NCMB 316 – ENDOCRINE SYSTEM

ENDOCRINE SYSTEM • Follicles-stimulating hormone (FSH)

- Stimulates follicle development in the ovaries; as the
Functions of Endocrine System:
follicles mature, they produce estrogen and eggs that
1. Water equilibrium are readied for ovulation; in men, FSH stimulates sperm
2. Growth, metabolism, and tissue maturation development by the testes
3. Heart rate and blood pressure management • Luteinizing hormone (LH)
4. Immune system control - Triggers ovulation of an egg from the ovary and
5. Reproductive function controls causes the ruptured follicle to produce
6. Uterine contractions and milk release progesterone and some estrogen; in men, LH
7. Ion management stimulates testosterone production by the interstitial
8. Blood glucose regulator cells of the testes.
9. Direct gene activation
10. Second messenger system
HORMONES OF POSTERIOR PITUITARY
Organs that produce hormones:
• Oxytocin
1. Hypothalamus -Is released in significant amount only during childbirth
2. Pituitary gland and in nursing women
3. Thyroid gland - It stimulates powerful contractions of the uterine
4. Parathyroids muscle during labor, during sexual relations,
5. Adrenal glands and during breastfeeding and also causes milk
6. Pancreatic islets ejection (let-down reflex) in a nursing woman.
7. Pineal gland • Antidiuretic hormone (ADH)
8. Thymus gland
- Causes the kidneys to reabsorb more water
9. Gonads
from the forming of urine; as a result, urine
10. placenta
volume decreases and blood volume
HYPOTHALAMUS increases; in larger amounts
- Also increases blood pressure by causing
- Major endocrine organ because it produces several constriction of the arterioles, so it is sometimes
hormones. It is an important autonomic nervous system referred to as vasopressin.
and endocrine control center of the brain located
inferior to the thalamus. THYROID GLAND

