Introduction to Medical-Surgical Nursing, 6th ed.
46
Lesson Plans for
Pituitary and Adrenal Disorders
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 46.1:
2. Describe the tests and procedures used to diagnose disorders of the adrenal and pituitary glands.
4. Assist in developing nursing care plans for patients with selected disorders of the adrenal and
pituitary glands.
CHAPTER TEACHING FOCUS
• In this chapter, students will be introduced to disorders of the adrenal and pituitary glands.
• Students will have the opportunity to learn about the anatomy and physiology of the endocrine system,
diagnostic tests and procedures, assessment of patients, and the pathophysiology and medical
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Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) Bromocriptine (Parlodel) is a pituitary hormone suppressant that acts to __________.
a) inhibit the production of clotting factor VIII from the posterior pituitary gland
b) inhibit the release of prolactin from the anterior pituitary gland
c) suppress the release of growth hormone from the anterior pituitary gland
d) suppress the release of antidiuretic hormone from the anterior pituitary gland
2) Two hormones produced by the posterior pituitary gland (neurohypophysis) are __________.
a) antidiuretic hormone (ADH) and oxytocin
b) growth hormone (GH) and adrenocorticotropic hormone (ACTH)
c) thyroid-stimulating hormone (TSH) and growth hormone (GH)
d) follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
3) A patient has undergone a cerebral angiogram and the arterial access catheter has been removed.
The nurse should apply pressure to the arterial puncture site for __________.
a) 5 minutes
b) 15 minutes
c) 25 minutes
d) 30 minutes
4) A pituitary adenoma is most commonly found in patients with __________.
a) Addison disease
b) hypopituitarism
c) hyperpituitarism
d) Cushing disease
5) The most reliable test for acromegaly is the__________.
a) parathyroid hormone
b) cortisol level
c) thyroid-stimulating hormone level
d) glucose tolerance test
6) Excessive output of dilute urine from an antidiuretic hormone (ADH) abnormality is characteristic of
__________.
a) hyperthyroidism
b) diabetes insipidus
c) diabetes mellitus
d) adrenal insufficiency
7) A common electrolyte imbalance found in patients with syndrome of inappropriate antidiuretic
hormone is __________.
a) hyponatremia
b) hyperkalemia
c) hyperglycemia
d) hypochloremia
8) Maintenance of extracellular fluid volume is controlled by __________.
a) prolactin
b) glucocorticoids
c) mineralocorticoids
d) thyroid-stimulating hormone
9) A 42-year-old woman reports excessive weight gain in the abdomen and shoulders, excessive hair
growth on her face, and an intermittent menses. The reported signs are associated with __________.
a) Addison disease
b) Cushing syndrome
c) gigantism
d) diabetes insipidus
10) A tumor of the adrenal medulla causing excessive secretion of catecholamines and resulting in
hypertension is a__________.
a) leiomyoma
b) sarcoma
c) pituitary tumor
d) pheochromocytoma
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Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: What are the signs and symptoms and treatment of pheochromocytoma?
Answer: Pheochromocytoma is generally a benign tumor of the adrenal medulla. Hypertension,
Question: What are the definitions of hypopituitarism and hyperpituitarism? What are the hormonal
changes that result in dwarfism and gigantism?
Answer: The pituitary gland is part of the endocrine system, located at the base of the brain. It consists
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 46.1
Instructor Preparation
Textbook Objectives Covered
1. Identify nursing assessment data relevant to the function of the adrenal and pituitary glands.
3. Describe the pathophysiology and medical treatment of adrenocortical insufficiency, excess
adrenocortical hormones, hypopituitarism, diabetes insipidus, and pituitary tumors.
4. Assist in developing nursing care plans for patients with selected disorders of the adrenal and
pituitary glands.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying pituitary and adrenal disorders, including:
• Patient assessment
• Signs and symptoms
• Diagnostic tests and procedures
• Nursing interventions
• Assemble materials and supplies needed for each lesson as indicated below.
