CHAPTER 56 ENDOCRINE SYSTEM Disorders of the Pituitary Gland PG. 947  Acromeg aly (Hype rpituitaris m):  A condition in which an over secretion of GH (gro wth hormone ) occurs after the epiphyses of the long bones have sealed  Results of hyperplasia (increase in the number of cells) or a tumor of the anterior pituitary. S/S of Acromegaly  S/S: coarse features, a huge lower jaw, thick lips, a thickened tongue, a bulging forehead, a bulbous nose, and feet (fig 56-1)  The heart, liver, and spleen may be enlarged. Despite enlarged tissues, muscle weakness is common, and hypertrophied joints may become painful and stiff  Osteoporosis of the spine and joint pain develop. Acromegaly Medical Management  Treated by surgical removal of the pituitary gland or by radiation therapy with consequent destruction of the pituitary.  Even if the disease is arrested successfully, physical changes are irreversible.  If the tumor is removed or destroyed by radiation therapy, replacement therapy with thyroid hormone, corticosteroids, and sex hormones is necessary Simmond’s Disease (Panhypopituitarism) PG. 949  Simmond’s dis e as e is a rare disorder caused by destruction of the pituitary gland followed by an absence of pituitary hormonal activity.  Events such as postpartum emboli, surgery, tumor, and TB can destroy pituitary function. S/S Simmond’s Disease  The gonads and genitalia atrophy.  S/s of hypothyroidism, hypoglycemia, and adrenal insufficiency are apparent.  The client ages prematurely and becomes extremely cachectic. Medical Management  Administration of substitute hormones for the glands that depend on the pituitary for stimulation.  If untreated, the disease is fatal.  Assess the client’s mental status, emotional state, energy level, and appetite. Diabetes Insipidus pg 950  An endocrine disorder that develops when there is insufficient antidiuretic hormone (ADH) from the posterior pituitary gland.  Can be caused by head trauma that damages the pituitary and by primary or metastatic brain tumors. S/S  Urine output for a 24 – hour period may be as high as 20 liters (20,000 mL)  The urine is dilute, with a specific gravity of 1.002 or less.  The excretion of urine cannot be controlled by limiting the intake of fluids  The need for drinking and voiding frequently limits activities  Weakness, dehydration, and weight loss develop. [...]... used to block the synthesis of thyroid hormones A corticosteroid may be given IV to replace depletion that results from overstimulation of the adrenals during the hypermetabolic state Thyrotoxic Crisis    IV sodium iodide prevents the release of thyroid hormones by the thyroid gland Inderal, a beta blocker, reduces the effect of thyroid hormones on the cardiovascular system Supportive therapy includes... respects to those of hyperthyroidism The metabolic rate and physical and mental activity are SLOWED!! Lethargic, lacks energy, dozes frequently during the day, is forgetful, and has chronic headaches The face takes on a mask like unemotional expression, yet the client often is irritable S/S      The tongue may be enlarged and the lips swollen, and there may be edema of the eyelids The temperature... and oxygen therapy Thyrotoxic Crisis   Nurs ing Manag e me nt: Pt is ac ute ly ill!! Monitor V/S esp the temperature (may require measures other than antipyretics such as cooling blankets or the application of ice) Hypothyroidism pg 954    Occurs when the thyroid gland fails to secrete an adequate amount of thyroid hormones May originate within the thyroid (primary) or within the pituitary, in... hyponatremia is treated with IV administration of a 3% hypertonic sodium chloride solution Nursing Management   S/s of fluid overload: confusion, dyspnea, pulmonary congestion, hypertension S/s of hyponatremia: weakness, muscle cramps, anorexia, nausea, diarrhea, irritability, HA, and weight gain without edema Disorders of the Thyroid Gland PG 951  Thyroid disorders include hyperthyroidism, thyrotoxic... synthetic drugs with ADH activity that reduce the urine output to 2 to 3 L/24 hours IV fluids if unable to take po Syndrome of Inappropriate Antidiuretic Hormone Secretion    SIADH—characterized by renal reabsorption of water rather than its normal excretion Causes include lung tumors, central nervous system disorders, brain tumors, CVA, head trauma, and drugs such as vasopressin, general anesthetic... rate are decreased, and there is an intolerance to cold The weight increase despite a low caloric intake The skin is dry, and hair characteristically is coarse and sparse and tends to fall out Menstrual disorders are common S/S      Constipation may be severe The voice is low pitched and hoarse, and speech is slow Hearing may be impaired There may be numbness or tingling in the arms or legs that... iodine is used to destroy thyroid tissue, tell the client that it does not seriously affect other tissues Radioactive Iodine Thyrotoxic Crisis   An abrupt form of hyperthyroidism that is a lifethreatening event Thought to be triggered by extreme stress, infection, diabetic ketoacidosis, trauma, toxemia of pregnancy, or manipulation of a hyperactive thyroid gland during surgery or physical examination... surrounds the rear & sides of the eyeball S/s in Table 56-1 PG 952 Hyperthyroidism Medical Management    Antithyroid drugs are given to block the production of thyroid hormone Potassium iodide (Lugol’s solution) is prescribed in combination with an antithyroid drug Antithyroid medications should be avoided during pregnancy because they can induce hypothyroidism, or cretinism, in the fetus Nursing Management... tremors of the hands occur, resulting in unusual clumsiness ( 56-4) Graves Disease Hyperthyroidism      Cannot tolerate heat, and experience an increased appetite with weight loss Diarrhea also occurs Visual changes, such as blurred or double vision, can develop Exophthalmos, seen in client with sever hyperthyroidism, is due to enlargement of muscle and fatty tissue that surrounds the rear & sides of. .. hypoglycemics, and tricyclic antidepressants Continued release of ADH results in ↑ fluid volume and hyponatremia S/S   Water retention, HA, muscle cramps, and anorexia develop As the condition becomes more severe, nausea, vomiting, muscle twitching and changes in the LOC occur Medical Management   Treatment is aimed at eliminating the underlying cause Osmotic diuretics, such as mannitol and loop . removal of the pituitary gland or by radiation therapy with consequent destruction of the pituitary.  Even if the disease is arrested successfully, physical changes are irreversible.  If the. SYSTEM Disorders of the Pituitary Gland PG. 947  Acromeg aly (Hype rpituitaris m):  A condition in which an over secretion of GH (gro wth hormone ) occurs after the epiphyses of the long. epiphyses of the long bones have sealed  Results of hyperplasia (increase in the number of cells) or a tumor of the anterior pituitary. S/S of Acromegaly  S/S: coarse features, a huge lower