CA 2 NCM 116 Case Analysis 2: Endocrine Disorders

Endocrine System Feedback Mechanism

● the essential regulator of the body’s internal environment ● regulates hormone concentration in the bloodstream and helps in the
● It regulates growth, reproduction, metabolism, fluid and electrolyte regulation of many biologic processes
balance, and gender differentiation through hormones ● Stimulus
● made up of glands that produce and secrete hormones, chemical ○ change in homeostatic environment
substances that are produced in the body that regulate the activity of ○ signal sent to CNS
cells or organs
● controls systems, maintains homeostasis ● Response
○ control chemical and water balance in body ○ signal sent from CNS
○ control growth and metabolism ○ produce effect
○ control embryonic development and preparation for ○ body returns to homeostasis
nurturing a newborn
○ influence sexual behavior, stimulate growth and Negative Feedback Mechanism
maturation of the gonads ● ⬆levels of substance= Inhibit hormone synthesis and
○ feedback to the nervous system secretio
● ⬇levels of substance= stimulate hormone synthesis
Major Organs in the Endocrine System and secretion
● Pituitary gland ● Example:
● Thyroid gland ○ ⬇ calcium➖⬆ PTH (intestine,bone,kidney)
● Parathyroid gland
● Adrenal gland
● Pancreas and gonads Positive Feedback Mechanism
● Increasing levels of one hormone which causes another gland to
release a hormone
Hormones ● An example would be release of estradoil which is a female ovarian
● regulate the body's growth, metabolism, and sexual development and hormone. During your follicular stage of your menstrual cycle in also
function stimulates the production of follicle stimulating hormone in the anterior
● released into the bloodstream and may affect one or several organs pituitary gland
throughout the body
● chemical messengers secreted by the endocrine organs and
transported throughout the body. These hormones exert their action
on specific cells or target cells and they do not cause reaction directly Gland Hyperfunction Hypofunction
but rather regulate tissue responses. They may produce generalized
effects or localized effects. Anterior Pituitary Gigantism, Dwarfism
Gland Acromegaly
Classifications of Hormones
Posterior Pituitary Syndome of Diabetes Insipidus
Steroid hormones
Gland Inappropriate ADH
● smaller size; high lipid solubility
● require several hours to exert their effects
Thyroid Gland Grave’s Disease Myxedema
Peptide or protein hormones
- act within seconds or minutes
Parathyroid Gland Hyperparathyroidis Hypoparathyroidism
Amine hormones m
- action similar to peptide hormones
Fatty acid derivatives Adrenal Glands Cushing’s Syndrome Addison’s Disease
Pheochromocytoma
Control of Hormonal Release
● Humoral Endocrine glands release hormones in direct response to
changing levels of ions or nutrients
○ The hypothalamus secretes hormones it stimulates the
anterior pituitary glands to secrete hormones that Assess Endocrine Function:
stimulate other endocrine glands to secrete hormones ● The function of the endocrine gland is assessed by findings from:
● Neural Nerve fibers stimulate hormonal release ○ Health assessment interview
○ The pre-gangiolinic sympathetic nervous system fiber ○ Physical assessment
stimulat ethe adrenal medula cells to secrete ○ Diagnostic tests
catecholamines
● Hormonal Glands release hormones in response to other hormones Basic Structure of Feedback Loop
○ Example would be capillary blood flow contains low Environmental Stimulus
concentration of calcium which will then stimulate the
secretion of your parathyroid hormones Stimulates Control Center (hypothalamus)

Hypothalamic hormones stimulate the Pituitary

Pituitary hormone stimulate the Target area Target area

Produces change

Change acts negatively or positively on the

Hypothalamic-Pituitary-Endocrine Mechanism
 ANTERIOR PITUITARY GLAND
Generic Particular Example: Thyroid
Hormone Cells Hormones

- A certain item in the blood - Thyroxine (thyroid hormone) Somatotropic Cells Growth Hormone Stimulates growth of
decreases - Hypothalamus (Somatotropin) the body
- A certain area of the brain - TRF from the hypothalamus
senses this decrease - TSH from anterior pituitary
Lactotropic Cells Prolactin (PRL) Stimulates milk
- A certain hormone is released - Thyroxine from the thyroid
production
- This hormone stimulates the (TSH has caused cleavage of
release of another hormone thyroglobulin into thyroxine)
- This other hormone stimulates Thyrotropic Cells Thyroid Stimulating Stimulates the release
the release of the hormone Hormones and synthesis of thyroid
which was sensed to be hormones
decreased in the first place,
causing it to be increased to Corticotropic Cells Adenocorticotropic Release hormones,
desired level Hormones (ACTH) glucocorticoid

