54
Endocrine Problems
Ann H. Crawford
http://evolve.elsevier.com/Lewis/medsurg/
CONCEPTUAL FOCUS
Coping Perfusion
Fluids and Electrolytes Reproduction
Hormonal Regulation Thermoregulation
Nutrition Tissue Integrity
LEARNING OUTCOMES
1. Explain the pathophysiology, clinical manifestations, and 4. Describe the pathophysiology, clinical manifestations, and
interprofessional and nursing management of the patient interprofessional and nursing management of the patient
with an anterior pituitary gland problem. with a parathyroid problem.
2. Describe the pathophysiology, clinical manifestations, and 5. Identify the pathophysiology, clinical manifestations, and
interprofessional and nursing management of the patient interprofessional and nursing management of the patient
with a posterior pituitary gland problem. with an adrenal cortex problem.
3. Explain the pathophysiology, clinical manifestations, and 6. Describe the pathophysiology, clinical manifestations, and
interprofessional and nursing management of the patient interprofessional and nursing management of the patient
with a thyroid problem. with an adrenal medulla problem.
7. Outline the side effects of corticosteroid therapy.
KEY TERMS
acromegaly hypoparathyroidism
Addison disease hypopituitarism
Cushing syndrome hypothyroidism
diabetes insipidus (DI) myxedema
goiter pheochromocytoma
Graves disease syndrome of inappropriate antidiuretic hormone (SIADH)
hyperaldosteronism thyroid cancer
hyperparathyroidism thyroiditis
hyperthyroidism thyrotoxicosis
The endocrine system is made up of several organs and glands may be a wide range of psychologic responses, including anxiety
involved in the synthesis and secretion of hormones which and depression.
affect every body system. Because hormones have a wide range
of action, problems with their regulation may cause homeo-
static changes that can affect many aspects of a person’s life. The
ANTERIOR PITUITARY GLAND PROBLEMS
severity varies widely. There may be adverse effects on perfu- The pituitary gland is considered the master gland of the endocrine
sion, metabolism, skin integrity, and nutrition. Regulating fluid system. The anterior pituitary gland secretes growth hormone
and electrolyte balance and temperature may be difficult. The (GH), prolactin, and 4 tropic hormones—adrenocorticotropic
patient may have problems with growth and fertility and repro- hormone (ACTH), thyroid-stimulating hormone (TSH), folli-
ductive processes because these are hormone dependent. There cle-stimulating hormone (FSH), and luteinizing hormone (LH).
1322
, CHAPTER 54 Endocrine Problems 1323
The life expectancy of those with acromegaly is reduced by
5 to 10 years. They are prone to cardiovascular disease (CVD),
diabetes, and colorectal cancer.3 Even if patients are cured or the
disease is well controlled, manifestations such as joint pain and
deformities often remain.
Diagnostic Studies
In addition to the history and physical assessment, a diagnosis
requires evaluating plasma insulin-like growth factor-1 (IGF-
1) levels and GH response to an oral glucose tolerance test
(OGTT). IGF-1 mediates the peripheral actions of GH. As GH
Fig. 54.1 Progressive development of facial changes from acromegaly. levels rise, so do IGF-1 levels. Since GH is released in a pulsatile
(Courtesy Linda Haas, Seattle, WA.) fashion, we need several samples to obtain an accurate assess-
ment. Serum IGF-1 levels are more constant, giving a reliable
These hormones affect growth, sexual maturation, reproduction, diagnostic measure of acromegaly. During an OGTT, GH con-
metabolism, stress response, and fluid balance. As a result, pitu- centration normally falls because glucose inhibits GH secretion.
itary gland disorders manifest in a variety of ways. In acromegaly, GH levels do not fall and in some cases GH levels
Pituitary gland tumors account for 5% to 20% of primary rise.
intracranial tumors.1 The most common, a pituitary adenoma, MRI or high-resolution CT scan with contrast can detect
is a slow-growing, benign tumor. It often occurs in adults pituitary adenomas. A complete eye examination, including
between 40 and 60 years of age. Hypersecretory pituitary ade- visual fields, is done because a tumor may cause pressure on the
nomas secrete an excess of a specific hormone causing manifes- optic chiasm or optic nerves.
tations related to the action of that hormone. The most common
are prolactinomas and GH- and ACTH-secreting adenomas.1 Interprofessional and Nursing Care
The patient’s prognosis depends on the age at onset, age when
treatment started, and tumor size. The overall goal is to return
ACROMEGALY the patient’s GH levels to normal. Treatment consists of sur-
Acromegaly is a rare condition characterized by an overproduc- gery, radiation therapy, drug therapy, or a combination of these.
tion of GH. Around 3 cases per 1 million people in the United Treatment can stop bone growth and reverse tissue hypertro-
States are diagnosed annually.2 It affects both genders equally. phy. However, sleep apnea, diabetes, and cardiac problems may
The mean age at the time of diagnosis is 40 to 45 years old. persist.
