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Nur-354
Pituitary and Adrenal Disorders
| Term | Definition |
|---|---|
| This structure is located at the base of the brain, just below the hypothalamus and attached to it by nerve fibers | Pituitary gland |
| This gland is a pea-sized structure | Pituitary gland |
| This pituitary disorder involves an excess of growth hormone in adults | Acromegaly |
| The presence of this on the pituitary gland can cause excess release of growth hormone that causes thickening and changes to the bones and soft tissues | Benign tumor |
| Another name for a tumor on the pituitary gland | Pituitary adenoma |
| Large hands and feet, a larger tongue and a deeper voice are clinical manifestations of this pituitary disorder | Acromegaly |
| Because the thickened tissues (i.e. tongue) falls back in the throat while sleeping, this disorder can be a problem for people with acromegaly | Sleep apnea |
| Because of the presence of a tumor on the pituitary, these clinical manifestations may occur in regards to acromegaly | Headache, visual changes and anosmia |
| Loss of sense of smell | Anosmia |
| Peripheral neuropathy, weakness, atherosclerosis, and hyperglycemia (polydypsia, polyuria) are clinical manifestations of this pituitary disorder | Acromegaly |
| This pituitary disorder involves the reduced secretion of pituitary hormones | Hypopituitarism |
| Growth hormone (GH), follicle-stimulating hormone (FSH), lutenizing hormone (LH), thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH) and prolactin are all secreted in what part of the pituitary gland? | Anterior pituitary |
| Antidiuretic hormone and oxytocin are produced in what part of the pituitary gland? | Posterior pituitary |
| This syndrome is from postpartum hemorrhage that causes circulatory collapse resulting in panhypopituitarism | Sheehan syndrome |
| Pituitary tumor, autoimmune, and Sheehan syndrome are all possible causes of this pituitary disorder | Hypopituitarism |
| Because of the presence of a tumor on the pituitary, these clinical manifestations may occur in regards to hypopituitarism | Headache, blurred vision, anosmia, and seizures |
| The clinical manifestations of hypopituitarism vary depending on what? | Hormone and target gland; if TSH is not getting released, then hypothyroidism would result in dry, brittle nails, weight gain, fatigue and being cold; if FSH is affected, then you might see menstrual irregularities |
| This syndrome results in increased antidiuretic hormone | Syndrome of inappropriate antidiuretic hormone (SIADH) |
| This syndrome results in fluid retention, serum hypoosmolality, dilutional hyponatremia, and concentrated urine | Syndrome of inappropriate antidiuretic hormone (SIADH) |
| This is the most common cause of SIADH | Small cell lung cancer |
| Opioids and thiazide diuretics can cause what syndrome? | Syndrome of inappropriate antidiuretic hormone (SIADH) |
| CNS disorders such as head injury, stroke and meningitis can cause this syndrome | Syndrome of inappropriate antidiuretic hormone (SIADH) |
| Low urinary output, weight gain, exertional dyspnea, dilutional hyponatremia and cerebral edema are clinical manifestations of what syndrome? | Syndrome of inappropriate antidiuretic hormone (SIADH) |
| Stomach cramps that can progress to muscle twitches and seizures are manifestations of what electrolyte imbalance? | Hyponatremia |
| Lethargy, confusion, coma, anorexia, headache and seizures are manifestations of what complication of SIADH? | Cerebral edema |
| Is diabetes insipidus related to diabetes mellitus? | No - then why is it called that!? |
| This disorder results in decreased antidiuretic hormone | Diabetes Insipidus |
| This disorder results in excessive fluid loss, serum hyperosmolality, and hypernatremia | Diabetes Insipidus |
| Impaired ADH synthesis is what type of cause of diabetes insipidus? | Neurogenic |
| Decreased renal response is what type of cause of diabetes insipidus? | Nephrogenic |
| What medication is a common cause of nephrogenic diabetes insipidus? | Lithium |
| Excessive water intake is what type of cause of diabetes insipidus? | Psychogenic |
| What might a hypothalamic tumor cause? | Increased thirst |
| Polyuria, polydypsia, and fluid and electrolyte imbalances are clinical manifestations of what disorder? | Diabetes Insipidus |
| The water restriction test is used to diagnose what disorder? | Diabetes Insipidus |
| What is another name for Vasopressin? | ADH |
