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ENDOCRINE SYSTEM CONDITIONS

Exocrine glands:
• Discharge secretions through a duct onto an epithelial surface
• Have lubricating or digestive function

Endocrine glands:
• Discharge secretions directly into the bloodstream, called hormones.

Hormones
• Chemical substances secreted by endocrine glands directly into the
blood stream to act on specific target cell.
• Regulate growth and development, F & E, reproduction, adaptation
to stress and metabolism.
• Types are:
a. Protein peptides (insulin, ADH, GH, ACTH).
b. Amine & amino acid derivatives (epinephrine & norepinephrine).
c. Steroids (cortisol, estrogen, testosterone)

• May or may be controlled directly or indirectly by feedback


mechanisms
a. Negative feedback mechanism
b. Positive feedback mechanism

Some nonendocrine organs secrete special endocrine cells that also


secrete hormone:
a. Kidneys: renin and REF
b. GI Tract: gastrin

Glands Related to Endocrine System

PITUITARY GLAND
• A small pea-shaped gland connected to the hypothalamus
• 2 lobes – anterior and posterior

Anterior

a. GH promotes tissue growth


• Helps metabolize fats
• Promotes protein synthesis by facilitating amino acid entry
into the cells.
• Enhances fat metabolism of energy

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b. Prolactin – stimulates milk secretion by the breasts (prepared by
estrogen & progesterone)
• Thyrotropin-releasing hormone (TRH) stimulates its secretion
c. TSH – stimulates thyroid gland to synthesize and secrete thyroid
hormones
• Thyroxine (T4) and Triiodothyronine (T3) – control general
metabolic processes.
• TRH stimulates its secretion
d. ACTH – stimulates the adrenal cortex to manufacture and secrete
adrenocorticol hormones.
• Controlled by ACTH-releasing factor from the hypothalamus
• Controls carbohydrates metabolism.
e. FSH and LH – gonadotropic hormones
• Growth and development of the gonads
• Development of secondary sex characteristics.
• LHRH – regulates the 2; from the hypothalamus

Posterior
a. Oxytocin
• Contraction of pregnant uterus
• Stimulates milk ejection
b. Antidiuretic hormone (ADH, vasopressin)
• Promotes water retention

THYROID GLAND
• 2 lateral lobes fixed to the anterior surface of the upper
trachea
• Pituitary TSH T3 & T4 (negative feedback)
• Metabolic effects of T3 and T4
a. Controls rate of metabolic process
b. Normal growth and development
c. Maturation of nervous system

PARATHYROID GLANDS
• 4 small structures embedded in the surface of the thyroid
gland
• Secrete parathyroid hormone – principal regulator of calcium
metabolism
• Together with Vitamin D – raise blood calcium level
• Thyrocalcitonin – lowers blood calcium level

ADRENAL GLANDS
• Located on top of the kidneys
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• Consists of an outer cortex and an inner medulla

Adrenal cortex
a. Glucocorticoids – cortisol (major), corticosterone and cortisone,
which acts by:
• Raising the blood glucose through gluconeogenesis
• Promoting protein breakdown into amino acids  converted
into liver as glucose
b. Mineralocorticoids
• Promotes sodium absorption and potassium excretion at the
renal tubules.
• The major is aldosterone
c. Sex hormones
• Small amounts of progesterone, estrogen and testosterone.
• Small amounts of androgen appears  sex drive for women

Adrenal Medulla
• Produces catecholamines (norepinephrine and epinephrine)
• Emotional stress activates sympathetic nervous system 
release by A. Medulla
• Liberated catecholamines  “Fight or Flight”

ISLETS OF LANGERHANS
Islets are about 1 million cell clusters throughout the pancreas.

Classified with cells:

Alpha
• 20% of islet cells
• Secretes glucagon – raises blood glucose level by promoting the
conversion of liver glycogen into glucose
Beta
• 70% of islet cells
• Secretes insulin which lowers blood glucose level

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DIABETES MELLITUS

Diagnostic Tests

1. FBS
• 80 – 120 mg / dl
• DM: 140 mg / dl for 2 readings
2. 2° PPBS
• Initial blood specimen is withdrawn
• 100 g. of carbohydrate in diet
• 2° after meal blood specimen is withdrawn – blood sugar returns
to normal level
3. Glycosylated Hgb
• Most accurate
• Reflects glucose levels for the past 3 – 4 mos.