Gonadotropic Cells Gonadotropin Stimulate ovaries and

Why is Hypothalamus Important?
hormones testes
● Secretes regulatory hormones RH RIH ● Follicle
● "Directs" pituitary stimulating For Women FSH
hormones stimulates the
Hypothalamus (FSH) development of ovarian
● The link between the nervous system and the endocrine system ● Luteinising follicles and induces the
● Hypothalamus receives input from higher brain centers that can affect Hormone secretion of estrogenic
(LH) female hormones
anterior pituitary gland secretion
female hormones
● Regulates the neuroendocrine system, maintaining homeostasis in the including LH. LH works
body together with FSH to
● can use motor nerves to send short-lived electrical messages or lead to ovulation and
hormones to send chemical messages with a longer duration formation of Corpus
Luteum from the
ovarian follicle.

In Men, FSH involves

the development and
maturation of sperm.
LH or Interstitial Cell
Stimulating Hormones
in men ICSH stimulates
the interstitial cells of
the testis to produce
male sex hormones.

Posterior Pituitary (Neurohypophysis)- extension of the hypothalamus. No

Hypothalamus Controls Anterior Pituitary Hormone Release
● Releasing hormones (releasing factors) Secreted like
neurotransmitters from neuronal axons into capillaries and veins to
anterior pituitary (adenohypophysis)
○ Thyroid Releasing Hormone - turns on TSH
○ Corticotropin Releasing Hormone - turns on ACTH
○ GnRH (=LHRH) - turns on FSH and LH
○ Lactotropic/ Prolactin RF - turns on PRL
○ GHRH - turns on GH
● Inhibiting hormones
○ PIF - turns off PRL
○ GH inhibiting hormone - turns off GH
The hypothalamus controls secretion of hormones, which in their turn, control the
secretion of hormones by the thyroid gland, the adrenal cortex and gonads: in this
way the brain controls these endocrine glands
need to secrete hormones since this is extension of the hypothalamus.
● Oxytocin
○ Induces contraction of the smooth muscles in the
reproductive organs
○ Stimulates the myometrium of the uterus to contract
during labor
○ Induces milk injection from the breast
● Antidiuretic hormone (ADH)/ Vasopressin
○ Decreased urine production/ stop urine
○ This causes the renal tubules to reabsorb water from the
urine and return it to the circulating blood volume
○ Note: Desmopressin- synthetic hormone for Diabetes
Insipidus
Pituitary Disorders
● Results from excess or deficiency in one or more of the pituitary
hormones due to:
○ Pathologic condition within the gland itself
○ Hypothalamic dysfunction
ANTERIOR PITUITARY GLAND(APG)

Pituitary Gland
● Hypophysis
● The “master gland” because its hormones regulate many bodily
functions – it secretes the hormones that control the secretion of
hormones by other endocrine glands
● Located in the skull beneath the hypothalamus of the brain
APG HYPERPITUITARISM: GIGANTISM
● Growth hormone (GH) hypersecretion occurs in childhood begins
before puberty and the closure of the epiphyseal plates of the long
bones

Anterior Pituitary(Adenohypophysis)- composed of grandular tissue Manifestations:

● Growth Hormone/ Somatotropin ● Abnormally tall (7-9 feet in height)
● Prolactin ○ 213 cm (6 ft 11 in)
● Thyroid-stimulating hormone (TSH) ● Large in all body proportions
● Adrenocorticotropic hormone (ACTH) ● Body proportions are relatively normal
● Follicle-stimulating hormone (FSH) ● Weak and lethargic that he or she can hardly stand
● Luteinizing hormone (LH) ● Sultan Kosen
 ○ One of the tallest man in the world according to guinness
book of world record
○ 8 ft 3 in

TREATMENT FOR GROWTH HORMONE EXCESS: HYPOPHYSECTOMY

● The surgical removal of the pituitary gland
● TRANSSPHENOIDAL APPROACH or Transfrontal Surgical Procedure
● GOAL: to remove the tumor that causes excess growth hormone
secretion
● DISADVANTAGE IN ACROMEGALY: patient may sometimes need two
operations due to recurrence so with their transphenoidal approach
they insert the endoscope and the curette into your nose

