Endocrine

Joshua W. Atienza, USRN

Overview Of Endocrine System

* Pituitary Gland
-
Master gland
-

Controls all the hormones

-
2 distinct parts

a. anterior pituitary gland

-

Thyroid stimulating hormone

Melanocytes stimulating hormone
-

Growth hormone
action
pro 1
-

Foliate stimulating hormone

-

Luteinizing hormone
- Adrenocorticotropic hormone
-
Melatonin

b. posterior pitvitar gland

-

oxytocin
-
ADH

the Hormones
physiology of

* Poteen or Pituitary
-

gland
a. Oxytocin
-

uterine contraction
-
nipple stimulation
b- Anti Diuretic Hormone
-
(ADA)
-
reabsorbs water to prevent dehydration
* Anterior Pituitary gland
hormone
1. Melanocytes stimulating
↳ skin pigmentation
Disorders :
-
Albinism
-

vitiligo ( white patches)

2. Thyroid stimulating hormone

-

Body metabolism
DIO :

Graves Dsel Myxedema

3. Melatonin
-

For circadian rhythm ( sleep wake cycle)

DIO : Insomnia
Hyperso Mia

4. Growth hormone
-

For bone growth

-
stimulated during sleep
-
Epiphyxis
↳ closure -
21 yrs
⑨
18
yrs ⑤
-

DIO
-

Gigantism
-

Acromegaly
-
Dwarfism

g. Prolactin
-

Milk production
6 '
Adrenocorticotropic hormone
( )
regulates stress hormones glucocorticoids
(mineralocorticoid / Aldosterone)
-

reabsorption sodium and water

-

prevents dehydration by of
Heart rate
regulates catecholamines →Epinephrine
=

-
- 1>

Norepinephrine = blood pressure

DIO
- Addison Dse .

crushing Dse .

-
pheochromocytoma aldosterone Mia
-
Conn 's syndrome = Hyper
hormones estrogen
7- •

Follicle stimulating -1>

Ovaries
-1>
→
progesterone
↳ Activation and , → Testes
of Gon → Testosterone
D /0 :
Gynecomastia
Hirsutism
Pcos

Hormone
8. Luteinizing
↳ For men station
excessive
Menorrhagia
=

DIO :
on and OFF pattern
metrorrhagia
=

small amount
men orrhea
=

oligo
absent
Amenhorhea = no /
↳ presumptive sign of pregnancy
Anorexia
 Edoorine Disorder

1. Thyroid
Hormone problems
a) Hypothyroidism
+ Metabolism
slsx :

-
Brain Fogs -
oliguria
-

lethargic
-

constipated
-
Cold intolerance
- hair problem
-

mens problem
-
Dry skin
- HUH
-

Weight gain
complication :
buildup Coronary Artery
-
Atherosclerosis = Iv metabolism =P Accumulation of = =

fatty deposits OF plaques Dse .

my edema coma
Management :
- Assess Loo
-

weight loss reduction

-

Encourage exercise
-
Low fat diet
-

Emollients
A OFI
-

Medication :
* Lewthyroxine

↳A metabolism
↳ morning before breakfast
↳ safe For pregnancy
↳ WOF : rebound effect
Agranulocytosis ( Fever and sorethroat )
* HMG coenzyme inhibitors ( Anti hyperlipidemia)
-

"
↳ "
- statins

b) Hyperthyroidism
Graves Dse
T metabolism
Slsx : - Diarrhea
-
Alert
poly vria
-

-
Irritable
-
Anxious
-
Menstation / hair problems
-

Heat intolerance -
puts
-
moist skin ☒ Exophthalmos
of the eyeballs
Weightloss ↳ Abnormal protrusion
-

↳ Management :
-

Artificial tears
-

smoking cessation
-

eye patch -

T IOP ( ⑧ 10-22)
sunglasses
-

-
skin tape

management
:
thywideotomy
-
Assess too
↳ removal of the thyroid
-

prevent dehydration
-

TOEI ↳ pre -
op medication
-
T caloric food ,
T protein ↳ got 's solution =
High Iodine solution
= decrease vascularity of the thyroid
medication :
-