Exact cause: unknown

Predisposing Factors
• Stress
• Heredity
• Obesity
• Viral infection
• Autoimmune Disorder
• Women
o Multigravida with Large babies

Types:

A. Acquired

Type1 Type 2
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• IDDM • NIDDM
• Juvenile – onset • Maturity – onset
• Unstable DM • Stable DM
• below 30 yrs. • above 40 yrs.
• Absolute Insulin • With insulin sec., 
deficiency demands
• Thin • Obese
• Prone to DKA • Prone to HHNC (Ketosis –
resistant)

B. Secondary
1. Gestational

2. Cushing’s-related

Chronic Complications:
Macrocirculation Microcirculation

Manifestations:

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1. Polyuria

2. Polydipsia

3. Polyphagia

Management: (DAM)

1.Diet
• ↓ caloric diet
• fiber diet
• Complex carbohydrates

2.Activity
• Enhances CHO uptake by the cells
• Decreases insulin requirements
HCHO
• Done 1 – 2 hours p.c.
• Regular pattern
• Other benefits
30%
o Allows additional snacks
o Maintains
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 IBW
 Serum glucose
 Serum lipids

3.Medications

a.Oral Hypoglycemic Agents


• For NIDDM only
• Stimulates beta cells to secrete insulin

Examples:
• Diabenese • Glucotrol
• Orinase • Daonil
• Tolinase • Diamicron
• Micronase • Glucophage
• Dymelor • Glucobay

Observe for:
• G.I. Upset
• Hypoglycemia

b. Insulin

Rapid Acting Intermediate Long-acting


Acting
Characteristic Clear Cloudy Cloudy
Onset 30 mins – 1 1 – 2 hours 3 – 4 hours
hour
Peak 2 – 4 hours 6 – 8 hours 16 – 20 hours
Duration 6 – 8 hours 18 – 24 hours 30 – 36 hours
Examples Regular NPH PZI
Humulin – R Humulin – N Ultralente
Semilente Lente
Crystalline zinc Monotard
Actrapid

Nursing Management (insulin administration)

a. Route : SC
• slow absorption
• less painful
• Angle: 90

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• Needle:
o thin: 3/8”
o obesed: ½”, 5/8”
• IV – DKA
• Don’t massage site of injection

b. Refrigerate unused insulin


c. Never shake the vial
• Roll at the palm of hands
d. Prevent lipodystrophy
• administer at room temperature
• rotate the site of injection

Side – effects:
Localized
• Induration or Redness
• Swelling
• Lesion at the site
• Lipodystrophy
Generalized
• Edema
• Hypoglycemia
• Somogyi phenomenon

Foot Care:
• Wash the feet daily.

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• Wash feet with warm water and mild soap.
• Pat dry the feet – avoid rubbing
• Wear comfortable, properly – fitted pair of shoes (leather/ canvass)
o
• Break – in new pair of shoes(1 – 2 / day)
• Use white cotton socks (males)
• Avoid going barefoot
• Trim the toenails straight across.
• Apply lotion on the feet (not on interdigital spaces)
• Exercise / massage the feet.
• X wear knee – high / stay – up stockings
• For any signs and symptoms of injury; consult a Podiatrist

THYROID CONDITIONS

Diagnostic Tests:
1. T3 T4 levels
2. PBI (Protein – Bound Iodine)
• No foods, drugs, test dyes with Iodine 7-10 days before the test
3. RAIU (Radioactive I Uptake)
• Tracer dose of I131, p.o.
o o o
• 2 , 6 , 24 exposure to scintillation camera
• No foods, drugs, test dyes with Iodine 7-10 days before the test
• Temporarily discontinue contraceptive pills

↑ Uptake – hyperthyroidism
↑ Uptake – hypothyroidism

4. Thyroid Scan
• Radioisotope / IV
• Exposure to scintillation camera
5. FNB (Fine Needle Biopsy)

6. BMR (Basal Metabolic Rate)


• Measures oxygen consumption at the lowest cellular activity
Preparation
• NPO 10 – 12°
• Night Sleep 8 - 10°
• X get up from the bed the following morning until the test is
done
• A device with a noseclip and a mouthpiece is used
• The client performs deep breathing exercises

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• Normal : ± 20% (euthyroid)

7. Reflex Testing (Kinemometry) - Tendon of Achilles Reflex


• Hyperactive – Hyperthyroidism
• Hypoactive - Hypothyroidism

HYPERTHYROIDISM

• medical term to describe the signs and symptoms associated with an


over production of thyroid hormone

Kinds:
• Grave’s Disorder
• Parry’s Disorder
• Basedow’s Disorder
• Exophthalmic Goiter
• Toxic Diffuse Goiter

3 Basic concepts
1. Increased metabolic rate
2. Increased body heat production
3. Hypocalcemia

Etiology and Incidence:


• Females, below 40 yrs.
• Severe emotional stress
• Autoimmune Disorder

Manifestations:

Thyroidal Disturbances
Cardiovascular
• Hypertension
• Tachycardia

CNS
• Restlessness • Agitation
• Nervousness • Fine tremors
• Irritability

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GI-Metabolism
• ↑ appetite to eat • Amenorrhea
• Weight loss • Fine silky hair
• Diarrhea • Pliable nails

Other symptoms:
• Diaphoresis
• Heat intolerance

Ophalmopathy

Exophthalmos
• Corneal ulceration
• Ophthalmitis
• Blindness
Dalyrimple’s sign (Thyroid stare)
• Bright – eyed stare
• Infrequent blinking
Von Graefe’s sign (lid lag)
• Long and deep palpebral fissure when one looks down
Jeffrey’s sign
• Forehead remains smooth when one looks up

Management:
1. Rest
• Non-stimulating, restful environment
2. Diet
• ↑ caloric
• ↓ fiber
3. Promote safety
4. Protect the eyes
• artificial tears
• dark sunglasses
5. Replace fluid – electrolyte losses
6. Administer medications, as ordered:
a. Beta – blockers : Inderal
• To control tachycardia, HPN

b. Potassium Iodides: To inhibit release of thyroid


• Lugol’s solution

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• SSKI
• Mix with fruit juice with ice or glass of water
• Provide drinking straw
• Side effects: allergic reaction, increased salivation, coryza
c. Thioamides:
• PTU (Propylthiouracil)
• Tapazole (Methimazole)
• To inhibit release of thyroid hormones
• Side effects: agranulocytosis
o Fever, Sore throat, Skin rashes
d. Ca – channel blockers
e. Dexamethasone: inhibit the action of thyroid hormones
7. Radiation therapy (I131) – Isolation for few days
8. Surgery: Subtotal Thyroidectomy

Preop Care
• Promote euthyroid state
• Administer Iodides as ordered
o To decrease the size & vascularity of thyroid gland  prevent
hemorrhage, thyroid crisis
• Monitor ECG

Postop Care
• Position:
o Semi – Fowler’s with head, neck & shoulder erect
o Support neck with interlaced fingers when getting up from bed
• Prevent hemorrhage - Ice collar over the neck
o
• Keep on bed side: (first 48 )
o Tracheostomy set
o Calcium Gluconate
• Assess for laryngeal nerve damage: ask the patient to speak every
hour
• Monitor:
o Temperature
o Monitor BP (to assess for Trousseau’s sign)
• Steam inhalation to soothe irritated airways

• Observe for potential complications


o Hemorrhage
o Tetany - airway obstruction
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o Laryngeal nerve damage
o Thyroid crisis
o Myxedema
• Client Teaching
o ROM exercises of the neck 3 – 4 x / day after discharge.
o Regular follow – up care

HYPOTHYROIDISM
• Myxedema (Adult)
• Cretinism (Children)
• Causes
o Autoimmune
o Surgery
o Radiation therapy
o Antithyroid drugs
o Thyroiditis

3 Basic concepts:
1. decreased metabolic rate
2. Decreased body heat production
3. Hypercalcemia

Assessment:
• Slowed physical, mental • Cold intolerance
reactions • Constipation
• Dull look • Coarse, dry, sparse
• Anorexia hair
• Obesity • Brittle nails
• Bradycardia • Irregular
• Hyperlipidemia menstruation

Management:
1. Monitor VS. Be alert for signs and symptoms of CV disorders
2. Diet
• ↓ caloric
• ↑ fiber
3. Provide warm environment during cold climate.

4. Pharmacotherapy
• Proloid (Thyroglobulin)
• Synthroid (Levothyroxine)
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• Dessicated Thyroid Extract
• Cytomel (Liothyronine)
o Check BP, PR before administration
o Start with low dose , gradually increase

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ADRENAL GLAND CONDITIONS

CUSHING’S DISORDERS

Diagnostic test: Dexamethasone Suppression Test

Description:
• Hypersecretion of adrenal hormones
• hypercorticism due to administration of steroid hormones

Etiology: Tumor (adrenal gland neoplasm)

Pathophysiology:

Elevated GC and MC

Exaggeration of hormonal effects

Manifestations:

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Elevated GC
• Emotional lability
• Increased gluconeogenesis  hyperglycemia cataracts
• Fat misdistribution
o Thinning arms and legs  muscle wasting  increased BUN
o Buffalo hump
o Truncal obesity  femoral congestion  thrombophlebitis

