Hypopituitarism

Etiology

Clinical manifestations

Diagnosis

Treatments

Nursing Management

X-ray
Look at areas of
calcification

Growth hormone
(IM, SQ)

Weight to height ratio is off

Injury

* Short stature
* Deteriorating or absent rate of
growth
* Higher weight-for-height ratio
* Delayed bone age
* Permanent teeth delay
* Underdeveloped jaw
* Sexual development delay
* Normal intelligence
* HA with tumors
* Hypoglycemia

Etiology

Clinical manifestations

Diagnosis

Prior to epiphyseal closure

- proportional overgrowth of long
bones
- weight proportional to height
- HA related to tumors
- Possible hyperglycemia
(glucagon) & DM

History of
Surgery to
excessive growth remove tumor

Growth hormone
deficiency
> 50%
idiopathic
Infection
(TB,
meningitis,
encephalitis)
Tumor

MRI
Look for tumors
Blood test
Growth hormone
levels, 60-90
min after
sleeping,
thyroid, renal

Surgery/radiation
for tumors
Replace
hormones after
surgery/radiation

GH: prep, storage, dose

SE: Na retention, slipped
epiphysis, pseudo tumors,
hyperlipidemia, impaired
glucose, leukemia
*do not happen in those
actually deficient

GOAL promote
normal growth

VERY expensive
$50-60,000 year
Patient assistance programs

Treatments

Nursing Management

Hyperpituitarism
Growth hormone
hypersecretion
Tumors

After epiphyseal closure

- acromegaly: overgrowth of
head, lips, nose, tongue, jaw,
hands

X-ray
MRI
Lab test

Therapies to
destroy pituitary
tissue

Emotional support

- skin hyperplasia
- possible hyperglycemia
- teeth spacing

Anterior Pituitary
Etiology

Clinical manifestations

Diagnosis

Treatments

Nursing
Management

5x greater in females

* accelerated growth
* advanced bone age
* premature evidence of
secondary sexual characteristics
* acne
* adult body odor
* possible behavior change

History

Diet change

Support

Surgery,
radiation, chemo

Teaching meds

Precocious Puberty
Early sexual
development d/t
gonadotropin
(excessive for age)
caused by premature
activation of the
hypothalmicpituitary
gonadal axis

8 yo
Breasts: Caucasian
< 7, African
American < 6
90% idiopathic
Secondary to
antiseizure meds
Males:
CNS abnormalities
TUMOR
9yo

* sources of exogenous
hormones milk, milk
products, meats

Exam
* tanner staging
* height, weight,
span, upper/lower
body ratio
X-ray, US, CT, MRI
Labs
Evaluate response to
GnRH

Financial
GnRH analog

Thyroid
Etiology
Congenital
Hypothyroidism
Thyroid does not
produce thyroxine

Permanent
* not present
* partially exists
* ectopic
Transient
* mom taking meds for
hyperthyroidism during
pregnancy

Acquired
Hypothyroidism

Hashimotos
6 yo - adolescent

Clinical manifestations
* Large anterior & posterior
fontanel
* Umbilical hernia
* Constipation
* Prolonged jaundice

Diagnosis

Treatments

Nursing Management

Labs

Thyroid hormone
replacement

Early recognition to
prevent cretinism
(severe mental
retardation)

Thyroid hormone
replacement

Support

Thyroid scan

Not pooping out dead RBCs,

reabsorbed bilirubin causing jaundice

* Hypothermia
* Hypotonia
* Swollen eyelids
* Delayed mental response
NEURO
* Decreased rate of growth
* Goiter (enlarged thyroid gland) antithyroid
TSH keeps hitting thyroid
antibodies
* Weight gain with appetite
* Constipation
TSH levels
* Dry skin, thinning, coarse hair
* Lethargy/ fatigue/ sleepiness/
mental decline
* Cold intolerance
* Edema (boggy) of face, eyes,
hands
* Delayed deep tendon reflexes
* Delayed puberty
* metabolism

Teaching

Hyperthyroidism

Graves disease
(autoimmune)

* Increased rate of growth

* Goiter
* Weight loss despite excellent
appetite
* Warm, moist skin
* Tachycardia
* Ophthalmic changes
* Heat intolerance
* Emotionally labile
* Insomnia, fine tremors

Serum thyroid
tests

Anti-thyroid meds
* propylthiouracil
* methimazole

Teaching home,
school, community

Radioactive iodine
therapy
Thyroidectomy
Thyroid storm: HR,
hyperthermia, HTN

Adrenal Gland

Congenital Adrenal
Hyperplasia

Etiology

Clinical manifestations

Diagnosis

Treatments

enzyme activity

Male: no physical changes to

genitalia

Prenatal
*dexamethason
e

Hydrocortisone or
dexamethasone
(replace cortisol)

Recognition of
ambiguous genitalia

NB
* CA newborn
screening

Cortisol

Support

Florinef
(replace aldosterone)

Teaching signs of
dehydration

21-hydroxylase
deficiency
No secretion of
glucocorticoids
(cortisol, aldosterone)
increased ACTH
which stimulates
adrenals to secrete
more and get bigger

Female: male sex

characteristics
* enlarged clitoris
* fusion of labial folds
* rugae appearance to labia
* pseudohermaphroditism
Children (toddlers) present
* adrenarche
* accelerated growth velocity
* advanced bone age
* acne
* hirsutism

* labs
* physical
* US (look for
ovaries)

Surgery/gender
assignment
(very controversial)

Nursing
Management

 Na and cortisol K
Loss of water and Na
dehydration, hyperkalemia
Salt wasting

Pancreas
Etiology

Clinical manifestations

Diagnosis

Treatments

Genetics

Polyphagia

Glycosuria

Insulin management

Fasting blood
glucose levels

Blood glucose
management

History

Nutrition

DM type I

Destruction of beta
cells

Polyuria
Polydipsia
Weight loss

Nursing Management
Fluid balance
Insulin
Glucose/urine ketone
monitoring
TEACHING

Exercise
DKA
* Careful with
rehydration
* endogenous osmoles
in brain cerebral
edema
DM type II

Body unable to use

insulin effectively
Glucose accumulates
in body

Normally overweight

Insulin (sometimes)

3 Ps

Blood glucose
management
Nutrition
Exercise