Pwphy thiouracil (
PTV )
post
-

OP
and Infection
↳ 1^01=1 = Avoid high iodine foods shrimp
oyster
shellfish
AIE Agranulocytosis woe : bleeding
↳
:

IF more than5- 7dam Report !

ti verify hoarseness
=

WOF : Rebound effect

chiwstek
Check the
-

Tapazole * WOF Tetany

: -
trasseow
nape area -

laryhgovpavm
Management :
-
Tache set at bedside
Thyroid Hormone problems
→ For metabolism

Hypothyroidism
tt '
" '

Vs Hyperthyroidism
( Graves disease)
( Myxedema)
- T UH
-
tr Vls
Irritable , Anxious
.

- -

lethargic -

Weight loss
-

weight gain -
-
Moist skin
-
Dry skin -
-
Heat Intolerance
cold intolerance
-
-
- mens problem
-
Mens problem - Hair growth problem
-

growth problem
Hair -
Diarrhea
-

Constipation -
-

poly via
Oliguria production
-
T genus humor
-
-
OF a

A cholesterol Build up / Iv
( exophthalmos)
-

in the arteries Atherosclerosis =

T Fluid retention in eye muscle
( CAD )
management
management :
> Diet = T caloric diet
> Diet
= low caloric Diet > A fluid intake
> Normal fluid intake
> Bulk Forming Foods
> + Fiber intake > Meds :
> meds : HMG coenzyme inhibitor Antidiarrheal
/tapazole
*
( PTV )
↳ Anti hyperlipidemia Doc :
pwphy thiouracil
Doc : Lew thyroxine ( synth wid ) Ale : Agranulocytosis
I. take before B. Fast
a. time each day Exopthalmus
management
same
for
3.
Okay for pregnant
↳ Avoid cretinism
-
Artificial tears
-

eyepatch
4. Agranulocytosis
Sunglasses
-

↳ Infection Fever
smoking
-

-
sore Thwath
-
Abstain
5. Do not take when forgotten use paper tape
-

take it on the other

day
surgery :

> Thywidectomy
Thyroid high vascular organ
T iodine
-

↳ prop meds tugol 's solution

=

shellfish)
Avoid T iodine foods ( shrimp oyster
,

↳
-
,

post op = WOF : Bleeding

Infection
hormone replacement therapy)
= Maintenance meds : Lewthyroxine (thyroid
removal
Nctex = Hypocalcemia t calcium due parathyroid
WOF : stridor =
=

coma
HOT TOPIC

(Éirm
calcium from
I
>
bone

Complication : Myxedema =
> Complication : Thyroid storm
to blood
Slsx : Slsx
-
cardiac arrest
shock

3-
-

-
stroke
Seizure to MD
mgt Report
.

-
t sugar
to MD
mgt : Report
 cortex =
Glucocorticoid , Aldosterone
Adrenal
media catecholamines HRRBP
epi
=
Adrenal
Adrenal Gland
nor
> epi

role in the body

→ plays an important
Functions cortex )
→
:
Adrenal
metabolism (
Regulates Glucose cortisol)
-

↳ secretes Glucocorticoids (
TREE
sodium and water reabsorption (prevent from dehydration)
-

Regulates
↳ (Adrenal cortex )
epinephrine norepinephrine ↳ secrets mineralocorticoid ( Aldosterone)
T T

( Adrenal medulla)
HR and BP
-

Regulates
* Tatham

a.) Addison Disease

Autoimmune
Attack
+
Adrenal Gland
Targets
to →
Abnormal = Bronze color skin

Skin Color
Decrease function
Of Adrenal
Gland
↳
Abnormal Function
& Adrenal Medulla
Of
☐erase Function f
Cortex
of Adrenal catecholamine
It + pop - nor epi
* HR
epi
Aldosterone
-