Surgery (hypophysectomy) is the treatment of choice. It
Etiology and Pathophysiology offers the best chance for a cure and optimal symptom manage-
Acromegaly most often occurs because of a benign GH-secreting ment, especially for smaller pituitary tumors.4 Surgery results
pituitary adenoma. The excess GH results in an overgrowth of in an immediate reduction in GH levels. IGF-1 levels fall within
soft tissues and bones in the hands, feet, and face. Because the a few weeks. Patients with larger tumors or those with GH lev-
problem develops after epiphyseal closure, the bones of the els greater than 45 ng/mL may need adjuvant radiation or drug
arms and legs do not grow longer. therapy. Surgery and radiation therapy for pituitary tumors are
discussed later in this chapter.
Clinical Manifestations Drug therapy is an option for patients whose surgery did not
The changes resulting from excess GH in adults can occur slowly, result in a cure and/or in combination with radiation therapy.
over many years. They may go unnoticed by the person, family, The main drug used is octreotide (Sandostatin), a somatosta-
and friends. Thickening and enlargement of the bony and soft tin analog. It reduces GH levels to normal in many patients.
tissues on the face, feet, and head occur (Fig. 54.1). Patients may Octreotide is given by subcutaneous injection 3 times a week.
have proximal muscle weakness and joint pain that can range Long-acting somatostatin analogs, octreotide (Sandostatin
from mild to crippling. Carpal tunnel syndrome and peripheral LAR), pasireotide (Signifor), and lanreotide SR (Somatuline
neuropathy may be present. Depot), are available as IM injections given every 4 weeks. GH
Tongue enlargement causes dental and speech problems. levels are measured every 2 weeks to guide drug dosing and
The voice deepens because of hypertrophy of the vocal cords. then every 6 months until the desired response is achieved.
Sleep apnea may occur because of upper airway narrowing and Dopamine agonists (e.g., bromocriptine, cabergoline) may
obstruction from increased amounts of pharyngeal soft tissues. be given alone or with somatostatin analogs if surgery does not
The skin becomes thick, leathery, and oily with acne outbreaks. result in a complete remission. These drugs reduce GH secre-
Vision changes may occur from pressure on the optic nerve tion from the tumor.
from a pituitary adenoma. Headaches are common. Since GH GH antagonists (e.g., pegvisomant [Somavert]) reduce the
antagonizes the action of insulin, glucose intolerance and man- effect of GH in the body by blocking liver production of IGF-1.
ifestations of diabetes may occur, including increased thirst and Most patients taking this drug achieve normal IGF-1 levels with
polyuria (increased urination). symptom improvement.3
, 1324 SECTION 11 Problems Related to Regulatory and Reproductive Mechanisms
Serial photographs showing improvement in appearance TABLE 54.1 Manifestations of
may be helpful to the patient’s recovery. Psychosocial effects of Hypopituitarism
acromegaly include body image problems, sexual problems, and
Hormone Deficiency Manifestations
depression. Fatigue and sleep problems may persist after sur-
Adrenocorticotropic Involves cortisol deficiency: weakness, fatigue,
gery. Patients will need strategies for dealing with these symp-
hormone (ACTH) headache, dry and pale skin, ↓axillary and
toms. Referral to a support group may be helpful.
