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ENDOCRINE SYSTEM

Anatomy and Physiology

Endocrine glands
Specialized cluster of cells that secure
that secretes hormone chemical
messengers

Hormones
Secreted by the endocrine organs body
target cells
Regulator of tissue responses

Mechanism of hormones
Hormones interact with high affinity
receptor
Some receptors are located on the
surface of cell
Others are located in the cell
Maintain homeostasis
Hypothalamus
Pituitary gland (Hypophysis)
APG (Adenohypophysis
PPG (Neurohypophysis)
Target cells/organs

Hypothalamus
Below the thalamus above the brain
stem
Link Nervous system to Endocrine
system via pituitary gland

Stimulating
hormones and
Trophic hormones
*ACTH
-Adrenal Cortex
*TSH
-Thyroid gland (T3,
T4)
*MSH
-Melanin (skin
pigment)
Common Laboratory and Diagnostic
Procedures
RAUI (Radio Active Iodine Uptake)
Oral Intake, measurement after 24 hours
Administration of iodine
Measurement by a counter of the I 123, I
131
Increase uptake may indicate HYPER
functioning gland
Decrease uptake may indicate HYPO
functioning gland
Normal value : 5-30% in 24 hours
Avoid cough syrup (contains iodine) before
test (10 day before)
Temporarily discontinue contraceptive pills
No to pregnancy (teratogenic)
Not radioactive after procedure
Treatment : radioactive after procedure
Diagnostic : not radioactive

Thyroid Scan
Administration of radioactive isotope
(Oral/IV) and scanner will be use
Releasing hormones

Perform to determine location, size, shape


Corticotropin Releasing Hormone (ACTH
and anatomic function of thyroid gland :
APG)
identifies areas of increase or decrease
Thyrotropin Releasing Hormone (TSH
uptake (valuable in evaluating thyroid
APG)
nodules)
Gonadotropin Rekasing hormone (FSH,
Pre
Test
LH)
Check for pregnancy : SAFETY
Thyroid medication may be withheld
Pituitary gland
temporarily, advise NPO
Below hypothalamus
Post Test
At sella turcica
Ensure proper disposal of body water
Optic chiasm passes pituitary gland
Not radioactive if diagnostic only
Anterior Pituitary
Posterior Pituitary
Fasting Blood Glucose
Gland
Gland
Aids in the diagnosis of Diabetes
Growth
Oxytocin :
NPO for 8 hours (midnight before the test)
Prolactin
contraction of uterine
Normal : 80-109 mg/dl
muscle
Gonadotropin
ADH/Vasopressin
DM: 126 mg/dl and above 2 consecutive
*luteinizing
occasion
hormones
F: Corpus Luteum
Oral Glucose Tolerance Test
M: Testosterone
Aids in the diagnosis of Diabetes Mellitus
*Follicular
Pre Test
Stimulating Hormone
Provide high CHO foods x 3 days
F: Ovarian Follicles
Instruct to avoid caffeine, alcohol and
M: Spermatogenesis
smoking for 36 hours before the test

Fast for 10-16 hours before the test


Withhold morning insulin or OHA (client
with DM)
The test will take 3-5 hours require IV or
oral administration of glucose and
multiple blood samples
Post Test
Avoid strenuous activity for 8 hours due to
hypoglycaemia (fasting) :SAFETY
Normal OGTT : 1-2 hours post, glucose is
<200mg/dl
Glycosylated Hgb A1C
Most accurate/highly effective
Blood glucose bound to RBC Hgb
Reflects how well blood glucose is
controlled for the past 3 months
No need for FASTING
Normal level expressed as percentage of
total Hgb : 4-7%
Good control : 7.5% or less
Fair control : 7.5% to 8.9%
Poor control : 9% and above
ENDOCRINE DISORDERS
Disorder of Pituitary Gland
Hyperpituitarism
Hyperfunctioning pituitary gland
Oversecretion of one or more of APG
Can lead to Acromegaly / Gigantism
Common Cause
Benign pituitary adenoma
Hyperplasia of the pituitary tissue
Signs and Symptoms
Enlarged hand and extremities
Prominent supraorbital ridge
Spade shape hands and feet
Large nose and jaw, teeth are separated
Cardiomegaly, enlarged liver
Visual Disturbances
Abnormal glucose level
Hypertrophy of the sweat and sebaceous
gland
Galactorrhea (prolactin)
Peripheral Neuropathy
Arthrosis
Sexual Dysfunction
Diagnostic
Skull Xray
CT Scan
MRI
Nursing Intervention
Provide emotional support to clients and
family
Provide frequent skin care
Surgery : Transphenoidal
Hypophysectomy (removal of pituitary
gland)
Location : Between the upper lip and
gum (no incision)

