nursing course

1. ASSESSMENT AND
MANAGEMENT OF
PATIENTS WITH
ENDOCRINE
SURGERIES:
HYPOPHYSECTOMY
Prepared by: May Mawzi
HN MSN

2. Outline
 Introduction
 Indication for hypophysectomy
 Contraindications
 Hypophysectomy highlights
 Transphenoidal approach:
1. Indications
2. Complications
3. Preparation before operation
4. Medical management
5. Nursing Management

3. Introduction
 Pituitary tumors are commonly benign
adenomas and only rare are pituitary
carcinomas or posterior pituitary neoplasias
 Pituitary adenomas present most common in
the third and fourth decades.
 their clinical presentation depends on whether
the tumor is secreting (less common) or
nonsecreting (more common).
 The most common is a prolactin-secreting
tumor.

4. Hypophysectomy
 Is a removal of the pituitary gland and may be
performed to treat primary pituitary gland
tumors (most are benign tumors).
 It is the treatment of choice in patients with
Cushing’s syndrome due to excessive
production of ACTH by a tumor of the pituitary
gland.
 Hypophysectomy may also be performed on
occasion as a palliative measure to relieve
bone pain secondary to metastasis of
malignant lesions of the breast and prostate.

5. Hypophysectomy (cont-d)
 Several approaches are used to remove or
destroy the pituitary gland: surgical removal by
transfrontal, subcranial, or oronasal, or
transsphenoidal approaches, irradiation or
cryosurgery.
 The absence of the pituitary gland alters the
function of many body systems.
 Menstruation ceases and infertility occurs after
total or near-total ablation of the pituitary gland.
 Replacement therapy with corticosteroids and
thyroid hormone is necessary; therefore, patient
teaching is imperative.

7. Indications for hypophysectomy
Surgery can be carried out on the pituitary gland
for diagnostic or therapeutic purposes:
o Diagnostic: to obtain a tissue for histology
when a lesion has been identified which
cannot be identified by biochemistry or
imaging, or if histological confirmation is
required for a lesion that is not treated by
surgery.
o Therapeutic: to treat an identified condition,
such as a pituitary adenoma or other
amenable pathology.

8. Contraindications
General contraindications:
 Uncontrolled disease caused by adenoma: as
poorly controlled cushing’s syndrome
 Poor general health: a risk for anesthesia?
 Increased risk for hemorrhage
Local contraindications:
 Sinusitis, nasal vestibulitis, or any nasal
infection
 Abnormal anatomy

10. Transphenoidal surgery:
 an incision is made beneath the upper lip and
entry is then gained successively into the nasal
cavity, sphenoidal sinus, and sella turcica.
 The transsphenoidal approach offers direct
access to the sella with minimal risk of trauma and
hemorrhage.
 It avoids many of the risks of craniotomy, and the
postoperative discomfort is similar to that of other
transnasal surgical procedures. It may also be
used for pituitary ablation (removal) in patients
with disseminated breast or prostatic cancer.

11. Transphenoidal
hypophysectomy
Complications:
o Transient diabetes insipidus of several days
duration, which is treated with vasopressin and
could occasionally persist.
o CSF leakage
o Visual disturbances
o Postoperative meningitis
o SIADH: Syndrome of inappropriate anti-
duiretic hormone.

12. Preparation : patient information
and consent form
 Detailed explanation is always necessary
which includes:
 Careful explanation of the traetment
 Serious nature of the procedure
 Surgical approach
 Nasal pack
 Importance of medication post-op
 Range of outcomes following OR
 The likelihood of complications and their
nature.

13. Preparation Before OR
Education highlights pre-op:
o Deep breathing is taught before surgery.
o The patient post-op is instructed that to avoid
vigorous coughing, blowing the nose, sucking
through a straw, or sneezing, because these
actions may cause a CSF leak.

14. Preparation Before OR
 Endocrine tests
 Rhinologic evaluation (to assess the status of the
sinuses and nasal cavity)
 Neuro-radiologic studies
 Fundoscopic examination and visual field
determinations are performed, because the most
serious effect of pituitary tumor is localized pressure
on the optic nerve or chiasm.
 The nasopharyngeal secretions are cultured
 Corticosteroids may be administered before and after
surgery
 Antibiotics may or may not be administered
prophylactically.

15. Post-op Management
 Focus on Prevent infection and promote
healing
 Medications :
1. Antimicrobials till the nasal packing is
removed
2. Analgesics
3. Corticosteroid therapy
4. Medications to control diabetes insipidus
when needed

16. Nursing Management
hypophysectomy
 Group work:
1. Suggest nursing diagnosis based on the patient
needs post-op
2. State the outcome
3. Plan the care
4. Put interventions
5. Re-assess and evaluate your patient
6. Document using PIE: problem, intervention, and
evaluation
7. Home education

17. Nursing Management
 Monitor hemodynamic, cardiac, and ventilatory
status
 Assessment to visual acuity at regular intervals:
ask patient to count the fingers of a nurse,
decreasing visual acuity implies expanding
hematomas.
 Head of bed elevated at least 2 weeks post
surgery: promote normal drainage and reduce
pressure on the sella turcica.
 Avoid activities that increase ICP: blowing nose,
bending over, or straining during urination or
defecation.

18. Nursing Management
 Monitor intake-output
 Urine specific gravity measured after each voiding
 Daily weight
 Check nasal package for blood and/or CSF
 Relieve patient discomfort due to thirst secondary to
mouth breathing, dryness of oral cavity. Mouth care q
4 hours, no teeth brushing until incision above teeth
heals.
 Room humidifier
 Warm saline wash to mouth
 Petrolatum to lips
 4 days later, nasal pack removed , then patient can
clean the area around nares.

19. Any Questions?
If no, please refer to post- course
evaluation questions
Good luck