ENDOCRINE HEALTH

Chapter 39 ENDOCRINE HEALTH




KEY TERMS/CONCEPTS

























LIVED EXPERIENCE









STRUCTURE AND FUNCTION OF THE ENDOCRINE SYSTEM




THE PITUITARY GLAND


The pituitary gland is about the size of a grape and is positioned at the base of the brain in a depression in the sphenoid bone. It lies just beneath the hypothalamus, to which it is connected by a stalk containing blood vessels and nervous tissue. It has two functional lobes: the anterior lobe comprised of glandular tissue, and the posterior lobe comprised of nervous tissue. Each lobe performs specific functions.


The anterior lobe produces:










DISORDERS OF THE PITUITARY GLAND



Hyperpituitarism


Hyper-function of the anterior pituitary gland commonly results from a tumour, which creates pressure on cerebral structures and causes neurological manifestations, such as severe headaches and visual disturbances, or excessive secretion of pituitary hormones, with consequent increased stimulation of the target organs. It is a chronic progressive disorder marked by hormonal dysfunction and skeletal overgrowth, which can appear in two forms: gigantism and acromegaly.


Gigantism occurs in childhood and begins before epiphyseal closure. Children with gigantism may grow up to 15 cm a year, have slow sexual development and may have slow mental development. Gigantism is often the result of a tumour growing on the pituitary gland. Radiation therapy, surgical removal of the tumour and drug therapy may be used to decrease secretion of the growth hormone and slow down the excessive growth pattern. With this treatment, prognosis for the individual with gigantism is generally good.


Acromegaly occurs in adulthood and develops after epiphyseal closure. In acromegaly, over-secretion of growth hormone (GH) causes atrophy of skeletal muscle and formation of new bone and cartilage. The long bones are unable to grow in length, but the smaller bones of the hands, feet and face grow, giving the individual a characteristic appearance, with an enlarged lower jaw, bulging forehead and thickened ears and nose. The extremities become elongated and enlarged, resulting in large hands and feet. Thickening of the tongue may cause the voice to sound deep and hollow, associated with slurred speech. Acromegaly is a chronic disfiguring disease that often shortens life expectancy, as it may lead to respiratory, cerebrovascular and congestive heart diseases. Surgical intervention to remove the pituitary tumour often leads to hypopituitarism, and the tumours tend to recur.


Clients with anterior pituitary disorders require nursing interventions to assist them cope with the physical and emotional changes and also to prevent complications involving other organs.







DISORDERS OF THE THYROID GLAND



Hyperthyroidism


Hyperthyroidism (also referred to as thyrotoxicosis) is hyper-functioning of the thyroid gland and may be caused by many factors, such as thyroiditis or an overproduction of thyroid stimulating hormone (TSH). An increase in the secretion of thyroid hormones affects the basal metabolic rate, as well as the functions of other body systems. The manifestations of hyper-functioning are generally related to increased metabolic processes. The condition can be caused by genetic or immunological factors, thyroid gland nodules or chronic inflammation of the thyroid gland.




Goitre


The thyroid gland can become enlarged, hyperactive or hypoactive as a result of pathophysiological changes. An enlarged thyroid gland may be the result of a simple goitre, thyroiditis or neoplasia. Goitre refers to any thyroid enlargement and may be associated with either over-secretion or under-secretion of thyroid hormones. Goitre can cause local problems by exerting pressure on the trachea, which may produce dysphagia or respiratory distress. Simple goitre (non-toxic goitre) is due to an iodine deficiency that causes a compensatory enlargement of the thyroid gland in an attempt to maintain thyroid hormone production. Endemic goitre occurs in regions away from coastal areas, where there is little iodine in the soil and water. The introduction of iodised salt has reduced the incidence in most Western countries. Exopthalmic goitre occurs in hyperthyroidism.


Management of hyperthyroidism involves assisting the individual and their family to manage the symptoms associated with hyperthyroidism until it is controlled with medication, or surgery if indicated. Surgical intervention may involve a subtotal thyroidectomy, which removes part of the thyroid gland, leaving enough gland to produce adequate thyroid hormone, or a total thyroidectomy may be performed if the gland is cancerous. A person who has had a total thyroidectomy requires long-term hormone replacement. The critical pathway in Table 39.2 outlines the nursing care of a client undergoing thyroidectomy surgery.







DISORDERS OF THE PARATHYROID GLANDS


Feb 12, 2017 | Posted by in NURSING | Comments Off on ENDOCRINE HEALTH
Premium Wordpress Themes by UFO Themes