ENDOCRINE SYSTEM
 Plays a vital role in orchestrating
cellular interactions, metabolism,
growth, reproduction, aging, and
response to adverse conditions
 Composed of endocrine glands and
specialized endocrine cells
 Disorders of the endocrine system are
common and are manifested as
hyperfunction and hypofunction
ENDOCRINE GLANDS
 Are glands that secrete hormones in
the blood. Hormones (travel through
blood circulation) exert their effort on
target organs or tissues or effectors.
 Target tissues are specific sites where
hormones produce a particular
response of the target tissues.
 These glands are the ff: Pituitary gland,
thyroid gland, Thymus, parathyroid
gland, Pineal, adrenal glands,
 Organs: Pancreas, ovaries and testes.
REGULATION OF HORMONES
 Endocrine glands are composed of
secretory cells known as ACINI. A rich
blood supply provides a vehicle for the
hormones produced by the endocrine
glands to enter the bloodstream
rapidly.
 Hormones are secreted when there is a
need for their effects on their target
organs. Each hormone has specific
stimulus for their secretions. Remember
that the amount of circulating
hormones depends on their unique
function and the body needs. In healthy
physiologic state, hormone
concentration in the blood stream is
maintained at constant level.
 To prevent accumulation, the secretion
of most hormones must be regulated or
inactivated by NEGATIVE FEEDBACK
MECHANISM so that when the
hormone concentration increases,
further production of hormone is
inhibited. Or when the hormone
concentration decreases, the rate of
production of that hormone increases.
NEGATIVE FEEDBACK MECHANISM
 Negative means “to decrease”
 Reverses a change in the variable to
bringing it back to “normal”
 is a control system in which a stimulus
initiates a response that reverses or
reduces the stimulus, thereby stopping
the response until the stimulus occurs
again and there’s a need for response.
 As the hormone exerts its effects, the
stimulus for secretion is reverse, and
the secretion of hormone decreases.
 Ex: of NFM: Insulin is secreted by the
Pancreas when the blood glucose is
high; that is, Hyperglycemia is the
stimulus for secretion of insulin. Insulin
enables cells to remove glucose from
the blood so that it can be used for
energy production and enables the liver
to store glucose as glycogen. As a result
of these actions of insulin, the blood
glucose decreases, reversing the
stimulus for secretion of insulin.
POSITIVE FEEDBACK MECHANISM
 A control system that requires an
external event to stop or reverse the
stimulus; may become a self-
perpetuating cycle that causes harm.
 The response to the stimulus does not
stop or reverse the stimulus, but
instead keeps the sequence of event
going.
 The release of oxytocin from the
posterior pituitary gland during labor is
an example of positive feedback
mechanism. Oxytocin stimulates the
muscle contractions that push the baby
through the birth canal. The release of
oxytocin result in stronger or
augmented contractions during labor.
CLASSIFICATION OF HORMONES
Hormones maybe classified into three groups
a. AMINES
 Structural variations of the amino acids
 tyrosine, thyroxine (from thyroid gland)
and epinephrine and norepinephrine
(from adrenal medulla).
b. PROTEINS
 Are chains of amino acids
 Insulin (pancreas), growth hormones
(from APG) and calcitonin (from the
thyroid gland) are all proteins
 Short canes of amino acids are called
PEPTIDES
  Antidiuretic hormones and oxytocin
(synthesized by hypothalamus) are
peptide hormones.
 TRH, FSH, GH
c. STEROIDS.
 penetrate cell membrane and interact
with cellular receptors.
 Includes cortisol, corticosteroids and
aldosterone produce by adrenal cortex),
estrogen and progesterone (ovaries)
and testosterone (testes)
d. Fatty acid derivatives
 Ex: eicosanoids and retinoids
 Eicosanoids - include prostaglandins,
leukotrienes that mount or inhibit
inflammation, allergy, fever and other
immune responses;
 Retinoids- reduce fine lines and
wrinkles by increasing the production of
collagen. They also stimulate the
production of new blood vessels in the
skin, which improves skin color.
