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Nur-354

Pituitary and Adrenal Disorders

TermDefinition
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