1. General information
    1. Partial or complete removal of the pituitary gland
    2. Indications: pituitary tumors, diabetic retinopathy, metastatic cancer of the breast or prostate, which may be endocrine dependent
    3. Surgical approaches
      1. Craniotomy: usually transfrontal
      2. Transphenoidal: incision made in inner aspect of upper lip and gingiva; sella turcica is entered through the floor of the nose and sphenoid sinuses
  2. Nursing care
    1. In addition to pre-op care of the craniotomy client, explain post-op expectations.
    2. In addition to post-op care of the craniotomy client, observe for signs of target gland deficiencies (diabetes insipidus, adrenal insufficiency, hypothyroidism) due to total removal of the gland or to post-op edema.
      1. Perform hourly urine outputs and specific gravities; alert physician if urine output is greater than 800-900 ml/2 hours or if specific gravity is less than 1.004.
      2. Administer cortisone replacement as ordered.
    3. If transphenoidal approach used
      1. Elevate the head of the bed to 30° to decrease headache and pressure on the sella turcica.
      2. Administer mild analgesics for headache as ordered.
      3. Perform frequent oral hygiene with soft swabs to cleanse the teeth and mouth rinses; no toothbrushing.
      4. Observe for and prevent CSF leak from surgical site.
        1. warn the client not to cough, sneeze, or blow nose.
        2. observe for clear drainage from nose or postnasal drip (constant swallowing); check drainage for glucose; positive results indicate that drainage is CSF.
        3. if leakage does occur
          1. elevate head of bed and call the physician.
          2. most leaks will resolve in 72 hours with bed rest and elevation.
          3. may do daily spinal taps to decrease CSF pressure.
          4. administer antibiotics as ordered to prevent meningitis.
    4. Provide client teaching and discharge planning concerning
      1. Hormone therapy
        1. if gland is completely removed, client will have permanent diabetes insipidus (see below)
        2. cortisone and thyroid hormone replacement
        3. replacement of sex hormones
          1. testosterone: may be given for impotence in men
          2. estrogen: may be given for atropy of the vaginal mucosa in women
          3. human pituitary gonadotropins: may restore fertility in some women
      2. Need for lifelong follow-up and hormone replacement
      3. Need to wear Medic-Alert bracelet
      4. If transphenoidal approach was used
        1. avoid bending and straining at stool for 2 months post-op
        2. no toothbrushing until sutures are removed and incision heals (about 10 days)