Elevated MC
• Hypokalemia  possible cardiac arrest
• Hypernatremia  increased BV
o Edema
o Increase in weight  obesity
o Thinning of the skin  easy bruising
o Moon face
• Hypertension
• Increased ICP
• Complications:
o CHF
o Pulmonary edema

Elevated steroids
• Increased catabolism  increased appetite
• PTH elevation  osteoporosis
• Immunosuppression
o Poor wound healing
o Risk forinfection

Management:
1. Assess for:
• fluid balance
• edema
2. Monitor and record:
• vital signs
• intake and output
• urine specific gravity
• fingersticks
• urine glucose and ketones
• laboratory studies
3. Apply antiembolism stockings
4. Maintain the patient’s diet

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5. Maintain standard precautions
6. Provide meticulous skin care and reposition the patient every 2
hours
7. Limit water intake
8. Protect the client
9. Weigh the patient daily
10. Allow ventilation of feelings
11. Provide rest periods to prevent fatigue

ADRENAL HYPOFUNCTION

• A condition of insufficient adrenal cortex hormones.

May be:
• Primary (Addison’s disease)
• Secondary

Etiology:

Addisons Disease
• Atrophy or autoimmune destruction of the A.C.
• Tumors
• Suppressed pituitary functioning:
o head injuries
o craniocerebral disorders

Secondary adrenal hypofunction


• hypothalamic-pituitary-adrenal axis
• insufficient ACTH

Pathophysiology:

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Management:
1. Administer:
• I.V. hydrocortisone and saline solution as ordered
• IVF to maintain hydration
2. Facilitate fluid balance
3. Monitor and record:
• vital signs
• intake and output
• urine specific gravity
• laboratory studies
• weight
4. Maintain the patient’s diet
5. Advise the patient to gradually change positions
6. Encourage fluid intake
7. Assist with ADL to conserve energy and decrease metabolic
demands
8. Maintain a quiet and calm environment

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PITUITARY CONDITIONS

HYPERPITUITARISM

Description:
• Chronic, progressive disease
• Excessive growth hormone (GH) secretion and tissue over-growth.
• Appears as:
o Gigantism
o Acromegaly

Etiology: An anterior pituitary adenoma

Pathophysiology:
• Overgrowth of tissues (neurologic and secretory problems)
• Local expansion of a pituitary adenoma (when present) causes both
neurologic and secretory effects.
• Optic and trigeminal nerve involvement causes visual disturbances.

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Nursing Interventions:
1. Counseling to deal with feelings about change body image.
2. Assist with ROM to maximize joint movement.
3. Monitor for visual disturbances.
4. Prepare the patient for surgery, if indicated.

***

ADH-RELATED PROBLEMS

Syndrome of Inappropriate ADH (SIADH)

• Involves continuous secretion of ADH


• Is one of the most common causes of hyponatremia

Characteristics:
• Edema
• Weight gain
• Hypertension
• Hyponatremia

Etiology: CNS disorder that interferes with the hypothalamic-pituitary


mechanisms

athopysiology:

failure of feedback mechanisms



continuous ADH production

excessive water reabsorption

dilution of plasma

hyponatremia

hypotonicity

water intoxication

Management:
1. Monitor intake and output carefully
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2. Weigh the patient daily
3. Take vital signs every shift and PRN
4. Assess for edema
5. Assess lung sounds
6. Teach the patient the fundamentals of a sodium-restricted diet, as
ordered.
7. Administer diuretics, as prescribed
8. Restrict sodium and water as ordered

Diabetes Insipidus

• A permanent or transient deficiency in ADH


• It may be pituitary, nephrogenic or psychogenic in nature.

Characteristics:
• Inability of the renal tubules to retain water
• Polyuria (20 L/day)
• Dehydration
• Constipation
• Dilute, water-like urine (↓ specific gravity)

Etiology:
• Familial or Idiopathic
• Other possible causes include:
o Traumatic injury
o Neoplasms
o Infections (meningitis)
o Vascular Disorders (aneurysm)
o Infiltration disorders
o Renal Disease

Pathophysiology:
Inability secrete ADH

Excessive urination (Polyuria)

Hypernatremia (concentrated Na)

S/sx of dehydration

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Management:
1. Monitor I & O
2. Monitor urine specific gravity
3. Weigh the patient daily
4. Monitor skin
5. Monitor skin turgor
6. Maintain adequate hydration through oral or IV supplementation
7. Administer medications, as ordered
a. Aqueous vasopressin (SC)
b. Desmopression acetate (intranasal) – long-acting
c. Lypressin (intranasal) – short- acting

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