HYPOTHALAMUS
 The part of the brain superior to the
pituitary gland and inferior to the
thalamus
 It releases and inhibit hormones
 It regulates body temperature and
regulates the secretions of the
pituitary gland
 Thyrotropin-releasing hormone(TRH,
Gonadotropin-Releasing
Hormone(GnRH), Corticotropin
Releasing Hormone(CRH), somatostatin,
dopamine , PIH, PRH
Thyrotropin-releasing hormone (TRH)
 is a hormone produced by the
hypothalamus that stimulates the
release of thyroid-stimulating hormone
(TSH) and prolactin from the anterior
pituitary.
Gonadotropin-Releasing Hormone (GnRH)
 causes the APG in to secrete and
release the luteinizing hormone (LH)
and follicle-stimulating hormone (FSH).
 In men, these hormones cause the
testicles to make testosterone. In
women, they cause the ovaries to make
estrogen and progesterone.
Corticotropin Releasing Hormone(CRH)
 Causes the release of ACTH from the
anterior Pituitary Gland
 Adrenocorticotropic hormone in turn
travels in the bloodstream to the
adrenal glands, where it causes the
secretion of the cortisol.
 CRH is produced during physiological
stress situation such as injury, disease,
exercise and hypoglycemia
Somatostatin
 Inhibits the GH and TSH
Dopamine
 Inhibits the prolactin, FSH and LH
PITUITARY GLAND
 Hangs from the hypothalamus and
enclosed by sella turcica of the the
sphenoid bone. (the bonny floor that
supports the brain)
 It is composed of two Parts: Anterior
Pituitary Gland and Posterior Pituitary
Gland
Hormones of Anterior Pituitary Gland
 Secretes GH, ACTH,TSH, FSH, LH,
Prolactin
1. Growth Hormones
 Known as somatotropin or
somatotropic hormones
 Regulated by GHRH (hypothalamus) -
stimulates secretion
 GHIH (Somatostatin)
- inhibits secretion
Functions
 Promotes growth of body tissues. It
concerns with growth of cells, bones
and soft tissues
 Stimulate cells to produce insulin
 Increase the rate of CHON synthesis and
increases the use of fats as energy
metabolism.
 It increases blood glucose levels by
reducing glucose utilization (insulin
antagonist)
 GH increases the transport of amino
acids into cells and increases the rate of
CHON synthesis. Amino acid cannot be
restored by the body, so when they are
available, they must be used in protein
synthesis.
2. ADENOCORTICOTROPIC HORMONES (ACTH)
 Stimulates the adrenal cortex to secrete
cortisol
 Corticotropin releasing hormone (CRH)-
stimulate the APG to increase the secretion
of ACTH
 CRH is produced during physiological stress
situation such as injury, disease, exercise
and hypoglycemia
 Cortisol is a steroid hormone made by the
adrenal cortex that is important for
regulating glucose, protein, and lipid
metabolism, suppressing the immune
system's response, and helping to maintain
blood pressure
3. THYROID STIMULATING HORMONE/TSH
 AKA thyrotropin and the target organ is the
Thyroid gland
 Increases the secretion of thyroxine (T4)
and thriodothyronine T3 by the TG
 Stimulus: Thyrotropin Releasing Hormone
(TRH)- stimulates the secretions of TSH
from the hypothalamus. When metabolic
rate decreases, TRH is produced.
GONADOTROPHIC HORMONES
TWO TYPES
4. Follicle Stimulating Hormone (FSH)
 Its effects is on the gonads (ovaries and
testes
 GNRH- stimulated the secretion of FSH.
In women:
 stimulates the growth of ovarian follicle,
ovulation
 Increases secretion of estrogen by follicle
cells
In Men
 Initiates sperm production in the testes
5. LUTEINIZING HORMONE
In women
 Responsible for ovulation (aids in egg
maturation and provides the hormonal
trigger to cause ovulation and the release
of eggs from the ovary)
 Causes the rupture ovarian follicle to
become and develop corpus luteum which
secretes progesterone.
Progesterone
 prepares the uterus for pregnancy
 After you ovulate each
month, progesterone helps thicken the
lining of the uterus to prepare for a
fertilized egg. If there is no fertilized
egg, progesterone levels drop and
menstruation begins
In Men
 Increases the secretion of testosterone
6. PROLACTIN
 AKA mammotropic hormone, lactotropic
hormone or luteotrophic hormone
 Stimulates milk production by the
mammary gland
 It is necessary for breast development and
lactation
 If mothers continue to breastfeed, prolactin
levels remain high.