PITUITARY GLAND
- It's the “master” gland because it tells other glands to
release hormones
- Anterior and posterior
HORMONES OF ANTERIOR PITUITARY
• Growth hormone (GH)
- a general metabolic hormone, however, its major effects
are directed to the growth of skeletal muscles and long
bones of the body.
- It is a protein-sparing and anabolic hormone that causes
amino acids to be built into proteins and stimulates most
target cells to grow in size and divide.
• Prolactin (PRL)
- a protein hormone structurally similar to growth
hormone.
- Its only known target in humans is the breast because,
after childbirth, it stimulates and maintains milk
production by the mother’s breast.
• Adrenocorticotropic hormone (ACTH)
- Regulates the endocrine activity of the cortex portion of
the adrenal gland
• Thyroid-stimulating hormone (TSH)
- Also called thyrotropin hormone influences the growth
and activity of the thyroid gland
• Gonadotropic hormones
- Hormones regulate the hormonal activity of gonads
(ovaries and testes)
-It plays a major role in the metabolism, growth and
development of the human body. It helps to regulate
many body functions by constantly releasing a steady
amount of thyroid hormones into the bloodstream
• Thyroid hormones
- Thyroid hormone controls the rate at which glucose is
“burned” oxidized, and converted to body heat and
chemical energy; it is also important for normal tissue
growth and development.
➢ Thyroxine
- Is the major hormone secreted by the thyroid follicles
➢ Triiodothyronine
- Most triiodothyronine is formed at the target tissues by
conversion of the thyroxine to triiodothyronine.
• Calcitonin
- Decreases blood calcium levels by causing calcium to
be deposited in the bones; calcitonin is made by the
so called parafollicular cells found in the connective
tissues between the follicles.
PARATHYROIDS
• Parathormone
- which is the most important regulator of calcium
ion homeostasis of the blood
- a hypercalcemic hormone (that is, it acts to increase
blood levels of calcium), whereas calcitonin is a
hypocalcemic hormone.
- PTH also stimulates the kidneys and intestines to absorb
more calcium.
NCMB 316 – ENDOCRINE SYSTEM
ADRENAL GLANDS
- Produce hormones that help regulate your metabolism,
immune system, blood pressure, response to stress and
other essential functions
- Adrenal cortex and adrenal medulla
HORMONES OF ADRENAL CORTEX
• Mineralocorticoids
- important in regulating the mineral (or salt) content of
the blood, particularly the concentrations of sodium
and potassium ions and they also help in regulating
the water and electrolyte balance in the body.
• Renin
- An enzyme produced by the kidneys when the blood
pressure drops, also cause the release of aldosterone
by triggering a series of reactions that form angiotensin
II, a potent stimulator of aldosterone release
• Atrial natriuretic peptide (ANP)
- Prevents aldosterone release, its goal being to reduce
blood volume and blood pressure.
• Glucocorticoids
- Include cortisone and cortisol; glucocorticoids promote
normal cell metabolism and help the body to resist
long-term stressors, primarily by increasing blood
glucose levels, thus it is said to be a hyperglycemic
hormone; it also reduce pain and inflammation by
inhibiting some pain-causing molecules called
prostaglandins.
• Sex hormones
- Both male and female sex hormones are produced by
the adrenal cortex throughout life in relatively small
amounts
- Although the bulk of sex hormones produced by the
innermost cortex layer are androgens (male sex
hormones), some estrogens (female sex hormones), are
also formed.
HORMONES OF ADRENAL MEDULLA
• Catecholamines
- When the medulla is stimulated by sympathetic nervous
system neurons, its cells release two similar hormones,
epinephrine, also called adrenaline, and norepinephrine
(noradrenaline), into the bloodstream; collectively, these
hormones are referred to as catecholamines.
PANCREATIC ISLETS
- Are small islands cells that produce hormones that
regulate blood glucose levels
HORMONES OF PANCREATIC ISLETS
• Islet cells
- act as fuel sensors, secreting insulin and glucagon
appropriately during fed and fasting states.
• Beta cells
- High levels of glucose in the blood stimulate the
release of insulin from the beta cells of the islets.
• Alpha cells
- Glucagon’s release by the alpha cells of the islets is
stimulated by low blood glucose levels.
• Insulin
- Acts on just about all the body cells and increases their
ability to transport glucose across their plasma
membranes; because insulin sweeps glucose out of the
blood, its effect is said to be hypoglycemic.
• Glucagon
- Acts as an antagonist of insulin; that is, it helps to
regulate blood glucose levels but in a way opposite that
of insulin.
- Its action is basically hyperglycemic and its primary
target organ is the liver, which it stimulates to break
down stored glycogen into glucose and release the
glucose into the blood.
PINEAL GLAND
Receive information about the state of the light-dark
-
cycle from the environment and convey this information
to produce and secrete the hormone melatonin
• Melatonin
- Is the only hormone that appears to be secreted in
substantial amounts by the pineal gland; the levels of
melatonin rise and fall during the course of the day
and night
- Peak levels occur at night and make us drowsy as
melatonin is believed to be the “sleep trigger” that
plays an important role in establishing the body’s day-
night cycle.
THYMUS GLAND
-The thymus makes white blood cells called T lymphocytes
(also called T cells). These are an important part of the
body's immune system, which helps us to fight infection
• Thymosin
- Appear to be essential for normal development of a
special group of white blood cells (T-lymphocytes, or T
cells) and the immune response.
GONADS
- Responsible for producing the sperm and ova, but they
also secrete hormones and are considered to be
endocrine glands
HORMONES OF OVARIES
• Estrogen
Responsible for the development of sex characteristics in
women at puberty; acting with progesterone, estrogens
promote breast development and cyclic changes in the
uterine lining (menstrual cycle)
• Progesterone
- Acts with estrogen to bring about the menstrual cycle;
during pregnancy, it quiets the muscles of the uterus so
that an implanted embryo will not be aborted and helps
prepare breast tissue for lactation
HORMONES OF TESTES
• Testosterone
- Promotes the growth and maturation of the reproductive
system organs to prepare the young man for
reproduction
NCMB 316 – ENDOCRINE SYSTEM
- It also causes the male’s secondary sex characteristics to TYPE 1 DIABETES MELLITUS
appear and stimulates male sex drive
ETIOLOGY
- Necessary for the continuous production of sperm.
PLACENTA 1. Autoimmune destruction
2. Environmental trigger
- In addition to its roles as the respiratory, excretory, and
RISK FACTORS
nutrition delivery systems for the fetus
- It also produces several proteins and steroid 1. Age (children and adolescents)
hormones that help to maintain the pregnancy and 2. Genetic abnormality
pave the way for delivery of the baby. 3. Virus
4. Diet
HORMONES IN PLACENTA 5. Drugs/toxins
6. Stress
• Human chorionic gonadotropin (HCG)
During very early pregnancy, a hormone called
- CLINICAL MANIFESTATIONS
human chorionic gonadotropin (hCG) is produced by
the developing embryo and then by the fetal part 1. Blurry vision
of the placenta 2. Numbness/tingling sensation
- hCG stimulates the ovaries to continue producing 3. Fatigue and weakness
estrogen and progesterone so that the lining of the 4. Hyperglycemia
uterus is not sloughed off in the menses. 5. Weight loss
• Human placental lactogen (HPL) 6. Glucosuria
- hPL works cooperatively with estrogen and 7. Polyuria
progesterone in preparing the breasts for lactation. 8. Polydipsia
9. Polyphagia
• Relaxin
- Another placental hormone, causes the mother’s pelvic DIAGNOSTIC TEST
ligaments and the pubic symphysis to relax and become
more flexible, which eases birth passage. TEST N. VALUE PREDIABETES DIABETES
Glycosylated Below 5.7% 5.7 – 6.4% 6.5% or
COMPLICATIONS IN IENDOCRINE SYSTEM hemoglobin above
(A1C) test
1. Type 1 DM
Random N/A N/A 200 mg/dL
2. Type 2 DM
blood sugar or above
3. Hyperpituitarism
test
4. Hypopituitarism
Fasting 99 mg/dL 100 – 125 126 mg/dL
5. Diabetes insipidus
blood sugar or below mg/dL or above
6. Hyperthyroidism
test
7. Hypothyroidism
8. SIADH Fingerstick 72 – 140 N/A More than
9. Cushing’s disease glucose test mg/dL 180 mg/dL
10. Addison’s disease Lipid profile Less than 150 to 199 200 to 499
150 mg/dL mg/dL mg/dL
DIABETES MELLITUS
- A chronic metabolic disease characterized by NURSING MANAGEMENT
hyperglycemia due to disorder of carbohydrate, fat
and protein metabolism 1. DIET:

TYPES OF DIABETES MELLITUS ➔ Limit carbohydrates to 45-60% a day

1. Type 1 – Insulin Dependent Diabetes Mellitus ➔ Fats: No more than 20% a day
-Characterized by destruction of the pancreatic beta-
cells due to genetic, immunologic, and possibly - Limit saturated fats
environmental - Encourage the patient to eat monounsaturated fats
2. Type 2 (formerly non-insulin-dependent Diabetes Mellitus)
- it results from a decreased sensitivity to insulin (insulin ➔ Protein: 15-20% a day
resistance) or from a decreased amount of insulin
production. - Avoid red meat
- First treated with diet and exercise, and then with oral 2. EXERCISE:
hypoglycemic agents as needed.
3. Gestational Diabetes Mellitus ➔ Check blood sugar before, during, and after exercise
- Characterized by any degree of glucose intolerance
with onset during pregnancy (second or third trimester) ➔ If the glucose is high avoid exercise

➔ If the glucose is less than 100 eat snack such as simple

carbohydrates to avoid hypoglycemia
NCMB 316 – ENDOCRINE SYSTEM

➔ Aerobic Exercise (Cardiovascular Exercise) 3. Non-compliance related to diabetic maintenance as

evidenced by uncontrolled blood glucose levels.
- Helps body use insulin - Assess the patient’s understanding about his or her
current condition.
MEDICAL MANAGEMENT - Educate the patient about what the importance of taking
1. Insulin Therapy insulin in his/her current condition.
- Teach the patient how to monitor his/her glucose level.
❖ Rapid acting: 1-1.5 hr peak / lasts for 3-4 hours before meal - Teach the patient how and when to administer the
and its usually used with long acting insulin medication; also discuss the locations of where to inject
the insulin.
➢ Lispro
TYPE 2 DIABETES MELLITUS
➢ Aspart ETIOLOGY
➢ Glulisine 1. Resistance to insulin action in target tissues
2. Abnormal insulin secretion
❖ Short acting: 2.5 hr peak / Lasts 4-6 hours short acting insulin 3. Inappropriate hepatic gluconeogenesis (over
covers insulin needs for meals eaten within 30-60 minutes production of glucose)
➢ Humulin R, Novolin R (insulin regular) RISK FACTORS

❖ Intermediate acting: 8 hours peak / Lasts 10-16 hours - Family history of diabetes
Intermediate acting insulin covers insulin needs for about half the - Obesity
day or overnight. This type of insulin is often combined with a - Race/ Ethnicity ( African Americans, Hispanic Americans,
rapid or short acting-acting type. Native Americans, Asian Americans, Pacific Islanders)
- Age ( ≥ 45 years old)
➢ NPH (neutral protamine Hagedorn) - Hypertension ( ≥ 140/90 mmHg)
- High- density lipoprotein (HDL) cholesterol level ( ≥ 35
❖ Long acting: No peak / Lasts 24 hours - it usually used to
mg/dL)(0.90 mmol/L)
control the blood sugar overnight
- Triglyceride level ( ≥ 250 mg/dL)(2.8 mmol/L)
➢ Glargine - History of gestational diabetes or delivery of a baby
over 9 lb
➢ Detemir CLINICAL MANIFESTATIONS
2. Pramlintide 1. Glycosuria
2. Polyuria
➢ The initial dose is 15 mcg (micrograms), it is administered
3. Polydipsia
subcutaneously. It is administered usually on the abdomen, and
4. Polyphagia
in front of thigh. It is administered before meal.
5. Muscle weakness, fatigue
SURGICAL MANAGEMENT 6. Blurred vision, blindness
7. Pain and numbness in the hands or feet
1. Pancreas transplant 8. Chronic kidney disease
2. Islet cell transplantation 9. Slow healing wounds
10. Stroke
NURSING DIAGNOSIS AND INTERVENTIONS 11. Coronary artery disease
1.
Imbalanced nutrition: less than body requirements DIAGNOSTIC TESTS
related to diminished insulin secretion as evidenced by
hyperglycemia 1. Fasting plasma glucose (FPG)
- Teach the patient how to perform home glucose 2. HgbA1C (A1C)
monitoring. 3. Urinalysis
- Instruct patient on the proper injection of insulin allowing 4. Serum creatinine level
them to become self-reliant in the long run.
NURSING MANAGEMENT
- Educate patient on the correct rotation of injection sites
when administering insulin. 1. DIET- Guidelines for appropriate dietary intake have
2. Risk for fluid Volume Deficit related to hypertonic been provided by the American Diabetes Association,
dehydration as evidenced by excessive urine which consist of a balanced, nutritious diet that's low in
production cholesterol, simple sugar, and fat.
- Monitor vital signs 2. EXERCISE- It's very important for patients diagnosed
- Monitor I&O and note urine-specific gravity with diabetes to exercise regularly to reduce weight.
- Encourage the patient to drink the recommended amount 3. BLOOD GLUCOSE MONITORING- Blood glucose
of fluid. monitoring is a useful tool, which can help to achieve
- Examine changes in mentation and consciousness levels. good glycemic control, by allowing the patient to
understand the effect of diet, and exercise, on their
NCMB 316 – ENDOCRINE SYSTEM
blood glucose levels, make decisions about diet, RISK FACTORS
activity levels, and medications
1. Overweight
MEDICAL MANAGEMENT 2. Age
3. Family history
1. MEDICATIONS-The first medication recommended for 4. gender
type 2 diabetes is metformin because its action
decreases glucose production by the liver and SYMPTOMS
increases the body's sensitivity to insulin.
2. Insulin therapy- In type 2 diabetes, insulin may be → Abnormally large growth and deformity of the:
necessary on a long-term basis to control glucose levels
if meal planning and oral agents are ineffective or • Hands (rings nlonger fit)
when insulin deficiency occurs. • Feet (need a bigger size shoe)
• Face (protrusion of brow and lower jaw)
SURGICAL MANAGEMENT • Jaw (teeth dnot line up correctly when the mouth is
1. Bariatric surgery – the goal of these operations is to closed)
modify the stomach and intestines to treat obesity and • Lips
related diseases. • Tongue --> Carpal tunnel syndrome

