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60 Cards in this Set
- Front
- Back
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Growth Hormone
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an anabolic hormone that promotes protein synthesis and mobilizes glucose and free fatty acids
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What does GH stimulate?
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The liver to produce IGF-1, which stimulates the growth of bones and soft tissue
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What is overproduction of GH typically caused by?
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benign pituitary tumor(adenoma)
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What does overproduction of glucose cause and elevation in?
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Blood glucose, which can lead to glucose intolerance
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Gigantism
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Excessive secretion of GH in children
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What happens if GH excess occurs before closure of epiphyses?
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The long bones are still capable of longitudinal growth and growth is usually proportional. ex. 8' tall 300 lbs.
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Acromegaly
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Excessive secretion of GH in adults
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If GH excess occurs after epiphyseal closure what occurs?
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The bones are unable to grow longer, so they get thicker and wider.
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What are the clinical manifestations of acromegaly?
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Enlargement of hands and feet, tufted or club-like fingertips, joint pain, crippling arthritis, enlarged mandible causing the jaw to jut forward, enlargement of paranasal and frontal sinuses, enlarged bony tissue of forehead, enlarged tongue (speech difficulties), and hypertrophy of vocal cords (deep voice)
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Why is a patient with Acromegaly at risk for developing atherosclerosis?
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Because GH mobilizes stored fat for energy it increases the amount of free fatty acids in the blood
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If Acromegaly is left untreated, what changes will it have on cardiovascular system?
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The patient will develop cardiomegaly, left ventricular hypertrophy, angina pectoris, and hypertension.
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What other systems will be affected by untreated acromegaly?
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Respiratory, GI, GU, Musculoskeletal, and Nervous systems
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What is the diagnostic criteria for Acromegaly?
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history and physical exam + failure of GH to fall below 1ng/ml during a glucose tolerance test + elevation of plasma IGF-1 levels and IGFBP-3 levels
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What other diagnostic tests are used after dx of Acromegaly to determine tumor locationand size?
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MRI, CT with contrast media, Opthalmologic Exam (d/t pressure on optic chiasm or nerves)
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What is the therapeutic goal in acromegaly?
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To restore GH levels to normal
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How do we treat acromegaly?
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Surgery, Drug Therapy, Radiation, or a combo of the above
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What are the conditions from acromegaly that may persist after treatment?
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Sleep apnea and diabetic and cardiovascular complications.
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Hypophysectomy
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Removal of the entire pituitary gland
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Transsphenoidal Approach
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The approach taken to remove the majority of pituitary tumors associated with acromegaly. It removes only the tumor associated with GH secretion.
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If a patient undergoes a hypophysectomy what must happen?
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They must take an oral form of the 3 essential hormones secreted by the pituitary gland(gluccocorticoids, thyroid, and sex hormones) for the rest of their life!
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When is radiation therapy most often used for treatment of acromegaly?
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If surgery fails to produce complete remission and to reduce the size of the tumor before surgery
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Stereotactic Radiosurgery
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Used for small surgically inaccessible tumors or in place of conventional radiation
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Drug therapy for Acromegaly includes what 3 types of drugs?
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Somatostatin analogs, GH receptor antagonists, and Dopamine agonists
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What is the most common drug used to treat Acromegaly?
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octreotide (Sandostatin) SQ 3x/wk - a somatostatin analog
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What are the names of other drugs used to treat acromegaly?
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lanreotide, pegvisomant, cabergoline, somatropin
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What does the nurse need to assess with acromegaly?
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Abnormal tissue growth, physical size, question about hat, ring, glove, and shoe size changes, photograph comparisons.
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What are nursing diagnoses for a patient with acromegaly?
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Disturbed body image, Deficient fluid volume r/t polyuria, Insomnia r/t soft tissue swelling, Disturbed sensory (visual) perception r/t enlarged pituitary gland
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What are the goals/outcomes for a patient with acromegaly?
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1) cope effectively with altered body image 2)Maintain adequate fluid volume 3)Experience restful sleep patterns 4)Develop no complications 5)Obtain long-term follow up care
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After surgery for acromegaly the nurse should tell the patient to avoid doing what?
