick things up because this position increases ICP; the client can seek assistance or bend the knees and lower the body. The client must not cough, sneeze, or blow the nose; these activities increase ICP and the risk of cerebrospinal fluid leakage. Deep breathing does not affect ICP, rather it prevents pulmonary problems.

A client taking exogenous glucocorticoids is to be discharged from the hospital. What does the nurse teach the client and the caregiver? Select all that apply. A) Monitor the client's weight once a week. B) Adhere to the drug regimen. C) Make a point to receive an influenza vaccination. D) Use proper hygiene and avoid crowds. E) Report weight gain of more than 5 lb in a week.

B, C, D The client taking exogenous glucocorticoids must strictly adhere to the drug regimen because these drugs prevent the hypothalamus from secreting corticotropin-releasing hormone (CRH). The lack of CRH inhibits the secretion of adrenocorticotropic hormone (ACTH) from the anterior pituitary gland. Without normal levels of ACTH, the adrenal glands atrophy and completely stop the production of any of the corticosteroids. The client is completely dependent on the exogenous drug. If the drug is stopped even for a day or two, the client develops acute adrenal insufficiency, a life-threatening condition. The client is prone to infection and should be encouraged to receive an influenza vaccination, use proper hygiene, and stay away from crowds. The client must monitor weight daily and maintain a weight chart; a weight gain of 1-2 lb in a 24-hour period or more than 3 lb in a week must be reported to the health care provider.

S/S of addison's disease

Bronze Winners Lose Weight Playing Heavy Disc Golf (bronze skin, weakness, weight loss, postural hypotension, hypoglycemia, distribution of hair abnormal, GI disturbances)

These data are obtained by the RN who is assessing a client who had a transsphenoidal hypophysectomy yesterday. What information has the most immediate implications for the client's care? A) Dry lips and oral mucosa on examination B) Nasal drainage that tests negative for glucose C) Client report of a headache and stiff neck D) Urine specific gravity of 1.016

C Headache and stiff neck (nuchal rigidity) are symptoms of meningitis that have immediate implications for the client's care. Dry lips and mouth are not unusual after surgery. Frequent oral rinses and the use of dental floss should be encouraged because the client cannot brush the teeth. Any nasal drainage should test negative for glucose; nasal drainage that tests positive for glucose indicates the presence of a cerebrospinal fluid (CSF) leak. A urine specific gravity of 1.016 is within normal limits.

A client with Cushing's disease begins to laugh loudly and inappropriately, causing the family in the room to be uncomfortable. What is the nurse's best response? A) "Don't mind this. The disease is causing this." B) "I need to check the client's cortisol level." C) "The disease can sometimes affect emotional responses." D) "Medication is available to help with this."

C The client may have neurotic or psychotic behavior as a result of high blood cortisol levels. Being honest with the family helps them understand what is happening. Telling the family not to mind the laughter and that the disease is causing it is vague and minimizes the family's concern. This is the perfect opportunity for the nurse to educate the family about the disease. Cushing's disease is the hypersecretion of cortisol, which is abnormally elevated in this disease and, because the diagnosis has already been made, blood levels do not need to be redrawn. Telling the family that medication is available to help with inappropriate laughing does not assist them in understanding the cause of or the reason for the client's behavior.

What skin change does the nurse expect to find in a client with hypercortisolism? A) Thick skin B) Smooth shiny skin C) Reddish-purple striae D) Hypopigmentation

C The client with hypercortisolism has reddish-purple striae or stretch marks over the abdomen, thighs, and upper arms because of the destructive effect of cortisol on collagen. This client also has thinning "paper-like" skin, especially on the back of the hands. Excessive cortisol secretion causes acne and a fine coating of hair over the face and body. The client also has hyperpigmentation.

The nurse is caring for a client with pituitary infarction following postpartum hemorrhage. What condition does the client have? A) Conn's syndrome B) Cushing's syndrome C) Sheehan's syndrome D) Schwartz-Bartter syndrome

C The pituitary gland normally enlarges during pregnancy. When hypotension occurs due to hemorrhage, ischemia and necrosis of the gland occur. This condition is called Sheehan's syndrome. Conn's syndrome, or primary hyperaldosteronism, results from excessive excretion of aldosterone from one or both adrenal glands. When glucocorticoid excess results from drug therapy for another health problem, it is known as Cushing's syndrome. Schwartz-Bartter syndrome, or syndrome of inappropriate antidiuretic hormone (SIADH), is a problem in which vasopressin is secreted even when plasma osmolarity is normal or low.

The nurse is caring for a client with hypercortisolism. The nurse begins to feel the onset of a cold but still has 4 hours left in the shift. What does the nurse do? A) Asks another nurse to care for the client. B) Monitors the client for coldlike symptoms. C) Refuses to care for the client. D) Wears a facemask when caring for the client.

