1. Adult Medical-Surgical Nursing
Endocrine Disorders Module:
Anterior Pituitary Hypersecretion:
Growth Hormone

2. The Anterior Pituitary: Hormones
Growth Hormone (Somatotropin)
Thyroid Stimulating Hormone (TSH)
Adrenocorticotrophic Hormone (ACTH)
Follicle Stimulating Hormone (FSH)
Luteinising Hormone (LH)
Prolactin
Melanocyte Stimulating Hormone

3. Anterior Pituitary: Hypersecretion
Related to a pituitary adenoma, usually a benign tumour of the pituitary gland
A space-occupying lesion
Results in increased hormone secretion

4. Anterior Pituitary: Hypersecretion
Most common disorders are related to hypersecretion of:
Growth Hormone (eosinophilic cells)
ACTH (basophilic cells)
Prolactin (Prolactinoma)

5. Growth Hormone

6. Functions of Growth Hormone
Growth and repair of bone and soft tissue by:
Protein synthesis
Mobilisation of glucose and fatty acids
GH stimulates liver to produce Somatomedin-C (IGF-1) mediated by Somatostatin (GH release inhibiting hormone) under control of Hypothalamus)
Production increased during deep sleep

7. Pituitary Adenoma: Hypersecretion of Growth Hormone
Hypersecretion leads to:
Uncontrolled growth of bone and soft tissue
Uncontrolled mobilisation of stored fat increasing levels of fatty acids and glucose in circulation

8. Hypersecretion of Growth Hormone
Uncontrolled growth leads to:
Gigantism in young (very tall, exhaustion)
Acromegaly in adults

9. Hypersecretion of Growth Hormone Acromegaly: Clinical Manifestations
Large jaw, forehead, cheek bones, hands, feet
Enlargement of heart and all soft tissues
Hypertension

10. Hypersecretion of Growth Hormone Clinical Manifestations (cont)
Uncontrolled mobilisation of stored fat →
Atherosclerosis and hypertension
Truncal obesity, muscle-wasting
Diabetic tendency
Menstrual disturbances
FATIGUE
Visual disturbance, headache, neuropathy related to space-occupying lesion

11. Hypersecretion of Growth Hormone Diagnosis
History and clinical picture
Brain MRI
CT with contrast
Blood hormone levels especially Somatomedin-C
GTT (assessment of GH after glucose)

12. Hypersecretion of Growth Hormone Medical Treatment
GH (may stabilise levels reducing secretion)
Octreotide: synthetic Somatostatin (lowers level GH secretion)
Carbelogine: (Dopamine agonist) ↓ GH secretion
Somavere: GH receptor antagonist

13. Hypersecretion of Growth Hormone Neurosurgical Management
Surgery: trans-sphenoidal excision of pituitary adenoma
Craniotomy: removal of tumour or hypophysectomy (removal of gland)
Radiation prior to surgery to reduce size or instead of surgery if inaccessible
Gamma knife to target deep tissue

14. Hypersecretion of Anterior Pituitary: Nursing Considerations
Patient education and support
Post-neurosurgery: care in ICU
Elevate head of bed 300 (↓ ICP ↑ drainage)
Watch conscious level/ no convulsion
Monitor vital signs (infection risk/ haemodynamics)
Fluid balance (risk of Diabetes Insipidus)
Administer medications as prescribed: Dexamethasone, Epanutin, Antibiotics,HRT