Pre- Op
Routine Pre op Care
Post Op
Monitor VS : Increased ICP (increased
systolic, decreased all , widened pulse
pressure), LOC and neurologic status
(monitor packing and reinforce as
needed)
Place patient on Semi Fowlers (airway
and drainage)
LOC (Pedia : High pitch, shrill cry)
(Adult: Irritability and Restlessness)
Monitor for bleeding and CSF
leakage : Check for the fluid , for
the presence of glucose (increase
20 mg)
Instruct patient to avoid sneezing,
coughing and nose blowing
Deep breathing is good just avoid
coughing
Provide mouth care with saline or
toothes (avoid toothbrush)
Sneezing, mouth open technique
Monitor development of DI/SIADH:
measure Input and output
Administer prescribed medications :
Antibiotics, analgesics, steroids
Medical Therapy
Growth Hormone Inhibitors
DOC: Sandostatin (SQ : 20-30 mg)
- Effectively inhibits GH secretion for
30 days with just one injection of
20-30 mg
Bromocriptine (long acting dopamine
agonist) : can reduce GH levels
Octretide Acetate (SQ : 3x/week) :
analog of somastatin, produce
feedback inhibition on GH
Hypopituitarism
Hyposecretion of APG
Causes
Congenital
Post Partal necrosis (Sheehans
syndrome)
Infection
Surgery
Radiation Therapy
Assessment
Retarded physical growth due to
decrease Growth hormone Dwarfism!
Low intellectual development
Poor development of secondary sexual
characteristics
Diagnostic
Physical Examination and History
CT Scan
MRI
Hormone level determination

Nursing Intervention
Provide emotional support to the family
Encourage client and family to express
feelings
Administer prescribed growth hormone
supplements
Sermorelin (Geref) IV
Somatren (Protropin) IM/SC
Somatropin (Humatrope) IM/SC
Oral route is inactivated by enzymes use
cautiously to diabetic patient
Disorder of Anti Diuretic Hormone
Diabetes Insipidus
Hypofunctioning of the Posterior
Pituitary gland (ADH)
Hyposecretion of ADH
Signs and Symptoms
Polyuria
Dehydration
Polydipsia
Muscle pain and weakness (excretes
potassium)
Hypotension and tachycardia
Diagnostic
Fluid Deprivation Test :
Confirmatory
8-12 hours or 3-5% weight loss :
inability to increase specific gravity
and osmolarity
WOF Hypovolemic Shock
Priority Intervention : Monitor the VS
Specific Gravity : inversely proportional
to urine (very low)
Decrease/low specific gravity : 1.006
and below
High Serum Na levels
Nursing Interventions
Monitor VS, neurologic status and
cardiovascular status
Monitor I and O/ Daily weight
Monitor urine specific gravity
Provide adequate fluids
No to Diuretics
Avoid coffee, tea, alcohol
Meds :
DOC Desmopressin (Inhalation)
- Vasopressin

Syndrome of Inappropriate Diuretic


Hormone
Hyperfunctioning of the Posterior
Pituitary Gland
Hypersecretion of Anti Diuretic Hormone
abnormally
Cause
Neurosurgery/trauma
Earliest signs and symptoms
Mental status changes (confusion)
Abnormal weight gain

Hypervolemia
Hypertension
Hyponatremia
Anorexia/ N and V
Diagnostic
Increase Urine Specific Gravity
Hyponatremia
CBC shows Hemodilution
Nursing Intervention
Priority : Monitor VS and neurologic
status (WOF crackles it signifies
Pulmonary Edema
Restrict FI : <50cc/day
Monitor I and O and daily weight
Provide safe environment (Siderails
up!)
Administer Diuretics and IVF
DOC: Demeclocycline (Tetracycline
Antibiotic) : because of its side
effect that makes you urinate
Tube feedings, NGT irrigation used
SALINE!

Disorders of Thyroid Gland


Anterior to the neck lateral to the
trachea
Functional unit : Thyroid follicles
Secretes T3, T4 and Thyrocalcitonin
T3 : nagpapataas ng metabolism
T4 : nagpapataas ng body heat
Thyrocalcitonin : Calcium balance in our
body ; promotes bone deposition
Hyperthyroidism
Everything is fast, high and wet
Aka Graves Disease
Hyperfunctioning of the thyroid gland
Hyperthyroid state characterized by
increase circulating T3, T4 and
Thyrocalcitonin
Possible Causes
Autoimmune : common
Thyroiditis
Infection
Tumor
Radiation
Signs and Symptoms
Weight loss
Heat Intolerance
Tachycardia
Exopthalmos
Diarrhea (fast persitalsis)
Warm skin
Diaphoresis
Smooth and soft skin
Fine tremors
HEAT intolerance
Diagnostic
Thyroid gland enlarged
Increase T3 and T4