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• acromegaly (p. 1011)
• Addison disease (p. 1024)
• adrenalin (p. 1022)
• glucocorticoid (p. 1023)
• hypophysectomy (p. 1012)
• mineralocorticoid (p. 1023)
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LESSON 46.1
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 1005-1008, 1022-1025)
REVIEW
• Figure 46-1: The endocrine system (p. 1006)
• Figure 46-2: The feedback system of the hypothalamus, pituitary, and target glands (p. 1007)
• Box 46-1: Assessment of the Patient with a Pituitary Disorder (p. 1008)
• Box 46-2: Assessment of the Patient with an Adrenal Disorder (p. 1025)
ANSWER – Text
ANSWER – Study Guide
• Part IA: 1, 8-10, 13-15 (pp. 303-304)
• Part IE: 1-12 (pp. 305-306)
• Part IH: A-G (p. 307)
• Part II I: 1, 3, 4, 12, 21, 23, 29 (pp. 308-310)
• Part IIIK: 8 (p. 311)
2
READ – Textbook (pp. 1008-1010)
REVIEW
• Table 46-1: Diagnostic Tests and Procedures for Pituitary Disorders (pp. 1009-1010)
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LESSON 46.1
3
READ – Textbook (pp. 1010-1034)
REVIEW
• Figure 46-3: Clinical features of growth hormone excess (p. 1011)
• Figure 46-4: Progression of acromegaly (p. 1012)
• Figure 46-5: Transsphenoidal surgical approach to the pituitary gland (p. 1013)
• Table 46-2: Drug Therapy for Pituitary Disorders (pp. 1014-1015)
ANSWER – Text
• Review Questions for the NCLEX Examination: 3-9 (p. 1035)
ANSWER – Study Guide
• Part IA: 2-7, 11-15 (pp. 303–304)
• Part IB: 1-5 (p. 304)
• Part IC: 1-8 (pp. 304-305)
• Part ID: 1-14 (p. 305)
• Part IF: 1-5 (p. 306)
• Part II I: 2, 5-7, 9, 13-20, 22, 24-26, 31, 33, 34 (pp. 308-310)
• Part IIJ: 6-13 (p. 311)
• Part IIIK: 2, 5, 9 (pp. 311-312)
• Part IIIL: 2, 3 (p. 312)
4
READ – Textbook (pp. 1010-1034)
REVIEW
• Nursing Care Plan 46–1: Patient with Addison Disease (p. 1029)
ANSWER – Text
• Review Questions for the NCLEX Examination: 10 (p. 1035)
ANSWER – Study Guide
• Part II I: 10, 28, 30, 32 (pp. 309-310)
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LESSON 46.1
50-Minute Lesson Plan
Lecture Outline 20 minutes
Slide 1
Chapter 46
Pituitary and Adrenal Disorders
1
Slide 2
Hormone Functions and Regulation
• Released in response to body’s needs
• Responsible for reproduction, fluid and electrolyte balance, host defenses, responses to
stress and injury, energy metabolism, and growth and development
• Endocrine system: maintain homeostasis
• Maintenance of physiologic stability despite constant changes in the environment
Slide 3
Hormone Functions and Regulation (cont.)
• Feedback mechanisms
• Controls regulation of endocrine activity by either stimulating or inhibiting hormone
synthesis and secretion
• May be positive or negative
TALKING POINTS:
• In negative feedback, high levels of a substance inhibit hormone synthesis and secretion,
whereas low levels stimulate hormone synthesis and secretion.
• In positive feedback, high levels of a substance stimulate hormone synthesis and
secretion, whereas low levels inhibit additional hormone synthesis and secretion.
• What is a diurnal rhythm?
Anatomy and Physiology
• Weighs approximately 0.6 g; located in the sella turcica, a small indentation in the
Slide 5
Anatomy and Physiology (cont.)