 Prolactin Releasing Hormone (PRH)-
stimulate the secretion from the
hypothalamus.
 Prolactin Inhibiting Hormone- inhibits the
secretion from the hypothalamus
7. MELANOCYTE STIMULATING HORMONE (MSH)
 Necessary for skin pigmentation (skin,
retina)
 Increases melanin production in
melanocytes to make skin darker;
POSTERIOR PITUITARY GLAND
 There are two hormones of PPG,
 the ADH and Oxytocin
 Their release is stimulated by nerve
impulses from the hypothalamus.
ANTI-DIURETIC HORMONE
 AKA VASOPRESSIN
 Increases the reabsorption of water by
kidney tubules which decreases the amount
of urine formation
 It decreases sweating
 The water is reabsorbed in the blood, so
urinary output is decrease, blood volume
increase that maintain normal BP.
 If too much water is loss through sweating
or diarrhea, Osmoreceptors in the
hypothalamus detect the increase
“saltiness” of the body fluids, the
hypothalamus transmit impulses to the PPG
to increase the secretion of ADH and
decrease the loss of water
 Any type of dehydration stimulates the
secretion of ADH to conserve body water
 In case of Hemorrhage- ADH (in large
amount) is release that will cause
VASOCONSTRICTION in arterioles to raise
or maintain BP. (Vasopressin)
 Ingestion of alcohol inhibits the secretion
of ADH and it increases the UO.
OXYTOCIN
 Cause contraction of myometrium of the
uterus after labor has begun.
 Stimulus: nerve impulses from the
hypothalamus as cervix is stretched and as
infants suck the nipple
  As labor begins, the cervix of the uterus is
stretched which generates sensory impulses
to the hypothalamus, which in turn
stimulates the PPG to release oxytocin. This
causes the strong uterine contraction to
bring about delivery of the baby and the
placenta. (positive feedback mechanism).
The external break or shutoff of the
feedback cycle is the delivery of the baby
and the placenta.
 Promotes release of milk “let down” reflex
from the mammary glands.
PINEAL GLAND
 Located at the back of the third ventricle of
the brain
 Secretes melatonin
MELATONIN
 A hormone produced by the pineal gland
that stimulates the onset of sleep, brings
sleep
THYROID GLAND
 Is located in front and on the side of the
trachea just below the larynx.
 produces thyroid hormones that play a big
role in body metabolism, regulation of body
temperature, and growth/development.
 Thyroid follicles- the structural units of the
thyroid gland that produces
T3 Triiodothyronine, T4 Thyroxine (most
important when talking about hypo/hyper
thyroidism), and Calcitonin.
 Thyroid can NOT make thyroid hormones
without iodine (Iodine is necessary for the
synthesis of these hormones ) which comes
from foods (if you don’t have enough iodine
in your diet…low t3 and t4…this leads to
hypothyroidism and if you have too much
hyperthyroidism)
 Secretion of T3 and T4 is stimulated by TSH
from APG.
 When metabolic rate decreases, the
hypothalamus detect this changes, which
secretes the Thyrotropin releasing
Hormone (TRH). TRH stimulate
the APG to secrete TSH. TSH will stimulate
the thyroid gland to release T3 and T4,
which raise the metabolic rate by
increasing energy production. (Negative
feedback mechanism) then shut off TRH
from the hypothalamus until metabolic rate
decreases again.
HORMONES SECRETED BY THYROID GLAND
1. T4 (Thyroxine) and T3 (Triodothyronine)
 Produced by thyroid follicles
 Both are amino acids that contain iodine
molecules
T4
 weak hormone, maintains body metabolism
in a steady rate
 contains 4 iodine atoms
 NV: 5.4-11.5ug/dl or 57-148nmol/L
T3
 five times potent as T4 and has more
metabolic action
 contains 3 iodine atoms
 80-200ng/dl or 1.2-3.1 nmol/L
Functions: plays a huge role in:
 Main function: to control the cellular
metabolic activity
 burning calories (Regulates energy
production and protein synthesis)
 how new cells replace dying cells
 how fast we digest food
 stimulate sympathetic nervous system
(alertness, quick responsiveness/reflexes)
 increases body temperature and heart rate
 important in brain development and normal
growth
 muscle contraction and fertility
 regulates TSH (thyroid-stimulating
hormones through the negative feedback
loop)
 Necessary for normal physical, mental and
sexual development.
