Signs and Symptoms
such as fatigue, weakness, weight change, and
 Tumor: bitemporal hemianopia on visual
confrontation
 Varying signs of hormonal disturbances
depending on which hormones are being
under secreted
 Gonadotropin Deficiency
 Congenital onset
- Delayed or absent secondary sexual
characteristics
- May have micropenis, cryptorchidism
 Acquired
- Loss of body hair
- Infertility, decreased libido, impotence in
males, amenorrhea in females
- Osteopenia, muscle atrophy
 Loss of luteinizing hormone (LH) and follicle-
stimulating hormone (FSH), which causes
hypogonadism and infertility.
 Patients with isolated gonadotropin
deficiency may present as delayed
adolescence.
 Congenital gonadotropin deficiency may be
associated with micropenis or cryptorchidism
 Kallman’s syndrome: most common cause of
congenital isolated gonadotropin deficiency.
- Transmitted as an X-linked recessive trait.
- Associated with hyposmia caused by
hypoplasia of olfactory bulbs
- 50% of affected patient have unilateral renal
agenesis
 Congenital adrenal hypoplasia: a rare X-linked
disorder caused by a mutation in DAX-1 gene.
 Acquired gonadotropin deficiency, both men
and women lose axillary, pubic, and body hair
gradually, particularly if they are also
hypoadrenal.
- Men note diminished beard growth
- Libido is diminished
- Women have amenorrhea
- Men noted decreased erections
- Most patients are infertile
- Androgen deficiency predisposes patients to
osteopenia and muscle atrophy
 Thyroid-stimulating (TSH) deficiency
- Causes hypothyroidism with manifestations
hyperlipidemia
 Adrenocorticotropic hormone (ACTH) deficiency
- results in diminished cortisol secretion.
- Symptoms include weakness, fatigue, weight
loss, and hypotension.
 Growth hormone (GH) deficiency
- In childhood: failure to grow
- In adulthood: mild to moderate central
obesity, increased systolic blood pressure, and
increases in LDL cholesterol, GH deficiency
also results in a small heart with reduced
cardiac output, asthenia, and feelings of social
isolation.
 Panhypopituitarism
- Absence of all anterior pituitary hormones
- Patients with long-standing hypopituitarism
tend to have dry, pale, finely textured skin.
- Face has fine wrinkles and an apathetic
countenance
- Diagnosis of hypopituitarism must confirm decreased
hormone levels due to an abnormality of the
pituitary gland and rule out disease of the target
organ.
- cranial CT scan, revealing a tumor or abnormal
mass in the pituitary gland
- cranial MRI, revealing a tumor or abnormal mass
in the pituitary or hypothalamus
- serum luteinizing hormone (LH), decreased or
normal
- serum follicle stimulating hormone (FSH),
decreased or normal
- serum testosterone level, decreased
- serum estradiol (estrogen), decreased
- serum cortisol, decreased
- serum ACTH, decreased
- T4 (thyroid hormone), decreased
- serum thyroid stimulating hormone (TSH),
decreased or normal
- serum thyroid stimulating hormone response to
thyroid-releasing hormone, decreased
- serum growth hormone (GH), decreased
- serum insulin-like growth factor 1 (IGF-1),
decreased