NURSING DIAGNOSIS AND INTERVENTIONS → skin changes, such as:

1. Risk for Fluid Volume Deficit related to Polyuria • Thickened, oily, and sometimes darkened skin
➢ Maintain fluid intake of at least 2500 mL/day • Severe acne
within cardiac tolerance when oral intake is • Excessive sweating and offensive body order due to
resumed. enlargement of the sweat glands
➢ Promote a comfortable environment—cover • Deepening voice due to enlarged sinuses, vocal cords,
patient with light sheets. and soft tissues of the throat
➢ Investigate changes in mentation and level of
• Fatigue and weakness in legs and arms
consciousness.
2. Risk for Injury related to Muscle Weakness and • Sleep apnea
Numbness of Hands and Feet • Arthritis and other joint problems especially in the jaw
➢ Instruct the patient in the hygiene principle: wash • Hypothyroidism
the feet daily in warm water using mild soap; • Enlargement of the liver, kidneys, spleen, heart, and/or
avoid soaking the feet. Dry carefully and gently, other internal organs, which can lead to:
especially between toes. Use moisturizing lotion at
least once daily. Avoid the area between the toes. --> Diabetes
➢ Instruct the patient to inspect the feet daily for cuts, --> High blood pressure
scratches, and blisters. A mirror may be necessary
to assess the bottom of the foot. Instruct to use both --> Cardiovascular disease
visual inspection and touch.
➢ Instruct the patient always to wear protective In women:
footwear; never go barefoot.
3. Risk for Infection related to Slow Healing of Wounds • irregular menstrual cycles
➢ Teach and promote good hand hygiene. • Galactorrhea (abnormal production of breast milk) in
➢ Maintain asepsis during IV insertion, administration 50% of cases
of medications, and providing wound or site care.
In men:
Rotate IV sites as indicated.
➢ Provide catheter or perineal care. Teach female • In about 50% of cases, impotence
patients to clean from front to back after
elimination. DIAGNOSTIC TESTS
HYPERPITUITARISM 1. Blood tests
2. Glucose tolerance test
- Having an overactive pituitary gland 3. Head CT scan
- Acromegaly is a rare disorder of excessive bone and 4. MRI
soft tissue growth due to elevated levels of growth 5. Stereotactic therapy
hormone. 6. Conventional radiation therapy
- In young children, prior the completed fusion and growth
of bones, excessive growth hormone can cause a similar TREATMENT
condition called gigantism
• Reduce production of GH to normal levels
ETIOLOGY • Stop and reverse the symptoms caused by over-
secretion of GH
1. Pituitary tumor (pituitary adenoma is most common • Correct other endocrine abnormalities (thyroid,
cause)
adrenal, sex organs)
• Reduce the tumor size
NCMB 316 – ENDOCRINE SYSTEM
TREATMENT MAY INCLUDE - Rationale: Positive Aspects of the client is able to
foster confidence in the client.
• Surgical removal of the pituitary tumor ➢ Exhibit positive caring in routine activities
• Radiosurgery is the use of highly focused external - Rationale: Positive remarks by the nurse may encourage
beams of radiation shrink the tumor. It is used most the patient develop more positive responses to the
often in patients who did not respond conventional changes in his or her body.
surgery or medications. 2. Fluid volume deficit related to polyuria as manifested by
• Radiation therapy is used in combination with either excessive thirst of the patient
medical and/or surgical treatment ➢ Urge the patient to drink the prescribed amount of fluid
➢ Aid the patient if they cannot eat without assistance,
MEDICATION and encourage the family to assist with feeding as
- Drugs may be given reduce the level of GH secretion necessary
from the pituitary gland. These include: ➢ Emphasize the importance of oral hygiene
➢ Provide a comfortable environment by covering the
• Cabergoline (Dostinex)—given orally
patient with light sheets
• Pergolide (Permax)—given orally 3. Risk for injury related to a decrease in sensory perception
• Bromocriptine (Parlodel)—may be given before
surgery tshrink tumor HYPOPITUITARISM
• Octreotide (Sandostatin)—given by injections
- A rare disorder in which your pituitary gland fails to
• Pegvisomant—given by injections for patients not
produce one or more hormones, or doesn't produce
responding to other forms of treatment
enough hormones.
PREVENTION
ETIOLOGY
- there are guidelines for preventing acromegaly.
- Infection or inflammation by: fungal, pyogenic bacteria.
- Early diagnosis and treatment, however, will help
- Autoimmune diseases
prevent serious complications, some of which are
irreversible. - Tumors
- Feedback from the target organ experiencing
SURGICAL MANAGEMENT malfunctions
- Hypoxic necrotic
• Surgery - removal of the pituitary tumor that is believed to
be causing acromegaly may be done. SYMPTOMS
• Radiosurgery - the use of highly focused external beams of
