DISORDERS OF PITUITARY GLAND:

• Primary pituitary dysfunction : Disturbance in

pituitary gland Result in hypo-hyper secretion
of pituitary hormone
• Secondary pituitary dysfunction : Problem in
hypothalamus Excess or deficit of pituitary
hormone
Test Normal range
TSH 0.4 to4 MIU/ML
FSH During puberty - 0.3 to 10.0
mIU/mL female
In males 1.5 to 12.4 mIU/mL
LH For males, the normal range is 1.24–7.8
IU/L
For female 1.68 to 15 IU/L.
GH <5 ng/ml
ACTH 9 to 46 pg/ml
PRL 3 to 30 ng/ml
ADH 1 to 5 pg/ml
 HYPOPITUITARISM

• Deficiency of one or more hormone produced

by anterior lobe of pituitary.
PANHYPOPITUITARISM : Both anterior &
posterior lobe fail to secrete hormones.
 HYPOPITUITARISM

• Hypopituitarism disease is a clinical syndrome

in which pituitary gland fails to produce
normal amounts of one or more hormone.
Pituitary gland produce 9 hormones, when it
unable to supply one or more of hormone that
affect normal body function such as growth,
blood pressure, reproduction etc.
 Causes of Hypopituitarism Disease:

• Head injury,
• Brain surgery,
• Radiation therapy to head and neck area,
• Infection or inflammation of brain,
• Stroke (Subarachnoid haemorrhage)
• Necrosis of pituitary gland
• Inflammation like meningitis & hypophysitis
 Sign & symptoms(LH & FSH)
• Deficiency of LH and FSH leads to different symptoms in men and
women.
• In men, it leads to loss of facial, trunk and scrotal hair, decreased
muscle mass, decrease sperm count & infertility.
• In women, it results in menstrual irregularities like oligomenorrhea,
amenorrhea, infertility & vaginal dryness.
• In both the gender it leads to a decrease in libido and loss of sexual
function. Delayed puberty is reported in children with hypopituitarism.
 Growth hormone(sign & symptoms)

• Deficiency of GH leads to impaired attention,

memory, decrease in energy and physical
activity, decrease in muscle mass, and
increase in body fat around the waist in adults.
• In children, it leads to growth retardation and
short stature(dwarfism)
 Sign & symptoms(ACTH)
• Deficiency of ACTH leads to adrenal
insufficiency characterized by lack of
production of glucocorticoids such as cortisol
by the adrenal gland.
• This leads to symptoms such as weight loss,
weakness, fatigue, low blood pressure and low
serum sodium level.
TSH deficiency (Sign & symptoms)
• Deficiency of TSH leads to hypothyroidism
characterized by tiredness, low heart rate,
constipation, low blood pressure, weight gain,
hair loss, intolerance to cold, slowed thinking
and delayed growth in children sometimes
leading to a syndrome called cretinism.
Sign & symptoms (Prolactin/ADH/Oxytocin)

• Deficiency of prolactin leads to an inability to

breastfeed.
• Deficiency of ADH leads to diabetes insipidus
characterized by an inability to concentrate the
urine, polyuria, dehydration, extreme thirst,
and high sodium levels in the blood.
• Deficiency of oxytocin does not cause many
symptoms due to its role only in parturition
and breastfeeding.
 Diagnostic test
• Brain CT Scan
• Pituitary MRI
• Serum ACTH (Adrenocorticotropic hormone)
• Serum Cortisol
• Serum FSH (Follicle stimulating hormone),
• Serum Lutinizing Hormone
• Serum testesterone level
• Serum TSH( Thyroid stimulating hormone)
 Treatment for Hypopituitarism

• Treatment of underlying cause

• Hormone therapy
• Corticosteroids (cortisol) for adrenal
insufficiency
• Growth hormone
• thyroid hormone-Levothyroxine for
hypothyroidism
• Sex hormone-Testosterone for male
hypogonadism for female hypogonadism
(usually with a progestogen to inhibit
unwanted effects on the uterus)
• Antidiuretic hormone can be replaced by
desmopressin tablets or vasopressin nose
spray.
 Nursing Intervention for Hypopituitarism Disease:

• Monitor vital signs blood pressure, heart rate and

rhythm in every 2 hours.
• Assess lung and heart sounds 4 hourly, be alert
for s/s of congestive heart disease
• Monitor weight daily because ADH from pituitary
gland regulates fluid retention and excretion in
the body.
• Teach patients that thyroid replacement therapy must be
taken for lifetime and administered in the morning on an
empty stomach because thyroid medications can cause
insomnia if taken at night.
• Teaching patient to never miss any dose of medication
without consulting with physician.
• Provide high protein, low calorie fiber food.
• Provide iodine rich diet, which is easily accomplished with
iodized salt.
• Instruct patient to avoid constipation and
provide stool softeners.
• Monitor laboratory test for hormonal
deficiencies until the patient completes
hormone replacement therapy.
• Administer replacement fluids, electrolytes,
and glucose as prescribed by physician to
maintain normal serum levels.
• If patient have cold sensitivity, keep patient warm
and provide extra clothing and avoid the patient
getting chilled.
• Wet the eye with sterile water to provide comfort
to the eye.
 Hyperpituitarism
• Hyperpituitarism is the primary hypersecretion
of pituitary hormones. It typically results from
a pituitary tumor or adenoma.
 Cause of hyperpituitarism

• hyperplasia and carcinoma of

adenohypophyseal
• secretion by non - pituitary tumors and
certain hypothalamic disorders and
carcinoid tumors.
Symptoms of gigantism or Acromegaly 

Gigantism It is a rare disorder resulting from

increased levels of growth hormone before
the fusion of the growth plate which usually
occurs at some point soon after puberty.

•Excessive height
•Body grows in uncontrolled but in systematic
manner
 Acromegaly is a disorder that
results from excess 
growth hormone (GH) after
the growth plates have closed

• Hands and feet that grow

larger
• enlarged or unusually
prominent facial features
 Symptoms of Cushing syndrome
 
• excess upper body fat
• unusual amount of facial hair on women
• easy bruising
• bones easily broken or fragile
• abdominal stretch marks that are purple or
pink
 Symptoms of galactorrhea or prolactinoma

• tender breasts in women

• breasts that begin to produce milk in women
who are not pregnant and rarely in men
• reproductive dysfunctions
• irregular periods or menstrual cycle stops
• infertility
• low sex drive
• erectile dysfunction
 Symptoms of hyperthyroidism

• anxiety or nervousness
• rapid heart rate
• irregular heartbeats
• exhaustion
• muscle weakness
• loss of weight
 Diagnostic test
• Blood tests
• Oral glucose tolerance test
• Specialized blood sampling tests
• Imaging tests with MRI or CT scan if a tumor is
suspected
 Test
• Serum prolactin levels ; ACTH , GH.
• CT - Scan / MRI
• Hormone tests.
• Angiography.
• Glucose tolerance test.
• The dexamethasone suppression test.
 Management: Radiation therapy
• Conventional radiation therapy. Small doses
are given over a four- to six-week period.
Surrounding tissues may be damaged during
this type of radiation therapy.
• Stereotactic therapy. A beam of high-dose
radiation is aimed at the tumor. This is usually
done in a single session. When done in a
single session, there is less possibility of
damaging surrounding tissue. It may require
ongoing hormone replacement therapy
afterward.
Nursing Diagnosis for Hyperpituitarism
• Disturbed body image related to the change in physical
appearance.
• Acute pain : the head relate to suppression by tumor
tissue.
• Disturbed Sensory Perception (visual) related to
disorders of impulse transmission due to compression
of the optic nerve tumor.
• Anxiety related to threats to life status change.
• Risk for injury related to a decrease in sensory
perception.