Simmonds Disease

Simmonds disease is a chronic deficiency of function of the pituitary gland, a form of hypopituitarism, that leads to atrophy of many of the viscera, including the heart, liver, spleen, kidneys, thyroid, adrenals, and gonads. The disease results in emaciation and death if left untreated.

1. SIMMONDS DISEASE PRESENTED BY--- ISHITA DAS

2. ANATOMY AND PHYSIOLOGY 2

3. Panhypopituitarism Anterior lobe of the pituitary gland Loss of function : Thyroid Adrenals Gonads Common in females. (Simmonds disease is a chronic deficiency of function of the pituitary gland , a form of hypopituitarism , that leads to atrophy of many of the viscera , including the heart , liver , kidney , thyroid , adrenals and gonads .) Simmonds disease

4. PATHOPHYSIOLOGY

5. 5 Hypertrophy &hyperplasia of lactotrophs Massive bleeding or hypovolemic shock Decreased blood supply ;hypotension Enlargement of anterior pituitary Decreased blood supply in anterior pituitary

6. 9/3/20XX 6 Spasm in small artery in anterior pituitary vasoconstriction Ischemia of the affected region hypoxia Infraction necrosis

7. 7 panhypopituitarism Cessation of function of anterior pituitary

8. Causes of Simmonds disease Blunt force trauma Disease – tuberculosis; syphilis Tumors Aging Complications in pregnancy 8

9. Signs and symptoms 9 Lack of gonadotropin (LH and FSH) – delayed puberty , small and soft testes , lack of beard, pubic hair , primary amenorrhoea . Lack of growth hormone – bone growth retardation, short stature Lack of prolactin : absence or decrease in breast milk production . Lack of TSH- fatigue , cold , dry skin ,

10. 9/3/20XX Presentation Title 10 Lack of adrenocorticotropic hormone (ACTH )- weakness , nausea , vomiting , low blood pressure , low blood sugar , coma , pale skin . Pituitary crisis – is a potential life threatening medical condition requiring immediate emergency treatment .

11. 9/3/20XX Presentation Title 11

12. Assessment 9/3/20XX Presentation Title 12 History taking Hemianopsia / headache Varying signs of hormonal disturbances Menstrual dysfunction Adrenal insufficiency Hypometabolism

13. DIAGNOSTIC FINDINGS Blood tests : Basal test – t3 &t4 , testosterone & estradiol , lh / fsh Stimulation tests – gh , acth , tsh , prl CT scan / MRI of brain { targeting pituitary gland} Cerebral angiography 9/3/20XX Presentation Title 13

14. Treatment of Simmonds disease is hormone replacement therapy – - Hydrocortisone (cortisol) for adrenal insufficiency -Levothyroxine for hypothyroidism -Testosterone for male hypogonadism -Estradiol for female hypogonadism TREATMENT 9/3/20XX Presentation Title 14

15. Nursing diagnosis 9/3/20XX Presentation Title 15 Disturbed body image related to illness sexual dysfunction related to illness

16. Goals 9/3/20XX Presentation Title 16 Removing the underlying cause Treating the hormone deficiencies Addressing any other repercussions that arise from the hormone deficiencies

17. Nursing management for altered body image 17 Observe emotional changes Assist in correcting underlying problems Assume all individuals are sensitive to changes in appearance but avoid stereotyping

18. Nursing management for sexual dysfunction 18 Establish therapeutic nurse – client relationship Assist with treatment of underlying problems Provide information about availability of corrective measures such as medications Encourage patient to engage in regular self examination , as indicated

19. Nursing management Monitor vitals signs Assess mental status ,emotional state ,energy level and appetite Administer hormone replacements as prescribes Explain the patient : - the need to take the medication for the rest of the patients life -the need for the frequent laboratory tests 19

20. Thank you