PITUITARY GLAND DISORDER

HYPERPITUITARISM

Data Base
A. General information: Etiology and Pathophysiology
1. Hyperfunction/overactivity of the anterior pituitary gland resulting in oversecretion of one or more of the anterior pituitary
hormones
2. Characterized by an excessive concentration of pituitary hormones (GH, ACTH, PRL) in the blood, overactivity, and changes in
the anterior lobe of the pituitary gland
3. Two classifications of GH overproduction
a. Giantism or gigantism: generalized increase in size, especially in children; involves the long bones (before epiphyseal closure)
b. Acromegaly: occurs after epiphyseal closing, with the subsequent enlargement of cartilage, bone, and soft tissue of body (after
the closure of the epiphyses of the long bones)
4. Usually caused by a benign pituitary adenoma
B. Medical management: surgical removal or irradiation of the gland
C. Assessment findings
1. Tumor: bitemporal hemianopia; headache
2. Subjective: headaches; depression; weakness
3. Objective
a. Increased soft tissue and bone thickness
b. Facial features become coarse and heavy, with enlargement and protrusion of lower jaw, lips (become heavier), and tongue
c. Enlarged hands and feet
d. Increased growth hormone (GH), corticotropic hormone (ACTH), or prolactin (PRL)
e. X-ray examination of long bones, skull (sella turcica area), and jaw demonstrates change in structure
f. Amenorrhea, arthritic changes, visual disturbances, oily and rough skin, organomegaly
g. Signs of increased intracranial pressure such as vomiting, papilledema, focal neurologic deficits
h. Diabetes and hyperthyroidism may also occur
4. Hormonal disturbances depending on which hormones are being excreted in excess
D. Diagnostic tests
1. Skull x-ray, CT scan reveal increased growth hormone, oversecretion of other hormones
2. Plasma hormone levels reveal increased growth hormone, oversecretion of other hormones
E. Nursing/Therapeutic interventions
1. Monitor for hyperglycemia and cardiovascular problems (hypertension, angina, CHF) and modify care accordingly.
2. Provide emotional support to client and family, and encourage client and family to express feelings related to altered body image
3. Provide care for the client undergoing hypophysectomy or radiation therapy if indicated
4. Provide skin care
5. Provide pharmacological and nonpharmacological interventions for joint pain
6. Prepare the client for radiation of the pituitary gland if prescribed
7. Prepare the client for hypophysectomy if planned
8. Medications
a. Somatostatin analog octreotide (Sandostatin)
b. Dopamine agonist bromocriptine (Parlodel)
c. Medications to relieve symptoms of other endocrine imbalances resulting from pituitary hyperfunctioning
9. Surgical intervention (hypophysectomy) or irradiation of the pituitary

Nursing Care of Clients with Hyperpituitarism

A. ASSESSMENT 5. Assist the client in expressing feelings

1. Changes in energy level, sexual function and menstrual
patterns
2. Face, hands, and feet for thickening, enlargement; and
changes in the size of hat, gloves, rings, or shoes
3. Presence of dysphagia or voice changes
4. Presence of hypogonadism as a result of
hyperprolactimia
5. Reaction to changes in physical appearance and sexual
function
B. ANALYSIS/NURSING DIAGNOSES
1. Disturbed body image related to altered appearance
2. Disturbed sensory perception related to neurologic
deficits
3. Sexual dysfunction related to hormonal imbalance
C. PLANNING/IMPLEMENTATION
1. Help the client accept the altered body image that is
irreversible
2. Assist family to understand what the client is
experiencing
3. Help the client recognize that medical supervision will
be required for life
4. Help the client understand the basis for the change in the
sexual functioning
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6. Care for the client following a hypophysectomy
a. Encourage following an established medical
regimen
b. Protect from stress situations
c. Protect from infection
d. Follow and maintain and established schedule for
hormone replacement
7. Care for the client undergoing intracranial surgery
a. Perform neurologic assessments
b. Measure specific gravity of urine, monitor intake
and output, and check daily weight to identify
complication of diabetes insipidus
c. Check clear nasal drainage for glucose to determine
presence of CSF
d. Encourage deep breathing, but not coughing
e. Institute measures to prevent constipation because
straining increases intracranial pressure
D. EVALUATION/OUTCOMES
1. Verbalizes an improved body image
2. Reports satisfying sexual relationship
3. Continues medical supervision
ST. MICHAEL’S COLLEGE, INC. – ILIGAN CITY