Pituitary gland

The pituitary gland, or the hypophysis, is a round

structure about 1.27 cm (1⁄2 inch) in diameter
located on the inferior aspect of the brain.
It is divided into the anterior, intermediate, and
posterior lobes.
Commonly referred to as the master gland, the
pituitary secretes hormones that control the
secretion of hormones by other endocrine glands
The pituitary itself is controlled by the
hypothalamus, an adjacent area of the brain
connected to the pituitary by the pituitary stalk.
 HYPOPITUITARISM
Hypofunction of the pituitary gland (hypopituitarism)
Causes:-
Destruction of the anterior lobe of the pituitary gland.
Panhypopituitarism is total absence of all pituitary
secretions and is rare.
Postpartum pituitary necrosis (Sheehan’s syndrome) is
another uncommon cause of failure of the anterior
pituitary.
Complication of radiation therapy to the head and neck
area. The total destruction of the pituitary gland by
trauma, tumor.
Clinical manifestations:-
The result is extreme weight loss.
Emaciation.
Atrophy of all endocrine glands and organs.
hair loss
 impotence and amenorrhea
 hypometabolism and hypoglycemia.
Coma and death occur if the missing hormones are not
replaced.
Medical management:
Replacement of the misssing hormones
 PITUITARY TUMORS
Pituitary tumor are usually benign, but can cause life
threatening effects.
Clinical Manifestations
Clinical manifestations depends on tumor site but may
include
Gigantism if early in life
Acromegaly if developed late in life.
Cushing’s syndrome,
obese and somnolent
 fine, scanty hair
 dry, soft skin, and small bones.
headaches, loss of libido
visual defects progressing to blindness.
Assessment and Diagnostic Findings
 Assessment of visual acuity and visual fields.
CT and MRI
Serum levels of pituitary hormones
Evaluating hormones of target organs (eg,
thyroid, adrenal).
Medical management:-
Radiation therapy.
bromocriptine (dopamine antagonist), and
octreotide (synthetic analog of growth hormone).
 SURGICAL MANAGEMENT: HYPOPHYSECTOMY
Hypophysectomy, or removal of the pituitary
gland, may be performed to treat primary
pituitary gland tumors.
The absence of the pituitary gland alters the
function of many body systems. Menstruation
ceases and infertility occurs after total or near-
total ablation of the pituitary gland.
Replacement therapy with corticosteroids and
thyroid hormone is necessary; therefore,
patient teaching is imperative and is discussed
later in this chapter.
 DIABETES INSIPIDUS
Diabetes insipidus is a disorder of the posterior lobe of the pituitary
gland characterized by a deficiency of (ADH).
Clinical Manifestations:
Sever polyuria, water-like urine
Intense thirst, the patient tends to drink 2 to 20 liters of fluid daily.
Hypernatremia and severe dehydration.
Medical management:-
Life long replacement of antidiuretic hormone.
Nursing Management
Teach and show the patient how to administer the medications, and
observe return demonstrations as appropriate.
Wear a medical identification bracelet and to carry medication and
information about this disorder.
 SYNDROME OF INAPPROPRIATE
ANTIDIURETIC HORMONE SECRETION
(SIADH) includes excessive growth hormone and (ADH)
secretion from the pituitary gland.
Clinical manifestations:-
Oliguria
Dilutional hyponatremia.
Management:-
Eliminating the underlying cause
Fluid restrictions
Vincristine, tricyclic antidepressants, thiazide diuretics
Diuretics (eg furosemide [Lasix]) may be used along
with fluid restriction if severe hyponatremia is present.
Disorders of thyroid
gland
 Thyroid Gland
Thyroid gland is a butterfly-

shaped organ located in the lower

neck anterior to the trachea
It consists of two lateral
connected by an isthmus
The blood flow to the thyroid is

very high ( about 5 ml/min/g of

thyroid).
Thyroid Gland
Thyroid hormone

Two separate hormone produced by the thyroid gland

make up thyroid hormone : thyroxine and
triodothyronine. T4 contains four iodine atoms in each
molecule and T3 contains only three
Thyroxine (T4) accounts for about 90% of the

hormone secreted from the thyroid.