APG HYPERPITUITARISM: ACROMEGALY

Diagnostic Test:
● “enlarged extremities” ● History
● Growth hormone hypersecretion that occurs in the middle age, after ● Physical examination
the closure of the epiphyses of the longs bones / adult hood ● Evaluation of plasma – insulin like growth factor – 1(1GF-1) levels
○ The peripheral actions of GH are mediated by IGF-1.
Manifestations: ○ As GH levels rise, so do IGF-1 levels.
● Bone thickness ○ However, GH is released in a pulsatile fashion, requiring
● Forehead enlarges several samples to obtain an accurate measure. Serum
● Maxilla lengthens = prognantism IGF1 levels are more constant, providing a more reliable
● Tongue enlarges diagnostic measure of acromegaly
● Voice deepens ● Oral glucose tolerance test
● MRI – presence of tumors
Other Manifestation:
● Peripheral nerve damage NURSING RESPONSIBILITIES: POST-HYPOPHYSECTOMY
● Swelling of hands and feet ● Elevate head of the patinet at all times 30 degrees angle
● Joint pains ○ This is to avoid pressure and it decreases headaches as
● Headaches well
● Gaps between teeth ● Nasal packing
● Barrel chest ● Instruct client to avoid gastric irritation
● Thick and oily skin ● Prevent infection
● Strong body odor ● Advise patient not to cough, sneeze and brush teeth
● Hypotension ○ Avoid toothbrush for at last 10 days to protect the suture
line
● Assess for meningitis:
○ Severe headache
○ Nuchal rigidity
○ Positive Kernig’s Sign
○ Positive Brudzinski’s Sign
● Monitor for signs of increased ICP:
○ High BP, Low HR, Low RR
● Radiation Therapy
○ Radiation therapy is used when surgery has failed to
produce a cure or when patients are poor candidates for
surgery.
○ Radiation therapy is usually offered in combination with
drugs that reduce GH levels. However, the full effects may
not be noted for months to years.
○ Radiation can also be used to reduce the size of a tumor
before surgery.
○ Radiation therapy may lead to hypopituitarism, which then
requires lifelong hormone replacement therapy.

TREATMENT FOR GROWTH HORMONE EXCESS: Drug Therapy

● Octreotide acetate (Sandostatin) = for patients with Acromegaly
○ a somatostatin analog that reduces GH levels to normal in
many patients.
○ given by subcutaneous injection three times a week.
○ Two long-acting analogs, octreotide (Sandostatin LAR) and
lanreotide SR (Somatuline Depot), are available as
intramuscular (IM) injections given every 4 weeks.
○ GH levels are measured every 2 weeks to guide drug
dosing, and then every 6 months until the desired
response is obtained.
 PPG HYPOPITUITARISM: Diabetes Insipidus

APG HYPOPITUITARISM: SIMMOND’S DISEASE ● Results in the inability to conserve water

● Permeability of water is diminished resulting to excretion of large
● Panhypopituitarism – total absence of all pituitary secretions
volumes of fluid
● Results from surgery, infection and tumor
Types:
● Neurogenic Diabetes Insipidus
Manifestations:
○ Results from disruption of the hypothalamus and pituitary
● Extreme weight loss
gland (trauma, radiation, surgery)
● Lethargy Pallor
● Loss of libido
● Nephrogenic Diabetes Insipidus
● Amenorrhea
○ Renal tubules are not sensitive to ADH and does not absorb
● Loss of pubic and axillary hair
water, result of renal failure.
● Cold intolerance
○ Thiazide Diuretics- if this is used with nephrogenic, iya
● Premature wrinkling of the skin
effect kay decreased in urine output

● Central DI
APG HYPOPITUITARISM: Dwarfism ● Nephrogenic- produce the Antiduiretic Hormones that the kidneys
● Insufficient secretion of GH during childhood results in generalized already problem
limited growth ● Gestational- placenta produces enzyme that inhibits that secretion

Manifestations: Manifestations (DRY INSIDE)

