Endocrine System

CARE OF CLIENTS
WITH PROBLEMS IN
ENDOCRINOLOGY
FGV JAMINIT, RN, CNN, MAN
Diabetes Care Specialist
HIV/AIDS Counselor
2
Glands of the Endocrine System

CARE OF CLIENTS WITH PROBLEMS IN ENDOCRINOLOGY
 Hypothalamus
 Posterior Pituitary
 Anterior Pituitary
 Thyroid
 Parathyroids
FGV Jaminit, RN, CNN, MAN
 Adrenals
 Pancreatic islets
 Ovaries and testes

3
Hypothalamus
 Prolactin releasing and inhibiting hormones

 Corticotropin-releasing hormone
 Thyrotropin-releasing hormone
 Growth hormone-releasing hormone
 Gonadotropin-releasing hormone
 Somatostatin-=-inhibits GH and TSH

4
Anterior Pituitary
 Growth Hormone (GH)

 Adrenocorticotropic hormone (ACTH)
 Thyroid stimulating hormone (TSH)
 Melanocyte-stimulating Hormone (MSH)
 Follicle stimulating hormone—ovary in female,

sperm in males
 Luteinizing hormone—corpus luteum in

females, secretion of testosterone in males
 Prolactin—prepares female breasts for
lactation
5
Posterior Pituitary
 Antidiuretic Hormone
 Oxytocin—contraction of uterus, milk ejection

from breasts
6
Thyroid
 Follicular cells—excretion of triiodothyronine

(T3) and thyroxine (T4)—Increase BMR,
increase bone and calcium turnover, increase
response to catecholamines, need for fetal
G&D
 Thyroid C cells—calcitonin. Lowers blood
calcium and phosphate levels

FGV Jaminit, RN, CNN, MAN 7

calcium
Parathyroid
Parathyroid hormone—regulates serum

8
Pancreatic Islet cells

 Endocrine & exocrine gland

- endocrine portion: islets of Langerhans
1. alpha cells – glucagon
2. beta cells – insulin
3. gamma cells – pancreatic
polypeptide
4. delta cells – somatostatin
- exocrine portion – cholecystokinin,
secretion
9
Pancreatic Islet cells

 Insulin
 Glucagon—stimulates glycogenolysis and

glyconeogenesis
 Somatostatin—decreases intestinal absorption

of glucose
10
Kidney
 1, 25 dihydroxyvitamin D—stimulates calcium

absorption from the intestine
 Renin—activates the RAAS
 Erythropoietin—Increases red blood cell

production
11
Adrenal Cortex
 Mineralocorticoid—aldosterone. Affects
sodium absorption, loss of potassium by
kidney
 Glucocorticoids—cortisol. Affects metabolism,
regulates blood sugar levels, affects growth,
anti-inflammatory action, decreases effects of
stress
 Adrenal androgens—dehydroepiandrosterone
and androstenedione. Converted to
testosterone in the periphery.
12
Adrenal Medulla
 Epinephrine and norepinephrine

serve as neurotransmitters for sympathetic
system
13
Ovaries
 Estrogen
 Progesterone—inportant in menstrual
cycle,*maintains pregnancy,
14
Testes
 Androgens, testosterone—secondary sexual

characteristics, sperm production
15
Thymus
 Releases thymosin and thymopoietin

 Affects maturation of T lymphocetes
Melatonin 
Pineal
 Affects sleep, fertility and aging

17
Prostaglandins
 Work locally
 Released by plasma cells
 Affect fertility, blood clotting, body temperature

18
Assessment
 Health history—energy level, hand and foot

size changes, headaches, urinary changes,
heat and cold intolerance, changes in sexual
characteristics, personality changes, others
 Physical assessment—appearance including
hair distribution, fat distribution, quality of skin,
appearance of eyes, size of feet and hands,

peripheral edema, facial puffiness, vital signs
19
Diagnostic Evaluation
 Serum levels of hormones

