Adult Medical-Surgical Nursing Endocrine Module: Anterior Pituitary Hypersecretion (ACTH)

Pituitary Adenoma (ACTH)  Benign tumour but space-occupying lesion  Hyperplasia of basophilic cells  Hypersecretion of Adrenocorticotrophic hormone (ACTH) which over-stimulates the target organ the adrenal cortex → Cushing ’ s Syndrome

Pituitary Adenoma (ACTH): Pathophysiology  “Cushing’s Syndrome”  Fluid and fat retention and redistribution (altered body image)  Disturbance in CHO and fat metabolism → diabetic tendency and atherosclerosis  Retention of salt and fluid → hypertension  ↑ calcium resorption → osteoporosis

Pituitary Adenoma (ACTH): Cushing’s Syndrome  Moonface  Truncal obesity  Muscle wasting, thin limbs  Hypertension  Atherosclerosis  Amenorrhoea/ masculinity in female  Diabetic tendency  Osteoporosis

Pituitary Adenoma: Hypersecretion of ACTH: Diagnosis  Patient history and clinical picture  Blood hormone levels of: ACTH Cortisol  Brain MRI  Brain CT scan

Pituitary Adenoma (ACTH): Management  Surgery is first option:  Trans-sphenoidal excision of pituitary tumour or  Craniotomy (excision of tumour or hypophysectomy) followed by  Hormone Replacement Therapy  Dexamethasone may be given before surgery to ↓ tumour size; also given to reduce inflammation at surgery

Hypersecretion of Anterior Pituitary: Nursing Considerations  Patient education and support  Post-neurosurgery: care in ICU  Elevate head of bed 30 0 ( ↓ 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