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disorders of the endocrine gland (pituitary gland) (hypopituitarism(DWARFI…
disorders of the endocrine gland (pituitary gland)
pituitary tumors
diagnostic findings
history taking and physical examination
assessment of visual activity and visual fields
CT and MRI scans -used to diagnose presence and extent of of pituitary tumor
serum levels of pituitary hormones to assist in diagnosing
pathophysiology
abnomalities in pituary function are caused by oversecretion or undersecretion of any hormone secreted or released by the gland
abnormalities of the anterior and posterior portion of the gland may occur independently
the tumors may be primary or secondary, functional or non-functional
functional tumors secrete pituitary hormones whereas non-functional do not secrete any hormone.
location and effect of these tumors on hormone production by target organs can have a life threatening sffect
there are three principal types of pituitary tumors represent an overgrowth of eosinophil cells ,basophil cells,or chromophobic cells
clinical manifestations
Esosinophilic tumors are those that develop early in life they result from giganism,affected person may be more than 7 feet tall and large in all proportions
person may be weak and lethargic that they can hardly stand
If the disorder begins during adult life ,the excessive skeletal growth occurs in feet ,hands ,the suiperciliary ridge ,the nose ,the chin
many patients suffer from severe headaches and visual disturbances ,because the tumor exert pressure on the optic nerves
decalcification of the skeleton,
muscular weakness
endocrine disturbances
basophilic tumors give rise to cushing syndrome
pituitary tumors produce no hormones but destroy the rest of the pituitary gland
assessment
requires a careful history and physical examination
assessment of visual acuity and visual fields
ct scan and mri scans used to diagnose the presence and extent of pituitary tumors
serum levels of pituitary hormones may be obtained
MEDICAL MANAGEMENT
Surgical removal of pituitary gland (hypophsectomy)
neurosurgery -type sterotactic frame may be used to deliver external beam radiation therapy presicely to pituitary tumor with minimal effects on normal tissue
convectional radiation therapy
bromocriptic and octreotide are medications that inhibit production of growth hormone and bring about marked improvement of symptoms.
hypopituitarism(DWARFISM)
pathophysiology
There is an endocrine deficiency syndrome due to partial or complete loss of anterior pituitary lobe functioning
the onset is often insidious and may not be recognised by the patientit characterised by an abnormal short stature due to decreased functioning of the growth hormone,
the height of the individual is less than the third percentile and growth velocity is less than or equal to 4cm per year.
CAUSES
they are unknown but related to pituitary tumours
low or decreased growth hormone secretion
defective growth hormone action
impaired skeletal response to growth hormone
primary or secondary hypothyroidism ,diabetes mellitus in the patient
ASSESSMENT AND COMMON FINDINGS
growth retardation
delayed or failure to begin pubertal development
emotional depression family history of short stature
DIAGNOSTIC FINDINGS
XRAYS will be done to confirm bone status
ct scan as well to confirm bone status
growth hormone studies will reveal low levels of growth hormones
MANAGEMENT
Replacing lacking pituitary gland hormones
possible surgical removal of any tumour
irradiation of the tumour if malignant ,may be carried out
NURSING CARE
there is no direct or permanent treatment except for replacing the lacking hormone ,surgical or radiation therapy in the case of malignant tumours.
give education and emotional support focusing on the couse of a disease , the prescribed medication and praparation for surgerry
encourage the patient to interact with the family
reasure the patient that treatment reverse some of the physical deformities
PRE-OPERATIVE NURSING CARE
POST-OPERATIVE NURSING CARE
Elevate the patient head to fascilitate breathing and fluid drainage
assist with exercise to promote maximum joint mobility
discourage the patient to cough as this may interfere with the healing of the operation
explain the need to avoid activities tha may increase intracranial pressure
symptoms
abnormal slow growth rate
degradation of fat
protein synthesis is diminished and the muscle mass is proportionally decreased.
Sexual organs are not sufficiently developed ,women have the uterus and vagina of reduced dimensions, mammary glands are also underdeveloped ,amenorrhoea Is also present
inadequate degradation of glycogen to glucose can lead to hypoglycaemia and seizures.
Head and limbs are too small but proportionate
PITUITARY HORMONES
HORMONES OF THE ANTERIOR LOBE
gonado trophin
- Control growth of gonads and reproductive activities
Growth hormone
- Promotes Growth
thyrotrophin
-Control the rate of secretion of thyroxine by the thyroid gland
Corticotrophin
- Control secretion of body fluids
POSTERIOR LOBE
Oxytocin
- Promotes uterine contractions during and after childbirth
Antidiuretic Hormone
-Controls concentration of body fluids