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Disorders of the anterior pituitary?
- Growth hormone excess--> Gigantism (children) or Acromegaly (adults)
- Hypopituitarism--> Growth hormone deficiency-->
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pathophys of growth hormone excess
- Anabolic hormone
- GH produced by anterior pituitary
- Stimulates liver to produce insulin-like growth factor-1 (ICF-1)
- Stimulates growth of bones and soft tissues
- Overproduction caused by benign pituitary adenoma (tumor)
- Acromegaly (adults):
- Overgrowth of bones and soft tissues, large hands, tongue, feet, etc.
- Bones become thick and wide
- Cardiomyopathy, enlarged visceral organs
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SnSs of growth hormone excess
- Begin gradually in 30’s and 40’s
- Enlarge hands and feet
- Thickening and enlargement of face & head
- Enlarged tongue
- Sleep apnea
- Cardiomegaly/HTN
- Enlarged visceral organs
- Local effects of tumor
- Visual disturbance
- Headache
- Glucose intolerance (Antagonizes the action of insulin)
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Diagnostics for growth hormone excess
- Serum GH, IGF-1 levels, IGF binding protein -3 levels
- Definitive test: oral glucose challenge test
- --GH normally falls
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Collaborative care for growth hormone excess
- Surgery
- --Hypophysectomy is treatment of choice
- --Transsphenoidal approach
- --Hormone replacement
- Radiation
- --Secondary treatment
- Drugs
- --Somatostatin analogs
- --Octreotide (sandostatin)
- --Dopamine agonists
- --GH receptor antagonists
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Nursing management of GH excess
- Nursing Assessment
- S & S of abnormal tissue growth
- Nursing Diagnoses
- --Body Image
- --Fluid volume deficit
- --Sleep pattern
- --Sensory perception
- Implementation
- --Preop teaching
- --HOB elevated
- --Check nasal drainage
- --Analgesia
- --Mouth care
- --Transient DI
- --Hormone replacement
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Hypotituitarism
- Rare
- Pituitary tumor most common cause
- Deficiencies in anterior pituitary hormones can be life threatening
- --Infertility may be first sign
- --v TSH
- --v ACTH: shock and adrenal insufficiency
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SnSs of hypopituitarism
- Vary depending on target organ deficiency
- --Reproductive
- --Adrenal insufficiency-->hypotension
- --Hypothyroid
- --Signs from expanding tumor
- Diagnostic Studies
- CT
- MRI
- Pituitary hormones
- Hormone levels
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Disorders of post-pituitary
- Antidiuretic hormone secretion
- Syndrome of Inappropriate ADH (SIADH)
- --Oversecretion of ADH
- Diabetes insipidus (DI)
- Undersecretion of ADH
- ADH is synthesized in hypothalamus and stored in posterior pituitary
- Major role in regulation of water balance and osmolarity
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Etiology and SnSs of SIADH
- One of the only times you want to restrict fluids.
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Collaborative care and nursing management of SIADH
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DI?
- psychotics can be prone to fluid volume overload.
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Disorders of thyroid
- Thyroid hormones regulate energy metabolism --Thyroxine (T4)
- --Triiodothyronine (T3)
- Thyroid enlargement is called a goiter
- --Increased, decreased or normal hormone production
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- Storm: Every thyroid hormone is
- Myxedema coma:
- Look them up.
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SnSs of hyperthyroidism
- shock-->coma
- Treatment by decreasing thyroid hormones.
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What's a great antithyroid drug to know
- Propylthiouracil (PTU)
- Can also take
- --Iodine (radioactive for non-pregant women)
- --B-blockers
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Etiology of hypothyroidism
- Common medical problem
- Insufficient thyroid hormone
- Causes
- --Iodine deficiency (worldwide)
- --Thyroid gland atrophy (U.S.)
- --Primary: atrophy of gland
- --Secondary: d/t tx of hyperthyroid
- --Transient: illness (thyroiditis)
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SnSs of hypothyroidism
- Hypometabolism
- Often slow changes
- Fatigue, lethargy
- Mental changes
- Cardiac
- GI: generalized.
- Cold intolerance
- Skin: dry, cold
- Weight gain
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Nursing management of hypothyroid
- Health promotion
- Screen at risk groups
- Interventions
- Myxedema (ABCs)
- Home care
- Pt. education
- Lifelong drug therapy
- Know overdose and underdose S & S
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