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