 Detection of antibodies against certain hormones
 Urinary tests to measure by-products (norepinephrine,
metanephrines, dopamine)
 Stimulation tests—determine how an endocrine gland
responds to stimulating hormone. If the hormone
responds, then the problem lies w/hypothalmus or
pituitary
 Suppression tests—tests negative feedback systems

that control secretion of hormones from the
hypothalamus or pituitary.
20
Disorders of the Pituitary

Pituitary Tumors
 Eosinophilic tumors may result in gigantism or in
acromegaly. May suffer from severe headaches,
visual disturbances, decalcification of the bone,
endocrine disturbances
 Basophilic tumors may cause Cushing’s syndrome
w/features of hyperadrenalism, truncal obesity,
amenorrhea, osteoporosis
 Chromophobic tumors—90% of pituitary tumors.

Present with lowered BMR, obesity, somnolence,
scant hair, low body temp, headaches, visual changes
21
 Growth hormone deficiency in childhood will

result in primary dwarfism.
Deficiency
Growth Hormone
23
Growth Hormone Deficiency

 S/sx:
1. Face appears infantile
2. Teeth crowded in small jaw or may erupt

late
3. High-pitched voice
4. Delayed onset of pubic, facial, & axillary

hair & genital growth
24
Diagnosis
 Dx:
1. Appearance
2. History – well child except for abnormal

lack of growth
3. ↓circulating growth hormone
4. Blood studies for hypothyroidism,

hypoadrenalism, hypoaldosteronism
5. X-ray of wrist
25
History
 Evaluate:
1. Family history
2. Prenatal & birth history
3. History of chronic illness
Nutritional history, urinary & bowl function
4.
26
Management
 Mx:
1. Recombinant human GH
2. Suppression of luteinizing hormone-

releasing hormone
3. Supplementation of gonadotropin
releasing hormone
27
Nursing Diagnoses
 NDx: LOW SELF-ESTEEM DUE TO

SHORT STATURE
1. Discuss parents’ feelings of guilt &
resentment to health care provider
2. Assign duties & responsibilities that match
chronological age
28
Growth Hormone Excess

 Due to somatotropin-secreting tumor of

pituitary gland
1. Pituitary Gigantism
- Overproduction occurs before epiphyseal
lines have closed
- Weight is excessive but proportional to height

- Growth noted during puberty
Pituitary Gigantism
30
Growth Hormone Excess

2. Acromegaly
- Overproduction occurs after epiphyseal lines
have closed
- Large hands & feet, thick lips, coarse facial
features, protruding forehead & jaw, widely
spaced teeth
Acromegaly
32
Management
 Mx: 1. Surgery – laser or cryo

2. Irradiation or radioactive
implants
3. GH antagonists –
medroxyprogesterone acetate,
chlorpromazine, somatostatin, L-dopa,

bromoergocryptine
33
Diabetes Insipidus
 Deficiency of ADH
 Excessive thirst, large volumes of dilute urine
 Can occur secondary to brain tumors, head

trauma, infections of the CNS, and surgical
ablation or radiation
 Nephrogenic DI—relates to failure of the renal

tubules to respond to ADH. Can be related to
hypokalemia, hypercalcemia and to
medications (lithium demeocycline)
Excessive thirst 
 Urinary sp. gr. of 1.001.1.005

Manifestations
35
Assessment and Diagnostic
Findings
 Fluid deprivation test—withhold fluids for 8-12

hours. Weigh patient frequently. Inability to
slow down the urinary output and fail to
concentrate urine are diagnostic. Stop test if
patient is tachycardic or hypotensive
 Trial of desmopressin and IV hypertonic saline
 Monitor serum and urine osmolality and ADH

levels
36
Pharmacologic Tx and Nursing
Management
 DDAVP—intranasal bid
 Can be given IM if necessary. Every 24-96h.
Can cause lipodystrophy.
 Can also use Diabenese and thiazide diuretics
in mild disease as they potentiate the action of
ADH
37
Pharmacologic Tx and Nursing
Management
 If renal in origin—thiazide diuretics, NSAIDs

