HYPOPHYSECTOMY

A. General information
1. Partial or complete removal of the pituitary gland
2. Indications: pituitary tumors, diabetic retinopathy, metastatic cancer of the breast or prostate, which may be endocrine
dependent
3. Surgical approaches
a. Craniotomy: usually transfrontal
b. Transphenoidal: incision made in inner aspect of upper lip and gingival; sella turcica is entered through the floor of the
nose and sphenoid sinuses
4. Complications: increased intracranial pressure (ICP), bleeding, and meningitis
B. Nursing care
1. In addition to pre-op care of the craniotomy client, explain post-op expectations.
a. Initiate post-operative care similar to craniotomy
b. Monitor vital signs, neurologic status, and level of consciousness (LOC)
2. In addition to post-op care of the craniotomy client, observe for signs of target gland deficiencies (diabetes insipidus, adrenal
insufficiency, and hypothyroidism) due to total removal of the gland or to post-op edema.
a. Perform hourly urine outputs and specific gravities; alert physician if urine output is greater than 800-900 ml/2 hours or if
specific gravity is less than 1.004.
b. Monitor electrolyte values and for temporary diabetes mellitus resulting from antidiuretic hormone (ADH) disturbances
c. Monitor intake and output (I&O) and avoid water intoxication
d. Administer cortisone/glucocorticoids replacement as ordered, on time
e. Administer antibiotics, analgesics, antipyretics as prescribe
f. Instruct the client in the administration of prescribed medications, which may include hormones and glucocorticoids if the
entire gland was removed
3. If Transphenoidal approach used
a. Elevate the head of the bed to 30 degrees to decrease headache and pressure on the sells turcica.
b. Administer mild analgesics for headache as ordered.
c. Perform frequent oral hygiene with soft swabs to cleanse the teeth and mouth rinses; no toothbrushing.
d. Observe for and prevent CSF leak from surgical site.
1. Warn the client not to cough, sneeze, or blow nose.
2. Observe for clear drainage from nose or postnasal drip (constant swallowing); check drainage for glucose; positive
results indicate that drainage is CSF.
3. If leakage does occur
a. Elevate the head of bed and call the physician.
b. Most leaks will resolve in 72 hours with bed rest and elevation.
c. May do daily spinal taps to decrease CSF pressure.
d. Administer antibiotics as ordered to prevent meningitis.
4. Provide client teaching and discharge planning concerning
a. Hormone therapy
1. If gland is completely removed, client will have permanent diabetes insipidus
2. Cortisone and thyroid hormone replacement
3. Replacement of sex hormones
a. Testosterone: may be given for impotence in men
b. Estrogen: may be given for atrophy of the vaginal mucosa in women
c. Human pituitary gonadotropins: may restore fertility in some women
b. Need for lifelong follow-up and hormone replacement
c. Need to wear Medic-Alert bracelet
d. If Transphenoidal approach was used
1. Avoid bending and straining at stool for 2 months post-op
2. No toothbrushing until sutures are removed and incision heals (about 10 days)

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