• Anterior lobe
• Larger of the two lobes: accounts for 70% to 80% of the gland’s weight
• Called the adenohypophysis
• Secretes
• Growth hormone (GH), or somatotropic hormone
• Adrenocorticotropic hormone (ACTH)
• Thyroid-stimulating hormone or thyrotropic hormone
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LESSON 46.1
Slide 6
Anatomy and Physiology (cont.)
• Posterior lobe
• The smaller lobe
• Also called the neurohypophysis
• Secretes
• Antidiuretic hormone (ADH), or vasopressin
• Oxytocin
2
Slide 7
Health History
• Present illness
• Slowed or accelerated growth, visual disturbances, headache, and changes in urine
output, appearance, skin, and secondary sex characteristics
• Medical history
• Brain tumors; pituitary surgery; head trauma; central nervous system infection;
Slide 8
Health History (cont.)
• Review of systems
• Fatigue, weakness, restlessness, or agitation
• Skin moisture and changes in body hair distribution
• Significant sensory changes such as blurred vision and diplopia (double vision)
• Changes in the breasts
Slide 9
Health History (cont.)
• Functional assessment
• Determine whether the patient has had sleep disturbances
• Usual diet; note the effects of symptoms on the person’s self-concept and usual
activities
Slide 10
Physical Assessment
• Vital signs, height, and weight
• Skin for moisture and edema
• Inspect head and face for thickened lips, broad nose, and prominent forehead and jaw;
test visual acuity
• Inspect the breasts for enlargement in men, atrophy in women, and nipple discharge
Slide 11
Age-Related Changes
• In healthy older adults, pituitary function remains adequate
• Increased ADH secretion impairs ability to concentrate urine, increasing risk of
dehydration
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 46.1
Slide 12
Diagnostic Tests and Procedures
• Radiographic studies
• Conventional radiographs
• Computed tomographic (CT) scans
• MRI
• Cerebral angiography
• Laboratory studies
• Radioimmunoassay
3
Slide 13
Hyperpituitarism
• Cause
• Pathologic state caused by excess production of one or more of the anterior pituitary
hormones
• Common factor is presence of a pituitary adenoma
• Tend to occur in young women during teens, early 30s
TALKING POINTS:
• What is the most common factor in hyperpituitarism?
• Pituitary adenomas that secrete hormones may cause amenorrhea, galactorrhea
(abnormal milk secretion), hyperthyroidism, and Cushing’s syndrome, in addition to
gigantism or acromegaly.
Slide 14
Hyperpituitarism(cont.)
• Acromegaly
• Most patients with acromegaly have pituitary macroadenomas that secrete excess growth
hormone
Slide 15
Hyperpituitarism (cont.)
• Signs and symptoms
• Visual deficits and headaches may be first symptoms; often a result of pressure on
optic nerves
• Enlarged hands, feet, sinuses, deformities of spine and mandible
• Enlarged tongue, skin, liver and spleen
TALKING POINTS:
• What other symptoms are possible with acromegaly and gigantism?
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LESSON 46.1
Slide 16
Hyperpituitarism (cont.)
• Medical diagnosis
• Radiographic studies
• CT scans using a water-soluble dye
• MRI
Slide 17
• Drug suppresses insulin secretion; blood glucose most be monitored
Hyperpituitarism (cont.)
• Medical treatment
• Drug therapy
• Somatostatin analogs, dopamine agonists, GH receptor antagonists, and
octreotide (Sandostatin)
TALKING POINTS:
• What are common side effects of octreotide acetate?
• Radiation therapy is sometimes used to treat tumors that produce excess GH, but the
Slide 18
Hyperpituitarism (cont.)
• Surgical management
• Hypophysectomy: surgical removal of the adenoma or of the pituitary gland
• Transsphenoidal approach: microsurgical procedure under general anesthesia.
• Incision made at inner aspect of the upper lip, sella turcica entered through
TALKING POINTS:
• What type of medication will the patient need if the entire pituitary is removed?
Slide 19
Hyperpituitarism (cont.)