D A client with hypercortisolism will be immune-suppressed. Anyone with a suspected upper respiratory infection who must enter the client's room must wear a mask to prevent the spread of infection. Although asking another nurse to care for the client might be an option in some facilities, it is not generally realistic or practical. The nurse, not the client, feels the onset of the cold, so monitoring the client for coldlike symptoms is part of good client care for a client with hypercortisolism. Refusing to care for the client after starting care would be considered abandonment.

A client is prescribed an adrenocorticotropic hormone (ACTH) stimulation test for adrenal insufficiency. What cortisol response should the nurse expect in secondary insufficiency? A) Absent B) Decreased C) Normal D) Increased

D An ACTH stimulation test involves administering ACTH intravenously to the client, and plasma cortisol levels are obtained at 30-minute and 1-hour intervals. In secondary insufficiency, cortisol response is increased. Cortisol response is either absent or decreased in primary insufficiency. Plasma cortisol is not normal in a client with adrenal insufficiency.

A client with a possible adrenal gland tumor is admitted for testing and treatment. Which nursing action is most appropriate for the charge nurse to delegate to the nursing assistant? A) Assess skin turgor and mucous membranes for hydration status. B) Discuss the dietary restrictions needed for 24-hour urine testing. C) Plan ways to control the environment to avoid stimulating the client. D) Remind the client to avoid drinking coffee and changing position suddenly.

D Drinking caffeinated beverages and changing position suddenly are not safe for a client with a potential adrenal gland tumor because of the effects of catecholamines. Reminding the client about previous instructions is an appropriate role for a nursing assistant who may observe the client doing potentially risky activities. Client assessment, client teaching, and environment planning are higher-level skills that require the experience and responsibility of the RN, and are not within the scope of practice of the nursing assistant.

A client has undergone a hypophysectomy. What postoperative interventions does the nurse perform for this client? A) Monitor neurologic status every 4 hours. B) Discard and replace the nasal drip pad at regular intervals. C) Have the client lie flat after surgery. D) Have the client avoid brushing the teeth for 2 weeks after surgery.

D Following a hypophysectomy, the client should be instructed to avoid brushing the teeth for 2 weeks after surgery until the incision sufficiently heals. Frequent mouth care with mouthwash and daily flossing provide adequate oral hygiene. The client must use a mirror to check the gums for bleeding; reduced sensation in the mouth increases the risk for injury. The nurse monitors the client's neurologic status every hour for the first 24 hours and then every 4 hours. The nasal drip pad is assessed for quantity and quality of drainage before it is discarded; a light yellow color at the edge of clear drainage on the dressing is indicative of cerebrospinal fluid leak. The head of the bed is elevated after surgery to prevent edema.

The assessment and clinical findings for a client show decreased production of all hormones from the anterior pituitary. What is this condition called? A) Pituitary hypo function B) Secondary pituitary dysfunction C) Selective hypopituitarism D) Panhypopituitarism

D Panhypopituitarism is an extremely rare condition in which a person has a decreased production of all of the pituitary hormones. Pituitary hypofunction is the condition in which one or more hormones of the anterior pituitary gland are under-secreted. Hormone disorders of the anterior pituitary due to problems in the hypothalamus are referred to as secondary pituitary dysfunction. Selective hypopituitarism is the condition in which there is a decrease in only one anterior pituitary hormone.

What changes does the nurse note in a client with hypercortisolism upon physical assessment? A) Excessively dry skin B) Absence of hair on the body C) Muscle atrophy in the trunk D) Presence of fat pads on the shoulders

D The client with hypercortisolism has fat pads on the neck, back, and shoulders due to fat redistribution. The client develops extremely thin and translucent skin following increased blood vessel fragility. Excessive cortisol secretion causes acne; coats of fine hair cover the face and the body. The client develops muscle atrophy or muscle wasting and weakness, especially at the extremities. The client also has truncal obesity following changes in fat distribution.

Musculoskeletal changes associated with Cushing's

Decreased bone density, risk for compression fractures of vertebrae, kyphosis, loss of muscle mass, osteoporosis

Diagnostic test for cushings

Dexamethasone suppression testing

Dexamethasone suppression testing

Diagnostic test for Cushing's Administer set doses of dex IV and then measure cortisol levels at intervals Normally this would stop cortisol production, but in a patient with Cushing's the levels remain elevated

Psychosocial changes associated with Cushing's

Difficulty sleeping, depression, mood swings, irritability, confusion, psychosis

Conn's syndrome

Primary hyperaldosteronism Due to an adrenal tumor Result of excessive secretion of aldosterone from one or both adrenal glands

What should you tell the patient with pheochromocytoma to avoid?

