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Adult Medical-Surgical Nursing

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Presentation on theme: "Adult Medical-Surgical Nursing"— Presentation transcript:

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

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