● Retarded physical growth ● Polyuria
● Premature aging ● Polydipsia
● Low intellectual development ● Dehydration
● Poor development of secondary sex characteristics ● Decreased skin turgor, dry mucous membranes
● Inability to concentrate urine, low urinary specific gravity
ANTERIOR PITUITARY GLAND – HYPOPITUITARISM: TREATMENT ● Weight loss
● Surgery ● Hypernatremia
● Radiation therapy
● Hormone therapy Diagnostic Test
○ Human Growth Hormone (hGH) ● Water Deprivation Test (POSITIVE)
○ Somatropin (Genotropin, Humatrope) = growth hormone ○ The patient is deprived of water for 8 to 12 hours, and then
replacement therapy given desmopressin acetate (DDAVP) subcutaneously or
■ Recombinant human GH nasally. Patients with central DI exhibit a dramatic increase
■ Used for long term hormone therapy in adults in urine osmolality, from 100 to 600 mOsm/kg, and a
with GH deficiency significant decrease in urine volume. The patient with
■ Increases energy, increases lean body mass, nephrogenic DI will not be able to increase urine osmolality
improves body image to greater than 300 mOsm/kg.
Treatment
POSTERIOR PITUITARY GLAND(PPG) ● Monitor vital signs and neurological and cardiovascular status
● Monitor fluid and electrolyte balance
● Monitor intake and output, weight
● Maintain intake of adequate liquids
PPG HYPERPITUITARISM: Syndrome of inappropriate adh
● Instruct client to avoid foods or liquids with a diuretic type action
● High levels of ADH in the absence of serum hypo-osmolality ○ Caffeinated beverages, tea, watermelon anything that will
● Common cause is malignancy, small cell lung cancer, tumors, promote diuresis
metabolic disease. ● Administer Desmopressin acetate (Stimate) = DOC for diabetes
● Results in water intoxication or retention, hyponatremia and hypo- insipidus. Gold Standard. Watch out for hyponatremia.
osmolality ● IV Fluid: Hypotonic/Isotonic Solutions
● Diet: Low Sodium
Manifestations: SOAKED INSIDE
● Brain cells swell
● Signs of fluid overload Thyroid Gland
● Changes in LOC and mental status changes ● Located in the anterior to the upper part of the trachea and just inferior
● Weight gain without edema to the larynx
● Hypertension ● Butterfly shaped gland
● Tachycardia, tachypnea, rales ● It has two lobes connected by a structure called Ismuth
● Anorexia, nausea and vomiting ● Dependent on the adequate supply of iodine in the body
● Dilutional hyponatremia ● Hormones: Thyroxine (T4) and Triiodothyronine (T3), Calcitonin- a
hormone that decreases excessive levels of calcium in the body by
Treatment slowing calcium-releasing activity of bone cells which serves as marker
● Restore normal fluid volume for sepsis and is believed to be a mediator of inflammatory responses
○ Water restriction = prevents further hemodilution ● Abnormal thyroid gland function: Enlargement of the thyroid gland -
(increased water in the plasma); less than 800 mL per day goiter Hypofunction Hyperfunction
○ Give hypertonic IV solution (D5.33% NaCl) ● Primary Role: Increase Metabolism
○ Give ice chips ● If thyroid gland is totally removed and thyroid hormones is replaced
● Increase sodium and potassium in the diet calcium homeostasis and bone density remains relatively unchanged
● Monitor for patient’s safety without replacing calcitonin
● Promote diuresis:
○ Furosemide (Lasix) Thyroid Disorders
○ Demeclocycline (Declomycin) ● EUTHYROID = thyroid gland is functioning normally
● Tetracycline Antibiotic/ Demeclocycline ● Alterations in thyroid hormone (TH) secretion result in increased or
○ Inhibits ADH decreased rates of metabolic function, heat production, and oxygen
consumption
● In adult, TH changes primarily affect metabolism, cardiovascular
function, gastrointestinal function, and
 ● Extremely agitated and irritable
Goiter ● Hand tremor at rest
● Enlargement of the thyroid gland that may be seen with both ● Ravenous appetite with weight loss
hyperthyroidism and hypothyroidism ● “Speed up” bodily processes
● Results from: lack of iodine, inflammation, benign or malignant tumors ● Loose bowel movements
● Forms: ● Heat intolerance
○ Endemic ● Profuse diaphoresis (perspiration)
■ Primarily caused by nutritional iodine ● Tachycardia
deficiency ● Incoordination
○ Sporadic ● Moods (cyclic)
■ Cause: Genetic defects – faulty iodine
metabolism Thyroid Crisis
● Also called Thyroid Storm
● Extreme state of hyperthyroidism
● Due to untreated hypoerthyroidism
● Potentially fatal acute episodes of thyroid overacity characterized by
high fever, severe tachycardia, delirium, dehydration, and extreme
irritability