pubic hair, ↓ resistance to infection, fasting
hypoglycemia
EXCESSES OF OTHER TROPIC HORMONES Follicle-stimulating Women: Menstrual irregularities, loss
hormone (FSH) and of libido, changes in secondary sex
Excess prolactin or tropic hormone (e.g., ACTH, TSH) secre- luteinizing hormone characteristics (e.g., ↓ breast size)
tion by the anterior pituitary gland will cause other endocrine (LH) Men: Testicular atrophy, ↓ spermatogenesis,
glands to overproduce certain hormones. An excess of these loss of libido, impotence, ↓ facial hair and
hormones (discussed later in the chapter) can cause significant muscle mass
problems in metabolism and general health. Growth hormone (GH) Subtle, nonspecific findings: truncal obesity,
A prolactin-secreting adenoma is known as a prolactinoma. osteoporosis, ↓ muscle mass and strength,
weakness, fatigue, depression, or flat affect
They account for about 40% of pituitary tumors.5 Women with
Thyroid-stimulating Mild form of primary hypothyroidism: fatigue,
prolactinomas may have galactorrhea, anovulation, infertil-
hormone (TSH) cold intolerance, constipation, lethargy,
ity, infrequent or absent menses, decreased libido, and hirsut- weight gain
ism. In men, impotence, decreased sperm density, and libido
may result. Compression of the optic chiasm can cause vision
changes and signs of increased intracranial pressure, including In addition to a history and physical assessment, diagnos-
headache, nausea, and vomiting. tic studies such as MRI and CT can identify a pituitary tumor.
Because prolactinomas do not typically grow, drug therapy Laboratory tests generally involve the direct measurement of
is usually the first-line treatment. The dopamine agonists cab- pituitary hormones (e.g., TSH) or an indirect determination of
ergoline and bromocriptine are given to block prolactin release. the target organ hormones (e.g., triiodothyronine [T3], thyrox-
Surgery may be an option, depending on the extent and size ine [T4]). See Chapter 52 for more information about diagnostic
of the tumor. Radiation therapy can reduce the risk for tumor studies.
recurrence for patients with large tumors.
Interprofessional and Nursing Care
The treatment for hypopituitarism often consists of surgery or
PITUITARY GLAND HYPOFUNCTION radiation therapy followed by lifelong hormone therapy. Surgery
Hypopituitarism is a rare disorder that involves a decrease in 1 and radiation therapy for pituitary tumors are discussed in the
or more of the pituitary hormones. A deficiency of only 1 pitu- next section. Appropriate hormone therapy is used (e.g., corti-
itary hormone is called selective hypopituitarism. Total failure costeroids, thyroid hormone). Hormone therapies for thyroid
of the pituitary gland results in deficiency of all pituitary hor- hormone and corticosteroids are discussed later in this chapter.
mones—a condition called panhypopituitarism. The most com- Somatropin (Genotropin, Humatrope, Omnitrope) is recom-
mon hormone deficiencies from hypopituitarism involve GH binant human GH. It is used for long-term hormone therapy
and gonadotropins (e.g., LH, FSH). in adults with GH deficiency. These patients respond well to
GH replacement. They have increased energy, increased lean
Etiology and Pathophysiology body mass, a feeling of well-being, and improved body image.
The usual cause of pituitary hypofunction is a pituitary tumor. Side effects include fluid retention with swelling in the feet and
Autoimmune disorders, infections, pituitary infarction (Sheehan hands, muscle and joint pain, and headache. GH is given daily
syndrome), or destruction of the pituitary gland (from trauma, as a subcutaneous injection, preferably in the evening. The dos-
radiation, surgery) can also cause hypopituitarism. The incidence ing is variable and adjusted based on symptoms, IGF-1 levels,
varies among populations, with a higher mortality in women. and side effects.
Anterior pituitary hormone deficiencies can lead to end-or- Although gonadal deficiency is not life threatening, hormone
gan failure. TSH and ACTH deficiencies are life threatening. therapy will improve sexual function and general well-being.
ACTH deficiency can lead to acute adrenal insufficiency and It is contraindicated in those with certain medical conditions,
hypovolemic shock from sodium and water depletion. such as phlebitis, pulmonary embolism, breast cancer, and pros-
tate cancer. Estrogen and progesterone replacement therapy
Clinical Manifestations and Diagnostic Studies may be given to hypogonadal women to treat hot flashes, vagi-
The manifestations vary with the type and degree of dysfunc- nal dryness, and decreased libido (see Chapter 58). Testosterone
tion. Early manifestations of a space-occupying lesion include is used to treat men with gonadotropin deficiency. The benefits
headaches, vision changes (decreased visual acuity, decreased of testosterone therapy include a return of male secondary sex
peripheral vision), loss of smell, nausea and vomiting, and sei- characteristics, improved libido, and increased muscle mass,
zures. Manifestations associated with hyposecretion of the tar- bone mass, and bone density. Hormone therapy for men is dis-
get glands vary widely (Table 54.1). cussed in Chapter 59.