Treatment    only after the patient is assessed for cortisol
 If hypopituitarism is caused by a tumor, treatment
by surgical removal and/or radiation therapy may be
indicated. However, replacement of deficient
hormones is often required even after successful
treatment of a pituitary tumor.
 Hormone therapy is needed to replace hormones
no longer made by organs under the control of the
pituitary gland.
 These include corticosteroids (cortisol), thyroid
hormone, sex hormones (testosterone for men and
estrogen for women), and growth hormone. Drugs are
also available to treat associated infertility in men and
women.
 Trans sphenoidal removal of pituitary tumors will
reverse hypopituitarism.
 Postoperative hyponatremia often occurs; serum
sodium must be checked frequently for 2 weeks after
pituitary surgery
 Hypogonadism due to prolactin excess usually
resolves during treatment with dopamine agonists
 Endocrine substitution therapy must be used
before, during, and often permanently after such
procedures.
 GH-secreting tumors may respond to octreotide.
 Radiation therapy with x-ray, gamma knife, or
heavy particles may be necessary but increases the
likelihood of hypopituitarism.
 Mainstay of substitution therapy for pituitary
insufficiency remains lifetime hormone replacement.
 Corticosteroids
 Hydrocortisone tablets
 Additional coriticosteroids must be given during
states of stress, eg, during infection, trauma, or
surgical procedures.
 For mild illness, corticosteroid doses are doubled
or tripled.
 Patients with secondary adrenal insufficiency due
to treatment with glucocorticoids at supraphysiologic
doses require their usual daily dose of glucocorticoid
during surgery and acute illness; supplemental
hydrocortisone is not usually required.
Thyroid
 Levothyroxine is given to correct hypothyroidism
deficiency or is already receiving glucocorticoids.
 Sex Hormones
 Androgen replacement: male hypogonadism
 Estrogen replacement: female hypogonadism
Nursing Intervention
 Provide care for the client undergoing
hypophysectomy or radiation therapy if
indicated
 Provide client teaching and discharge planning
concerning hormone replacement therapy and
importance of follow up care
Hyperpituitarism
- Hyperfunction of the anterior pituitary gland 
oversecretion of one or more of the anterior
pituitary hormones
- Usually caused by a benign pituitary adenoma
- 2 most common hormones affected:
- Prolactin
- Growth hormone
Prolactinoma
- Manifestation: HYPOGONADOTROPIC
HYPOGONADISM because of impingement of
tumor on normal tissue
- Female: menstrual disturbances, infertility,
galactorrhea, ovarian steroid deficit manifestations (
vaginal mucosal atrophy, decreased vaginal
lubrication and libido)
- Male: Decreased libido and possible impotence,
reduced sperm count and infertility, gynecomastia
Growth Hormone Hypersecretion
Gigantism: Gigantism: GH hypersecretion
prior to closure of epiphyses; proportional
growth
Gigantism: GH hypersecretion prior to closure
of epiphyses; proportional growth
ACROMEGALY AND GIGANTISM
Growth hormone exerts much of its growth-
promoting effects through the release of IGF-1
produced in the liver and other tissues.
Acromegaly: caused by a pituitary adenoma.
These tumors may be locally invasive,
particularly into the cavernous sinus.
 Usually sporadic but may rarely be familial.
Associated with endocrine tumors of the
parathyroids or pancreas.
May also be seen in McCune-Albright
syndrome and as part of Carney’s complex
(atrial myxoma, acoustic neuroma, and spotty
skin pigmentation.
Growth Hormone Hypersecretion: Signs and
symptoms
Enlarged hand and feet; Carpal tunnel
syndrome common
Coarsening of features esp. in acromegaly;
prominent mandible, tooth spacing widens,
Macroglossia  OSA
Hypertension, cardiomegaly, heart failure
Insulin resistance DM
Visual field defects: bitemporal
hemianopsiacomplete blindess
Headaches
Arthritis
Hypogonadism
Medication:
- Parlodel – AKA bromocriptine (2.5-15 mg
daily) .- used for enclosed tumors especially
for prolactinomas,
- dopamine agonist
- effective in lowering GH levels
- used if surgery or radiation therapy is not
successfully
Octreotide – Sandostatine
- long acting somatostin analogue
- used in treating carcinoid, used to relieve
GH oversecretion
- given SQ, 3-4 times daily
- S/E: pain at injection site, diarrhea,
steatorrhea, abdominal cramps, and
flatulence
- teach patient how to self-administer the drugs
Surgery:
- Transpenoidal approach: inscision is in the
gingival mucosa. Another inscision in the thigh
or abdomen is made to obtain muscle or fat.
The muscle or fat is used to pack the sella
turcica. . The floor of the sella turcica is
reconstructed with muscle and bone. After
surgery, cortisol replacement is started via IV..
- Position Post Op: Semi fowlers. (at least 30”)
- No activity that may increase the ICP of the
Px.
- WOF: CSF leak (postnasal drip even with
packing in place, constant swallowing or
statement that the px needs to swallow, halo
ring on the gauze sling). (Tes tape is
unreliable, send to lab for analysis). If + place
the px on bed rest. . Px may have to be
returned to surgery for repair. , Institute
measures to prevent infection. (Meningits
may occur so WOF for signs of nuchal ridity)
- Radiation Therapy
- Used when tumors have exceeded the sella
turcica and surgery has resulted in incomplete
removal of the tumor
- Given 4-6 weeks
- Diet
- CHO intolerance, CHF or frank DM may be
associated with these disorders. Adjust
accordingly
Nursing Interventions
Provide emotional support striking body
change can cause psychological stress.
Perform or assist with range-of-motion
exercises to promote maximum joint mobility
and prevent injury.
Evaluate muscle weakness, especially in the
patient with late-stage acromegaly.
Keep the skin dry. Avoid using an oily lotion
because the skin is already oily.
Be aware that pituitary tumor may cause
visual problems. If there is hemianopia, stand
where he can see you.
Provide emotional support striking body
change can cause psychological stress.
Perform or assist with range-of-motion
exercises to promote maximum joint mobility
and prevent injury.
Evaluate muscle weakness, especially in the
patient with late-stage acromegaly.
Keep the skin dry. Avoid using an oily lotion
because the skin is already oily.
 Be aware that pituitary tumor may cause Anticipate that the patient may develop
visual problems. If there is hemianopia, stand transient diabetes insipidus, usually 24 to 48
where he can see you. hours after surgery.
Transsphenoidal hypophysectomy
Be alert for increased thirst and increased
Endoscopic, transnasal, transsphenoidal urine volume with a low specific gravity.
pituitary microsurgery removal of adenoma
while preserving anterior pituitary function in If diabetes insipidus occurs, replace fluids and
administer aqueous vasopressin, or give
most patients.
Transsphenoidal surgery is usually well sublingual desmopressin acetate, as ordered.
Diabetes insipidus may resolve within 72
tolerated, but complication occur in about
10% (infection, CSF leak, and hypopituitarism) hours
Hyponatremia can occur 4-13 days
postoperatively and is manifested by nausea,
vomiting, headache, malaise, or seizure.
Diabetes insipidus may occur
PostoperativeCare

Keep the patient on bed rest for 24 hours after

surgery and encourage ambulation

Keep the head of bed elevated to avoid

placing tension or pressure on the suture line.

Instruct patient not to sneeze, cough, blow his

nose, or bend over for several days to avoid
disturbing the suture line.

Mild analgesics for headache cause by CSF loss

during surgery or for paranasal pain. Paranasal
pain typically subsides when the catheters and
packing are removed, usually 24 to 72 hours
after surgery. Provide oral care.

Anticipate that the patient may develop

transient diabetes insipidus, usually 24 to 48
hours after surgery.

Be alert for increased thirst and increased

urine volume with a low specific gravity.

If diabetes insipidus occurs, replace fluids and

administer aqueous vasopressin, or give
sublingual desmopressin acetate, as ordered.
Diabetes insipidus may resolve within 72
hours