 Increase cell respiration of all food types to
increase energy and heat production
 Regulate CHON, CHO and fat metabolism
 Act as insulin antagonist
 Maintain growth hormone secretion and
promote skeletal maturation
 Affects CNS development CR, force and
output
 Stimulate SNS activity
 Stimulus: TSH from APG
Regulation of Thyroid Hormone
TSH (Thyrotropin):
 produced from the anterior pituitary gland
that stimulates T3 and T4 production
 Controls the rate of hormones release
though negative feedback mechanism.
 The level of thyroid hormone in the blood
determines the release of TSH. If the
thyroid hormone in the blood decreases
the release of TSH increases, which causes
increase of T3 and T4.
Negative Feedback Loop of Thyroid Hormone
Production
 Hypothalamus produces -
> TRH (Thyrotropin-releasing hormone)…
this causes the Anterior Pituitary Gland to
produce ->TSH (thyroid-stimulating
hormone)….this cause the thyroid gland to
produce-> T3 & T4
Note: There can be problems with the feedback
system where the pituitary gland is not stimulating
the thyroid gland enough so hormones are not
produced or the thyroid is not receptive to the TSH
from the pituitary gland.
CALCITONIN (Thyrocalcitonin)
 Produced by parafollicular cells
 acts to reduce calcium levels in
the blood/ lowers blood calcium levels
 It inhibits osteoclastic activity
 It lowers phosphate levels
 It decreases CA and Phosphorous in the GI
tract
 It helps maintain stable and strong bones
matrix.
 Stimulus: hypercalcemia
 Relationship of Calcitonin and Calcium
 Calcitonin is High, Calcium is Low
 Calcitonin is Low, Calcium Is High
PARATHYROID GLANDS
 are located in the neck behind the thyroid
where they continuously monitor and
regulate blood calcium levels.
 Four parathyroid glands on the back of the
thyroid gland that secretes parathormone.
PARATHYROID HORMONE
 The hormone produced by parathyroid
gland
 Is an antagonist to calcitonin
 PTH regulates CA and phosphorus balance
 PTH elevates Ca levels by withdrawal of ca
from the bones and inversely, lowers
phosphorus levels
 Increases the reabsorption of calcium and
phosphate from bone to blood
 Increases the reabsorption of calcium and
the excretion of phosphate by the kidneys;
activates Vit D.
 Hypocalcemia stimulate the secretion of
PTH, Hypercalcemia inhibit the secretion of
PTH
 Hypersecretion of PTH- Hypercalcemia,
Hypophospatemia
 Hyposecretion of PTH- Hypocalcemia,
Hyperphosphatemia
PANCREAS
 Located in the left upper quadrant of the
abdominal cavity
 It has both exocrine (secreting externally,
hormonal secretions from excretory ducts
and endocrine (secreting internally,
hormone secretion of a ductless gland)
 Exocrine functions includes secretions of
pancreatic enzymes into the GI tract
through the pancreatic duct.
 The endocrine functions include secretion
of insulin, glucagon and somatostatin
directly in the blood stream
EXOCRINE Function
 the secretions of the exocrine pancreas are
digestive enzymes high in protein content
and electrolytes rich in fluid
 Amylase- aids in digestion od CHO
 Trypsin- aids on digestion of CHON
 Lipase- aids in digestion of fats
ENDOCRINE PANCREAS
ISLET of LANGERHANDS
 The endocrine portion of the pancreas that
secretes insulin and glucagon.
 Contain alpha, beta and delta cells
 ALPHA CELLS- produce glucagon
 Beta Cells- produce insulin
 Delta cells- secrete somatostatin
HORMONES OF THE PANCREAS
A. GLUCAGON
 Secreted by alpha cells, its effect is to raise
the blood glucose by converting the
glycogen to glucose in the liver
 Stimulates the liver to change glycogen to
glucose (Glycogenolysis)- glycogen
breakdown)
 Enhances gluconeogenesis (breakdown of
fats and proteins into glucose) and elevates
blood glucose levels
 The secretion of glucagon is stimulated by
hypoglycemia.
