NURSING CARE FOR

HIPOPITUITARISME
 DEFINITIONS
• Hypofunction of the pituitary gland (hypopituitarism)
can occur due to diseases of the gland or the
hypothalamus. (Robbins Cotran Kumar)
Hypopituitarism refers to the state of the anterior
pituitary secretion of several hormones, which is very
low. (ElizabethC Erorwin)
Hypopituitarism is hyporsecretion of one or more
anterior pituitary hormones. (Barbara C. Long)
Hypopituitarism is a condition that arises as a result
of pituitary hypofunction. Definition of anterior
pituitary hormones may occur from 3 pathways:

• Abnormalities in the gland that can damage the

secretory cells.
• Abnormalities within or adjacent to the pituitary stalk
which can lead to termination of the spread of the
factors that originate from the hypothalamus.
• Abnormalities in the hypothalamus which may impair
the release of the regulator on the front hypofyse.
 Etiology
Hypopituitarism may occur due to a malfunction of the pituitary gland
or hypothalamus. Cause concerns:

• Infection or inflammation by: fungal, pyogenic bacteria.

• Autoimmune diseases (autoimmune lymphoid pituitary)
• Tumors, for example of a type of hormone-producing cells that can
interfere with the formation of one or another hormone arbitrarily.
• Feedback from the target organ experiencing malfunctions. For
example, there will be a decrease in the secretion of TSH from the
pituitary gland when the thyroid is diseased secrete excessive levels
of HT.
• Hypoxic necrotic (death due to lack of O2) pituitary or oxygenation
can damage some or all of the hormone-producing cells. One of
them sheehan syndrome, which occurs after maternal hemorrhage.
 Clinical Manifestations
• Headache and visual disturbances or signs of increased intracranial pressure.
• Overview of the production of growth hormone excess include acromegaly (large
hands and feet as well as the tongue and jaw), profuse sweating, hypertension and
arthralgia (joint pain).
• Hyperprolactinemia : amenorrhea or oligomenorrhea, galactorrhea (30 %),
infertility in women, impotence in men.
• Chusing syndrome : central obesity, hirsutism, striae, hypertension, diabetes
mellitus, osteoporosis.
• Growth hormone deficiency : (growt hormone = GH) growth disorders in children.
• Gonadotropin deficiency : impotence, decreased libido, body hair loss in men,
amenorrhea in women.
• TSH deficiency : fatigue, constipation, dry skin laboratory picture of
hyperthyroidism.
• Corticotropin Deficiency : malaise, anorexia, fatigue is real, pale, the symptoms are
very severe for ordinary mild systemic disease, laboratory overview of the decline
in adrenal function.
• Vasopressin deficiency : polyuria, polydipsia, dehydration, unable to concentrate
urine.
 Phisical Examination
• Inspection : Observe the shape and size of the body, measuring weight
and height, observe the shape and size of the breast, axillary and pubic
hair growth in male clients, observe also the growth of facial hair (beard
and mustache).
• Palpation : Palpation of the skin, the woman usually becomes dry and
rough.Depending on the cause hipopituitary, other data should also be
assessed as a concomitant of data as if the cause is a tumor it is necessary
to check the function of the cerebrum and cranial nerve function and the
presence of headaches.
Diagnostic Test
• Assess the physical changes also impact on the ability of clients to meet
their basic needs.
3. Supporting data of the diagnostic workup such as :
X-ray of cranium to see the dilation and erosion of the sella turcica or .
• Examination of blood serum : LH and FSH GH, prolactin, alsdosteron,
testosterone, cortisol, androgens, which include test stimulation of insulin
tolerance test and thyroid releasing hormone stimulation.
 Nursing Diagnosis
• 1. Disturbed Body Image related to changes in body structure and function
of the body due to deficiency of gonadotropin and growth hormone
deficiency.
2. Ineffective individual coping related to the chronicity of the disease
condition.
3. Low Self-Esteem related to changes in body appearance.
4. Disturbed Sensory perception (visual) related to impaired transmission
of impulses as a result of suppression of tumor on the optic nerve.
5. Anxiety related to threat or change in health status.
6. Self care deficit related to the decrease in muscle strength.
7. Risk for impaired skin integrity (drought) related to declining hormonal
level
 Nursing Intervention for
Hypopituitarism Disease
• :
• Various nursing intervention for hypopituitarism disease are described in the
below:
• Monitor vital signs blood pressure, heart rate and rhythm every 2 hours.
• Assess lung and heart sounds 4 hourly, be alert for s/s of congestive heart disease
• Watch for chest pain or dyspnea because hypothyroidism can develop chronic
arteriosclerosis.
• Monitor weight daily because ADH from pituitary gland regulates fluid retention
and excretion in the body.
• Administer human growth hormone as prescribed.
• Somatropin should be injected subcutaneously on a daily basis, preferably in the
evening.
• Teach patients that thyroid replacement therapy must be taken for lifetime and
administered in the morning on an empty stomach because thyroid medications
can cause insomnia if taken at night.
• Teaching patient to never miss any dose of medication without consulting with
physician.
 NURSING INTERVENTIONS
• Provide high protein, low calorie fibre food.
• Provide iodine rich diet, which is easily accomplished with iodized salt.
• Instruct patient to avoid constipation and provide stool softeners.
• Monitor laboratory test for hormonal deficiencies until the patient completes
hormone replacement therapy.
• Administer replacement fluids, electrolytes, and glucose as prescribed by physician
to maintain normal serum levels.
• Monitor intake and output to ensure the balance is equal due to hormone
regulation.
• Monitor physical and mental status and Encourage patient to express their
feelings.
• Instruct the patient when sleeping with head elevation position to reduce trauma
to the eye.
• Teach patients to change positions slowly and to notify healthcare provider
immediately if they develop an increased or irregular pulse, palpitations,
nervousness, heat intolerance, diarrhoea, sweating or irritability.
• Encourage clients to ask about the issue of face.
 NURSING INTERVENTION
• Encourage clients to discuss the issue of sexual dysfunction with partner.
• Generate patient motivation to continue the treatment programme on a
regular basis.
• Give the clients a chance to meet their needs independently.
• Make a mutual trust relationship with client.
• Provide emotional and psychological care that patient feel comfort.
• Give skin care and encourage patient to perform regular skin care.
• If patient have cold sensitivity, keep patient warm and provide extra
clothing and avoid the patient getting chilled.
• Avoid using heating pads and electric blankets because of the risk of
peripheral vasodilation.
• Refer the family for psychological counselling.
• Observe eyelids, nails beds and skin pallor which indicate anemia.
• Ensure safety prequitions for patients with impaired visual field.
• Wet the eye with sterile water to provide comfort to the eye.