RAUI: increase uptake


Nursing Interventions
Rest (quiet room)
Administer Anti thyroids (inhibits the
synthesis of thyroid hormones) : best
given with food to prevent GI upsets
Methimazole
PTU (Prophylthyuracil)
Monitor VS and weight
(increase)
WOF: Hypertension and
Tachycardia
Causes Agranulocytosis :
decreases production of WBC
Assess presence of fever /
sorethroat
Administer Iodine preparation
Lugols solution (Anti thyroid)
Decrease vascularity of the thyroid
gland
To prevent bleeding during/after
thyroidectomy
Mixed with fruit juice or milk
Can shrink the thyroid of the patient
Administer Propanolol
Provide a High calorie diet, high protein
Manage diarrhea
Prepare clients for Radioactive Iodine
Therapy
Evidence results after 8 weeks
Avoid stimulants like chocolate, coffee,
tea and energy drinks
No ASPIRIN : convert globulin to thyroid
globulin
Complication : Thyroid storm (earliest
sign is high fever)
Do not massage the thyroid of the
patient
Types of Thyroidectomy
1.
Total Thyroidectomy
o Indicates for thyroid cancer
o All thyroid gland will be removed
2. Subtotal Thyroidectomy
o Part of the thyroid gland will b removed
o Where is the incision?
Pre op
Obtain VS and weight
Assess for electrolyte levels, glucose
levels and T3 and T4 levels
Teach to support neck while moving
Post Op
Position : Semi Fowlers (neck
midline)
Bedside? Tracheostomy set, oxygen,
suction machine, Ca Gluconate
Check for signs of bleeding
Assess for hoarseness Check for Acute
Laryngeal Nerve Damage (Instruct your
patient to say aaaa) : not normal for 1
week

Hypothyroidism
Everything is low, slow and dry
Hypofunctioning of the thyroid gland
Hyposecretion of thyroid hormones
Decrease T3 and T4 Decrease basal
metabolism
Causes
Autoimmune (Hashimotos Thyroiditis)
Iodine deficiency
Congenital
Radiation Therapy
Pituitary Disorder
Thyroid Surgery
Signs and symptoms
Lethargy and fatigue
Weakness and paresthesia
COLD intolerance
Weight gain
Bradycardia
Constipation
Dry hair and skin
Generalized puffiness and edema around
the eyes and face
Menstrual irregulation
Diagnostics
Decrease Serum T3 and T4 level
Increase Serum cholesterol level
<5% RAUI (decreased)
Nursing Interventions
Monitor VS especially HR
DOC: Levothyroxine (Synthetic
Thyroid Hormone Supplement)
o Must be given morning on an empty
stomach for best absorption
o Can cause insomnia
o Get baseline VS and weight
o Can cause hypertension and
tachycardia
o Assess for complains of chest
pain
o Manage weight
Diet : low calories, low cholesterol,
low fat
Provide warm environment
Manage constipation appropriately
o Give high fiber
Complication : Myxedema coma
Avoid stress, infection, sedatives,
anesthetic, narcotics and exposure to
extreme cold
How will you know if the patient is
improving? The patient can already
defecate everyday

Disorders of the Parathyroid Gland


Located at the of thyroid gland
Secretes parathyroid hormone
Calcium balance in the body Parathyroid
hormone : release calcium from the bone
Thyrocalcitonin: Ca back to the bone
Hypoparathyroidism

Hypofunctioning of the parathyroid gland


Hyposecretion of the parathyroid gland
Causes
Accidental removal of thee parathyroid
Autoimmune
Signs of Hypocalcemia
Numbness and tingling sensation on the
face (Trosseaus and Chvosteks Sign)
Muscle cramps
Bronchospasms, Laryngospasms
Seizures
Cardiac Dysrythmias
Hypotension
Nursing Interventions
Monitor VS and signs of Hypocalcemia
Place of tracheostomy set, Oxygen tank
and suction of the bedside
Initiate seizure precautions
Prepare Ca Gluconate
Diet : Provide a high Ca and Low
phosphate diet
Eat Vitamin D reach foods
Avoid Carbonated beverages and
Digitalis
Hyperparathyroidism
Hyperfunctioning of the parathyroid
gland
Hypersecretion of the parathyroid gland
Causes
Renal Failure
Vitamin D deficiency
Adenoma
Signs of Hypocalcemia
Fatigue and muscle weakness and pain
Skeletal pain and tenderness
Fracture
Osteoporosis
Cardiac Dysrythmias
Renal stones
Constipation
Anorexia
N/V
Nursing Interventions
Monitor VS , cardiac rhythm, I and O
Handle body parts carefully
Remember : lift sheet
Increase fluids to prevent the formation
of kidney stones
Administer Diuretics as ordered : No to
Thiazide
Administer calcitonin as ordered
Administer FOSAMAX (Alendronate) as
ordered
o Should not be chewed
o 30 minutes before breakfast
o Should be taken with water at least 30
minutes before breakfast and remain
upright for at least 30 minutes
NSS : IV

