Disorder of Pituitary Gland

Muhammad suliman
Lecturer
BTSON

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 Objectives
By the end of the session students will be able to:
• Anatomy and physiology of pituitary Gland
• Discuss the functions of growth hormone.
• Describe the disorders of anterior and posterior lobe of pituitary gland.
• Discuss treatment modalities of patients with pituitary gland disorders.
• Utilize nursing process in the provision of care for patients with disorder
of pituitary gland and for patients undergoing surgery of the gland.
• Discuss the impact of various endocrine disorders on patients and their
families
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 Pituitary Gland

Pituitary gland lies in the base of the skull in a portion of sphenoid bone called
Sella turcica and attached to the hypothalamus at the base of the brain.

1. The pituitary gland is commonly referred as the "master gland”

2. Controlled by hypothalamus. “chemical communication ”
Anatomy and Physiology of Pituitary Gland
• The pituitary fossa, is situated in the sphenoid bone in the middle cranial
fossa at the base of the brain.

• It consists of two Lobs:

• Anterior lobe (adenohypophysis):
• (FSH, LH, ACTH, TSH, GH, Prolactin)
• Posterior lobe (neurohypophysis):
• (ADH, oxytocin)
Pituitar y Gland
 PITUITARY GLAND
Pituitary gland or hypophysis is attached to the Hypothalamus at the base
of the brain

Anterior Pituitary Posterior Pituitary

Somatotrophs Store and release oxytocin (OT)

Produce Human Growth Hormone
(HcG) Or Somatotropin
Vasopressin Antidiuretic hormone
Thyrotrophs produce Thyroid (ADH)
Stimulating Hormone (TSH)

Gonadoptrophs produce Follicle-stimulating Hormone

(FSH) and Luteinizing Hormone (LH)

Lactotrophs produce Prolactin (PRL)

Corticotrophs produce Adrenocorticotropic Hormone (ACTH) and Melanocyte-

stimulating Hormone (MSH)
 Major Causes Pituitary Gland

• Tumors
• Pituitary infarction
• Genetic Disorders
• Trauma
 Pituitary Disorders
• Hypo secretion
• Dwarfism
• Hypothyroidism
• Myxedema
• Infertility
• Addison’s disease
Anterior • Hyper secretion
Pituitary • Acromegaly
• Hyperthyroidism
• Cushing’s disease
• Secondary thyrotoxicosis
• Graves' disease

Posterior • Diabetes insipidus

Pituitary • Syndrome of Inappropriate Antidiuretic Hormone (SIDAH)
DISORDER RELATED TO ANTERIOR
PITUITARY GLAND

NEXT SLIDE
 Disorders of Anterior Pituitary Gland
• The hypothalamus regulates the anterior pituitary by producing:
• Releasing hormones
• Inhibiting hormones

• Disorders of hormones secreted by anterior pituitary gland (adenohypophysis)

can results from:
• Problems arising within the anterior pituitary gland itself
(primary pituitary dysfunction)
• Problems in the hypothalamus

• In either case, one or more hormones may be under-secreted (pituitary hypo

function) or over-secreted (pituitary hyper function)
• The Anterior pituitary has five principle types of cells which secrete seven
major hormones.
 ANTERIOR PITUITARY CELLS

Somatotrophs Thyrotrophs Gonadoptrophs Corticotrophs

Lactotroph produce
• produce Human • produce • produce (FSH) and produce Adrenocorticotro
Growth Thyroid (LH).
Hormone Prolactin pic Hormone
Stimulating • FSH and LH (ACTH) and
(HCG) or Hormone stimulate the (PRL)
somatotropin which Melanocyte-
(TSH) secretion of estrogen
• which stimulates and progesterone and initiates milk
Stimulating
• which controls
general body secretions and the maturation of Hormone (MSH).
production in
growth and other activities oocytes in the ovaries ACTH stimulates
regulates certain and the secretion of the mammary
of the thyroid the adrenal cortex to
aspects of gland. testosterone and glands. secrete
metabolism. sperm production in glucocorticoids.
the testes. MSH affects skin
pigmentation.
Hypo Secretion of Pituitary Hormones
 Hypopituitarism
• Deficiency of one or more Anterior Pituitary Hormones (APH).
• Is usually gradual and may have single hormone deficiency or multiple
hormone
• Resulting in metabolic problem, sexual dysfunction and growth
retardation.
• Decrease production of all APH is a rare condition known as
Panhypopituitarism (Simmonds’disease)

• Treatment and prognosis depend on the extent of hypo-function, the

underlying cause and the location of the lesion
 Causes of Hypopituitarism

• Infarction
Vascular disease (diabetes-induced vascular lesions cause a vascular necrosis of the
adenohypophysis )