Thyroid Gland
Regulation of Thyroid Function
The secretion of T3 and T4 is under the control of
thyroid stimulating hormone (TSH or Thyrotropin) from
the anterior pituitary gland.
In turn the release of TSH is determined by the level of

thyroid hormones in the blood. (negative feedback)

Thyroid Gland
Function of thyroxine and triiodothyronine

1. Control the cellular metabolic activity

2. Influence cell replication

3. Important in brain development

4. Normal growth
 Thyroid Gland
Calcitonin

Calcitonin, or thyrocalcitonin, is another important

hormone secreted by the thyroid gland. It is secreted in
response to high plasma levels of calcium, and reduces
the plasma level of calcium by increasing its deposition
in bone.
Thyroid dysfunction
Consequently, hypo or hyperthyroidism
may
result from:
 A defect in the target gland
Disturbance in the secretion of TSH or
TRF
goiter
Enlargement of the
thyroid gland, which
often visible on the
anterior part of the neck.
Goitre is caused by
various hypothyroid and
hyperthyroid conditions
May be very large
compressing oesophagus
causing dysphagia or
alters trachea
 Hypothyroidism
Definition
Is a disorder in which levels of thyroid
hormones are decreased.
It can range from mild form to myxedema (advanced form).
Causes
Autoimmune thyroiditis (Hashimoto’s disease), in which the
immune system attacks the thyroid gland.
Hyperthyroidism treated by radioiodine, surgery, or antithyroid
medication.
Iodine deficiency
Hypothyroidism
Types
 Primary hypothyroidism
Dysfunction of the thyroid gland itself
 Pituitary or secondary hypothyroidism
entirely pituitary disorder
 Hypothalamic or tertiary hypothyroidism
the disorder is present in hypothalmus resulting in
inadequate secretion of TSH because of decreased
stimulation by TRH
 Cretinism
Hypothyroidism is present at birth
Hypothyroidism
Clinical Manifestation
Early symptom include:
 Fatigue
 Hair loss brittle nails and dry skin are reported
 Numbness and tingling of the fingers
 Amenorrhea
Sever hypothyroidism result in
 Subnormal temperature and pulse rate,
 Gain weight without an increase in food intake
 Skin thickness
 Myxedema coma, the patient become hypothermic and
unconscious
Hypothyroidism
Medical Management
 Thyroid hormone replacement

 Synthetic levothyroxine (synthroid or levothroid) is

the preferred medicine . The dose is based on the

patient’s serum TSH concentration
Hypothyroidism
Supportive therapy

1. Measured arterial blood gases.

2. Measure oxygen saturation by pulse oximetry

3. Application of external heat is avoided because it increase

oxygen requirement and may lead to vascular collapse .
4. If hypoglycemia is evident, concentrated glucose may be
prescribed.
 Nursing Management
1. The nurse role is to assist in the pt’s hygiene and encourage
him to participate in activity according to his tolerance

2. Monitor vital signs and cognitive level closely.

3. Help patient to get over the extreme intolerance to cold.

4. Prevent and control constipation

5. Assist with the treatment of myxoedema and myxoedema

coma
Hyperthyroidism
 Hyperthyroidism
Hyperthyroidism (Graves’ disease)
Excessive secretion of thyroid hormone
Clinical Manifestation
 Nervousness , hyperxcitable and irritable.
 They suffer from palpitations and Tachycardia even at rest

 Unable to tolerate heat

 Warm soft and moist skin, with asalmon colour,
 Patients may exhibit exophthalmos (bulging eyes)
 Increased appetite and dietary intake with Progressive weight loss
 Abnormal muscular fatigbility and weakness.
 Hyperthyroidism
Assessment and Diagnostic Findings
 Basis of symptoms

 Increase in serum T4 and an increased 123I or

125
I uptake by thyroid
Medical Management
1. Irradiation involving the administration of radioisotope
123
I for destructive effect on the thyroid gland.
2. Pharmacotherapy as antithyroid medication
3. Surgery , with removal of most of thyroid gland
Hyperthyroidism
Nursing Management

Improving Nutritional status

 Provide several well balanced meals of small size,

even up to six meals a day (because the patient

appetite is increased)
Hyperthyroidism
Nursing Management
1. Improving Nutritional status
2. Maintaining normal body temperature
3. Monitoring and Managing potential complication:-
 Monitor the patient for signs of thyroid strom
 Monitor cardiac and respiratory function by measuring Vital signs and
cardiac output, ECG,and pulse oximetry .
 Administer of oxygen to prevent hypoxia ,
 Administer IV fluid to maintain blood glucose levels and to replace lost fluids
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