N212: Health Differences Across the Life Span 2

Health Differences Across the Lifespan 2 Study Guide

©2017 Achieve Test Prep Page 73 of 140 Pituitary Gigantism This condition of growth hormone excess is rare in children and is referred to as pituitary gigantism because the excessive growth hormone produces excessive growth of bones and the child can achieve excessive height. Height is usually from 2.1 to 2.7 m (6'11" to 8'11") in stature by adulthood if left untreated. As a child becomes an adult, many of the adult problems can gradually develop. The distinction between gigantism (occurring in children) and acromegaly (occurring in adults) can be made by the occurrence of the adenoma in relation to the closure of the epiphyses. If elevated growth hormone levels occur before the closure of the epiphyses (in prepubertal children), then gigantism ensues. If it occurs after the closure of the epiphyses (in adults) then acromegaly ensues. Complications: • Severe headache • Arthritis and carpal tunnel syndrome • Enlarged heart • Hypertension • Diabetes mellitus • Heart failure • Kidney failure • Compression of the optic chiasm, leading to loss of vision in the outer visual fields (typically bitemporal hemianopia) • Increased palmar sweating and sebum production over the face (seborrhea) are clinical indicators of active growth hormone (GH) producing pituitary tumors; symptoms can also be used to monitor the activity of the tumor after surgery although biochemical monitoring Signs and symptoms include coarse facial features, enlarged tongue, protruding jaw, spiderlike fingers, wide hands and feet, thickened ears and nose, tall stature (if onset is in childhood), joint changes consistent with arthritis, deep voice, possible dysphagia, hypertension, and organomegaly. Treatment: monitor for disturbed body image and provide emotional support to patient and family; provide measures to relieve joint pain; possible radiation therapy to pituitary gland; possible trans sphenoidal hypophysectomy to remove effecting tumor; thyroid hormone replacement therapy; patient may experience transient diabetes insipidus post operatively and increased urine output; goals of treatment are to reduce GH production to normal levels, to relieve the pressure that the growing pituitary tumor exerts on the surrounding brain areas, to preserve normal pituitary function, and to reverse or ameliorate the symptoms of acromegaly; treatment options include surgical removal of the tumor, drug therapy, and radiation therapy of the pituitary Surgery: Surgery is a rapid and effective treatment. In trans sphenoidal surgery an incision is made into the gum beneath the upper lip. Further incisions are made to cut through the septum to reach the nasal cavity, where the pituitary is located. Treatments, such as medicinal therapy or radiostatic neurosurgery, may be used to reduce the remaining adverse effects of the remaining tumor. These procedures normally relieve the pressure on the surrounding brain regions and lead to a lowering

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