1. Growth hormone (GH) deficiency
radiation to shrink the tumor.
• Fatigue
• Radiation Therapy - used in combination with either medical
and/or surgical treatment. • Muscle weakness
• Transsphenoidal adenomectomy- Surgery is performed to • Changes in body fat composition
remove a tumor from the pituitary gland. • Lack of ambition
• Hypophysectomy- a brain surgery to remove all or part of • Social isolation
the pituitary gland. 2. Luteinizing hormone (LH) and follicle-stimulating hormone
(FSH) deficiency
NURSING MANAGEMENT ➢ Women may also have symptoms such as:
• Hot flashes
• PREOPERATIVE. At the time of diagnosis, the patient
• Irregular or no periods
requires education and emotional support. Focus education
on the prescribed medical regimen, and preparation for • Loss of pubic hair
surgery. • An inability to produce milk for breast-feeding
• Prepare the patient and family for surgery. Explain the ➢ Men may also have symptoms such as:
preoperative diagnostic tests and examinations. • Erectile dysfunction
• POSTOPERATIVE. Elevate the patient’s head to facilitate • Decreased facial or body hair
breathing and fluid drainage. Provide frequent mouth care, • Mood changes
and keep the skin dry. To promote maximum joint mobility, 3. Thyroid-stimulating hormone (TSH) deficiency
perform or assist with range-of-motion exercises. • Fatigue
• Weight gain
NURSING DIAGNOSIS AND INTERVENTIONS
• Dry skin
1. Anxiety related to body image disturbance over thickened • Constipation
skin and enlargement of face, hands and feet. • Sensitivity to cold or difficulty staying warm
➢ Encourage clients to want to express their thoughts and 4. Adrenocorticotropic hormone (ACTH) deficiency
feelings about body appearance changes. • Severe fatigue
- Rationale: Information from the client can • Low blood pressure, which may lead to fainting
determine the location of the discomfort as well as to • Frequent and prolonged infections
determine the next action.
➢ Help clients identify the strengths and positive aspects • Nausea, vomiting or abdominal pain
that can be developed by the client. • Confusion
NCMB 316 – ENDOCRINE SYSTEM
5. Anti-diuretic hormone (ADH) deficiency 6. Decrease osmolality in blood
• Excessive urination 7. Muscle cramps
• Excessive thirst 8. Euvolemia
• Electrolyte imbalances 9. Nausea and vomiting
10. Headache
COMPLICATIONS 11. Coma
12. Seizure
1. Cardiovascular 13. Hallucinations
• Hypertension 14. Mood swings
• Thrombophlebitis 15. Confusion
• Thromboembolism DIAGNOSTIC TEST
• Acceleration uterosklerosis
2. Immunology 1. Blood and urine osmolality
• Increased risk of infection and disguise any signs -Na- hyponatremia
of infection -Low serum osmolality
3. Changes in the eye -Elevated urinary sodium level
• Glaucoma 2. Water loading ADH suppression test
• Corneal lesions - Dilutional hyponatremia and low plasma osmolality
4. Musculoskeletal
• Muscle wasting MEDICAL MANAGEMENT
• Poor wound healing 1. SIADH is generally managed by eliminating the underlying
• Osteoporosis with vertebral compression fractures, cause if possible and restricting fluid intake.
long bone pathologic features, aseptic necrosis of 2. Diuretics are used with fluid restriction to treat severe
the femoral head hyponatremia.
5. Metabolic
• Changes in glucose metabolism of steroid DRUG MANAGEMENT
withdrawal syndrome
• Certain medications that inhibit the action of antidiuretic
6. Changes in appearance
hormone also called vasopressin .
• Such as moon face (moon face)
• Weight gain • Antidepressants: chlorpropamine, SSRIs
• Acne
• Anticonvulsants: carbamazepine, oxcarbazepine
SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE
SECRETION (SIADH) • Antineoplastics: cyclophosphamide, vinca alkaloids,
cisplatin
- The syndrome of inappropriate antidiuretic hormone
(SIADH) secretion refers to excessive antidiuretic • Others: NSAIDs, MAOIs, opiates, amiodarone,
hormone (ADH) secretion from the pituitary gland even ciprofloxacin, haloperidol, lisinopril, methotrexate.
in the face of subnormal serum osmolality.
- Patients with this disorder cannot excrete dilute urine. • Other medicines to help regulate body fluid volume such
They retain fluids and develop sodium deficiency as furosemide (Lasix), Metalazone.
(dilutional hyponatremia). SIADH is often of
nonendocrine origin. SURGICAL MANAGEMENT
- The syndrome may occur in patients with bronchogenic • Hypophysectomy, Surgical removal of a tumor that is
carcinoma (malignant lung cells synthesize and release producing ADH
ADH).
NURSING DIAGNOSIS AND INTERVENTIONS
ETIOLOGY
1.
Excess fluid volume related to increased Antidiuretic
1. Cancer (small cell lung cancer) hormone as evidenced by Hypervolemia
2. Brain injury ➢ Restrict fluid intake but establish scheduled mouth care
3. Drugs (chemo drugs) and ice chips as part of fluid allotment
