HYPERPITUITARISM

Moderator- Presenter-
Mrs.kavita Anamika
Nursing tutor B.Sc nursing 3rd
CON,Dr.RMLIMS semester
Student
 DEFINITION

Hyperpituitarism is defined as an excessive

secretion or production of one or more of the
hormones produced by the pituitary gland.
 Etiology

Prolactinomas (prolactin secreting pituitart tumors)-

40% of all tumors
Corticotropinomas -pituitary tumors that produces
ACTH in excess,leading to excess cortisol secretion.
Somatotropinomas are adenomas associated
with excessive production of growth hormone
called somatotropin.
Thyrotropinoma: These adenomas secrete
TSH.
 Clinical manifestations

Depends upon the hormones produced in excess and

presence of pituitary lesion.
Local effects of pituitary tumor such as visual field
disturbances and headache.
Excessive production of prolactin

Females- Infertility,galactorrhoea and

secondary amenorrhea in females.
Males- Loss of libido,and impotence
Excessive production of growth hormone

Acromegaly in adults
Gigantism in children
 Acromegaly
Skeletal overgrowth of flat bones like the
mandible.
Growth of bones in the feet with a resultant
increase in shoe size.
An increased presence of skin tags
Macroglossia
Cardiomyopathy
Peripheral neuropathy
Carpal tunnel syndrome
Osteoarthritis
Excessive sweating
 Gigantism in children
Tall stature

Mild to moderate obesity (common)

Macrocephaly

Exaggerated growth of the hands and feet,with thick fingers and toes.

Coare facial features

Frontal bossing

Proganthism

Hyperhidrosis
 Thyroid hormone excess
Weight loss

Heat intolerance

Anxiety

Menstrual disturbances

Palpitations
 Excessive production of ACTH causes
Cushing
Cental obesity
Skeletal muscle wasting
Buffalo hump
Excessive bruising
Menstrual abnormalities
Increased blood pressure
Glucose intolerance
Depression
Psychosis
 Diagnosis
Prolactin levels greater than 200mg/ml.
Oral glucose suppression test- hGH does not
suppress below 1mg/ml indicates acromegaly
IGF 1- Excessive GH production
 Hypercortisolism
Midnight serum cortisol greater than 5 microgram/dl or
salivary cortisol greater than 0.15 microgram/dl.

Overnight dexamethasone suppresson test (ODST)-1mg of

dexamethasone is administered between 11pm and midnight,
and the serum cortisol is measured the next morning
between 8am and 9am.
Serum cortisol level->1.8
microgram/dl
Increased ACTH level (>15pg/L to 20
pg/L) in the presence of elevated
cortisol production indicate the ACTH
dependent cause of Cushing syndrome.
Corticotrophin-releasing hormone(CRH)

CRH is administered intravenously,and ACTH and cortisol are measured at baseline and
short intervals .

Rise in ACTH of greater than 40% and cortisol levels of greater than 20% indicate an
ACTH dependent cause.

Increased or unsuppresses TSH levels and elevated thyroid hormone (free and total T4
and T3) levels indicate secondary hyperthyroidism.

CT/MRI-pituitary adenomas.
 Medical Management
Depends upon cause and the hormones affected
Prolactinomas-bromocriptine
Cushing disease -metyrapone, aminoglutithimide, and
ketoconazole
GH excess- octerotide
Surgery and radiotherapy for pituitary tumors.
 Nursing diagnosis
Disturbed Body Image related to anxiety over thickened skin and enlargement of
face, hands, and feet.
Provide knowledge to the patient about the diseased condition and the changes in
body that would happen.
Ineffective coping related to change in appearance.

Provide him psychological support and convincing

him to accept the changes and also educate his
family about the changes in appearance.
Disturbed sleeping pattern related to soft tissue
swelling

Make him and tell him to indulge in physical activities

or to do something atleast so he can be tired and its
easy for him to sleep.
 Fluid volume deficit

Provide I/V fluid therapy as prescribed.

Anxiety-related to change in appearance

Provide diversional therapy for example listening calm music

and reading book so the patient has no time to think and advise
family members to make him busy.
 SUMMARY
Hyperpituitarism, also known as hyperfunction of the pituitary
gland,involves excessive secretion of hormones.

Common causes includes pituitary adenomas,leading to elevated

levels of growth hormone,prolactin or other hormones.

Symptoms vary depending on the hormones involved,incompassing

gignatism,acromegaly and hormonal imbalance.

Diagnosis involves hormone level assessments and imaging studies.

Treatment options include surgery,medications or radiotherapy.