Chapter 57: Concepts of Care for Patients With Pituitary and Adrenal Gland Problems

The pituitary gland controls growth hormone and antidiuretic hormone secretion, while the adrenal cortex produces cortisol and aldosterone—hormones essential for maintaining cardiovascular stability, glucose metabolism, and stress response. Cushing syndrome, exemplified through Cushing disease (pituitary adenoma causing hypercortisolism), presents with distinctive clinical manifestations including central obesity with fat redistribution to the face and upper back, hypertension, hyperglycemia, muscle weakness, and psychological changes such as mood disturbances and cognitive impairment. Excessive growth hormone secretion leads to acromegaly, characterized by progressive enlargement of hands, feet, and facial structures alongside metabolic complications. Pituitary insufficiency can result in syndrome of inappropriate antidiuretic hormone secretion, causing dangerous water retention and hyponatremia. Conversely, adrenal insufficiency or Addison disease represents life-threatening hypofunction requiring permanent glucocorticoid and mineralocorticoid replacement therapy with medications such as hydrocortisone or prednisone to sustain hemodynamic stability and prevent acute adrenal crisis. Surgical management, particularly hypophysectomy for hormone-secreting adenomas, demands careful postoperative monitoring to prevent increased intracranial pressure through patient education about activity restrictions including avoiding Valsalva maneuvers, bending, and straining. Comprehensive nursing care addresses both the physiological complications of these endocrine disorders and the profound psychosocial impacts, as patients experience significant distress related to altered body image, facial changes, and loss of physical function. Therapeutic interventions integrate pharmacological management, surgical care, and emotional support to promote adaptation and quality of life.