① cortisol IRR
glucocorticoid ) f
① tr sodium lent
= Tk
,
,

Hypoglycemia ¢ Water level

(Arrithymial ,

I t I
+ Immune Sudan → -
-
'

t
IRiskforlnt-euh.co#
Management :
T Na NK intake
1) Diet : ,

Offer
relaxation activities
2) Activities
: -

- Avoid crowded places " "

3) Medications : Corticosteroids -
sone

to correct Dehydration
4) Fluids
:

-
Isotonic Fluids
 Disease
b.) Cushing

Autoimmune Attack
t
)
Target adrenal Gland Increased
release [Testosterone
androgen
Manly features
Hirsutism
of
t → -
↳
Gland
T Function Of Adrenal
I loss ti
* Memory
t Adrenal Medulla
'

T Adrenal Cortex Function

H ( ATN)
Function q pop
y,
µ THR
Torti Sol T' Aldosterone RK
p µa y, K (cardiac problem) T

t
- =

÷?n÷a
"

Hyperglycemia
-
* * w=c+i -
Moon Face
-

-
powfaloo Hump
µ
-

ti calcium , obesity -

in the bone T viscosity OF

v1 the blood
Fracture µ
poor wound Healing
a
busing )
bleeding (
easy
-
Risk For
-
Risk For Infection

Management :

* glucose intake
Diet M K intake
1)
:

ti Na intake

2) Activities : activities
-
No high impact
3) Medication :
-
Corticosteroids

Pheochromocytoma
Presence Of Tumor
Cells (cancer)
ti
target Adrenal gland
ti

addu"0
Tumor targets
ti
OF
catecholamines
Extreme increase
I
crisis
- Hypertensive
-
Diaphoresis
-
chest pain
-
Palpitations
-

Hyperthermia
-
Nausea and vomiting
:

Management : surgical Mgt

3) Adknalectomy glands

☐ µ
Adrenal
① Tf!
"
↳ removal
.

of
heating pad shook → seizure
activities - woe Addisonian crisis →

Give fluids or corticosteroids

Emergency Anti Hypertensive
-

2) Medication
:
- Sodium Nitro pwsside
-
Hydra la zine
 Prevention of dehydration
Anti - Diuretic Hormone problem ✓ =

Hao
→ Fx reabsorbs
:

→ Activates during DHN Diabetes

Iv ADH do to autoimmune
=

* → Insipidus
t
tr reabsorption
OF water
t
DAN
t
wt loss
FUD
-
-

Flat neck rein

-

poly una - D NK T Na
¥
xenstomiaf ☐Yf÷a
-

water
Cup
-

that circulate

|
the heart
-
* Het
-
abd
Bun h Crea
shock ( Hypo , tacky , Tacky )
-
.

I * increased serum osmolality Flow OF urine =

→* Decreased ty concentration =

= > Management :

> Isotonic
-
Fluids Hypotonic>

- Diet : T k h b Na diet
Monitor 1h0
urination
-

Meds : Corticosteroids = parent Intranasal

↳ Desmo press in WOF
- -

: Circulatory

↳ vasopressin overhead

SIADH)
Anti Diuretic Hormone (
due to Autoimmune or cancer Cwngs ) Syndrome of Inappropriate
* → T ADH =

to
Risk For Congestion
tr * at Hyponatremia
wt gain > Dilution
.
-

Distended neck win ri -

Seizure
FUE
-

-
T ICP
D T K tr Na
oliguria
-
-
coma
-

||
-
T Cup
T Ware
① Hot
-
-

congested Decreased serum osmolality

↳ pleural Increased urine specific

effusion
gravity

-
is CHF
→ periorbital edema
→ Anasarca
→ 1^1 up = Cerebral edema

= > Management :

corticosteroids Alibi Otis

Meds Demaio andine
=
- :