| Obtaining a baseline BP, HR, urine specific gravity and osmolaity are required before administering what diagnostic test for diabetes insipidus? | Water restriction test |
| What is the water restriction test used to diagnose? | The cause of diabetes insipidus |
| In regards to acromegaly, what is transsphenoidal hypophysectomy? | Surgical removal of the tumor to decrease GH production |
| What medication inhibits growth hormone? | Octreotide (Sandostatin) |
| If the pituitary gland is damaged or needs to be removed for whatever reason, what may be needed? | Lifetime hormone replacement |
| Postoperatively to a transsphenoidal hypophysectomy, what position should the bed be placed? | Elevate the HOB 30 degrees |
| Why should coughing, straining and the Valsalva maneuver be avoided postoperatively to a transsphenoidal hypophysectomy? | The pressure can cause CSF leakage |
| Name two other surgeries where postoperatively coughing is discouraged | Hernia and thyroid surgery |
| If someone has to cough postoperatively to a transsphenoidal hypophysectomy, how should they do it? | With their mouth open to put less pressure on their sutures |
| How often should oral care be performed postoperatively to a transsphenoidal hypophysectomy? | q 4 hrs |
| For how long should a patient refrain from toothbrushing postoperatively to a transsphenoidal hypophysectomy? | 10 days |
| In regards to hormone replacement following damage to or removal of the pituitary gland, where is the replacement hormone targeted? | At the target organ level |
| In managing SIADH, what is the primary intervention? | Correct the underlying cause; if it's a tumor, address that |
| Fluid restriction is necessary to treat SIADH; how much fluid should the patient be restricted to per day? | 800-1,000 mL/day |
| Using Lasix for the treatment of SIADH is fine, but since Lasix will also get rid of more sodium, where does the sodium level have to be (at a minimum) in order to use Lasix? | At least 125 mEq/L |
| Giving 3% hypertonic saline is a treatment for what disorder? | SIADH |
| DDAVP (Desmopressin), Vasopressin (ADH replacement), Chlorpropamide (Diabinese) and Carbamazepine (Tegretol) increase ADH levels and are used to treat what disorder? | Diabetes Insipidus |
| Treatment of this cause of diabetes insipidus includes low sodium diet, thiazide diuretics, and the use of Indomethacin (Indocin) | Nephrogenic |
| Name an example of a glucocorticoid | Cortisol |
| Name an example of a mineralcorticoid | Aldosterone |
| What catecholamines are produced in the medulla of the adrenal glands? | Epinephrine, norepinephrine, and dopamine |
| What hormones are produced in the cortex of the adrenal glands? | Glucocorticoids, mineralcorticoids, and androgens |
| This syndrome is from excess corticosteroid secretion | Cushing syndrome |
| What do glucocorticoids affect? | Metabolism; increase glucose |
| What do mineralcorticoids affect? | Na+ and K+ balance |
| What do androgens affect? | Growth and development |
| The most common cause of this adrenal disorder is excess exogenous corticosteroid use | Cushing syndrome |
| The presence of a pituitary tumor could also cause Cushing syndrome because of the release of this hormone that activates the adrenal glands to release steroids | Adrenocorticotropic hormone (ACTH) |
| Buffalo hump and moon face are classic signs of this disorder | Cushing syndrome |
| Adrenal tumors and lung/pancreas tumors can also lead to development of this adrenal disorder | Cushing syndrome |
| Truncal obesity, abdominal striae, hirsutism in women, menstrual disorders, hypertension and muscle wasting are clinical manifestations of what adrenal disorder? | Cushing syndrome |
| What is the first step in treating Cushing syndrome? | Treat the underlying cause |
| How should the use of exogenous steroids be stopped? | Gradual reduction |
| This medication can be used to inhibit corticosteroid synthesis as part of medical adrenaletomy management of Cushing syndrome | Aminoglutethimide (Cytaden) |
| What are three implications of long-term steroid use? | (1)risk for infection, (2)imbalanced nutrition due to altered metabolism and increased glucose, and (3)disturbed self-image |
| Are the physical changes associated with Cushing syndrome permanent? | No |
| This is a primary cause of a hypofunctioning adrenal cortex which results in diminished steroid synthesis | Addison's Disease |
| This is a secondary cause of a hypofunctioning adrenal cortex which results in diminished steroid synthesis | Pituitary dysfunction |
