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2. Pituitary gland
 The pituitary gland, or the hypophysis, is a round
structure about 1.27 cm (1⁄2 inch) in diameter located
on the inferior aspect of the brain.
 It is divided into the anterior, intermediate, and
posterior lobes.
 Commonly referred to as the master gland, the
pituitary secretes hormones that control the secretion
of hormones by other endocrine glands The pituitary
itself is controlled by the hypothalamus, an adjacent
area of the brain connected to the pituitary by the
pituitary stalk.

4. HYPOPITUITARISM
 Hypofunction of the pituitary gland (hypopituitarism)
Causes:-
 Destruction of the anterior lobe of the pituitary gland.
 Panhypopituitarism is total absence of all pituitary secretions
and is rare.
 Postpartum pituitary necrosis (Sheehan’s syndrome) is another
uncommon cause of failure of the anterior pituitary.
 Complication of radiation therapy to the head and neck area.
The total destruction of the pituitary gland by trauma, tumor.

5. Clinical manifestations:-
 The result is extreme weight loss.
 Emaciation.
 Atrophy of all endocrine glands and organs.
 hair loss
 impotence and amenorrhea
 hypometabolism and hypoglycemia.
 Coma and death occur if the missing hormones are not
replaced.
Medical management:
 Replacement of the misssing hormones

6. PITUITARY TUMORS
 Pituitary tumor are usually benign, but can cause life
threatening effects.
Clinical Manifestations
Clinical manifestations depends on tumor site but may include
 Gigantism if early in life
 Acromegaly if developed late in life.
 Cushing’s syndrome,
 obese and somnolent
 fine, scanty hair
 dry, soft skin, and small bones.
 headaches, loss of libido
 visual defects progressing to blindness.

7. Assessment and Diagnostic Findings
 Assessment of visual acuity and visual fields.
 CT and MRI
 Serum levels of pituitary hormones
 Evaluating hormones of target organs (eg, thyroid,
adrenal).
Medical management:-
 Radiation therapy.
 bromocriptine (dopamine antagonist), and octreotide
(synthetic analog of growth hormone).

8. SURGICAL MANAGEMENT: HYPOPHYSECTOMY
 Hypophysectomy, or removal of the pituitary gland,
may be performed to treat primary pituitary gland
tumors.
 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 and is discussed later in this chapter.

9. DIABETES INSIPIDUS
 Diabetes insipidus is a disorder of the posterior lobe of the
pituitary gland characterized by a deficiency of (ADH).
Clinical Manifestations:
 Sever polyuria, water-like urine
 Intense thirst, the patient tends to drink 2 to 20 liters of fluid
daily.
 Hypernatremia and severe dehydration.
Medical management:-
 Life long replacement of antidiuretic hormone.
Nursing Management
 Teach and show the patient how to administer the medications,
and observe return demonstrations as appropriate.
 Wear a medical identification bracelet and to carry medication
and information about this disorder.

10. SYNDROME OF INAPPROPRIATE
ANTIDIURETIC HORMONE SECRETION
 (SIADH) includes excessive growth hormone and (ADH)
secretion from the pituitary gland.
Clinical manifestations:-
 Oliguria
 Dilutional hyponatremia.
Management:-
 Eliminating the underlying cause
 Fluid restrictions
 Vincristine, tricyclic antidepressants, thiazide diuretics
 Diuretics (eg furosemide [Lasix]) may be used along with
fluid restriction if severe hyponatremia is present.

11. Disorders of thyroid gland

12. Thyroid Gland
 Thyroid gland is a butterfly-
shaped organ located in the
lower neck anterior to the
trachea
 It consists of two lateral
connected by an isthmus
 The blood flow to the
thyroid is very high ( about
5 ml/min/g of thyroid).

13. Thyroid Gland
Thyroid hormone
Two separate hormone produced by the thyroid gland
make up thyroid hormone : thyroxine and
triodothyronine. T4 contains four iodine atoms in each
molecule and T3 contains only three
 Thyroxine (T4) accounts for about 90% of the
hormone secreted from the thyroid.