Management:
● Nutritional status- high calorie, high protein food- well-balanced meals
● Coping measures- decrease stressful situations
● Improve self-esteem (exopthalmos)
● Maintain normal body temp (heat intolerance)
● Manage potential complications

Complications
● Exophthalmos
● Heart Disease
● Thyroid Storm
○ potentially fatal acute episode of thyroid over activity
Hyperthyroidism characterized by high fever, severe tachycardia, delirium,
dehydration, and extreme irritability
Treatment
● Antithyroid medication
○ Recommended for clients younger than 18 years of age
and for pregnant women
○ Propylthiouracil (PTU)
○ Methimazole (Tapazole)
● Adjunctive Therapy
○ Iodine Therapy
■ to reduce the vascularity of the thyroid gland
before thyroidectomy and to treat thyroid
storm
■ Choice: Saturated Solution of Potassium Iodide
(SSKI)
■ Iodine preparations are usually given only for
10 to 14 days before surgery
○ Propranolol-control nervousness, tachycardia, tremor,
anxiety, heat intolerance

● RADIOACTIVE IODINE THERAPY

○ Prescribed mainly for middle-aged and older clients
Hyperthyroidism:Graves Disease
○ Administration of the radioisotope iodine 131
● Most common cause of hyperthyroidism ○ After receiving the radioiodine, client may go home unless
● toxic diffuse goiter the dosage is extremely large and would require isolation
● An autoimmune disorder mediated by immunoglobulin G (IgG) for several days to
antibody that binds to and activates TSH receptors on the surface of
the thyroid cells
● Hallmarks: SURGERY
○ Hyperthyroidism ● Thyroidectomy (Total Thyroidectomy, Subtotal Thyroidectomy)
○ Thyroid Gland Enlarge ○ Recommended when other treatment are not effective
○ Exophthalmos ○ Nodule is too large that there is obstructive symptoms
○ Subtotal- leaves enough of the gland to produce adequate
amount of TH
Manifestation: ○ Total- removal of the gland, requires lifelong hormone
Goiter replacement
● Hyperplasia and hypertrophy of the thyroid cells Preoperative
● Gland may grow three to four times its normal size ● Client must be euthyroid before the operation before thyroidectomy.
● Enlarged thyroid gland Prevent hemorrhage.
Exophthalmos ● Administration of antithyroid medications and iodine preparations
● Due to autoimmunity against retro-orbital tissues ● Client should be adequately rested, at optimal weight, and in good
● Protruding eyes and a fixed stare health
● Forward protrusion ● Preparation may take as long as 2-3 months
Proptosis
● forward displacement of the eyes
Complications
Other Manifestation: ● Hemorrhage and Infection
Hyperthyroidism ● Thyroid storm, tetany, laryngeal edema
● Respiratory obstruction
 ● Hypoparathyroidism ● Hypercholesterolemia
● Vocal cord injury or paralysis ● Hyperlipidemia
● Extreme fatigue
Postoperative
● Hair loss, brittle nails, dry skin
● Maintain patent airway and observe for respiratory distress
● Numbness and tingling of the fingers
● Check hemorrhage- assess dressing, check neck area
● Husky and hoarseness of voice
● Semi-Fowler position- to decrease neck strain on the suture lin
● Assess for laryngeal damage ● Menstrual disturbances = menorrhagia or amenorrhea
● Voice rest ● Decreased libido
● Assess for Tetany- Chvostek’s sign and Trousseau’s sign ● Weight gain even without increase in food intake
● Increase calorie in the diet ● Expressionless and mask-like faceCold intolerance

Nursing Management: COMPILATION

Hyperthyroidism
● Nutritional status -high calorie, high protein foods -well-balanced ● Myxedema coma
meals
● coping measures -decrease stressful situations
● Improve self-esteem (exophthalmos) Treatment
● Maintain normal body temp (heat intolerance) DRUG THERAPY
● Manage potential complications ● Levothyroxine sodium (Synthroid or Levothroid)
○ principal form of replacement therapy; converted in the
HYPOTHYROIDISM body to both T4 and T3
○ Thyroid replacement
Medication
● Thyroxine, T4 (Levothyroxine)
○ Preffered therapy
○ Monitor heart rate and report pulse greater than 100
beats/min or irregular heartbeat