• Infections
 Tuberculosis, fungi, meningitis
 Pyogenic, syphilis
• Radiation

• Hypophysectomy(removal of P. Gland)
 Hypopituitarism (cont’…)
• In children lead to short stature and other manifestation of growth
retardation.
• In adults, it does not affect height but does increase bone destructive
GH activity, leading to thinner, more fragile bones.
• S/S: Fatigue, Decrease muscle mass, Loss of libido
• Women: Before puberty: Primary amenorrhea and failure of puberty
development
• After puberty: 2ndary amenorrhea and regression of 2ndary sexual
Gonadotropins
characteristic (breast atrophy, hair loss), Infertility
• Men: Before puberty: Failure of puberty development
(LH & FSH)
• After puberty: Decrease libido or impotence loss of 2ndary sexual
characteristic (facial & body hair loss), Infertility

• S/S: Cold intolerance, Dry skin, Loss of hair, Mental dullness,

Constipation, Weight gain, Bradycardia, Slow reflexes, Puffiness of the
TSH face, Myxoedema

• S/S: Weakness, Pallor of skin, Nausea and vomiting, Anorexia, Wt

ACTH loss, Postural hypotension, Addison’s disease
 Growth hormone (GH)

• Acts on the liver, stimulating it to release several polypeptide

hormones.
• Stimulates amino acid uptake and protein synthesis in target cells.
• Ultimately stimulates cell growth (cell size and number),
especially in muscle and bone.
• Also stimulates fat breakdown.
Hypopituitarism

Myxoedema
 Collaborative Assessment

• Neurologic S/S includes changes in vision and headaches

INVESTIGATIONS:
• Blood test of hormones:
• GH, ACTH, LH, PRL, FSH
• Stimulating tests:
• Injection of agents to stimulate specific pituitary hormones

• X-ray, CT scan and MRI of skull

• Changes in sella turcica-enlargement, erosion and calcification
 Interventions
Women:
• Replacement of deficient hormone • Hormonal treatment with
Men : combination of estrogen and
• with gonadotrophin deficiency: Steroid progesterone
replacement therapy with androgen
(testosterone) • High risk of HTN and
• IM or transdermal patch (contraindicated in Thrombosis with estrogen
prostrate cancer) therapy (specially who smoke)
• Begins with high dose till achievement of • For pregnancy(clomiphene
virility (presence of secondary sex
characteristics) citrate is prescribed)
• Dose then decreased but therapy is for • Or gonadotrophin releasing
lifetime hormone and human
• side effects include gynecomastia, acne, chorionic gonadotrophin is
baldness and prostrate enlargement used
• Fertility is difficult to achieve. Requires
additional human chorionic gonadotrophin • Growth hormone injections
• Outcome is uncertain.
Hyper Secretion of Pituitary Hormones
Tumours of the anterior pituitary can cause
syndromes of hormone excess

• GH Acromegaly

• ACTH Cushing’s disease

• TSH Secondary thyrotoxicosis

• LH/FSH (Non-functioning pituitary

tumour)

• PRL Prolactinoma
 Pituitary Tumors

• Are usually benign

• Their location and effects on hormone production can be life
threatening
• Three principal types of pituitary tumors represent an
overgrowth of
(1) Eosinophilic Cells
(2) Basophilic Cells
(3) Chromophobic Cells (ie, cells with no affinity for either
eosinophilic or basophilic stains).
 Pituitary Tumors (cont;...)

1. Eosinophilic Tumors: Early in life cause Gigantism. The

affected person is
• > 7 feet tall and large in all proportions
• Very weak that s(h)e can hardly stand.

• Acromegaly: During adulthood: Excessive skeletal growth occurs

only in the feet, the hands, the superciliary ridge,, the nose, and
the chin,
Median age at diagnosis is 40 years in males and 45 years in females.
 Difference b/w Gigantism & Acromegaly

Abnormally high linear growth due to

excessive action of insulin-like growth
factor-I (IGF-I)

Epiphyseal growth Growth plate cartilage fuses in

plates are open adulthood but the soft tissue can
during childhood. continue to grow and the bones
can grow in thickness.

Gigantism Acromegaly
 symptoms of gigantism

• Gigantism is characterized by extreme growth.

• Children with gigantism are very tall for their age and may also have
the following conditions:
• Enlarged hands, fingers, toes, head or tongue
• Excessive sweat production
• Headache
• Irregular menstrual periods in teens
• Late onset of puberty
• Production of breast milk (galactorrhea)
• Unusually large jaw, prominent forehead, and thick facial features
• Vision distortion, such as double vision and problems with peripheral
vision
• Weakness and tingling in the arms and legs due to enlarging tissues
compressing nerves
 Gigantism
Hyper secretion of GH

Bao Xishun, a 7ft 8.95in herdsman

from Inner Mongolia
 symptoms of Acromegaly
1. Swelling of the hands and feet 10. Enlarged lip, nose, and tongue
2. Facial features become coarse 11. Thickened ribs (creating a barrel
as bones grow chest)
3. Body hair becomes coarse as 12. Joint pain
the skin thickens and/or darkens
13. Degenerative
4. Increased perspiration
accompanied with body odor 14. Arthritis
5. Protruding jaw 15. Enlarged heart
6. Voice deepening 16. Enlargement of other organs
7. Irregular menstrual cycles in 17. Strange sensations and weakness
women in arms and legs
8. Breast milk production in 18. Snoring
women 19. Fatigue and weakness
9. Impotence in men 20. Loss of vision
21. Headache
 Pituitary Tumors (cont’...)

