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Hypophysectomy/Pituitary surgery (Assessments and common findings (Visual…
Hypophysectomy/Pituitary surgery
Defination
Pituitary surgery is usually undertaken for removal of pituitary tumours.
The most usual approach is through the sphenoid bone via the nasal cavity, although a frontal approach may be selected depending on the situation and the size of the tumour.
Phathophysilogy
It is also applied in neurosciences (in experiments with lab animals) to understand the functioning of hypophysis.
Medications that are given as hormone replacement therapy following a complete hypophysectomy (removal of the pituitary gland) are often glucocorticoids.
Complications
internal cranial hemorrhage
leaking of the cerebrospinal fluid
nose bleeds
Causes
Headache
The cause of uncontrolled cell growth in the pituitary gland, which creates a tumor, remains unknown.
Signs and symptoms
Headache
Vision loss, particularly loss of peripheral vision
Overfunctioning
Risk factor
People with a family history of certain hereditary conditions, such as multiple endocrine neoplasia, type 1 (MEN 1), have an increased risk of pituitary tumors
In MEN I, multiple tumors occur in various glands of the endocrine system. Genetic testing is available for this disorder.
References
Buchfelder, M; Schlaffer, S (2010). "Pituitary surgery for Cushing's disease". Neuroendocrinology. 92 Suppl 1: 102–6. doi:10.1159/000314223. PMID 20829628
Jaffe, CA (2006). "Clinically non-functioning pituitary adenoma". Pituitary. 9 (4): 317–21. doi:10.1007/s11102-006-0412-9.
Swearingers. Manuel of medical surgical nursing: A care planning Resource. 7th Edition.
surgical management
This may include surgical removal of the tumour and postoperative care of a patient following craniotomy.
The transphenoidal approach is frequently used for the removal of pituitary tumours.
Assessments and common findings
Visual defects – tunnel vision is a fairly common finding
Headacheand Somnolence
Increased intracranial pressure
Behavioural changes
Hydrocephalus and papilloedema
Disturbed sleep pattern, appetite and temperature regulation.
Nursing management
Vital signs are measure to monitor hemodynamic, cardiac and ventilator status.
Because of the anatomic proximity of the pituitary gland to the optic ciasm, visual acuity is assessed at regular intervals.
One method is to ask the patient to count the number of fingers held by the nurse
Evidence of decreasing visual acuity suggests an expanding hematoma
The head of the bed is raised to decrease pressure on the sella turcica and to promote normal drainage
The patient is cautioned against blowing the nose or engaging in any activity that raises ICP, such as bending over or straining during urination or defecation
Pre-op microsurgery
Provide emotional support
Teach- head wrapped, eyes black/blue (settling of fluids and blood r/t surgery
Give cortisone
Post-op microsurgery
Check for S/sx pf cerebral edema (HR decreased, BP increased, pupil changes
HOB 30 degrees (decreases pressure on sella turcia, decreases headache)
Low dose pain meds