Page 330 - Critical Care Nursing Demystified

Chapter 7 CARE OF THE PATIENT WITH ENDOCRINE DISORDERS 315

In adults post puberty, an excessive secretion of GH produces acromegaly. The
adult bones are unable to grow longer as in the case of children whose long bones
continue to grow. Adult bones increase not in length, but in width and thickness.
Acromegaly usually begins gradually in the 3rd or 4th decades of life.

Hallmark Signs and Symptoms
Initial noticeable enlargement of the hand and fingers occurs with “clubbing” of the
fingertips. The skin becomes thick, leathery, and oily. Speech difficulties become
apparent as the tongue enlarges, the voice deepens, and vocal cords hypertrophy.
Additional symptoms of acromegaly may range from mild joint pain to severe,
debilitating arthritis. Sleep apnea can occur due to upper airway narrowing. Muscle
weakness and neuropathy may also result. Marked prognathism or projection of the
mandible forward can occur and interfere with the individual’s ability to chew.
Cardiovascular involvement may develop associated with congestive heart
failure (CHF), angina pectoris, and hypertension. Atherosclerosis may become
apparent due to increased circulating fatty acids in the bloodstream. Women
may develop menstrual disturbances. If the cause of acromegaly is a pituitary
tumor, increased pressure within the brain can create visual problems and head-
aches. Excessive secretion of GH can lead to symptoms of hyperglycemia and
eventual diabetes mellitus. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.

3 Patient Assessment
The nurse should assess the patient for signs and symptoms of abnormal growth
of bones and excessive soft tissue on the face and forehead and a thickening of
facial features around the eyes, nose, and mouth. An enlargement of the man-
dible will cause the jaw to protrude forward. Question the patient about
increases in shoe, hat, ring, and glove size and any noticeable changes in the
patient’s physical appearance. Such changes are usually gradual over the years,
so a photographic comparison would be helpful.

Interpreting Test Results
The normal GH level in the adult, fasting and at rest, is 2 to 5 ng/mL. In some
adults the results might be so low that the hormone remains undetected.
Giving L-Dopa may stimulate GH to increase to measurable levels. Since blood
GH levels fluctuate so much, the most reliable test for acromegaly is the oral
glucose load challenge test, given to demonstrate that excessive release of GH
cannot be suppressed. Under normal conditions, GH concentration levels
decrease during an oral glucose tolerance test but increase with acromegaly
because the cells become more resistant to insulin. The body strives unsuccess-
fully to handle increases in glucose and to metabolize carbohydrates. It has been