Fluids → Hypertonic ☐ oo ;

chemotherapy ↳ SIE Diuresis

-

Diet → Iv K A Na intake
☐ imy, , wasting
-

→ k
-
monitor 140
Furosemide
weight monitoring
-

fluid imbalances Bum ex

↳ sensitive indicator
-

of -
Hydro chlorothiazide
-
Mannitol Doc : cerebral edema
 MTH GH )
Pituitary Gland problems
TH
( ADA ,
, ,

↳ master gland

vs. Hypopituitarism
Hyperpituitarism - to ADA = DI
-

TADH = SIADH - f TH =
Myxedema
-
FTH =
Coronet -

AAA = Addison
-

4 AUTA =

Cushing
-

f GH =
Dwarfism
AGH =
Gigantism ( open )
-

medication : related to metabolism

Hypertension
µwE× Hot Acromegaly ( chose ) M
>
↳ Lew thyroxine
to P' U :HeÉdrrd Sa sound) Mental Retardation
Hypertrophy Cardiomegaly → a) Heart failure Complication :
=
↳↳
⑧ pedia
of organs

pituitary gland
Surgery :
transphenoidal Hypophysatomy = removal OF

↳ route Between upper lips and

: upper gums

post op : - Avoid Valsalva maneuver

-

Tooth eltes
-
Rinse using Nss
-
Avoid pressure in suture line

complication :

-
DI
-
ti icp clear fluid drainage
gauze ( ) Halo sign
t
in the sterile
-
W.o.fi (f) gw are ↳ CSF leak
-17419€
Diabetes Mellitus
-
Common in the U.s.
- Main
problem production
: OF iWw
Transport Gwwse
inside the cell

Risk factors :

African American
5 Race -

1. Hereditary = caucasians
2- Sedentary lifestyle
3. Bad Vices
4. T intake of 9 gwwlektcarbv

Diagnostic :

1dL
> CBG
__
④ -110mg
to
>
Fasting blood sugar

Glywsalated
CHBIAC)=⑧ 4% -7%
>

Hemoglobin
intake
months past glucose
↳
↳ Measures 2-3 OF
Ketoacidosis :
Accurate Diabetic

kvssmaulIB.ua/-hing--f
Pathophysiology :
T
Deep rapid Breathing
T
tr insulin
Lungs will
✓ ✓ Iv sale
pampers
ain
Eyes
Nerve
( Diabetic undelivered Noglucose delivery Acetone
(f) breathe "
Diabetic " ←

monomial Neuropath retinopathy) glucose is

going to the
cell Body Wi
get
rid OF

(µwwpñM Y T still in the

f T f ketones
✓
ÑmiI
blood
"" F ""
Kidnes j
cell hunger → as →
Release OF

( Diabetic ← Glucose in 1oTypTaf fats ketones and

F(↳
Nephropathy ) 1+4 acids
the blood , new source
t "" ^^ Toxins
TGWcose.in the "
in _e Body
kidneys
t
T kidney Filtration

ipolyvn-a-t.gg
-

-
Management
Monitor
,
Athirst

Exercise / Walking
:

opoaeroryday
, , ,µµn,
polydipsia
/

, Jogging)
,,

on lower parts -1> Risk For DM foot ulcer

- Avoid
having injury espeially
management :

-
Inspect daily
well fitted shoes
-

-
Socks
-
clean _c soap and water
toes
-
lotion but not in between
-

Nailwlting ( podiatrist )
↳ cut toenails straight
 DM
Complication of

1) DM type I ( Insulin Dependent ) Acute

↳ Diabetic ketoacidosis
Breathe
Slsx Acetone :

Kvssmaul 's Breathing

Acidosis
Metabolic
Management :

Dehydration
1st : to resolve
-

price ↳ Fluids : Isotonic

- 2nd price : Give Insulin ( regular )

2) DM type 2 ( Non Insulin Dependent) Chronic

keto Hu CHHNK)
Trigger : ↳ Hyperosmolar Hyperglycemic non

CBG is
j f Abdominal
> 600m91 " →
purine flow T Diuretic pain
(t) severe Dehydration
↳ FUD and
v1 water neurologic Manifestation
in the Body seizure
-