• Radiation therapy
• Sometimes used in combination with surgery, drug therapy
• Gamma knife radiotherapy (stereotactic radiosurgery) uses radiation delivered to the
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 46.1
4
Slide 20
Hyperpituitarism (cont.)
• Assessment
• Gigantism/acromegaly: energy level, height/weight, vital signs, contours of the face
and skull, visual acuity, speech, voice quality, abdominal distention
• If surgery, determine what patient knows and expects
• Interventions
• Disturbed body image
• Activity intolerance
• Chronic pain
• Ineffective self-health management
Slide 21
Hyperpituitarism (cont.)
• Postoperative nursing care
• Assessment
• Neurologic status and vision must be monitored closely with particular attention to
TALKING POINTS:
• Data used to assess for meningeal inflammation are obtained by asking the patient to
place his or her chin to the chest.
• Why should nasal packing be inspected closely for drainage?
Slide 22
Hyperpituitarism (cont.)
• Postoperative nursing care
• Interventions
• Anxiety
• Impaired sensory perception
• Acute pain
3
Slide 23
Cause and Pathophysiology
• Dwarfism
• Inadequate secretion of growth hormone during preadolescence
• Attainment of a maximum height 40% below normal
TALKING POINTS:
• What is considered to be the major cause of dwarfism?
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LESSON 46.1
Slide 24
Hypopituitarism
• Signs and symptoms
• Depends on the stage of life which hormones are deficient
• Dwarfism
• Occurs early; person as short as 36 inches but with proportional physical
characteristics
• Often have delayed or absent sexual maturation
• Accelerated pattern of aging, thus shorter life span
Slide 25
Hypopituitarism (cont.)
• Signs and symptoms
• Panhypopituitarism
• Simmonds cachexia
• Muscle and organ wasting and disruptions of both digestion and metabolism
TALKING POINTS:
• General signs and symptoms may include fatigue, weakness, malaise, cold intolerance,
and lethargy.
2
&
3
Slide 26
Hypopituitarism (cont.)
• Medical diagnosis
• Health history, physical examination, diagnostic tests
• Conventional radiographs and CT scans
• Cerebral angiography
• Serum levels of pituitary hormones
TALKING POINTS:
4
Slide 27
• Inspect the hair for distribution, texture, and thickness. Inspect and palpate the skin and
Hypopituitarism (cont.)
• Assessment
• Sense of well-being, energy level, appetite
• Changes in skin texture, body temperature, hair, and libido
• Determine whether there has been difficulty carrying out usual activities
TALKING POINTS:
• In the physical examination, measure height and weight and compare with previous
measurements.
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 46.1
Slide 28
Hypopituitarism (cont.)
• Interventions
• Education important: disturbances in body image, sexual function, nutritional status,
and fluid balance can be improved if patient follows the prescribed therapy
• Acknowledge patient’s feelings and encourage expression of concerns; refer to a
mental health counselor if patient has difficulty dealing with the effects of the disease
Slide 29
Hypopituitarism (cont.)
• Interventions
• Disturbed body image
• Sexual dysfunction
3
Slide 30
Diabetes Insipidus (DI)
• Cause
• Excessive output of dilute urine
• Nephrogenic DI
• Inherited defect: renal tubules do not respond to ADH, resulting in inadequate
water reabsorption
TALKING POINTS:
• Neurogenic DI can result from hypothalamic tumors, head trauma, infection, surgical
procedures (hypophysectomy), or metastatic tumors originating in the lung or breast.
• Which type of DI is associated with habitual excessive water intake and psychiatric
conditions?
2
&
3
Slide 31
Diabetes Insipidus (cont.)
• Pathophysiology
• Antidiuretic hormone deficiency or inability of kidneys to respond to ADH results in the
excretion of large volumes of very dilute urine
• Signs and symptoms
TALKING POINTS:
• How much urine per day may be excreted by the patient with DI?
• A water deprivation test may be done
• Water is withheld for 8 to 16 hours during which time BP, weight, and urine osmolality