Endocrine Problems
Ann H. Crawford
http://evolve.elsevier.com/Lewis/medsurg/
CONCEPTUAL FOCUS
Coping Perfusion
Fluids and Electrolytes Reproduction
Hormonal Regulation Thermoregulation
Nutrition Tissue Integrity
LEARNING OUTCOMES
1. Explain the pathophysiology, clinical manifestations, and 4. Describe the pathophysiology, clinical manifestations, and
interprofessional and nursing management of the patient interprofessional and nursing management of the patient
with an anterior pituitary gland problem. with a parathyroid problem.
2. Describe the pathophysiology, clinical manifestations, and 5. Identify the pathophysiology, clinical manifestations, and
interprofessional and nursing management of the patient interprofessional and nursing management of the patient
with a posterior pituitary gland problem. with an adrenal cortex problem.
3. Explain the pathophysiology, clinical manifestations, and 6. Describe the pathophysiology, clinical manifestations, and
interprofessional and nursing management of the patient interprofessional and nursing management of the patient
with a thyroid problem. with an adrenal medulla problem.
7. Outline the side effects of corticosteroid therapy.
KEY TERMS
acromegaly hypoparathyroidism
Addison disease hypopituitarism
Cushing syndrome hypothyroidism
diabetes insipidus (DI) myxedema
goiter pheochromocytoma
Graves disease syndrome of inappropriate antidiuretic hormone (SIADH)
hyperaldosteronism thyroid cancer
hyperparathyroidism thyroiditis
hyperthyroidism thyrotoxicosis
The endocrine system is made up of several organs and glands may be a wide range of psychologic responses, including anxiety
involved in the synthesis and secretion of hormones which and depression.
affect every body system. Because hormones have a wide range
of action, problems with their regulation may cause homeo-
static changes that can affect many aspects of a person’s life. The
ANTERIOR PITUITARY GLAND PROBLEMS
severity varies widely. There may be adverse effects on perfu- The pituitary gland is considered the master gland of the endocrine
sion, metabolism, skin integrity, and nutrition. Regulating fluid system. The anterior pituitary gland secretes growth hormone
and electrolyte balance and temperature may be difficult. The (GH), prolactin, and 4 tropic hormones—adrenocorticotropic
patient may have problems with growth and fertility and repro- hormone (ACTH), thyroid-stimulating hormone (TSH), folli-
ductive processes because these are hormone dependent. There cle-stimulating hormone (FSH), and luteinizing hormone (LH).
1322
, CHAPTER 54 Endocrine Problems 1323
The life expectancy of those with acromegaly is reduced by
5 to 10 years. They are prone to cardiovascular disease (CVD),
diabetes, and colorectal cancer.3 Even if patients are cured or the
disease is well controlled, manifestations such as joint pain and
deformities often remain.
Diagnostic Studies
In addition to the history and physical assessment, a diagnosis
requires evaluating plasma insulin-like growth factor-1 (IGF-
1) levels and GH response to an oral glucose tolerance test
(OGTT). IGF-1 mediates the peripheral actions of GH. As GH
Fig. 54.1 Progressive development of facial changes from acromegaly. levels rise, so do IGF-1 levels. Since GH is released in a pulsatile
(Courtesy Linda Haas, Seattle, WA.) fashion, we need several samples to obtain an accurate assess-
ment. Serum IGF-1 levels are more constant, giving a reliable
These hormones affect growth, sexual maturation, reproduction, diagnostic measure of acromegaly. During an OGTT, GH con-
metabolism, stress response, and fluid balance. As a result, pitu- centration normally falls because glucose inhibits GH secretion.
itary gland disorders manifest in a variety of ways. In acromegaly, GH levels do not fall and in some cases GH levels
Pituitary gland tumors account for 5% to 20% of primary rise.
intracranial tumors.1 The most common, a pituitary adenoma, MRI or high-resolution CT scan with contrast can detect
is a slow-growing, benign tumor. It often occurs in adults pituitary adenomas. A complete eye examination, including
between 40 and 60 years of age. Hypersecretory pituitary ade- visual fields, is done because a tumor may cause pressure on the
nomas secrete an excess of a specific hormone causing manifes- optic chiasm or optic nerves.
tations related to the action of that hormone. The most common
are prolactinomas and GH- and ACTH-secreting adenomas.1 Interprofessional and Nursing Care
The patient’s prognosis depends on the age at onset, age when
treatment started, and tumor size. The overall goal is to return
ACROMEGALY the patient’s GH levels to normal. Treatment consists of sur-
Acromegaly is a rare condition characterized by an overproduc- gery, radiation therapy, drug therapy, or a combination of these.
tion of GH. Around 3 cases per 1 million people in the United Treatment can stop bone growth and reverse tissue hypertro-
States are diagnosed annually.2 It affects both genders equally. phy. However, sleep apnea, diabetes, and cardiac problems may
The mean age at the time of diagnosis is 40 to 45 years old. persist.