Do not palpate their abdomen, tell them not to wear tight clothes, tell them to avoid red wine and aged cheese

Cardiac changes associated with Cushing's

Excess aldosterone causes retention of sodium and water, hypervolemia, HTN, edema, tachycardia

Crushings disease

Excess secretion of the corticosteroids Women are affected more than men Uncommon in children Affects every system in the body

Spironolactone therapy for hypercortisolism

For patients who are unable to have surgery Potassium sparing diuretic Child should have unrestricted access to bathroom

Nursing preop care for adrenalectomy and hypophysectomy

Get the patient as balanced as possible (electrolytes and diet) Start patient on glucocorticoids to prevent hypocortisolism after

Metabolic changes associated with Cushing's

Hyperglycemia

Symptoms of hyperaldosteronsim

Hypokalemia, hypernatremia, metabolic alkalosis, bed wetting in children, excessive thirst, headache, HTN, fatigue, muscle weakness, paresthesia "Hyperaldosteronism Has Many Benefits That Help Heal Metabolic Problems Fast"

treatment of addisonian crisis

IV fluids because they are volume depleted (FIRST/PRIORITY), expect stat electrolyte order from HCP, expect to administer IV corticosteroid and IV insulin

treatment of adrenal gland hypofunction

IV hydrocortisone initially may be on lifelong glucocorticoids fludrocortisone (reabsorption of sodium and water)

Immune changes associated with cushings

Immunosuppressive, infection risk, or does not exhibit signs of infection

Hyperaldosteronism

Increased secretion of aldosterone results in mineralocorticoid excess Goes hand in hand with hypercortisolism

treatment for precocious puberty

LH releasing hormone (suppress sex hormone secretion)

Symptoms of pheochromocytoma

Loss of "fight or flight", headache, palpitations, diaphoresis, flushing, sense of impending doom, weight loss, tremors, hypertensive crisis "PHeochromocytoma Feels Terrible For Dogs Doing HW"

Medicines for hypercortisolism (Cushing's)

Mitotane (cytotoxic to tumor) Cyproheptadine (used if hypercortisolism is caused by excess ACTH)

Classical signs of Cushing's

Moon face Buffalo hump Trunkal obesity

Risk for injury related to hypercortisolism

Skin breakdown (fragile blood vessels) Fractures (limit caffeine and alcohol) GI bleeding (cortisol inhibits production of protective mucus)

lab values drawn for hypopituitarism

T3 and T4, estrogen and testosterone, cortisol, GH in children

Skin changes associated with Cushing's

Thinning of the skin, easy bruising, stretch marks, oily skin (acne), hair loss in men, abnormal hair growth in women (hirsutism), clitoral hypertrophy

Lab tests for Cushing's

Urine, blood, or salivary cortisol levels They will be elevated

acromegaly

a type of hyperpituitarism growth hormone hypersecretion after puberty increased skeletal thickness hypertrophy or thickening of the skin enlarged organs

gigantism

a type of hyperpituitarism growth hormone hypersecretion before puberty growth is all proportional delayed closure of fontanels increased intracranial pressure

central precocious puberty

activated by the hypothalamic Gn-RH

addisonian crisis

acute adrenal insufficiency life-threatening event in which the need for cortisol and aldosterone is greater than the available supply occurs in response to a stressful event leads to hyponatremia, hyperkalemia, hypoglycemia, and hypotension

addison's disease

adrenal gland hypofunction primary and secondary

adrenal gland hypofunction

adrenocortical steroids may decrease as a result of inadequate secretion of ACTH dysfunction of the hypothalamic-pituitary control mechanism

symptoms of decreased gonadotropins (LH and FSH) associated with hypopituitarism in women

amenorrhea and anovulation, low estrogen levels, breast atrophy, loss of bone density, decreased axillary and pubic hair, decreased libido

causes of hypopituitarism

anything that affects adequate blood flow tumors, anorexia nervosa, shock or severe hypotension, head trauma, brain infection, radiation, surgery, sheehan's syndrome (type of HTN associated with postpartal hemorrhage), congenital

when is GH best given?

at night because it stimulates the natural increase in GH that happens in our bodies at night

what indicates congenital hypopituitarism?

birth trauma newborn will be hypoglycemic and exhibit seizure activity within the first 24 hours after birth

glucocorticoids

carb, fat, and protein metabolism play a role in our stress response, emotional stability, and immune function maintain blood glucose anti-inflammatory properties

why do you monitor neurological response after a hypophysectomy?