RISK FACTORS - To ensure minimal amount of liquid intake (500ml -to 1L
/day)
1. Family history - Involving client in therapy regimen may enhance sense
2. Tobacco use of control and cooperation with restrictions.
3. Medications (opioids, antidepressants, NSAIDs, anesthetics) ➢ Monitor 24-hour intake and output balance
- Diuretic therapy may result in sudden or excessive fluid
CLINICAL MANIFESTATIONS loss, creating a circulating hypovolemia
1. Decrease water in urine ➢ Weigh daily
2. Hypertension - A gain of 5 lb represents approximately 2 L of fluid.
3. Hypervolemia - Diuretics can also result in rapid and excessive fluid shifts
4. Hyponatremia and weight loss.
5. Decrease specific urine gravity
NCMB 316 – ENDOCRINE SYSTEM
2.
Risk for electrolyte imbalance: Hyponatremia related 7. Increased serum osmolality
to water intoxication 8. Increased thirst (polydipsia)
➢ Monitor respiratory rate and depth 9. Decreased urine osmolality and specific gravity (diluted
- Co-occurring hypochloremia may produce slow and urine)
shallow respiration as the body compensates for 10. Electrolyte imbalance
metabolic alkalosis. 11. Muscle weakness/ fatigue
➢ Assess level of consciousness and neuromuscular 12. Decreased in blood volume
response 13. Hypovolemia
- A deficit in sodium levels may lead in decreased 14. Low blood pressure
mentation to coma, as well as generalized muscle 15. Hypovolemic shock
weakness, cramps, or convulsions.
DIAGNOSTIC TESTS
➢ Note for signs of circulatory overload, as indicated
- Administration of sodium-containing IV fluids in the 1. Urine osmolality
presence of heart failure increases risk. 2. Water deprivation test
3. MRI
3.
Disturbed Thought Process as evidenced by mood 4. Genetic screening
swings secondary to cerebral edema
➢ Perform periodic neurological/behavioral MEDICAL MANAGEMENT
assessments, as indicated, and compare with baseline.
- Early recognition of changes promotes proactive • replace ADH (which is usually a long-term therapeutic
modifications for plan of care. program
➢ Reorient to time/place/person, as needed • To ensure adequate fluid replacement
- Inability to maintain orientations is a sign of • To identify and correct the underlying intracranial
deterioration. A confused patient needs to be pathology. Nephrogenic causes require different
reoriented. management approaches.
➢ Provide safety measures (e.g., side rails, padding, as DRUG THERAPY
necessary: close supervision, seizure precautions), as
indicated. 1. Desmopressin (DDAVP)
- It is always necessary to consider the safety of the -Administered intranasally, one or two administrations
patient. daily to control symptoms
2. Intramuscular administration of ADH
DIABETES INSIPIDUS
- (vasopressin tannate in oil) every 24 to 96 hours to
- is an uncommon disorder that causes an imbalance of reduce urinary volume (shake vigorously or warm;
fluids in the body. administer in the evening; rotate injection sites to prevent
- This imbalance leads you to produce large amounts of lipodystrophy).
urine. 3. Clofibrate (Atromid-S)
- It also makes a person very thirsty even if they have - A hypolipidemic agent, has been found to have an
something to drink. antidiuretic effect on patients who have some residual
hypothalamic vasopressin; chlorpropamide (Diabinese)
- If diabetes insipidus is inherited, the primary symptoms
and thiazide diuretics are also used in mild forms of the
may begin at birth, in adults, onset may be insidious or
disease because they potentiate the action of
abrupt
vasopressin.
ETIOLOGY 4. Thiazide diuretics
- mild salt depletion, and prostaglandin inhibitors
1. Hypothalamus decrease production of anti-vasopressin / (ibuprofen [Advil, Motrin], indomethacin [Indocin], and
diuretic hormone or ADH aspirin) are used to treat the nephrogenic form of
diabetes insipidus.
RISK FACTORS
NURSING MANAGEMENT
1. Dehydration
2. Smoking • Educate the patient, family, and other caregivers about
3. Diet follow-up care, prevention of complications, and
4. Lithium use emergency measures.
5. Gender (usually affects male)
6. Age • Verbal and written instructions about the dose, actions,
7. Family history side effects, and administration of all medications
8. Genetic predisposition
• Demonstrate and observe a return demonstration of
CLINICAL MANIFESTATIONS medication administration to ensure that the patient
received the prescribed dosage.
1. Excessive urine output (polyuria)
2. Bedwetting • The patient should be advised to wear a medical
3. Nocturia identification bracelet and carry required medication and
4. Dehydration information about DI at all times.
5. Dry skin
6. Constipation
NCMB 316 – ENDOCRINE SYSTEM
NURSING DIAGNOSIS AND INTERVENTIONS 3. Radioiodine uptake test
1. Fluid volume deficit related to excessive urinary output as
manifested by increased thirst and weight loss.
4. Thyroid scan