Surgery (hypophysectomy) is the treatment of choice. It
Etiology and Pathophysiology offers the best chance for a cure and optimal symptom manage-
Acromegaly most often occurs because of a benign GH-secreting ment, especially for smaller pituitary tumors.4 Surgery results
pituitary adenoma. The excess GH results in an overgrowth of in an immediate reduction in GH levels. IGF-1 levels fall within
soft tissues and bones in the hands, feet, and face. Because the a few weeks. Patients with larger tumors or those with GH lev-
problem develops after epiphyseal closure, the bones of the els greater than 45 ng/mL may need adjuvant radiation or drug
arms and legs do not grow longer. therapy. Surgery and radiation therapy for pituitary tumors are
discussed later in this chapter.
Clinical Manifestations Drug therapy is an option for patients whose surgery did not
The changes resulting from excess GH in adults can occur slowly, result in a cure and/or in combination with radiation therapy.
over many years. They may go unnoticed by the person, family, The main drug used is octreotide (Sandostatin), a somatosta-
and friends. Thickening and enlargement of the bony and soft tin analog. It reduces GH levels to normal in many patients.
tissues on the face, feet, and head occur (Fig. 54.1). Patients may Octreotide is given by subcutaneous injection 3 times a week.
have proximal muscle weakness and joint pain that can range Long-acting somatostatin analogs, octreotide (Sandostatin
from mild to crippling. Carpal tunnel syndrome and peripheral LAR), pasireotide (Signifor), and lanreotide SR (Somatuline
neuropathy may be present. Depot), are available as IM injections given every 4 weeks. GH
Tongue enlargement causes dental and speech problems. levels are measured every 2 weeks to guide drug dosing and
The voice deepens because of hypertrophy of the vocal cords. then every 6 months until the desired response is achieved.
Sleep apnea may occur because of upper airway narrowing and Dopamine agonists (e.g., bromocriptine, cabergoline) may
obstruction from increased amounts of pharyngeal soft tissues. be given alone or with somatostatin analogs if surgery does not
The skin becomes thick, leathery, and oily with acne outbreaks. result in a complete remission. These drugs reduce GH secre-
Vision changes may occur from pressure on the optic nerve tion from the tumor.
from a pituitary adenoma. Headaches are common. Since GH GH antagonists (e.g., pegvisomant [Somavert]) reduce the
antagonizes the action of insulin, glucose intolerance and man- effect of GH in the body by blocking liver production of IGF-1.
ifestations of diabetes may occur, including increased thirst and Most patients taking this drug achieve normal IGF-1 levels with
polyuria (increased urination). symptom improvement.3
, 1324 SECTION 11 Problems Related to Regulatory and Reproductive Mechanisms
Serial photographs showing improvement in appearance TABLE 54.1 Manifestations of
may be helpful to the patient’s recovery. Psychosocial effects of Hypopituitarism
acromegaly include body image problems, sexual problems, and
Hormone Deficiency Manifestations
depression. Fatigue and sleep problems may persist after sur-
Adrenocorticotropic Involves cortisol deficiency: weakness, fatigue,
gery. Patients will need strategies for dealing with these symp-
hormone (ACTH) headache, dry and pale skin, ↓axillary and
toms. Referral to a support group may be helpful.