 Result: Raises blood glucose level
GLYCOGEN- a polysaccharide that is storage from for
excess glucose in the liver and muscles.
GLYCOGENESIS- conversion of glucose to glycogen to
be stored in the liver as potential energy.
GLYCOGENOLYSIS- the conversion of stored
glycogen into glucose to be use for energy
production.
GLYCOLYSIS
 Increases the conversion of glycogen to
glucose in the liver
 Increase the use of fats and excess amino
acids for energy production
INSULIN
 Secreted by BETA CELLS
 The action is to lower the blood glucose by
permitting entry of glucose into the cells of
the liver, muscle and other tissues
 Promotes the storage of fat in adipose
tissue and the synthesis of proteins in
various body tissues
 Increases the transport of glucose from the
blood into the cells. In the absence of
insulin, glucose cannot enter the cells and
excreted in the urine. This condition called
Diabetes- high levels of glucose in the
blood. In diabetes, stored fats and proteins
 are used for energy instead of glucose
causing loss of body mass.
 Increases the use of glucose by cells to
produce energy. Once inside the cell,
Glucose is used in cell respiration to
produce energy.
 Stimulates the liver and muscles cells also
change glucose to glycogen (glycogenesis-
means glycogen production)
 Increases the cellular intake of fatty acids
and amino acids to use for synthesis of
lipids and CHON
 Stimulated by hyperglycemia
 Results: lowers blood glucose level
C. SOMATOSTATIN
 Exerts hypoglycemic effect by interfering or
inhibiting the release of growth hormone,
insulin and glucagon from the pancreas
 Inhibits the secretion of insulin and
glucagon
ADRENAL GLANDS/ Supra renal glands
 One on top on each kidney
 Each has an INNER ADRENAL MEDULLA and
OUTER ADRENAL CORTEX
ADRENAL MEDULLA
 the inner part of an adrenal gland, controls
hormones that initiate the flight or fight
response.
 Produces catecholamines in stress
situations such as epinephrine and
norepinephrine
 Stimulus: sympathetic impulses from the
hypothalamus
1. NOREPINEPRINE/ NOR-ADRENALIN
 Stimulates vasoconstriction and raises BP
2. EPINEPHRINE/ADRENALIN
 Increases the HR and force
 Causes vasoconstriction in skin and viscera
and vasodilation in skeletal muscles
 Dilates bronchi
 Slows peristalsis
 Causes the liver the to change glycogen into
glucose to raise blood glucose level
 Increases the use of fats for energy
ADRENAL CORTEX
 is the outer region and also the largest part
of an adrenal gland.
 Secretes three types of steroids hormones
 Mineralocorticoids (ex: Aldosterone),
Glucocorticoids, and very small amount of
sex hormones
 It control the 3 S, Sugar, Salt and Sex
ALDOSTERONE
 Most abundant mineralocorticoids
 Target organs are the kidneys
 Increases the reabsorption of Na and
excretion of K by kidney tubules
 Aldosterone is Pro NA (retain NA), ANTI K
(excretes K)
 High Aldosterone- Hypernatremia,
Hypokalemia:
 Low Aldosterone- Hyponatremia,
Hyperkalemia
 When BP decreases, secretion of
aldosterone stimulates the reabsorption of
Na ions by the kidneys. Water follows
sodium back to the blood to maintain
normal blood volume and blood pressure.
 Sodium ions return to the blood while the
potassium ions are excreted in urine
 Stimulus: decreased Na in the blood,
elevated potassium, decrease blood volume
or blood pressure.
 Low BP or blood volume activates the
RENIN ANGIOTENSIN MECHANISM of the
kidneys to secrete the enzyme RENIN.
 RENIN splits the plasma protein
angiotensinogen to Angiotensin I
 Angiotensin I is converted into Angiotensin
II by an enzyme (converting enzyme) causes
vasoconstriction and stimulates secretions
of aldosterone by the adrenal cortex that
will cause increase in BP.
CORTISOL
 Group of hormones called glucocorticoids
 Increases use of fats and amino acids for
energy.