(prostaglandin inhibition) and salt depletion
may help
 Educate patient about actions of medications,
how to administer meds, wear medic alert
bracelet
38
SIADH
 Excessive ADH secretion

 Retain fluids and develop a dilutional hyponatremia
 Often non-endocrine in origin—such as bronchogenic
carcinoma
 Causes: Disorders of the CNS like head injury, brain
surgery, tumors, infections or medications like
vincristine, phenothiazines, TCAs or thiazide diuretics
 Meds can either affect the pituitary or increase

sensitivity to renal tubules to ADH
 Management: eliminate cause, give diuretics (Lasix),
fluid restriction, I&O, daily wt., lab chemistries
39
SIADH
 Restoration of electrolytes must be gradual

 May use 3% NaCl in conjunction with Lasix
40
Thyroid
 T3 and T4
 Need iodine for synthesis of hormones—
excess will result in adaptive decline in
utilization called the Wolf-Chaikoff mechanism
 Thyroid is controlled by TSH
 Cellular metabolism, brain development,

normal growth, affect every organ in the body
 T3 is five times as potent as T4
41
Thyroid
 Calcitonin—secreted in response to high

levels of serum calcium, increases deposition
in the bone
 Inspect gland
 Observe for goiter

 Check TSH, serum T3 and T4

42
Thyroid
 T3 resin uptake test useful in evaluating

thyroid hormone levels in patients who have
received diagnostic or therapeutic dose of
iodine. Estrogens, Dilantin, Tagamet, Heparin,
amiodarone, PTU,steroids and Lithium can
cloud the accuracy
 T3 more accurate indicator of hyperthyroidism

43
Thyroid
 Antibodies seen in Hashimoto’s, Grave’s and

other auto-immune problems.
 Radioactive iodine uptake test measures rate
of iodine uptake. Patients with hyperthyroidism
exhibit a high uptake, hypothyroidism will have
low uptake
 Thyroid scan—helps determine the location,

size, shape and size of gland. “Hot” areas
(increased function) and “cold” areas
(decreased function) can assist in diagnosis.
44
Nursing Implications
 Be aware of meds patient is taking (see list in

text) that can affect accuracy of testing
 Also be aware if patient is taking multivitamins
and food supplements
45
Hypothyroidism
Most common cause is Hashimoto’s thyroiditis
 Common in those previously treated for

hyperthyroidism
 Atrophy of gland with aging
 Medications like lithium, iodine compounds,
antithyroid meds can cause
 Radiation treatments to head and neck
 Infiltrative diseases like amyloidosis, scleroderma

 Iodine deficiency and excess
 Hypothalamic or pituitary abnormality
 More common in women, especially over age 50
46
Manifestations
 From mild symptoms to myxedema

 Myxedema –accumulation of mucopolysaccharides
in sc and interstitial tissues. Is the extreme form of
hypothyroidism. Can progress to shock.
 S/S—fatigue, hair loss, dry skin, brittle nails,
numbness and tingling of the fingers, amenorrhea,
weight gain, decreased heart rate and temperature,

lassitude, cognitive changes, elevated cholesterol
levels, constipation, hypotension
47
Pharmacologic Management of
hypothyroidism
 Levothyroxine (Synthroid) is preferred agent

 Dosage is based on TSH
 Desiccated thyroid used infrequently due to
inconsistent dosing
 Angina can occur when thyroid replacement is
initiated as it enhances effects of cardiovascular
catecholamines (in pt. w/pre-existent CAD). Start

at low dose.
 Hypnotics and sedatives may have profound
effects on sensorium
48
Management in Myxedema
 Cautious fluid replacement

 Glucose to restore to normal glycemic levels
 Avoid rapid overheating due to increased

oxygen demands but keep warm
 May give levothyroxine intravenously
With recovery,
 Modify activity
 High fiber foods
 Home health for follow-up