pubic hair, ↓ resistance to infection, fasting
hypoglycemia
EXCESSES OF OTHER TROPIC HORMONES Follicle-stimulating Women: Menstrual irregularities, loss
hormone (FSH) and of libido, changes in secondary sex
Excess prolactin or tropic hormone (e.g., ACTH, TSH) secre- luteinizing hormone characteristics (e.g., ↓ breast size)
tion by the anterior pituitary gland will cause other endocrine (LH) Men: Testicular atrophy, ↓ spermatogenesis,
glands to overproduce certain hormones. An excess of these loss of libido, impotence, ↓ facial hair and
hormones (discussed later in the chapter) can cause significant muscle mass
problems in metabolism and general health. Growth hormone (GH) Subtle, nonspecific findings: truncal obesity,
A prolactin-secreting adenoma is known as a prolactinoma. osteoporosis, ↓ muscle mass and strength,
weakness, fatigue, depression, or flat affect
They account for about 40% of pituitary tumors.5 Women with
Thyroid-stimulating Mild form of primary hypothyroidism: fatigue,
prolactinomas may have galactorrhea, anovulation, infertil-
hormone (TSH) cold intolerance, constipation, lethargy,
ity, infrequent or absent menses, decreased libido, and hirsut- weight gain
ism. In men, impotence, decreased sperm density, and libido
may result. Compression of the optic chiasm can cause vision
changes and signs of increased intracranial pressure, including In addition to a history and physical assessment, diagnos-
headache, nausea, and vomiting. tic studies such as MRI and CT can identify a pituitary tumor.
Because prolactinomas do not typically grow, drug therapy Laboratory tests generally involve the direct measurement of
is usually the first-line treatment. The dopamine agonists cab- pituitary hormones (e.g., TSH) or an indirect determination of
ergoline and bromocriptine are given to block prolactin release. the target organ hormones (e.g., triiodothyronine [T3], thyrox-
Surgery may be an option, depending on the extent and size ine [T4]). See Chapter 52 for more information about diagnostic
of the tumor. Radiation therapy can reduce the risk for tumor studies.
recurrence for patients with large tumors.
Interprofessional and Nursing Care
The treatment for hypopituitarism often consists of surgery or
PITUITARY GLAND HYPOFUNCTION radiation therapy followed by lifelong hormone therapy. Surgery
Hypopituitarism is a rare disorder that involves a decrease in 1 and radiation therapy for pituitary tumors are discussed in the
or more of the pituitary hormones. A deficiency of only 1 pitu- next section. Appropriate hormone therapy is used (e.g., corti-
itary hormone is called selective hypopituitarism. Total failure costeroids, thyroid hormone). Hormone therapies for thyroid
of the pituitary gland results in deficiency of all pituitary hor- hormone and corticosteroids are discussed later in this chapter.
mones—a condition called panhypopituitarism. The most com- Somatropin (Genotropin, Humatrope, Omnitrope) is recom-
mon hormone deficiencies from hypopituitarism involve GH binant human GH. It is used for long-term hormone therapy
and gonadotropins (e.g., LH, FSH). in adults with GH deficiency. These patients respond well to
GH replacement. They have increased energy, increased lean
Etiology and Pathophysiology body mass, a feeling of well-being, and improved body image.
The usual cause of pituitary hypofunction is a pituitary tumor. Side effects include fluid retention with swelling in the feet and
Autoimmune disorders, infections, pituitary infarction (Sheehan hands, muscle and joint pain, and headache. GH is given daily
syndrome), or destruction of the pituitary gland (from trauma, as a subcutaneous injection, preferably in the evening. The dos-
radiation, surgery) can also cause hypopituitarism. The incidence ing is variable and adjusted based on symptoms, IGF-1 levels,
varies among populations, with a higher mortality in women. and side effects.
Anterior pituitary hormone deficiencies can lead to end-or- Although gonadal deficiency is not life threatening, hormone
gan failure. TSH and ACTH deficiencies are life threatening. therapy will improve sexual function and general well-being.
ACTH deficiency can lead to acute adrenal insufficiency and It is contraindicated in those with certain medical conditions,
hypovolemic shock from sodium and water depletion. such as phlebitis, pulmonary embolism, breast cancer, and pros-
tate cancer. Estrogen and progesterone replacement therapy
Clinical Manifestations and Diagnostic Studies may be given to hypogonadal women to treat hot flashes, vagi-
The manifestations vary with the type and degree of dysfunc- nal dryness, and decreased libido (see Chapter 58). Testosterone
tion. Early manifestations of a space-occupying lesion include is used to treat men with gonadotropin deficiency. The benefits
headaches, vision changes (decreased visual acuity, decreased of testosterone therapy include a return of male secondary sex
peripheral vision), loss of smell, nausea and vomiting, and sei- characteristics, improved libido, and increased muscle mass,
zures. Manifestations associated with hyposecretion of the tar- bone mass, and bone density. Hormone therapy for men is dis-
get glands vary widely (Table 54.1). cussed in Chapter 59.