Disorders of the Adrenal Gland


Cushings Disease
Hypersecretion of adrenal cortex
hormones (Glucocorticoid,
Mineralocorticoid and Adrenal
Hormones)
Reversible
Causes
Hypothalamus lesion
Adrenal Adenomas
Exogenous
Adrenal Carcinomas (Increase GMA)
Signs and symptoms
Hypervolemia
Hypokalemia
Hypertension
Edema
Hyperglycemia
Moon face, buffalo hump, truncal
obesity
Hirsutism
Diagnostics
24 hour urine cortisol (>275mmol/L) :
initial screening tool
Low dose Dexamethasone suppression
test (high ACTH level) : confirmatory test
CT scan / MRI (rule out tumor)
Nursing Interventions
Monitor VS, observe for HPN
Measure I and O and daily weight
PE: Auscultate the lung sounds for
crackles
Protect client from exposure to infection
Minimize stress in the environment
Prevent accidents and falls (SIDERAILS
UP!) : SAFETY
Monitor urine for glucose and acetone
(reportable sign!) if >180 mg/dl

Pheochromocytoma
Benign tumor of the chromaffin cells of
the adrenal medulla
Peak incidence is ages 20-50 years
Stimulates hypersecretion
5 Hs symptoms
Hypertension
Headache
Hyperhydrosis
Hypermetabolism
Hyperglycemia
Diagnostics
VMA (Vanillylmandelic Acid Test)
o Normal : 0.7 6.8 mg in 24 hours
o 24 hour urine specimen
o Instruct the patient to avoid the
following medications and foods which
may alter the results

- Coffee
- Tea
- Bananas
- Chocolate
- Vanilla
- Aspirin
CT scan , MRI and UTZ : To localize the
pheochromocytoma
Nursing Interventions
Monitor VS especially BP
Position ; Head of bed elevated
Administer meds as ordered to control
BP
o DOC: Phentolamine (Regitine)
o Na Nitroprusside (Nipride)
Provide adequate rest
Monitor urine test for glucose and
acetone
Provide high calorie, well balanced diet
Administer prescribed
phenoxybenzamine
Administer alpha adrenergic Blocker
Prepare for Adrenalectomy : Avoid
Abdominal palpation
Diabetes Mellitus
Chronic disorder of impaired glucose,
metabolism, protein and fat metabolism
Risk Factors
Family history of Diabetes
Obesity
Race / Ethnicity
Hypertension
Hyperlipidemia
History of gestational DM
Age of more than 45

Complications
DKA (Diabetic Ketoacidosis) :
Kussmauls breathing (deep, rapid and
labored breathing)
o NSS
o Regular Insulin IV
HHNK (Hyperglycemic
HyperosmoticNon Ketoacidosis)
Diagnostic Test
FBS : >126
RBS : >200
OGTT : >200
HGBa1c: above 7 %
Urine Glucose
Nursing Interventions
GOAL: Normalize
o Proper Medication
o Proper diet
o Proper exercise
Insulin Administration
Route : S
Q
Rotate the injection sites to prevent
lipodystrophy
Place it in the refrigerator : multiple
doses
Warm it at room temperature
Clear (regular) first before cloudy (NPH)
Inject air in the NPH insulin vial before
regular
Do not shake! Roll into the palm!
Insulin Types and Action : Type I

Types
IDDM (DM Type I)

NDDM (DM Type


II)

Juvenile onset

Adult onset

Zero insulin

Decrease insulin

Genetic, hereditary

Genetic, Hereditary

Autoimmune

Insulin resistance

Signs and symptoms


DM Type I

DM Type II

Polydipsia

Polydipsia

Polyphagia

Polyphagia

Polyuria

Polyuria

Pruritus

Pruritus

Weight loss

Onse
t

Peak

Durati
on

Rapid
Lispro
Aspart

<15
minut
es

45
minutes
-2
hours

3 hrs
4
hrs

Short
Soluble
Regular

-1
hr

2-4 hrs

6-8 hrs

1-2
hrs
1-3
hrs

6-12
hrs

18-24
hrs

Intermed
iate
NPH
Lente
Long
Acting

Oral Hypoglycaemic Agents : Type II


DOC for Type II DM
Stimulate the pancreas to secrete
insulin

OHA is teratogenic
(contraindicated during
pregnancy)
Diet/ Nutritional Modifications
Balanced diet is the best diet for DM
Carefully follow the exchange list of
the diet
Do not skip meals
Exercise
Exercise everyday to facilitate glucose
control
30 minutes jogging 1 hour of walking
Blood glucose monitoring before and
after exercise
Do not exceed for 30 minutes
Before doing strenuous activity have a
light snack