Hypothyroidism
50
Hyperthyroidism
 Extreme form is Grave’s disease

 Caused by thyroiditis, excessive amount
thyroid hormone, abnormal output by
immunoglobulins
 Is more common in women
51
Manifestations of hyperthyroidism
 Thyrotoxicosis—nervousness, irritable,
apprehensive, palpitations, heat intolerance,
skin flushing, tremors, possibly exophthalmos
 Have an increased sensitivity to
catecholamines
 Can occur after irradiation or presence of a

tumor
Hyperthyroidism
53
Assessment and Diagnosis

 Thyroid thrill and or bruit may be present

 Thyroid may be enlarged
 Decreased TSH, increased free T4 and an

increased radioactive iodine uptake
54
Management
 Reduce thyroid hyperactivity—usually use

radioactive iodine, antithyroid meds or
surgery)
 Beta blockers
 Can be relapse with antithyroid meds

55
Pharmacologic Therapy
 Irradiation with administration of radioisotope iodine

131—initially may cause an acute release of thyroid
hormones. Should monitor for thyroid storm
 S/S of thyroid storm—high fever. Tachycardia,
delirium, chest pain, dyspnea, palpitations, weight
loss, diarrhea, abdominal pain
 Management of thyroid storm—oxygen, IV fluids
with dextrose, hypothermic measures, steroids to treat
shock or adrenal deficiency, iodine to decrease output

of T4, beta blockers, PTU or Tapazole impedes
formation of thyroid hormone and blocks conversion
of T4 to T3
56
Antithyroid Medications
 PTU—propylthiouracil—blocks synthesis of hormones

 Tapazole (methimazole)—blocks synthesis of
hormones. More toxic than PTU.
 Sodium Iodide-suppresses release of thyroid hormone
 SSKI (saturated solution of potassium chloride)–
suppresses release of hormones and decreases
vascularity of thyroid. Can stain teeth

 Dexamethazone—suppresses release of thyroid
hormones
57
Surgical Management
 Reserved for special circumstances, e.g. large

goiters, those who cannot take antithyroid
meds, or who need rapid normalization
 Subtotal thyroidectomy
 Before surgery, give PTU until s/s of

hyperthyroidism have disappeared

 Iodine may be used to decrease vascularity
58
Nursing Management
 Reassurance r/t the emotional reactions

experienced
 May need eye care if has exophthalmos
 Maintain normal body temperature
 Adequate caloric intake

 Managing potential complications such as

dysrhythmias and tachycardias
 Educate about potential s/s of hypothyroidism
following any antithyroid tx.
59
Parathyroid Glands
 Parathormone maintains sufficient serum calcium

levels
 Excess calcium can bind with phosphate and
precipitate in various organs, can cause pancreatitis
 Hyperparathyroidism will cause bone decalcification
and development of renal calculi
 More common in women
 Secondary hyperparathyroidism occurs in those with

chronic renal failure and renal rickets secondary to
excess phosphorus retention (and increased
parathormone secretion)
60
Manifestations of
Hyperparathyroidism
 May be asymptomatic
 Apathy, fatigue, muscle weakness, nausea,
vomiting, constipation, hypertension and cardiac
dysrhythmias
 Excess calcium in the brain can lead to psychoses
Renal lithiasis can lead to renal damage and even

failure
 Demineralization of bones with back and joint pain,
pain on weight bearing, pathologic fractures
 Peptic ulcers and pancreatitis can also occur
61
Findings
 Persistent elevated calcium levels