Hypothyroidism:Cretinism Nursing Management

Hypothyroidism
● Modifying activity
● Children; irreversible ○ assist with care and hygiene
● Manifestations: ○ encourage participation in activities as tolerated
● Monitoring physical status
○ Large head, short limbs, short neck ○ V/S
○ Thick protruding tongue ○ cognitive level
○ Puffy eyes ● Promoting physical comfort
○ Dry skin ○ extra clothing, blankets
○ Lack of coordination ○ avoid heating pads & electric blankets
● If left untreated, the child will be permanently dwarf and mentally ● Enhancing coping measures
retarded

Parathyroid Gland
Hypothyroidism:Myxedema ● Embedded on the posterior surface of the lobes of the thyroid gland
● Secretes parathyroid hormone or parathormone (PTH)
○ Controls calcium and phosphate
● Causes: undiagnosed or undertreated hypothyroidism with stress ● When calcium levels in the plasma fall, PTH secretion increases
● Characterized by a dry, waxy type of swelling with abnormal deposits ● PTH also controls phosphate metabolism
of mucin in the skin and other tissues ● It acts primarily by increasing renal excretion of phosphate in the urine
● Edema is nonpitting type and is common in the pretibial and facial by decreasing the excretion of calcium and increasing bone
reabsorption
areas
● Normal levels of Vitamin D are necessary for parathyroid hormones to
● Severe state: Myxedema Coma
exert its effects on the bones and the kidneys

Manifestation based on picture:

● Hair dry, coarse, sparse

HYPERPARATHYROIDISM
● Lateral eyebrow thin
● Characterized by bone decalcification and the development of renal
● Periorbital edema calculi (kidney stones) containing calcium
● Puffy face with dry skin ● Results from increase in the secretion of PTH
● PTH regulates serum and calcium and phosphate
● Characterized by bone decalcification and the development of renal
calculi (kidney stones) containing calcium
Manifestations Manifestations Skeletal
● Bone and joint pain
 ● Backache ■ It also causes vasoconstriction of blood vessels
● Pathologic fractures of the spine, ribs and long bones throughout the body
● Deformity and bending of the bones Renal ○ These hormones are similar to substances released by the
● Polyuria and polydipsia Sympathetic Nervous System and thus not essential to life
● Appearance of sand, gravel and stones in the urine ● Functions as part of the autonomic nervous system
● Azotemia ● Catecholamines
● Hypertension due to renal damage ○ regulate metabolic pathways to promote catabolism of
stored fuels to meet caloric needs from endogenous
Pre Rec: sources
○ induces the release of free fatty acids
Skeletal ○ increases basal metabolic rate elevates blood glucose level
● Bone and joint pain
● Backache Adrenal Cortex
● Pathologic fractures of the spine, ribs, long bones ● Located at the outer portion of the gland, secretes steroid hormones
● Deformity and bending of bones ● Steroid hormones
Renal ● Secretes several hormones, all corticosteroids
● Polyuria and polydipsia ● Classified into two groups:
● Appearance of sand, gravel and stones in urine ○ Mineralocorticoids
● Azotemia ○ Glucocorticoids
● Hypertension due to renal damage
1. Glucocorticoids = hydrocortisone/ cortisol
Complication ● Influences glucose metabolism: increased hydrocortisone secretion
● HYPERCALCEMIC CRISIS results in elevated blood glucose levels
○ Serum calcium levels > 15 mg/dL ● Released in times of stress
○ result in neurologic, cardiovascular, renal symptoms 2. Mineralocorticoids = aldosterone
○ Can be life threatening ● regulates sodium – potassium balance
○ Emergency: given calcitonin and corticosteroids ● Increases rate of sodium reabsorption by kidneys increasing sodium
Treatment blood levels
● Lower severely elevated calcium levels 3. Adrenal Sex Hormones = androgens
○ Hydration ● Exert effects similar to those of male sex hormones
○ Low calcium and Low vitamin D diet
○ Furosemide (Lasix) ● Renin
● Fluid intake of 2000 mL or more – prevent calculus formation ○ controls release of mineralocorticoids
● Mobility is encouraged for bones to give up less calcium ■ When decreased blood pressure if there’s a
● Surgical: Parathyroidectomy decreased blood pressure and sodium is
detected cels in the kidneys release renin to act
on angiotensin and with angiotensin it then
HYPOPARATHYROIDISM initiates the process of your RAAS
● Serum calcium levels are abnormally low, serum phosphate levels are ○ Helps with RAAS (Renin-angiotensin- aldosterone releasing
abnormally high, and pronounced neuromuscular irritability (tetany) system)
may develop ○ If you have aldosterone already, it prompts the distal
tubules to increase reabsoption of water in to the
Manifestations: circulating blood volume
● Increased neuromuscular irritability, which results to tetany ● Glucocorticoids
● Painful muscle spasms, irritability, grimacing, tingling of the fingers, ○ Includes cortisol and cortisone
laryngospasm, dysrhythmias ○ These hormones affect carbohydrate metabolism by
● Positive Chvostek’s and Trousseau’s Signs regulating glucose in body tissues mobilizing fatty acids
● Hyperactive deep tendon reflexes from fatty tissues and shifting hte source of energy from
● Circumoral paresthesia- numbness and tingling sensation around the muscle cells to glucose to fatty acids and excess
mouth glucocorticoids in the body depress inflammatory
Treatment responses and inhibits and effectiveness of the immune
● DRUG THERAPY system
○ IV Calcium gluconate ○ Released in times of stress
○ Oral calcium replacements (Calcium gluconate, Calcium
lactate, Calcium carbonate)
○ Vitamin D(ergocalciferol)= enhance Ca absorption from
the GI tract Hyperfunction: Cushing’s Syndrome
○ Parenteral PTH
● High calcium, Low phosphate diet ● Cushion of Steroids HIGH- big, round, hairy
Adrenal Gland ● Results from overactivity of the adrenal gland, with consequent
● Pyramid-shaped organs that sit on top of the kidneys hypersecretion of glucocorticoids
1. Adrenal medulla –center, secretes catecholamines ● Occurs mainly in women 20-40 years old
2. Adrenal cortex outer portion; secretes steroid hormones ● Causes:

ADRENAL MEDULLA ○ use of corticosteroid medications

● Located at the center of the gland, secretes catecholamines: ○ excessive corticosteroid production (tumor)
○ Adrenaline (epinephrine) = fight or flight response
■ Increases blood glucose levels and stimulates
the release of adrenocortical hormone from the
Manifestations
pituitary
■ It also increases the heart rate and force of ● Growth stops
cardiac contractions which constrict blood
● Central-type obesity = fatty “buffalo hump”
vessels in the skin mucous membranes and
● Skin is thin, fragile and easily traumatized
kidneys.
■ It also dilutes blood vessels in the skeletal ● Ecchymoses (bruises) and striae develop
muscles coronary arteries and pulmonary ● Weakness and lassitude
arteries ● Disturbed sleeping pattern
○ Noradrenaline (norepinephrine) ● Musculoskeletal changes with glucose intolerance
■ Increases both heart rate and the force of ● Moon-faced appearance
cardiac contractions ● Excessive growth of hair in the face
 ● Mood swings and personality changes ● Fludrocortisone (Florinef) = given to replace mineralocorticoids
● Poor wound healing ● Prednisone (Deltasone)
● Sodium and water retention- hypertension ● 5% dextrose in normal saline
● Vasopressor amines (for persistent hypotension)
● hyperglycemia
● Lifelong replacement of corticosteroids & mineralocorticoids (for
damaged adrenal glands)
Diagnostics
● Increased plasma cortisol level
Nursing Management
● Increased serum sodium and blood glucose levels
● BP, PR monitoring
● Decreased serum potassium
● Assess for weight changes, muscle weakness, fatigue
● 24 hours urine collection for free cortisol
● Avoid physical & psychological stressors
Treatment
● Assess pt’s skin turgor, mucous membranes
DRUG THERAPY
● Encourage food & fluids (for electrolyte balance)
● Adjunct therapy to radiation or surgery
● Quiet, nonstressful environment
● Given to control the symptoms, they do not effect a cure
● Perform all activities for the patient during an acute crisis
● Mitotane
● Metyrapone or Ketoconazole
○ Adrenal enzyme inhibitor
CORTICOSTEROID THERAPY
○ suppresses activity of the adrenal cortex and decreases
● Used for adrenal insufficiency
peripheral metabolism of corticosteroids
● Used in:
● Somatostatin analog (Octreotide)
○ Suppressing inflammation & autoimmune reactions
○ Controlling allergic reactions
SURGERY
○ Reducing rejection process in transplantation
● Adrenalectomy
● Side Effects:
○ Indicated if cause by adrenal cortex tumor
○ High risk for infection
● Hypophysectomy
○ Hypertension
○ Reoval of pituitary gland
○ Glaucoma
○ Indicated if the disease is caused by a pituitary disorder
○ Muscle wasting
○ Alterations in glucose metabolism
Nursing Management
○ Weight gain
● Decrease risk for injury (weak patients)
○ Instruct the patient not to abruptly discontinue these
○ Assist in ambulating
drugs.
○ Protective environment
○ Monitor the patient for signs of infection.
● Frequently assess for signs of infection
○ Instruct patients with diabetes to closely monitor blood
● Encourage rest and activity
glucose
● Promote skin integrity= avoid adhesive tapes
● Improve body image
● Verbalization of feelings and concerns
Pheochromocytoma

