1. Interventions for Clients with Pituitary and Adrenal Gland Problems
Chapter 66
Interventions for Clients with Pituitary and Adrenal Gland Problems

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Hypopituitarism
Deficiency of one or more anterior pituitary hormone results in metabolic problems and sexual dysfunction.
Growth hormone stimulates the liver to produce substances known as somatomedins that enhance growth activity.
S&P
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3. Collaborative Management
Assessment
Interventions include:
Replacement of deficient hormones
Androgen therapy for virilization; gynecomastia can occur
Estrogens and progesterone
Growth hormone
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Hyperpituitarism
Hormone oversecretion occurs with pituitary tumors or hyperplasia
Neurologic symptoms may occur.
Galactorrhea, amenorrhea, and infertility can result.
(Continued)
S&P
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5. Hyperpituitarism (Continued)
Gigantism is the onset of growth hormone hypersecretion before puberty.
Acromegaly is the onset of growth hormone hypersecretion after puberty.
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Disturbed Body Image
Interventions include:
Nonsurgical management:
Drug therapy
Radiation therapy
Surgical management:
Preoperative care
Operative procedure
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Postoperative Care
Monitor neurologic response.
Observe for complications.
Assess for postnasal drip.
Teach client to avoid coughing early after the surgery.
Assess for meningitis.
Replace hormones and glucocorticoids as needed.
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Sexual Dysfunction
Interventions for hyperpituitarism:
Identification of specific client problems with sexual expression.
Drug therapy to supplement hormones as needed.
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Diabetes Insipidus
Water metabolism problem caused by an antidiuretic hormone deficiency
Diabetes insipidus is classified as:
Nephrogenic
Primary
Secondary
Drug-related
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Assessment
Diabetes insipidus related to dehydration
Increase in frequency of urination and excessive thirst
Dehydration and hypertonic saline tests used for diagnosis of the disorder
Urine diluted with a low specific gravity (<1.005)
S&P
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Interventions
Oral chlorpropamide
Desmopressin acetate intranasally
Early detection of dehydration and maintenance of adequate hydration
Lifelong vasopressin therapy for clients with permanent condition of diabetes insipidus
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12. Syndrome of Inappropriate Antidiuretic Hormone Secretion
Vasopressin is secreted even when plasma osmolarity is low or normal.
Feedback mechanisms do not function properly.
Water is retained, resulting in hyponatremia (decreased serum sodium level).
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Interventions
Fluid restriction
Drug therapy: diuretics, hypertonic saline, demeclocycline
Safe environment
Neurologic assessment every 4 hours
S&P
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14. Adrenal Gland Hypofunction
Addisonian crisis
Clinical manifestations include:
Decreased pigmentation
Decreased body hair
Hypoglycemia
Blood volume depletion
Hyperkalemia, which can cause cardiac arrest
S&P
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Interventions
Promote fluid balance and monitor for fluid deficit.
Record weight daily.
Ensure fluid balance.
Assess vital signs every 1 to 4 hours, assess for dysrhythmias or postural hypotension.
(Continued)
S&P
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16. Interventions (Continued)
Monitor laboratory values to identify hemoconcentration.
Give cortisol and aldosterone replacement therapy.
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17. Adrenal Gland Hyperfunction
Cushing’s syndrome
Pheochromocytoma
Clinical manifestations: buffalo hump, enlarged trunk, acne, muscle wasting, weakness
Hirsutism, clitoral hypertrophy, and male pattern balding in women
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18. Nonsurgical Management
Drug therapy gives temporary relief: mitotane, aminoglutethimide, metyrapone
Radiation therapy
S&P
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Surgical Management
Total hypophysectomy
Preoperative care
Operative procedure
Postoperative care
Preventing skin breakdown
Pathologic fractures
Gastrointestinal bleeding
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Hyperaldosteronism
Conn's syndrome
Interventions include:
Surgery when potassium levels are normal
Drugs to increase potassium levels
Glucocorticoid replacement to prevent adrenal crisis
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Pheochromocytoma
Catecholamine-producing tumors that arise in chromaffin cells
Intermittent episodes of hypertension or attacks varying in length from a few minutes to several hours
Main treatment: surgery
(Continued)
S&P
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22. Pheochromocytoma (Continued)
Treatment of hypertension to reduce stressors
Diet rich in calories, vitamins, and minerals
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