2. Basophilic tumors: Causes Cushing’s syndrome. Features include:

• Masculinization & amenorrhea in women, truncal obesity,
hypertension, osteoporosis, and polycythemia.

3. Chromophobic Tumors: represent 90% of pituitary tumors.

• They usually produce no hormones but destroy the rest of the
pituitary gland, causing hypopituitarism. Patients:
• Are often obese and somnolent (sleepy/drowsy)
• Exhibit fine, scanty hair, dry, soft skin
• Experience headaches, loss of libido, and visual defects
progressing to blindness. Other signs and symptoms include
polyuria, polyphagia, and a subnormal body temperature.
 Collaborative Assessment
1. Obtain data about client’s age, gender and family history
2. Changes in appearance, Change in hat, ring, glove or shoe size
3. Fatigue, lethargic
4. Backache, Arthralgia's, Arthritic changes in joints
5. PRL increase lead to sexual dysfunction, galactorrhea
6. Change in vision GH: facial features changes prominent brow ridge
7. Prognathism (jaw projection), Finger and toe thickness
8. Organomegaly, HTN, deepening of voice
9. Psychosocial assessment
10. Lab test includes GH, PRL, ACTH levels (elevated)
11. X-ray, CT scan and MRI of skull
12. Angiography (aneurysm or vascular malformation)
 Collaborative Interventions
Drug Therapy:
Dopamine Agonist (bromocriptine mesylate)
• Stimulate dopamine receptors in the brain and inhibit release of PH (GH
& PRL).
• Side effects: Orthostatic hypotension, GI irritation, headache, nausea,
vomiting, abdominal cramps and constipation.
• Treatment with low dose with gradual increase (usually 7.5mg per day).
Somatostatin analogues
• Inhibits GH release through negative feedback.
• Injection to be given on daily or weekly schedule.
• May cause gallbladder disease.
Psychosocial therapy:
• Encourage client to express concerns and fears about his or her altered physical
appearance.
• Help client identify personal strengths and positive characteristics, reinforcing each
client’s uniqueness and importance.
• Encourage client to discuss his or her feeling related to disease.
 Collaborative Interventions

Radiation Therapy Trans-sphenoidal Hypophysectomy

• Not useful for acute It is the surgical removal of the pituitary gland and tumor.
management. Pre-operative care:
• Takes long time to • Patient education regarding relief of some manifestation.
achieve therapeutic • Nasal packing 2-3 days post surgery therefore, mouth
effects. breathing.
• Side effect includes: • No brushing, nose blowing or bending forward.
• Hypo-pituitarism • Nasal and oral mucus membrane swab specimen.
• Optic Nerve Damage Operative Procedure: Trans sphenoidal approach to the
• Reduced Coordinated pituitary gland.
Eye Movement 1. Microscopic surgery under GA.
• Visual Field Defects 2. Incision above the upper lip.
3. Pituitary gland reached via sphenoid sinus.
4. Removal of gland and grafting of muscle (from thigh) to
support area and prevent leakage of CSF.
5. After incision closure, nasal packing is inserted and
mustache dressing is applied.
If the approach fails, craniotomy is indicated.
 Collaborative Interventions
Post-operative care:
1. Monitor patient’s neurologic response
2. Observe for complications (transient diabetes insipidus, CSF leakage, infection
and increased ICP), Monitor I/O, daily weights
3. Report post nasal drip, persistent severe headache
4. Assess nasal drainage for quantity, quality & presence of glucose
5. Teach to avoid coughing and perform deep breathing exercises
6. Frequent oral rinses
7. Application of petroleum jelly on lips
8. Monitor for meningitis (headache, fever, nuchal rigidity)
9. Replacement of hormones if necessary
 Health Education

Avoid activities that interfere healing (bending over from waist, straining
during bowel movement-increases ICP) till 2 months of surgery.
Avoid brushing of teeth till 2 weeks.
Frequent mouth care and flossing.
Numbness at incision sight and decreased sense of smell is seen till 3-4
months of surgery.
Use mirror to check gum bleeding.
Hormone replacement with vasopressin to maintain fluid balance.
Teach client to report return symptoms of hyperpituitarism immediately.
Thank you