● Rare condition
Hypofunction: Addison's Disease
● Caused by a tumor that is usually benign and originates from the
● Absent Steroid LOW- small, weak, tanned chromaffin cells of the adrenal medulla
● Destruction or dysfunction of the adrenal cortex ● results in an excess production of catecholamines (epinephrine,
● Chronic deficiency of cortisol, aldosterone, and adrenal androgens, norepinephrine)
accompanied by skin pigmentation ● One form of hypertension that is cured by surgery
● Causes: ● Most dangerous effects: peripheral vasoconstriction and increased
○ Autoimmune destruction
cardiac rate and contractility with resultant paroxysmal hypertension
○ Clients taking anticoagulants, with major trauma, having
(unpredictable)
open heart surgery
○ ACTH deficit
Manifestations
○ Abruptly withdrawn from long term, high-dose steroid
● HYPERTENSION (may reach 250/150 mm Hg)
therapy
● Triad of Symptoms:
Manifestations
○ Headache
● Postural hypotension and syncope
○ Diaphoresis
● Decrease in blood glucose
○ Palpitations
● Muscle weakness
● Hyponatremia
● FIVE H’s
● Hyperkalemia
○ Hypertension
● Stress, lethargy, weakness, anorexia, nausea, vomiting, diarrhea
○ Headache
● Dark pigmentation of the mucous membranes and skin
○ Hyperhidrosis
○ Hypermetabolism
○ hyperglycemia
ADDISONIAN CRISIS
● Is a life-threatening response to acute adrenal insufficiency
Diagnostic Tests
● Triggers include surgery, acute systemic illness, trauma or abrupt
● SBP = 200-300 mmHg
withdrawal of long-term corticosteroid therapy.
● DBP = 150-175 mmHg
● Slight overexertion, exposure to cold, acute infection or a decrease in ● Increased catecholamine levels in the blood, urine
salt intake may lead to circulatory collapse, shock and death if ● 24-hour urine collection
untreated
Treatment
Manifestation: Cyanosis, Classic signs of circulatory shock ● DRUG THERAPY
● (a high fever; weakness; severe, penetrating pain in the abdomen, ○ Phentolamine (Regitine)
lower back and legs; severe vomiting; diarrhea; hypotension; and ○ Sodium nitroprusside (Nipride)
circulatory collapse, shock, seizures and coma.) ○ Phenoxybenzamine (Dibenzyline)
○ Propanolol (Inderal)
● SURGICAL
Treatment ○ Adrenalectomy- definitive treatment
DRUG THERAPY:
● Hydrocortisone (Solu-cortef) = given to replace cortisol Nursing Management
 ● ICU care
● ECG monitoring
● BP monitoring
● Administer corticosteroid as ordered

Gonads
● The primary sources of steroid sex hormones in the body
● Hormones of the gonads are important in regulating body growth
and promoting the onset of puberty
MALES
● Androgens/ Testosterone
○ Produced by the testes
○ Maintains reproductive functioning and secondary sex
characteristics
○ Promotes the production of sperm
FEMALES
● Estrogen
○ Produced by the ovaries
○ Development of female sex organs, maintains
reproductive functioning and secondary sex
characteristics
● Progesterone
○ Produced by the ovaries
○ Promotes the growth of the lining of the uterus to
prepare for implantation of a fertilized ovum
○ Influences the menstrual cycle, maintains pregnancy

Pancreas
● It has endocrine and exocrine function
● This is located behind the stomach between the spleen and the
duodenum
● Endocrine Function
○ Produces hormones
○ Endocrine cells are clustered in bodies called Pancreatic
Islet which is gathered throughout the gland and it has
for different cell types:
■ Alpha- produces glucagon
■ Beta- produces insulin
■ Delta- secretes somatostatin
■ F- Cells- inihibit exo
● Exocrine Function
○ They produce digestive enzymes