➢ Monitor intake and output. Report urine volume 5. Thyroid ultrasound

greater than 200 mL for each of 2 consecutive hours MEDICAL MANAGEMENT
or 500 mL in a 2-hour period.
• Anti-thyroid medications. These medications gradually
➢ Weigh daily.
reduce symptoms of hyperthyroidism by preventing
➢ Monitor for signs of hypovolemic shock (e.g., your thyroid gland from producing excess amounts of
tachycardia, tachypnea, hypotension). hormones.

2. Risk for impaired skin integrity related to decreased water → Propylthiouracil (PTU) and Methimazole (Tapazole) given to
absorption as evidence by dry skin return the patient to the euthyroid (normal) state.

➢ Assess the overall condition of the skin.
➢ Assess patient’s nutritional status, including weight,
weight loss, and serum albumin levels.
➢ Reassess the skin regularly and whenever the patient’s
condition or treatment plan results in an increased
number of risk factors.
3. Activity intolerance related to decrease of hormone and
frequent urination as manifested by weakness and fatigue
of the patient.
➢ Restrict environmental stimuli, especially during
planned times for rest and sleep.
➢ Aid the patient with developing a schedule for daily
activity and rest. Emphasize the importance of
frequent rest periods.
➢ Teach energy conservation methods. Collaborate with
occupational therapist as needed.
HYPERTHYROIDISM
- Resulting from hypersecretion of thyroid hormones (T3
and T4)
- Hyperthyroidism is characterized by an increased rate
of body metabolism
ETIOLOGY
SYMPTOMS
• Weight loss despite an increased appetite
• Rapid or irregular heartbeat
• Nervousness, irritability, trouble sleeping, fatigueshaky
hands, muscle weakness.
→ PTU inhibits use of iodine by thyroid gland; blocks oxidation
of iodine and inhibits thyroid hormone synthesis
• Beta blockers. Although these drugs are usually used to
treat high blood pressure and don't affect thyroid
levels, they can ease symptoms of hyperthyroidism,
such as a tremor, rapid heart rate and palpitations.
• Potassium iodide, Lugol’s solution, and saturated
solution of potassium iodide (SSKI) may be added.
• Surgery (thyroidectomy). If pregnant or otherwise can't
tolerate anti-thyroid drugs and don't want to or can't
have radioactive iodine therapy, the patient can be a
candidate for thyroid surgery, although this is an option
in only a few cases.
HYPOTHYROIDISM
- Is a common condition where the thyroid doesn’t create
and release enough thyroid hormone into your blood
stream. This makes your metabolism slow down
- Results from suboptimal levels of thyroid hormone
ETIOLOGY
1. Hashimoto’s disease
2. Thyroidectomy
3. Radioactive iodine therapy
4. Antithyroid drugs
5. Iodine deficiency
RISK FACTORS
• Medication • 60 y/o above

• Sweating or trouble tolerating heat. • Iodine deficiency • Atrophy of the

thyroid gland
• Frequent bowel movements
• Postpartum thyroiditis • Autoimmune
• An enlargement in the neck, called a goiter disease
DIAGNOSTIC EVALUATION • female • family history
1. Medical history and physical exam CLINICAL MANIFESTATIONS

2. Blood test 1. Fatigue

NCMB 316 – ENDOCRINE SYSTEM

2. Weight gain and Carafate. (Decrease absorption of thyroid

replacement)
3. Constipation
2. Prevention of cardiac dysfunction
4. Enlargement of tongue
- As long as metabolism is subnormal and the tissues
5. Thickened skin require relatively little oxygen, a reduction in the blood
supply is tolerated without overt symptoms of coronary
6. Husky, hoarse voice artery disease.

7. Myxedema 3. Supportive therapy

- Oxygen saturation levels should be monitored; fluids
8. Narrowed pulse pressure should be administered cautiously; application of
external heat must be avoided, and oral thyroid
9. Anxiety hormone therapy should be continued.
10. Depression NURSING MANAGEMENT
DIAGNOSTIC TEST 1. DIET: Low Calorie, Low cholesterol, Low saturated- fat
1. Physical exam 2. Monitor Vital Signs
- Thyroid gland is inspected and palpated routinely in all 3. Provide warm environment (Give extra blanket,
patients clothing, and warm room to compensate to
hypothermia)
2. Serum thyroid-stimulating tests
4. Record daily weight
- Measurement of the serum TSH concentration is the
single best screening test of thyroid function because of 5. Provide high fiber/ roughage and fluids to prevent
its high sensitivity. constipation.
6. Avoid sedatives and opioid analgesics because of
3. Serum T3 and T4 increased sensitivity to those medications.
- Measurement of total T3 or T4 includes protein-bound NURSING DIAGNOSIS AND INTERVENTIONS
and free hormone levels that occur in response to TSH
secretion 1. Activity intolerance related to fatigue and reduced
cognitive function secondary to hypothyroidism
4. Thyroid antibodies
➢ Promote independence in self-care activities
- Results of testing by immunoassay techniques for
antithyroid antibodies are positive in Hashimoto’s - Space activities to promote rest and exercise as
thyroiditis (100%). tolerated.

