NCM 116 – Lecture a.

Symptoms are non-specific: weakness,

MODULE 2 fatigue, headache, diminished tolerance
ENDOCRINE SYSTEM (Pituitary Gland & Thyroid to stress, poor resistance to infection
Gland Disorders) b. In women: menstrual irregularities,
diminished libido, changes in secondary
PITUITARY GLAND char. decrease breast size
c. In men: testicular atrophy, loss of libido,
impotence, decrease muscular mass.
o Management: Replacement of
Hormones
 Ex: Corticosteroids, thyroid
hormones, sex hormones
 Dwarfism
o Failure to grow
o Slow but proportional growth
o Except for their small size, they appear
completely normal
 Located in the Sella Turcica at the base of the  Posterior Pituitary Gland
brain above the sphenoid bone.

 Syndrome of inappropriate ADH (SIADH)

o ADH is released in large amounts
 Diabetes Insipidus (H2O Diabetes)
o ADH deficiency

PITUITARY GLAND DISORDERS

 Anterior Pituitary P.G SIADH/DI
 Hyperpituitarism: growth hormone excess  Brain Pathology
o Clinical conditions: o Brain tumors
 Giantism/Gigantism o Brain/ CNS infections
 Acromegaly o Head trauma
 Hypopituitarism: growth hormone deficit = o Brain Vascular Disorders
decrease in 1 or more of APG hormones.

1
  Clinical Conditions:
1. Crentinism (children)

THYROID GLAND DISORDERS HYPERTHYROIDISM HYPOTHYROIDISM

 Assmt. Cues:  Assmt. Cues
MS: irritability, MS: fatigue, lethargy,
agitation, hyperactive slow clumsy
movements, tremors, movements.
heavy sweating,
insomnia
GIT: increased appetite GIT: decreased
Increased peristaltic appetite, decreased
activity. peristaltic activity.
Hyperactive bowel Hypoactive bowel
sounds sounds
Loose bowel Dry, hard stools
movements (diarrhea) (constipation)  wt.
 wt. loss. gain

: palpiations, : slow, thready pulse,

intolerance to heat, intolerance to cold,
tachycardia, increased bradycardia, decreased
BP, cardiac arrest BP, cardiac arrest.

HYPERTHYROID MYXEDEMA COMA

CRISIS
 Hyperthyroidism THYROID STORM
 Excessive circulating levels of T3, T4 or THYROTOXICOSIS
both
 More common in women Diagnostic Assmnt.
 Affects ages 30-40 years of age group
 Clinical Conditions:  Serum T3, T4, TSH (Thyroid panel)
1. Grave’s Disease  Radioactive Iodine Uptake (RAI)
o Multisystem, autoimmune syndrome  Thyroid Scan/ Scintigraphy
marked by increase production of
thyroid hormone
o Precipitating factor: insufficient  Management:  Management:
iodine supply. a. Drug therapy a. Drug therapy
2. Multimodular Goiter  anti-thyroid  Thyroid
o Char. by small, discrete, automously drugs: hormones:
functioning nodules that secrete o propylthiouracil o Levothyroxine
thyroid hormones (PTU) (Synthyroid)
o These nodules maybe benign or o methimazole o Thyroglobulin
malignant (Tapazole) (Proloid)
3. Exophthalmus / Exopthalmus o blocks synthesis o Dessicated
o Eyeballs protrude from the orbit of thyroid thyroid
o Upper lids are retracted & the hormones (Cytomel)
eyeballs are forced outward b. Radioctive I 131
o The sclera is visible therapy
 Hypothyroidism  given to destroy
 Hypofunction of the thyroid gland the thyroid gland,
 Decrease thyroid hormone secretion decrease thyroid
 Slowing of metabolic processes

2
 hormone
production
c. Thyroidectomy

 Simple Goiter
 Enlargement of the thyroid gland not caused
by inflammation or neoplasm
a. Endemic – caused by nutritional Idodine
deficiency
b. Sporadic – caused by ingestion or large
amounts of goiterogenic agents:
Cabbage, soybeans, peanuts, peaches,
peas, strawberries, spinach, radish.

 Thyroiditis
 Inflammatory process in the thyroid
 Thyroid tissue is replaced by fibrous tissue
 Stress aggravates these autoimmune process
 Hashimoto’s thyroiditis

ADRENAL CORTEX DISORDERS

Adrenal Glands  Alternative Management:

 Located in the upper pole of each kidney  Gradual discontinuance
 Consists of: cortex (outer = 90%), medulla  Reduction of Steroid dose
 Secretes 50+ hormones  Conversion to an alternate day regimen
 Glucocorticoids
 Mineralocorticoids NURSING DIAGNOSIS (ENDOCRINE
 Sex hormones PROBLEMS)
 Body Image Disturbance: Altered self-concept;
CUSHING SYNDROME self esteem
 A spectrum of clinical abnormalities caused by:  High Risk for Infection
excess of glucocorticoids particularly  Activity Intolerance
corticosteroids.  Altered Nutrition
 Occurs more in women  Sensory – Perceptual Alterations
 Iatrogenic – prolonged use of steroids  Fluid and Electrolyte Imbalance
 High Risk for Injury
CORTICOSTEROID THERAPY
 Common preparations:
 Cortisone, hydrocortisone, dexamethasone,
prednisone, betamethasone
 Therapeutic Effects/ Indications
 Anti-inflammatory agents
 (inflammation, allergic, immunoreactive,
edematous, skin problems, malignancies,
degenerative, chronic conditions)
 Adverse Reactions:
 Na+H2O retention: edema, weight gain,
increase BP, CHF
 GIT Symptoms: N&V, gastritis, GI ulcer,
GI bleeding
 Endocrine changes: Menstrual
irregularities, Cushingoid appearance
 Immunologic Response: mask infection,
increased susceptibility to infection
3
4