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Vigorous coughing, sneezing, and straining of stool to prevent CSF from leaking where the sella turcica was entered
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What measure needs to be taken to avoid pressure on the sella turcica after a transsphenoidal approach surgery for Acromegaly?
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Keep the head of the bed at a 30 degree angle at all times, this also decreases headaches
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After surgery for Acromegaly, what should the nurse do if the patient has clear drainage from their nose?
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Send drainage to the lab to be tested for glucose. Glucose >30mg/dl indicates CSF leakage.
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CSF leakage after hypophysectomy puts the patient at risk for...
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Meningitis
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After Acromegaly surgery the nurse should do what every 4 hours?
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Perform mouth care to keep the surgical area free from debri and promote patient comfort.
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What postoperative complication may occur after surgery for acromegaly?
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Transient Diabetes Insipidus d/t loss of ADH stored in pituitary gland
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What must be monitored after Acromegaly surgery to detect possible DI?
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Urine output and serum and urine osmolarity
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Prolactinomas
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The most frequently occuring pituitary tumor.
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What are the prolactimoma clinical manifestations in women?
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galactorrhea, ovulatory dysfunction, menstraul dysfunction, decreased libido, and hirsutism
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What are the prolactimoma clinical manifestations in men?
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impotence, decreased libido, sperm density
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What are the drugs used to treat prolactinomas?
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Dopamine agonists such as: bromocriptine, cabergoline, and pergolide
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What are the treatments for Prolactinomas?
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Drug therapy, Transsphenoidal Approach surgery, and radiation if no response to the first two.
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Hypopituitarism
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A rare disorder that involves the decrease in one or more of the pituitary hormones
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Selective Hypopituitarism
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A deficiency of only one pituitary hormone
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Panhypopituitarism
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Total failure of the pituitary gland resulting in deficiency of all pituitary hormones
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What are the most common hormone deficiencies associated with hypopitiutarism?
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GH and gonadotropins (LH, FSH)
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What is the most common cause of hypopituitarism?
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Pituitary tumor
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What are possible causes of hypopituitarism?
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autoimmune disorders, infections, pituitary infarction, destruction of the pituitary gland
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What is Sheehan Syndrome?
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A post partum condition of pituitary necrosis and hypopituitarism that occurs after circulatory collapse from uterine hemorrhaging
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What do deficiencies in anterior pituitary hormones lead to?
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End organ failure
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What are the clinical manifestations for hypopituitarism from a space-occupying lesion?
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Headaches, visual changes, anosmia(loss of smell), and seizures
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What are the common clinical manifestations for adults with GH deficiency?
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truncal obesity, decreased muscle mass, reduced strength, decreased energy, reduced exercise capability, flat affect
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What are the clinical manifestations of FSH and LH deficency in women and in men?
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Women- menstraul irregularities, diminished libido, changes in secondary sex characteristics
Men- testicalar atrophy, diminished spermatogenesis, loss of libido, impotece, and decreased facial hair and muscle mass |
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What are the clinical manifestations of a deficiency in ACTH?
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weakness, fatigue, headache, dry mouth, pale skin diminished axillary and pubic hair, postural hypotension, fasting hypoglycemia, diminished tolerance for stress, and poor resistance to infection
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What are the symptoms associated with thyroid deficiency due to hypopituitarism?
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cold intolerance, constipation, fatigue, lethargy, snd weight gain
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Diagnostic Studies for hypopituitarism are?
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History and physical exam + MRI, CT + pituitary hormone levels
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What is the treatment for hypopituitarism?
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Surgery, radiation, hormone replacement
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SIADH (Syndrome of Inappropriate Antidiuretic Hormone)
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Overproduction or oversecretion of ADH
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DI (Diabetes Insipidus)
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Underproduction or undersecretion of ADH
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What is ADH also known as?
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AVP (arginine vasopressin)
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What is SIADH characterized by?
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fluid retention, serum hypoomolarity, dilutional hyponatremia, hypochloremia, concentrated uring in the presence of normal or increase intravascular volume, and normal renal function
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What is the most common cause of SIADH?
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Malignancy, especially small cell lung cancer
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