 Elevated serum parathormone level
 Bone studies will reveal decreased density
 Double antibody parathyroid hormone test is

used to distinguish between primary
hyperparathyroidism and malignancy

 Ultrasound, MRI, thallium scan, fine needle
biopsy also can be used to localize cysts,
adenomas, or hyperplasia
62
Management
 Recommended treatment for hyperparathyroidism is

surgical removal
 Hydration therapy necessary to prevent renal calculi
 Avoid thiazide diuretics as they decrease renal excretion of
calcium
 Increase mobility to promote bone retention of calcium
 Avoid restricted or excess calcium in the diet
 Fluids, prune juice and stool softeners to prevent

constipation
 Watch for s/s of tetany postsurgically (numbness, tingling,
carpopedal spasms) as well as cardiac dysrhythmias and
hypotension
63
Hypercalcemic crisis
 Seen with levels greater than 15mg/dL

 Can result in life-threatening neurologic,
cardiovascular and renal symptoms
 Treatments include: hydration, loop diuretics
to promote excretion of calcium, phosphate
therapy to promote calcium deposition in bone

and reducing GI absorption of calcium
 Give calcitonin or mithramycin to decrease
serum calcium levels quickly
64
Hypoparathyroidism
 Seen most often following removal of thyroid

gland, parathyroid glands or following radical
neck surgery
 Deficiency of parathormone results in
increased bone phosphate and decreased
blood calcium levels
 In absence of parathormone, there is

decreased intestinal absorption of dietary
calcium and decreased resorption of calcium
from bone and through kidney tubules
65
Clinical Manifestations of
Hypoparathyroidism
 Irritability of neuromuscular system

 Tetany—hypertonic muscle contractions ,
numbnes, tingling, cramps in extremities,
laryngeal spasm, bronchospasm, carpopedal
spasm ( flexion of the elbows and wrists,
dorsiflexion of the feet), seizures
66
Findings
 Trousseau’s sign—can check with a BP cuff

 Chvostek’s sign—tapping over facial nerve
causes spasm of the mouth, nose and eye
 Lab studies may reveal calcium levels of 5-6
mg/dL or lower
 Serum phosphate levels will be decreased

67
Management of
Hypoparathyroidism
 Restore calcium level to 9-10 mg/dL

 May need to give IV calcium gluconate for immediate
treatment
 Use of parathormone IV reserved for extreme
situations due to the probability of allergic reactions
Monitor calcium levels
 May need bronchodilators and even ventilator

assistance
 Diet high in calcium and low in phosphorus; thus,
avoid milk products, egg yolk and spinach.
68
Management of
Hypoparathyroidism
 Keep calcium gluconate at bedside

 Ensure has IV access
 Cardiac monitoring
 Care of postoperative patients who have

undergone thyroid surgery, parathyroidectomy
or radical neck surgery. Be watchful for signs

of tetany, seizures, and respiratory difficulties
69
Adrenals--Pheochromocytoma
 Usually benign tumor

 Originates from the chromaffin cells of the
adrenal medulla
 Any age but usu. Between 40-50 years old
 Can be familial
 10% are malignant
 May be associated with thyroid carcinoma or

parathyroid hyperplasia or tumor
70
Clinical Manifestations
 Headache, diaphoresis, palpitations,

hypertension
 May have hyperglycemia related to excess
epinephrine secretion
 Tremors, flushing and anxiety as well
 Blurring of vision
 Feeling of impending doom
 BPs exceeding 250/150 have occurred

71
Findings
 Associated with the 5 H’s—hypertension, headache,

hyperhidrosis, hypermetabolism and hyperglycemia
 Urinary catecholamines and metanephrine are direct and
conclusive tests
 Serum epinephrine and norepinephrine levels will be elevated
 Urinary vanillymandelic acid also diagnostic
 Must avoid coffee, tea, bananas, chocolate, vanilla and ASA,

nicotine, amphetamines, decongestants before 24h urine testing
 Clonidine suppression test—in normal individual, would block
catecholamine release
 Imaging studies
72
Management
 Bedrest
 Elevated HOB
 ICU
 Nipride
 Calcium channel blockers and Beta blockers
 Surgical management (manipulation of the tumor

can cause excessive release of catecholamines)
 Steroid therapy if adrenalectomy performed
 Hypotension and hypoglycemia can occur post-op
73
Addison’s Disease
 Adrenocortical insufficiency
 Autoimmune or idiopathic atrophy
 Can be caused by inadequate ACTH from

pituitary
 Therapeutic use of steroids
74
Manifestations
 Muscle weakness
 Anorexia
 Dark pigmentation
 Hypotension
 Hypoglycemia
 Low sodium levels
 High potassium levels
 Can result in Addisonian crisis

