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

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

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

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

Growth Hormone

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

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

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

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

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

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)

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

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

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