MEDICAL MANAGEMENT - Assist with self-care activities when the patient is

fatigued.
- The primary objective in the management of
hypothyroidism is to restore a normal metabolic state by - Provide stimulation through conversation and non-
replacing the missing hormone. stressful activities.

1. Pharmacologic therapy: - Monitor patient's response to increasing activities.

➢ Synthetic Levothyroxine ➢ Teach energy conservation techniques, such as:

- Preferred preparation for treating hypothyroidism and - Sitting to do tasks

suppressing nontoxic goiters
- Frequent position changes
➢ Cytomel (Liothyronine)
- Pushing rather than lifting
➢ IV administration of T4 and T3 (Myxedema coma)
- Sliding rather than lifting
- Start with low dose, gradually increase
- Working at an even pace
- Monitor VS. BP and pulse rate
- Placing frequently used items within easy reach
- Take medication without food
- Resting for at least 1 hour after meals before starting a
- should be given at least 4 hours apart from new activity
multivitamins, antacids, bile acid sequestrants, iron,
NCMB 316 – ENDOCRINE SYSTEM
- Using wheeled carts for Laundry, shopping, and SIGNS AND SYMPTOMS
cleaning needs
1. irritability 17. muscle weakness
- Organizing
2. hyperkalemia 18. diarrhea
➢ Assess the physical activity level and mobility of the
3. weight loss 19. dehydration
patient
4. nausea & vomiting 20. joint pain
- Provide baseline information for formulating nursing
goals during goal setting 5. metabolic acidosis 21. arrythmia
2. Ineffective breathing patter related to depressed 6. dizziness when 22. chest pain
ventilation standing
23. fatigue
➢ Monitor respiratory rate, depth, pattern, pulse 7. hyponatremia
oximetry, and arterial blood gases. 24. confusion
8. tachycardia
➢ Encourage deep breathing, coughing, and the use of 25. hyperpigmentation
incentive spirometry. 9. muscle twitching
26. loss of motivation
➢ Administer medications (hypnotics and sedatives) with 10. muscle pain
27. decreased sex
caution.
11. hyponatremia drive
➢ Maintain patent airway through suction and
12. seizures 28. loss of hair
ventilatory support if indicated.
13. headache 29. loss of muscle mass
3. Acute confusion is related to depressed metabolism
and altered cardiovascular and respiratory status 14. confusion 30. comatose
➢ Orient patient to time, place, date, and events around 15. behavioral problems 31. lethargy
him or her.
16. depression
➢ Provide stimulation through conversation and
nonthreatening activities. DIAGNOSTIC TEST

➢ Explain to patient and family that change in cognitive 1. blood test

and mental functioning is a result of disease process.
2. insulin-induced hypoglycemia test
3. CT can
ADDISON’S DISEASE
4. MRI
- Primary adrenal insufficiency due to various causes NURSING MANAGEMENT
ETIOLOGY
1. Encourage rest periods after eating
1. Idiopathic – 4. Medications that causes low
2. Ask patient and family about onset of illness or
autoimmune cortisol
increased stress that may have precipitated crisis
response
(etomidate, mitotane)
3. Monitor blood pressure and pulse rate as the patient
2. Infections 5. Malignancy and metastasis moves from lying, sitting, and standing position to
assess for inadequate fluid volume
3. Trauma/ 6. Hemorrhage or infarction
injury 4. Urge patient to wear a medical alert bracelet and to
carry information at all times about the need for
4. Congenital 7. Infiltration of diseases corticosteroids
adrenal
hyperplasia 8. Latrogenic (surgery) MEDICAL MANAGEMENT

RISK FACTORS 1. Corticosteroid (steroid) – hydrocortisone, Prednisone,

Methylprednisolone
1. female 5. medications
2. Fludrocortisone, Dehydroepiandrosterone (DHEA)
2. heredity 6. infections (TB,
Meningococcal) SURGICAL MANAGEMENT
3. autoimmune disease
7. hemorrhage 1. Resection
4. adrenocortex auto-
antibody 2. Electrocauterization
3. Adrenalectomy
NCMB 316 – ENDOCRINE SYSTEM
NURSING DIAGNOSIS AND INTERVENTIONS
1. Risk for imbalance nutrition: less than body
requirements related to decrease cortisol production
- Assess the patient appetite and presence of nausea and
vomiting
- Monitor weight
- Monitor serum glucose level

- Encourage high protein, low carb and high sodium diet

- Advise small and frequent meals
2. Risk for deficient fluid volume related to increase
sodium and water excretion with potassium retention

- Assess skin turgor for any signs of dehydrations

- Observe for petechiae
- Encourage increase oral fluids as the patient tolerates

- Assess color, concentration, and amount of urine output

- Monitor changes in weight
3. Risk for decreased cardiac output related to
hyperkalemia
- Assess skin warmth and peripheral pulses
- Assess level of consciousness
- Monitor vital signs with frequent monitoring of BP.
Include assessment for orthostatic hypotension.
Anticipate direct intra-arterial monitoring of pressure
for a continuing shock state
- Monitor for dysrhythmias
- Minimize stressful situations and promote a quiet
environment
CUSHING SYNDROME