14. Thyroid Gland
Regulation of Thyroid Function
 The secretion of T3 and T4 is under the control of thyroid
stimulating hormone (TSH or Thyrotropin) from the
anterior pituitary gland.
 In turn the release of TSH is determined by the level of
thyroid hormones in the blood. (negative feedback)

16. Thyroid Gland
Function of thyroxine and triiodothyronine
1. Control the cellular metabolic activity
2. Influence cell replication
3. Important in brain development
4. Normal growth

17. Thyroid Gland
Calcitonin
Calcitonin, or thyrocalcitonin, is another important
hormone secreted by the thyroid gland. It is secreted in
response to high plasma levels of calcium, and reduces
the plasma level of calcium by increasing its deposition
in bone.

19. Thyroid dysfunction
 Consequently, hypo or hyperthyroidism may
result from:
 A defect in the target gland
 Disturbance in the secretion of TSH or TRF

20. goiter
 Enlargement of the thyroid
gland, which often visible on
the anterior part of the neck.
Goitre is caused by various
hypothyroid and
hyperthyroid conditions
 May be very large
compressing oesophagus
causing dysphagia or alters
trachea

21. Hypothyroidism
Definition
 Is a disorder in which levels of thyroid hormones are
decreased.
 It can range from mild form to myxedema (advanced
form).
Causes
 Autoimmune thyroiditis (Hashimoto’s disease), in which
the immune system attacks the thyroid gland.
 Hyperthyroidism treated by radioiodine, surgery, or
antithyroid medication.
 Iodine deficiency

22. Hypothyroidism
Types
 Primary hypothyroidism
Dysfunction of the thyroid gland itself
 Pituitary or secondary hypothyroidism
entirely pituitary disorder
 Hypothalamic or tertiary hypothyroidism
the disorder is present in hypothalmus resulting in
inadequate secretion of TSH because of decreased
stimulation by TRH
 Cretinism
Hypothyroidism is present at birth

23. Hypothyroidism
Clinical Manifestation
Early symptom include:
 Fatigue
 Hair loss brittle nails and dry skin are reported
 Numbness and tingling of the fingers
 Amenorrhea
Sever hypothyroidism result in
 Subnormal temperature and pulse rate,
 Gain weight without an increase in food intake
 Skin thickness
 Myxedema coma, the patient become hypothermic
and unconscious

24. Hypothyroidism
Medical Management
 Thyroid hormone replacement
 Synthetic levothyroxine (synthroid or levothroid) is
the preferred medicine . The dose is based on the
patient’s serum TSH concentration

25. Hypothyroidism
Supportive therapy
1. Measured arterial blood gases.
2. Measure oxygen saturation by pulse oximetry
3. Application of external heat is avoided because it
increase oxygen requirement and may lead to
vascular collapse .
4. If hypoglycemia is evident, concentrated glucose
may be prescribed.

26. Nursing Management
1. The nurse role is to assist in the pt’s hygiene and encourage
him to participate in activity according to his tolerance
2. Monitor vital signs and cognitive level closely.
3. Help patient to get over the extreme intolerance to cold.
4. Prevent and control constipation
5. Assist with the treatment of myxoedema and myxoedema coma

27. Hyperthyroidism

28. Hyperthyroidism
Hyperthyroidism (Graves’ disease)
Excessive secretion of thyroid hormone
Clinical Manifestation
 Nervousness , hyperxcitable and irritable.
 They suffer from palpitations and Tachycardia even at rest
 Unable to tolerate heat
 Warm soft and moist skin, with asalmon colour,
 Patients may exhibit exophthalmos (bulging eyes)
 Increased appetite and dietary intake with Progressive weight loss
 Abnormal muscular fatigbility and weakness.

29. Hyperthyroidism
Assessment and Diagnostic Findings
 Basis of symptoms
 Increase in serum T4 and an increased 123I or 125I
uptake by thyroid
Medical Management
1. Irradiation involving the administration of radioisotope
123I for destructive effect on the thyroid gland.
2. Pharmacotherapy as antithyroid medication
3. Surgery , with removal of most of thyroid gland

30. Hyperthyroidism
Nursing Management
Improving Nutritional status
 Provide several well balanced meals of small size,
even up to six meals a day (because the patient
appetite is increased)

31. Hyperthyroidism
Nursing Management
1. Improving Nutritional status
2. Maintaining normal body temperature
3. Monitoring and Managing potential complication:-
 Monitor the patient for signs of thyroid strom
 Monitor cardiac and respiratory function by measuring
Vital signs and cardiac output, ECG,and pulse oximetry .
 Administer of oxygen to prevent hypoxia ,
 Administer IV fluid to maintain blood glucose levels and
to replace lost fluids

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