Page 27 Complete Your CE Test Online - Click Here ● ● Laryngeal hypertrophy and enlargement of the paranasal sinuses, which causes the voice to sound deep, husky, and hollow. ● ● Irritability, hospitality, and a variety of mental health disturbances may occur. The effects of prolonged GH secretion eventually include bowlegs, barrel chest, arthritis, osteoporosis, kyphosis, hypertension, glucose intolerance, diabetes mellitus, and arteriosclerosis. Patients are at risk for the development of premature cardiovascular disease, colon polyps, and colon cancer[5] . Additional signs and symptoms include[5, 8] : ● ● Coarse, oily, thick skin. ● ● Excessive diaphoresis and body odor. ● ● Fatigue. ● ● Muscle weakness. ● ● Severe snoring because of upper airway obstruction. ● ● Impaired vision. ● ● Headaches. ● ● Pain and limited joint movement. ● ● Menstrual cycle irregularities. ● ● Erectile dysfunction. ● ● Enlarged liver, heart, kidneys, spleen, and other internal organs. Diagnosis Diagnosis is based on patient history, presenting signs and symptoms, and the results of various blood tests. Fasting blood samples for GH and insulin-like growth factor-1 (IGF-I) are obtained. Elevated levels of these hormones suggest acromegaly. However, the results from random samples are not conclusive[5,8] . The definitive test for verifying acromegaly is GH suppression test [8] . Baseline GH and glucose levels are obtained. A prescribed dose of glucose is then administered, after which GH and glucose levels are drawn at 10, 60, and 120 minutes after glucose ingestion[9] . Under normal conditions glucose suppresses GH secretion. So if a glucose infusion does not suppress GH levels to below accepted normal values, and these results are accompanied by characteristic clinical signs and symptoms, a diagnosis of acromegaly is likely[5,8] . Acromegaly alert! Patients should not be emotionally or physically stressed when obtaining blood samples for the GH suppression test since stress can elevate GH levels[9] . Nursing consideration: Nurses should teach patients and their families about the importance of obtaining blood samples when the patient is relatively calm since physical and/or emotional stress can elevate GH levels. Such education can help the accuracy of test results! Various imaging tests may also be performed to diagnosis acromegaly. Skull x-rays, CT scans, MRI, and arteriography are may be used to determine the presence and extent of pituitary lesions. X-rays of the bones can show bone thickening and osteoporosis[5, 8] . Treatment and nursing considerations Treatment focuses on reducing GH production and decreasing the adverse effects of excessive amounts of GH. Surgical removal or reduction of a tumor is essential when severe pathophysiology is present. Surgical removal of pituitary tumors is complex and should be performed by surgeons who have experience in this procedure. Most of these types of tumors are removed via transsphenoidal surgery. During this procedure the surgeon removes the tumor via the nose and sphenoid sinus[5,8] . Tumor removal can normalize GH production, relieve pressure on surrounding tissues, and eliminate signs and symptoms. However, it may not be possible to remove the entire tumor depending on its size and location. In these cases, additional treatment may be necessary[5,8] . Nursing consideration: Vital signs and neurological status must be carefully monitored following surgery. Alterations in levels of consciousness, vision disturbances, unequal pupil size, vomiting, elevated blood pressure, or decreasing pulse rate, should be reported immediately. These signs may indicate increased intracranial pressure as a result of intracranial bleeding or cerebral edema[5] . If tumor cells remain following surgery radiation therapy may be prescribed to destroy any remaining cells and to gradually reduce GH levels. However, it may take some time, even years, for radiation to cause noticeable improvement in the signs and symptoms of acromegaly[8] . Radiation may be administered in one of two ways[5,8] : ● ● Conventional radiation therapy: Conventional radiation therapy is usually administered over a 4- to 6-week period. Note that the full effect of this type of radiation therapy may not be achieved for as long as 10 or more years post-treatment. ● ● Stereotactic radiosurgery: Stereotactic radiosurgery is also known as Gamma Knife radiosurgery. A high dose of radiation directed at the tumor cells is administered in a single dose while limiting radiation exposure to surrounding normal cells. This type of radiation therapy may bring GH levels to within normal limits within 3 to 5 years. Acromegaly alert! Administration of stereotactic radiosurgery requires an extremely high level of technical skill and is available at only a few U.S. health care facilities. The type of radiation therapy used depends on the size and location of remaining tumor cells and the IGF-I levels [8] . Medications may also be prescribed to lower production or block the action of GH and include the following agents[8] : ● ● Somatostatin analogues: These drugs (e.g., octreotide and lanreotide) are synthetic forms of the hormone somatostatin. They act by interfering with excessive secretion of GH and promoting reduction in GH levels. Patients are initially injected subcutaneously three times a day with a short-acting form of octreotide to identify any resulting side effects and to evaluate its effectiveness. If the medication is tolerated, a long-acting form is administered intramuscularly once a month. Lanreotide is administered subcutaneously once a month. ● ● Dopamine agonists: Dopamine agonists such as cabergoline and bromocriptine are taken orally and act by reducing GH and IGF-I levels. These drugs may also decrease tumor size. Dopamine agonist alert! Dopamine agonists trigger compulsive behaviors in some patients[8] . ● ● GH antagonists: Pegvisomant, a GH antagonist, acts by blocking the effects of GH on the body. Patients (or family members) are taught to administer the medication via subcutaneous injection. This drug can help reduce/relieve symptoms and normalize IGF-I levels but does not lower GH levels or reduce the size of the tumor. Treatment alert! If GH levels can be maintained at less than 1 ng/ml and IGF-I levels at normal range for age and gender, life expectancy is restored to that of age-matched controls[5] . Nursing considerations focus on monitoring appropriate blood levels, signs and symptoms, and patient/family education. Some of these considerations include[5, 6] : ● ● Teach patients and families how to administer medications. Stress the importance of adhering to any medication regimen as prescribed. Have patients/families demonstrate their knowledge of proper medication administration by demonstrating how to administer/take medications and describing the medications’ actions, side effects, and how to deal with and when to report side effects. Warn patients and families not to stop taking medications without HCP approval. ● ● Stress how important it is for patients not to add or eliminate any medications without the approval of their HCPs. Emphasize that this includes not only prescription medications but vitamins, herbal