Endocrine Dysfunction: Adrenal controlled by corticotropin-releasing hormone (CRH)ANTERIOR PITUITARY(adenohypophysis)qTSH (thyroid stimulating hormone)nThyroid releasing hormone; secreted by hypothalamic neurons- control release of TSHqGH (growth hormone) (Somatotropin) stimulates growth of bone/tissue qProlactin- promotes mammary gland growth and milk secretionqFSH (follicle stimulating hormone)- stimulates growth of ovarian follicles evaluate serum/urine hormone levels; stimulation/suppression tests for hormone levels; CT, MRI, etc ANTERIOR PITUITARY HYPERFUNCTIONnWhat happens if:qTOO MUCH secretion of prolactin (prolactinoma)?qTOO MUCH release of Lutenizing Hormone (LH)? qToo much growth hormone secretion? nWhich goolish character on the Addams Family had too much GH secretionAnovulation; menstrual irregularities; galactorrhea“Polycystic ovary syndrome;, due to effect on corpus lutea GIGANTISM IN CHILDREN; ACROMEGALY IN ADULTSEffects of growth hormone. A, Comparison of (from left to right) gigantism, normal, and dwarfism. B and C, The patients hands and face show; Clinical signs of acromegaly. D, Acromegaly. Excessive secretion of growth hormone in the adult caused characteristic malocclusion of the teeth resulting from the overgrowth of the mandible.nSing along TOO MUCH GROWTH HORMONEnGIGANTISM IN CHILDRENq skeletal growth; may grow up to 8 ft. tall; 300 lbsnACROMEGALY IN ADULTSqenlarged feet/hands, thickening of bones, prognathism (jaw projects forward), diabetes, HTN, wt. gain, H/A,qVisual disturbances, diabetes mellitusnACROMEGALY IN ADULTSnprogessive change in facial featuresnHand in acromegaly; normal handWhat assessment findings would the nurse document? What priority health risks associated with acromegaly?Video-You Tube Lecture “Effects of GH Deficiency in Adults” You Tube-Pituitary Giantism/Agromegaly “Egor” the Giant VideoYou Tube-Pituitary Giantism- Robert Wadlow “Worlds Tallest Man” died age 22 Cont. Hyperfunction of the Anterior Pituitary-An individual has a tumor of anterior pituitary gland which causes excess ACTH secretionWhat “disease” is this? What signs and symptoms are likely to be found? Cushings disease- condition in which pituitary gland releases too much adrenocorticotropic hormone (ATCH). Cushings disease- a form of Cushing syndromeSee next slide for Video- Remember this one-see adrenal disordersCushings Disease-MEDICAL INTERVENTIONS PITUITARY TUMORn*Medications (goal.reduce GH levels)qSomatostatin analogs (octreotide)qGH receptor antagonists (Pegvisomant)qDopamine agonists (cabergoline) Dostinex *inhibits prolactin (prolactinoma)nFYI- If inadequate GH prior to puberty- what “condition” will this individual have? what drug might be given to treat? Pituitary Dwafism (panhypopituitarism)- give GH (somatostatin)MEDICAL INTERVENTIONS PITUITARY TUMOR/REPLACEMENT THERAPYnRadiation therapyqExternal radiation- bring down GH levels 80% of timeqSteriotactic radiosurgery-nClick to view You Tube video nRisk post-procedure-increased risk for seizuresnNeurosurgery:qTranssphenoidal hypophysectomynMost commonly used approachnIncision thru floor of nose into sella turcica.Newer Method-EndoscopicTranssphenoidal HypophysectomyNew Method Click to view! No incisions ! Less recovery time Fewer complicationsNursing Management-Pituitary Tumors/Hyperfunction nPre op hypophysectomyqAnxiety r/t nbody changes nfear of unknown n*brain involvement tumor extent, deficits n*chronic - life long care implications- develop hypopituitary conditions following procedureq*Need life-long replacement therapy!n Sensory-perceptual alteration r/ta. visual field cutsb. diplopia nsecondary to pressure on optic nerve.nAlteration in comfort (headache) r/t a. tumor growth/edema Knowledge deficit r/tnPost-op teachingqpain controlqambulationqhormone replacementqActivitynAvoid straining, coughing, sneezingn*Prevent cerebrospinal fluid leakagePost operative carenPost-op complications of hormone insufficiency:qTrauma lead to transient (or permanent) inadequate ADHqWhat is this disorder called?qDecreased ACTH- require cortisone replacement due to decreased glucocorticoid production (adrenal response)qCan you live without glucocorticoids?DI NOOther deficiencies post hypohysectomy:n in sex hormones-lead to infertility due to decrease production of ova monitor F show rise in urine osmolality if central DICollaborative Care Medical Management-DInIdentify etiology, H orally, nasally, IVnVasopressin (Pitressin)nDiabenese, carbamazepine (Tegretol)qPartial central DInDietary, low Na etc if neprhogenic cause Nursing Management-DInAssess for F critical in stress response)qCORTISOL responsible for control Cushings MENTAL CHANGESnMood swingsnEuphorianDepressionnAnxietynMild to severe depressionnPsychosisnPoor concentraion and memorynSleep disordersn s in hematologynWBCsnLymphocytesnEosinophilsSummary Signs and symptoms: Summary Signs and symp