| In Addison's Disease, all three classes of adrenocortico hormones are reduced; name the three classes | Glucocorticoids, mineralcorticoids, and androgens |
| Autoimmune, pituitary tumor, and abrupt discontinuation of exogenous steroids can cause what disorder? | Adrenocortical insufficiency |
| Insiduous onset is a clinical manifestation of Addison's Disease; what percentage of the adrenal cortex is damaged before symptoms present? | 90% |
| Hyperpigmented skin is a clinical manifestation of what adrenal disorder? | Addison's Disease |
| Orthostatic hypotension, hyponatremia and hyperkalemia are clinical manifestations of what adrenal disorder? | Addison's Disease |
| N/V and diarrhea are clinical manifestations of what adrenal disorder? | Addison's Disease |
| Hydrocortisone and Fludrocortisone (Florinef) are corticosteroid replacements used to treat what adrenal disorder? | Addison's Disease |
| Increasing salt intake is an intervention for what adrenal disorder? | Addison's Disease |
| Frequent assessment of vital signs, fluids and electrolytes are included in the nursing management of what adrenal disorder? | Addison's Disease |
| Without these, patients are not able to handle stressors such as noise and extreme temperatures | Glucocorticoids (such as cortisol) |
| When patients are experiencing increased physiologic, psychologic or environmental stress, they may need increased replacement levels of these | Glucocorticoids |
| Is Addison Crisis life-threatening? | Yes |
| Stress, abrupt withdrawal of corticosteroids, damage to the pituitary gland during surgery, or pituitary gland dysfunction can trigger this life-threatening emergency | Addison Crisis |
| Hypotension, tachycardia and shock are possible manifestations of what crisis? | Addison Crisis |
| During Addison Crisis, pallor, cyanosis, decreased capillary refill, decreased urinary output and decreased level of consciousness are signs of what? | Decreased tissue perfusion |
| During Addison Crisis, these solute imbalances result | Hyponatremia, hyperkalemia and hypoglycemia |
| How does corticosteroid therapy impact blood pressure? | Helps to maintain a normal blood pressure |
| During corticosteroid therapy, decreases in lymphocytes, monocytes and eosinophils result in what? | Decreased immune and inflammatory responses |
| During corticosteroid therapy, the release of what three substances are inhibited? | Kinins, prostaglandins, and histamine |
| Once exogenous corticosteroids are taken for longer than 1 week, what happens to the production of endogenous corticosteroids? | Adrenal production of corticosteroids stops |
| Besides teaching patients to check their blood sugar levels and watch for signs of infection, patients must also be taught about what side effects of oral corticosteroids? | Gastritis or ulcers; need to take in the morning and with food to decrease stomach irritation |
| Increased risk for osteoporosis is a side effect of what therapy? | Corticosteroid therapy |
| This adrenal disorder results from excessive aldosterone secretion | Hyperaldosteronism |
| What is the primary cause of hyperaldosteronism? | Tumor of the adrenal cortex that causes excessive secretion of aldosterone |
| What are secondary causes of hyperaldosteronism? | Renal artery stenosis and chronic kidney disease |
| Hypertension, hypernatremia and hypokalemia are clinical manifestations of what adrenal disorder? | Hyperaldosteronism |
| Because aldosterone results in sodium retention (and thus water retention) and potassium loss, this medication can be used to get rid of excess water while sparing potassium | Aldactone (Spironolactone) |
| These medications can be used to manage hypertension associated with hyperaldosteronism | Calcium channel blockers (Verapamil, Diltiazem) |
| This adrenal disorder results in excessive production of catecholamines | Pheochromocytoma |
| This is the cause of pheochromocytoma | Adrenal medulla tumor |
| Episodic hypertension is the major clinical manifestation of this adrenal disorder | Pheochromocytoma |
| Pounding headache, increased heart rate, hyperhydrosis and chest pain are clinical manifestations of this adrenal disorder | Pheochromocytoma |
| Term for excessive sweating | Hyperhydrosis |
| Preoperative treatment for the removal of an adrenal medulla tumor involves the use of these medications to control blood pressure and counteract the effects of excess catecholamines | Alpha- and beta-blockers |
Created by:
ssbourbon
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