changes in mental status or persistent headache could indicate CSF leak (resolves on its own with bed rest) notify HCP if patient has a headache

cortex adrenal gland hyperfunction

cushing's disease - hypercortisolism hyperaldosteronism excessive androgen production

symptoms of hyperpituitarism related to an ACTH secreting tumor

cushing's disease - weight gain, moon face

nursing interventions for fluid volume deficit associated with adrenal gland hypofunction

daily weight, I&O, monitor vitals, monitor heart rhythm, monitor electrolytes, glucocorticoid/mineralocorticoid administration (in ADDison's, you ADD steroids)

symptoms of decreased ACTH associated with hypopituitarism

decrease serum cortisol levels, lethargy, anorexia, postural hypotension, headache, hyponatremia (because mineralocorticoids cause us to retain sodium and water), hypoglycemia (b/c decreased glucocorticoids), decreased axillary and pubic hair (b/c decreased androgens) "PHLAP CHAH"

symptoms of decreased gonadotropins (LH and FSH) associated with hypopituitarism in men

decreased facial hair, decreased ejaculate volume, reduced muscle mass, loss of bone density, decreased body hair, decreased libido and impotence

hypopituitarism

deficiency of one of more anterior pituitary hormones resulting in metabolic problems and sexual dysfunction decrease in TSH and ACTH, which can be life-threatening if not treated decrease in GH decrease in gonadotropins

ACTH stimulation test

diagnostic test for adrenal gland hypofunction ACTH given IV and we measure blood cortisol levels if patient has primary addison's, no increase in cortisol levels if patient has secondary addison's, there will be an increase in cortisol levels

stimulation test

diagnostic test for hypopituitarism administer IV injection of insulin in people with normal pituitary function, the insulin will cause an increase in GH and ACTH in people who have hypopituitarism, these levels will remain unchanged

symptoms of hyperpituitarism related to a prolactin secreting tumor

difficulty in sexual function, increased body fat, breast milk production

nonsurgical management/drug therapy for hyperpituitarism

dopamine agonists (decrease the release of pituitary hormones) somatostatin (octreotide) (decrease GH) GH receptor blocker (pegvisomant) (used in patients with acromegaly; suppressed GH)

precocious puberty

early manifestation of sexual development puberty before 8yo in girls and 9yo in boys more common in girls

nursing postop care for hypophysectomy

elevate HOB, avoid coughing, hormone replacement (because removing pituitary can send them into hypopituitarism), avoid bending and straining, avoid toothbrushing (incision line), numbness in area of incision, decreased sense of smell

symptoms of decreased growth hormone associated with hypopituitarism

especially in children decreased rate of growth, decreased bone density and fractures, they appear a lot younger than they are in youth and older than they are in adulthood, delayed eruption of teeth, normal intelligence, decreased muscle strength, increased serum cholesterol

medulla adrenal gland hyperfunction

excessive secretion of catecholamines pheochromocytoma

what corticosteroid tastes bad?

fludrocortisone

what all could indicate potential CSF leak after a hypophysectomy?

headache or change in mental status, postnasal drip, halo sign in nasal drainage, meningitis

hyperpituitarism

hormone oversecretion

most common cause of hyperpituitarism in adults

hyperplasia caused by a pituitary adenoma (usually benign)

primary addison's disease

problem with the adrenal glands themselves autoimmune cause is the most common

secondary addison's disease

problem with the pituitary gland (decreased ACTH)

pituitary tumor types

prolactin secreting tumor (most common; leads to amenorrhea and infertility and lack of lactation) ACTH secreting tumor (hypersecretion of adrenal gland) GH secreting tumor (leads to gigantism or acromegaly)

interventions for hypopituitarism

replacement of deficient hormones

peripheral precocious puberty

secondary to anything other than the Gn-RH

mineralocorticoids

secretion of aldosterone, which is responsible for reabsorption of sodium and water and excretion of potassium

symptoms of decreased TSH associated with hypopituitarism

slow metabolism because TSH is not there to stimulate thyroid gland, decreased T3 and T4, weight gain, cold intolerance, alopecia, hirsutism, menstrual abnormalities, decreased libido, slowed cognition "Weight Gain CALMs CHildren ToMorrow"

lab tests for adrenal gland hypofunction

sodium, potassium, calcium (hypercalcemia), blood glucose, cortisol (low), BUN (high), urinary steroid levels (low)

what indicates hyperkalemia in addisonian crisis?

spiked T wave with a decreased HR <60

adrenocorticotropic hormone (ACTH)

stimulates the adrenal glands

diagnostic test for hypopituitarism

stimulation test

diagnostic test of hyperpituitarism

suppression test

hypophysectomy

surgical treatment of hyperpituitarism removal of pituitary gland and tumor general anesthesia patient is in sitting position and an incision is made just above the upper lip and they access the pituitary gland through the sphenoid sinus a graft of the thigh is placed to prevent CSF leakage nasal packing inserted

why would you treat a patient with hypopituitarism with a statin drug?

treat adult patients with statins because they will have a cholesterol problem associated with deficient GH