Hypopituitarism: Case Study Involving Hypernatremia Prompting Discovery of a Pituitary Disorder in a Patient With Lymphoma.

BACKGROUND: The endocrine system contributes to numerous physiologic processes. Compensatory mechanisms are in place that can assist when endocrine dysfunction occurs, which may make it difficult to identify pathologic states. OBJECTIVES: The case study in this article presents a 74-year-old woman with diffuse large B-cell lymphoma who was admitted to an oncology critical care unit with neutropenic fevers and suspicion of gastrointestinal bleeding. She was placed on NPO status (no oral intake) overnight and quickly developed hypernatremia. This prompted further investigation, resulting in the discovery of hypopituitarism. METHODS: A case study illustrates how altered endocrine function can contribute to rapid patient deterioration beyond hypothyroidism, diabetes, or other common endocrine conditions. FINDINGS: Compensatory mechanisms involving the endocrine system can mask dysfunction, which can cause providers to miss signs of altered endocrine function. Experienced clinical nurses should use critical thinking and assessment skills to monitor patients for abnormal signs and symptoms.

Educating children and families about growth hormone deficiency and its management: part 1.

The management of growth hormone deficiency is long term. Children may be diagnosed at pre-school age meaning relationships with the paediatric endocrine team may last more than 15 years. The education role of the paediatric endocrine nurse specialist is essential in working in partnership with families over a long period of time. Children and young people have changing needs for information to help them understand their condition and growth hormone deficiency treatment as they grow up. Developing positive working relationships with parents, children and young people enables their developmental needs and the context in which they live their lives to be central to any educational planning for them. Addressing developmental needs when providing information on growth hormone deficiency to children and young people reinforces the need for education to be an ongoing process and not a one-off event. This is part one of a two-part article. The second part will be published in the March issue of Nursing Children and Young People and it focuses on educating children, young people and their parents about the condition, and includes case studies.

Craniopharyngiomas.

Craniopharyngiomas are rare, benign, suprasellar brain tumors that account for 1%-3% of all intracranial tumors. Pituitary gland involvement causes loss of pituitary function, which makes endocrine evaluation necessary before and after surgery. Symptoms of intracranial mass effect, including visual field loss, obstructive hydrocephalus, and extraocular palsy of the cranial nerves, may occur. Lifelong follow-up is crucial because of the risk of recurrence and the need for ongoing hormone replacement therapy. Surgical resection is the primary therapy. However, radiotherapy may be indicated. Nurses play a major role in caring for patients with a craniopharyngioma by preventing and identifying complications, educating patients and families about the importance of long-term follow-up, and collaborating with multidisciplinary teams.

Hypopituitarism in patients with a history of irradiation to the head and neck area: diagnoses and implications for nursing.

Patients treated with irradiation for head and neck tumors are at risk of developing endocrine complications resulting from hypothalamic-pituitary damage caused by the radiotherapy. Since nurses are likely to see patients with a history of irradiation to the head and neck area in their practice settings, they should be aware of the signs and symptoms of hypopituitarism. As patients with hypopituitarism survive longer, nurses are more likely to come into contact with them for other healthcare problems. Nurses have an important role in the procedures used to diagnose hypopituitarism. Patient follow-up involves testing of the hypothalamic-pituitary axis by stimulatory testing.