Managing the patient with transsphenoidal pituitary tumor resection.

Patients who undergo transsphenoidal pituitary tumor resection require a multidisciplinary team approach, consisting of a neurosurgeon, an endocrinologist, and nurses. Successful transsphenoidal surgery needs expert nursing care for early identification and prompt treatment of pituitary dysfunction and neurosurgical complications. Pituitary dysfunction includes adrenal insufficiency, diabetes insipidus, syndrome of inappropriate antidiuretic hormone, and cerebral salt wasting syndrome. Neurosurgical complications may include visual disturbance, cerebrospinal fluid leak, subdural hematoma, and epistaxis.

Diabetes insipidus.

The author describes ways to recognize and control this potentially deadly condition.

Diabetes insipidus and syndrome of inappropriate secretion of antidiuretic hormone in children with midline suprasellar brain tumors.

Salt and water balance within the body is controlled by the hormonal influence of vasopressin. Vasopressin is produced in the hypothalamus, stored and released from the posterior lobe of the pituitary, and travels via the blood to the kidneys to regulate the amount and concentration of urine excreted. Oversecretion or undersecretion of vasopressin, eg, diabetes insipidus (DI) or syndrome of inappropriate secretion of antidiuretic hormone (SIADH) results in an imbalance of the salt-to-water ratio. In children this hormonal imbalance may occur secondary to a suprasellar brain tumor and/or the treatment of such. Approximately 50% to 75% of children with suprasellar tumors will develop permanent DI and the remainder will experience transient postoperative DI or SIADH. Pathophysiology of vasopressin's control on salt and water balance and its relationship to suprasellar brain tumors in children are presented. Nursing assessment and intervention parameters for management of DI and SIADH in children with brain tumors are also discussed.

Diabetes insipidus versus syndrome of inappropriate antidiuretic hormone.

Diabetes insipidus (DI) and the syndrome of inappropriate antidiuretic hormone (SIADH) are two endocrine disorders presenting a challenge to the critical care nurse. The challenge lies in the recognition and assessment of the effects on the patient's fluid balance and in the planning of interventions to prevent complications.

Clinical management of the organ donor.

Critical care nurses play a vital role in the clinical management of potential organ donors. Knowledge of the physiologic traits a donor will exhibit and the clinical interventions necessary to prevent circulatory collapse are essential in providing care to the organ donor. Maintaining hemodynamic stability in the donor optimizes organ function and improves the chances of successful results in transplant recipients.

Fluid and electrolyte problems associated with diabetes insipidus and syndrome of inappropriate antidiuretic hormone.

This article has presented the complex system by which the hypothalamus regulates body fluid balance. In summary, ADH is synthesized and released via the hypothalamohypophyseal system. The supraoptic nucleus in the hypothalamus produces the ADH and the neurohypophysis stores and releases it. Osmoreceptors in the hypothalamus sense minute changes in the extracellular osmolality and stimulate or inhibit ADH synthesis and secretion. At the same time the thirst center of the hypothalamus is stimulated by the extracellular osmolality and brings conscious awareness of thirst into play. Once ADH is secreted, its target organ is the kidney, specifically the collecting ducts and distal tubules. Blood volume, blood pressure, emotional input, medications, and various pathologic conditions also affect ADH synthesis and secretion. As with any complex system there are numerous opportunities for a breakdown to occur. The most common types of pathologic conditions are the various forms of DI and SIADH. Both of these disorders have numerous causes, which must be identified prior to effective treatment. Serum and urine osmolality and sodium content are of use in diagnosing the disorders. Treatment is then geared toward correcting the underlying problem and controlling water balance, usually through pharmacologic agents. Nursing care includes meeting both the physical and psychologic needs of patients and educating them in the process of living with their transient or permanent condition.

Nursing management of diabetes insipidus.

Diabetes insipidus is seen most frequently in neurosurgical patients. The transient form is more common and usually subsides prior to discharge. Permanent DI is seen in patients with extensive damage in the hypothalamic area. Treatment of either form of DI is usually with a preparation of vasopressin. Nursing assessements and interventions are crucial to a successful outcome in patients with this disorder. Health teaching for patients with permanent DI is an integral part of the nursing responsibility.