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Nursing Care & Interventions in Clients with Pituatary/Adrenal

Gland DisordersKeith Rischer RN, MA, CEN

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Today’s Objectives…

Compare and contrast pathophysiology & manifestations of pituitary/adrenal gland dysfunction.

Identify, nursing priorities, and client education associated with pituitary/adrenal gland dysfunction.

Interpret abnormal laboratory test indicators of pituitary/adrenal gland dysfunction.

Analyze assessment to determine nursing diagnoses and formulate a plan of care for clients with pituitary and adrenal gland dysfunction.

Describe the mechanism of action, side effects and nursing interventions of pharmological management with pituitary and adrenal gland dysfunction.

Patho: Endocrine System

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Endocrine glands• Pituitary glands• Adrenal glands• Thyroid glands• Islet cells of pancreas• Parathyroid glands• Gonads

Hormones• Negative feedback mechanism

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Patho: Pituitary Gland

Anterior• Growth hormone• Thyroid Stimulating

Hormone (TSH)• Adrenocorticotropic

Hormone (ACTH)• Follicle Stimulating

Hormone (FSH)• Luteinizing Hormone (LH)

Posterior• Vasopressin

Antidiuretic hormone (ADH)

Anterior Hypo-pituitarism

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Causes• Tumor

Brain or pituitary

• Anorexia• Shock

Growth hormone Gonadatropins

• Women• Men

TSH ACTH

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Anterior Hypo-pituitarism

Labs• T3, T4• Testerone, estradiol levels

Nursing interventions• Replacement of deficient hormones

Androgen therapy – gynecomastia can occur

Estrogens and progesteroneGrowth hormone

• Assess function of target organ thyroid

Anterior Hyper-pituitarism

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Causes• Pituitary tumors or

hyperplasiaGigantism Acromegaly

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Hypophysectomy

Post op Care• Closely monitor neuros• Assess for postnasal drip

“halo sign”• Avoid coughing early after

the surgery.• Keep HOB elevated• Assess for meningitis• Replace hormones and

glucocorticoids as needed• Diabetes insipidus

Assess I&O closely first 24 hours

Posterior Pituitary Gland: Diabetes Insipidus

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Patho• Antidiuretic hormone

deficiency

• Water unable to be reabsorbed

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Diabetes Insipidus: Clinical Manifestations

CV• Tachycardia• Hypotension• Heme concentration

Renal• Dramatic increased u/o

Skin• Dry mucous membranes

Neuro• Thirst• Irritable• Lethargy to unresponsive

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Diabetes insipidus: Interventions

Nursing Diagnostic Statements• Deficient fluid volume r/t…• Decreased cardiac output r/t…

Priorities• Early detection dehydration• Maintain adequate hydration

Desmopressin acetate (DDAVP) intranasally• Synthetic vasopressin• I&O-daily weights

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Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

Patho• Vasopressin (ADH)

Increased

• Water retained Dilutional hyponatremia

Causes• Cancer• Infection• Chemo agents• COPD

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SAIDH:Clinical Manifestations

Fluid retention• Hyponatremia

Neuro• Lethargy• HA• Altered LOC

CV• Tachycardia

Renal• u/o decrease

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SAIDH: Nursing Interventions

Nursing diagnostic priorities• Decreased cardiac output r/t…• Fatigue

Fluid restriction Drug therapy

• Diuretics• Hypertonic saline (3%)

Neurologic assessment• Orientation • Safe environment

Adrenal Glands

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Patho• Aldosterone• Cortisol • Catecholamines

Epinephrine– Beta receptors

Norepinephrine– Alpha receptors

• Deduced aldosterone levels Hyperkalemia

– acidosis Hyponatremia

– hypovolemia

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Adrenal Glands: Hypofunction

Acute adrenal insufficiency• Addisonian crisis • Causes

Steroids stopped abruptly

Clinical manifestations• Muscle weakness, fatigue, constipation• Hypoglycemia

Diaphoresis, tachy, tremors

• Blood volume depletion• Hyperkalemia

cardiac arrest-rhythm changes

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Addison’s Disease: Interventions

Promote fluid balance and monitor for fluid deficit.• Careful I&O• Record weight daily

Assess vital signs every 1 to 4 hours, assess for dysrhythmias or postural hypotension.

Monitor laboratory values • Na• K• Glucose

Cortisol and aldosterone replacement therapy Diet - ↑ sodium, ↓ potassium, ↑ Carbs

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Adrenal Gland: Hyperfunction

Patho Pheochromocytoma Cushing’s syndrome

• CausesPrimary/secondary malignancies Steroids

• Lymphocytes• Inflammatory/immune response

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Cushing’s Disease: Clinical Manifestations

Obesity• Changes in fat distribution

Moon face Facial hair for women Thin skin Blood vessels fragile Acne Immunosupression HTN

• Water/sodium retention Lab changes

• Glucose• WBC• Sodium• Potassium

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Nursing Priorities

Excess fluid volume r/t… Risk for infection r/t… Deficient knowledge

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Medical Management

Drug therapy • Mitotane• If caused by side effect of medication

try to decrease or change meds

Radiation therapy• Pituitary tumors

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Cushings: Surgical Management

Total hypophysectomy Adrenalectomy Preoperative care

• Correct lyte imbalances Postoperative care

• Prevent skin breakdown• Pathologic fractures• Education regarding lifelong steroid use

Take with mealsNever skip dosesWeigh daily