endocrine system is composed of a small group of:
 ductless glands that work together with the neurologic
system
 to regulate and coordinate all body systems . -
 glands produce chemicals called hormones (“to set in
motion”)
THE PITUITARY GLAND
directed by the hypothalamus (located in the center of the
brain; regulator of autonomic nervous system; rests in the
sella turcica, a depression of the sphenoid bone.)
regions:
1. anterior lobe, or adenohypophysis;
2. posterior lobe, or neurohypophysis;
3. intermediate lobe (pars intermedia), which lies
between the anterior and posterior lobes.
Pituitary Hormones
 antidiuretic hormone
 thyrotropin,
 corticotropin
 somatotropin
PITUITARY GLAND DISORDERS
can result from a:
- tumor growing in the pituitary or hypothalamus,
- interference with circulation to the gland,
- trauma,
- inflammation,
- structural abnormalities,
- erratic or nonfunctional feedback mechanisms,
- possibly can result in:
1. autoimmune responses hypopituitarism (lack of growth
hormone)
2. hyperpituitarism (excess secretion of growth hormone)
3. diabetes insipidus (undersecretion of antidiuretic
hormone)
Growth Hormone Deficiency
(GH, or somatotropin)
is deficient, children cannot grow to full size
- children remain in proportion
- but well below the average on a standard growth
chart.
- may result from a nonmalignant cystic tumor of
embryonic origin that places pressure on the
pituitary gland or from increased intracranial
pressure as a result of trauma.
- cause of the defect is unknown or genetic origin
- will not reach more than 3 or 4 feet in height w/o
treatment
Assessment
- The child with deficient production of GH is usually
normal in size and weight at birth
- mandible is recessed and immature
- nose is usually small.
- child’s teeth may be crowded in a small
- jaw (and may erupt late).
- voice may be high pitched
- onset of pubic, facial, and axillary hair and genital
growth is delayed.
Assess for:
- prenatal and birth history
- severe head trauma at birth,
- health history for any chronic illness,
24-hour nutrition history
- urinary and bowel function.
- actual height
Sudden halted growth suggests a tumor (gradual failure
suggests an idiopathic involvement, vision loss,
headache, increase in head circumference, nausea, and
vomiting)
1. funduscopic examination
2. and neurologic testing
3. wrist is examined radiographically to determine
bone age
4. computed tomography (CT) scanning
5. magnetic resonance imaging (MRI)
6. ultrasound
*4-6 will be performed to detect possible enlargement
of the sella turcica
Therapeutic Management
 IM recombinant human growth hormone (rhGH) two
or three times a week
 usually given at bedtime, at which GH normally
peaks
 Growth hormone has been used irresponsibly by
athletes in the hope that it improves muscle growth
and overall stamina
Growth Hormone Excess
- Skull circumference typically exceeds normal
- Fontanelles may close late or not at all
- Evident at puberty
- Acromegaly (enlargement of the bones of the
head and soft parts of the hands and feet)
- cause the tongue to be so enlarged and
thickened that it protrudes from the mouth,
giving the child a dull, apathetic appearance
and difficulty in articulating words.
- If untreated, child may reach more than 8 ft.
- Radiographs or ultrasounds
To remove tumor:
- Cryosurgery (freezing of tissue)
- laser surgery
If no tumor:
- irradiation or radioactive implants of the
pituitary
meds:
- romocriptine (Parlodel) taken orally
- octreotide (Sandostatin), taken by injection,
Diabetes Insipidus
- Release of antidiuretic hormone (ADH) by the
pituitary gland
- Urine becomes extremely dilute, and a great deal
of fluid is lost from the body
Assessment
- experiences excessive thirst (polydipsia) that is
relieved only by drinking water not BF
 - Urine output may reach 4 to 10 L in a 24-hour
period (normal range, 1 to 2 L), depending on
age
s/sx:
- Occur gradually
- Bedwetting or polyuria
- Weigh loss
- Dehydrated
Diagnostics:
- Radiography’
- CT scan
- Ultrasound
- administration of vasopressin (Pitressin) to rule
out kidney disease (dec. BP)
therap. Management:
- surgery if tumor is present
- desmopressin if idiopathic; orally and intranasal
spray for long term (can be given in IV firm in
emergency)

Syndrome of Inappropriate Antidiuretic

Hormone (SIADH)
- overproduction of antidiuretic hormone by the
posterior pituitary gland.
- Result in dec. urine prod. And water intoxication
- May develop hyponatremia (lowered serum
plasm level)
- Caused by CNS bacterial meningitis, long term +
pressure ventilation, or pituitary compression
Mild symptoms of hyponatremia:
- Weight gain
- Concentrated urine
- Nausea
- Vomiting
- If severe, coma and seizure
Therapy:
- Fluid restriction and supplementation of Sodium
by IV fluid if needed
- Declomycin

THE THYROID GLAND

responsible for controlling the rate of metabolism in the
body through production of the hormones thyroxine (T4)
and triiodothyronine (T3) by its follicular cells.
- A third hormone, thyrocalcitonin, is produced
by the interstitial cells of the gland
o Released if a high serum calcium level
occurs
o Inhibits bone resorption
o Elevates serum calcium levels