75
Addisonian crisis
 Circulatory shock
 Pallor, apprehension, weak&rapid pulse, rapid
respirations and low blood pressure
 Headache, nausea, abdominal pain and
diarrhea
 Can be brought on by overexertion, exposure

to cold, acute infection, decrease in salt intake
76
Findings
 Early morning serum cortisol and plasma

ACTH are performed. Will distinguish between
primary and secondary adrenal insufficiency.
In primary, will have elevated ACTH levels and
below normal cortisol levels.
 If the adrenal cortex is not stimulated by the
pituitary, a normal response to doses of

exogenous ACTH (see text)
 Blood sugar levels and electrolyte values
77
Management
 Restore circulatory status—fluids, steroids

 May need antibiotics if infection precipitated crisis
 May need lifelong steroid therapy and

mineralocorticoid therapy
 May need additional salt intake
 Check orthostatics
 Daily weights
 Aware that stressors can precipitate crises
 Medic alert bracelet or similar identification of

history
78
Cushing’s Syndrome
 Results from excessive adrenocortical activity

 May be related to excessive use of
corticosteroid medications or due to
hyperplasia of the adrenal cortex
 Oversecretion of corticosteroids can also be
caused by pituitary tumor

 Can be caused by bronchogenic carcinoma or
other malignancy
Manifestations of Cushing’s
79
syndrome
 Cataracts, glaucoma
 Hypertension, heart failure
 Truncal obesity, moon face, buffalo hump, sodium
retention, hypokalemia, hyperglycemia, negative
nitrogen balance, altered calcium metabolism
 Decreased inflammatory responses, impaired wound
healing, increased susceptibility to infections
 Osteoporosis, compression fractures

 Peptic ulcers, pancreatitis
 Thinning of skin, striae, acne
 Mood alterations
Manifestations of
Cushing’s Syndrome
81
Findings
 Overnight dexamethasone suppression test frequently

used for diagnosis
 Administered at 11pm and cortisol level checked at
8am
 Suppression of cortisol to less than 5mg/dL indicates
normal functioning
 Measurement of plasma ACTH (radioimmunoassay)
in conjunction with dexamethasone suppression test
helps distinguish pituitary vs. ectopic sites of ACTH.

 MRI, CT and CT also help detect tumors of adrenal or
pituitary
82
Medical Management
 If pituitary source, may warrant transphenoidal

hypophysectomy
 Radiation of pituitary also appropriate
 Adrenalectomy may be needed in case of adrenal
hypertrophy
 Temporary replacement therapy with hydrocortisone or
Florinef
 Adrenal enzyme reducers may be indicated if source if

ectopic and inoperable. Examples include: ketoconazole,
mitotane and metyrapone.
 If cause is r/t excessive steroid therapy, tapering slowly to a
minimum dosage may be appropriate.
Primary Aldosteronism or Conn’s
83
Syndrome
 Excessive aldosterone secondary to adrenal tumor

 retain sodium and excrete potassium
 Results in alkalosis
 Hypertension—universal sign of hyperaldosteronism
 Inability of kidneys to concentrate the urine
 Serum becomes concentrated

 Excessive thirst
 Hypokalemia interferes with insulin secretion thus will
have glucose intolerance as well
84
Findings
 High sodium
 Low potassium level
 High serum aldosterone level
 Low renin level
 Aldosterone excretion rate after salt loading is

diagnostic for primary aldosteronism

 Renin-aldosterone stimulation test
85
Management
 Surgical removal of tumor

 Correct hypokalemia
 Usual postoperative care with abdominal

surgery
 Administer steroids
 Fluids
 Monitoring of blood sugar
 Control of hypertension with spironolactone