+ - Altered LOC

te Na in the
body
↳ 9kt HCLT = Abdominal
pain
Management :

-
Fluids
-

Report to HD

3) Hypoglycemia
↳ CBG is < 70mg / d l
slsx :
-
seizure
-
Dizziness -
coma
-
weakness
-
tremors
-

Diaphoresis
-
pallor
-
Tachycardia
Management:
option if there
is
Give quick acting carbs ( choose this )
LAB VALUES
-

no
* honey
* orange juice
* crackers
* hard candies
option if there
is
-

Glucagon ( choose this LAB VALUES )

Insulin Therapy =
For DM Type 1

Peak Ctr GWW.ie)

Foods
"
"
> Rapid insulin -

Wg →
zoning - 1hr -7 Offer

As part

Lispro DKA
" Peak → N Insulin
Insulin
"

> Regular -

R → Only
2- 3ms
clear insulin
" "

Insulin N → 6- 12 hrs → Monitor CBG

> Intermediate -

"
lente
"
cloudy insulin
"
"

NPH
↳ Max units 40
→ monitor
vllralente → 12 hrs -16 hrs
Long Acting Insulin
-
CBG
>
24hm Enhancer
( Glargine)
→
Lantos →
> Very long Acting
-
Metabolic syndrome
-
endocrine problem related to high glucose and high triglyceride level .

Trigger : Problem in insvlinsensitiuity

Triggers pancreas to ( ⑧ less than
/
zoo )

release insulin cholesterol buildup = Increase triglyceride level

v Increase chance OF ↳ T waist circumference
→
High glucose level in the blood
d.
Increased blood viscosity → Poor blood circulation ( Risk For bleeding )
presence of darkening of skin folds
-

criteria to metabolic syndrome :

>
Nape area Cacanthosis negri cans )
> Axillary area
-
Waist circumference
> Femoral area
-

glucose
-

Triglyceride
gender
-

Management :
1- Diet modality [ Priority )
-
Balanced diet
CHO
CHOW
Fats
2. lifestyle modification
-

jogging
walking
-

cycling
-

swimming
3 .
Meds
-
HMG Genzyme reductase ihibitor C- statins

Endocrine diagnostics and labs

1- Transphenoid
at hypophysis to my

EmI¥:¥:÷
↳ Removal
*

Compose of 2 parts
a. Posterior =
oxytocin b ADH
b. Anterior
* GH
Dwarfism
-

Gigantism ( Before close )

-
Acromegaly ( After close)
* TSH
-

Graves
-

Myxedema
* Ms H

* FSH
* LH
☒ melatonin = Circadian rhythm
* ACTH

* Prolactin

Tips to remember :
1. Invasive procedure
2. Site : Between upper lip and upper gum

3. WOF : complication
* DI ( Monitor urine output)
* Addisonian crisis CDHN)
* 1^190 related to clear fluid drainage ( HALO SIGN )

↳ yellow concentric rings

4. Nursing management post op

-

- No Valsalva maneuver
-

Rinse mouth using isotonic solution ( Nss)

tooth eltes
-
 ( Hb Htc)
2. Glywsalated Hemoglobin
-

Diagnostic
test to verify patient is positive for DM
-
Very Accurate
- Main point : to check the insulin activity for the past 3 months

-
NO Fasting
-
Normal lab value 4- 7- %
* IF > 7- 5% , poor glycemic control

3. water deprivation test

-
Diagnostic test for diabetes insipidus
Procedure :

A) No water intake for 6- 8 hours

B) Monitor urine output

c) If (f) urine output , patient is candidate for DI

4. capillary blood glucose

Verify glucose level
-
in the body
-

Normal value ( 70 -110mg Id 1)

* NCUEX Hot topic
-

Ip patient
's CBG level is 140mg (abnormal) unless patent is
suffering From stress in any system
T cortisol → A glucose → Risk For Infection
* stress →
+ ( 140 180mg 1dL CB G)
-

stress eating