86
Corticosteroid Therapy
 Hydrocortisone--Cortisol
 Cortisone--Cortate
 Prednisone--Deltasone
 Prednisolone-Prelone
 Triamcinolone--Kenalog
 Betamethasone--Celestone
 Fludrocortisone (contains both

mineralocorticoid and glucocorticoid) Florinef
87
Indications
 RA
 Asthma
 MS
 COPD exacerbations
 Lupus
 Other autoimmune disorders
 Dermatologic disorders
88
Dosing
 Lowest dose
 Limited duration
 Best time to give dose is in early morning

between 7-8 am
 Need to taper off med to allow normal return of
renal function
89
Side Effects of Steroids

 Hypertension, thrombophlebitis, accelerated

atherosclerosis
 Increased risk of infection
 Glaucoma and corneal lesions
 Muscle wasting, poor wound healing,

osteoporosis, pathologic fractures

 Hyperglycemia, steroid withdrawal syndrome
 Moon face, weight gain, acne

again! ☺
Diabetes Mellitus
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Endocrine System

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Endocrine System

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CARE OF CLIENTS

Glands of the Endocrine System

 Ovaries and testes

 Prolactin releasing and inhibiting hormones

 Growth hormone-releasing hormone

 Somatostatin-=-inhibits GH and TSH

 Growth Hormone (GH)

 Thyroid stimulating hormone (TSH)

 Melanocyte-stimulating Hormone (MSH)

 Follicle stimulating hormone—ovary in female,

 Luteinizing hormone—corpus luteum in

 Oxytocin—contraction of uterus, milk ejection

 Follicular cells—excretion of triiodothyronine

calcium and phosphate levels

Parathyroid hormone—regulates serum

Pancreatic Islet cells

 Endocrine & exocrine gland

Pancreatic Islet cells

 Glucagon—stimulates glycogenolysis and

 Somatostatin—decreases intestinal absorption

 1, 25 dihydroxyvitamin D—stimulates calcium

 Erythropoietin—Increases red blood cell

 Epinephrine and norepinephrine

 Androgens, testosterone—secondary sexual

 Releases thymosin and thymopoietin

 Affects sleep, fertility and aging

 Affect fertility, blood clotting, body temperature

 Health history—energy level, hand and foot

appearance of eyes, size of feet and hands,

 Serum levels of hormones

 Suppression tests—tests negative feedback systems

Disorders of the Pituitary

 Chromophobic tumors—90% of pituitary tumors.

 Growth hormone deficiency in childhood will

Growth Hormone Deficiency

2. Teeth crowded in small jaw or may erupt

4. Delayed onset of pubic, facial, & axillary

2. History – well child except for abnormal

4. Blood studies for hypothyroidism,

2. Suppression of luteinizing hormone-

 NDx: LOW SELF-ESTEEM DUE TO

Growth Hormone Excess

 Due to somatotropin-secreting tumor of

- Weight is excessive but proportional to height

Growth Hormone Excess

 Mx: 1. Surgery – laser or cryo

chlorpromazine, somatostatin, L-dopa,

 Can occur secondary to brain tumors, head

 Nephrogenic DI—relates to failure of the renal

 Urinary sp. gr. of 1.001.1.005

 Fluid deprivation test—withhold fluids for 8-12

 Monitor serum and urine osmolality and ADH

 If renal in origin—thiazide diuretics, NSAIDs

 Excessive ADH secretion

 Meds can either affect the pituitary or increase

 Restoration of electrolytes must be gradual

 Cellular metabolism, brain development,

 Calcitonin—secreted in response to high

 Observe for goiter

 Check TSH, serum T3 and T4

 T3 resin uptake test useful in evaluating

 T3 more accurate indicator of hyperthyroidism

 Antibodies seen in Hashimoto’s, Grave’s and