 Decrease the use of glucose because it
conserves glucose for use by the brain.
 cortisol provides the body with glucose by
tapping into protein stores via
gluconeogenesis in the liver. This
energy can help an individual fight or flee a
stressor. However, elevated cortisol over
the long term consistently produces
glucose, leading to increased blood sugar
levels
 Anti-inflammatory effect- during
inflammation, histamine from damage
tissue makes capillaries more permeable
and the lysosomes of damage cells release
their enzymes which help breakdown
damage tissue.
 Inflammation, more damage on the tissue,
there will be secretion of cortisol to brake
or limit the inflammation process, which is
useful for tissue repair and to prevent tissue
destruction.
 it blocks the effect of histamine and
stabilize lysosomes to prevent excessive
tissue damage.
 Too much cortisol decreases the immune
response leaving the body susceptible to
 infection and slows the healing of damage
tissues.
 ACTH- direct stimulus of corstisol from APG.
HISTAMINE
- An inflammatory chemical release by damage
tissues as part of innate immunity; stimulates
increased capillary permeability and vasodilation.
OVARIES
 Located in the pelvic cavity on the either
side of the uterus
 Estrogen, progesterone, and inhibin
a. ESTROGEN
 Secreted by follicles cells in the ovary
 Promotes the maturation of the ovum in
the ovarian follicle and stimulates the
growth of blood vessels in the
endometrium.
 Affects the development of female sex
organs and Stimulates the development of
secondary sex characteristics
 Promotes the closure of epiphysis of long
bones.
 Lowers blood levels of cholesterol and
triglycerides.
 Stimulus: FSH from APG
b. PROGESTERONE
 Produced by corpus luteum of the ovary
and placenta
 “Hormone of pregnancy”
 Responsible for the growth of endometrium
and maintenance of pregnancy.
 Prepares uterus for implantation
 Promotes storage of glycogen and growth
of secretory cells of mammary glands.
 Decreases uterine contraction
 Stimulus: LH from APG
c. INHIBIN- inhibits secretion of FSH
TESTES –located in the scrotum between the upper
thighs
TESTOSTERONE
 Produced by interstitial cells
 Promotes maturation of sperm
 Stimulates the development of secondary
sex characteristics among males
 Promotes the closure of epiphysis of long
bones
Inhibin
 Inhibits the secretion of FSH to maintain
constant rate of sperm production.
Other Hormones
PROSTAGLANDIN
 Synthesized by cells from the phospholipids
of their cell membranes
 Involve in inflammation and pain,
reproduction, nutrient metabolism, changes
in blood vessels, blood clotting
THYMUS GLAND
 located behind your sternum and
between your lungs, is only active until
puberty.
 After puberty, the thymus starts to
slowly shrink and become replaced by
fat.
 Thymosin is the hormone of the
thymus, and it stimulates the
development of disease-fighting T cells.
 Thymopoietin and thymulin- assist in
the process where T cells differentiate
into different types
DIAGNOSTIC TEST
THYROID FUNCTION TEST
TSH ASSAY
 Serum TSH concentration is the primary
screening tests for thyroid function
 TSH has a high sensitivity (98%) and
specificity (92%) use to confirm thyroid
disease
 It is also used for monitoring patients
with thyroid replacement therapy
 The normal range for TSH is between
0.5 mU/l and 5.0 mU/l.
 A high TSH suggests your thyroid is
underactive (hypothyroid) and not
doing its job of producing enough
thyroid hormone. TSH levels will be
increased, if the thyroid gland is not
working due to infection or
inflammation, as in Hashimoto's
thyroiditis, or autoimmune thyroiditis.
 A low TSH suggests your thyroid is
overactive (hyperthyroid) and
producing excess thyroid hormone. If
the thyroid gland is secreting levels of
hormones that are too high, the
pituitary gland produces less TSH.
 High TSH– Hypothyroidism
 Low TSH- Hyperthyroidism
 No preparation is required
T4
 weak hormone, maintains body metabolism
in a steady rate
 NV: 5.4-11.5ug/dl or 57-148nmol/L
T3
 five times potent as T4 and has more
metabolic action
 contains 3 iodine atoms
 80-200ng/dl or 1.2-3.1 nmol/L
 No preparation is required
INTERPRETATION
 Increased- Hyperthyroidism
 Decreased- hypothyroidism
Radioactive Iodine Uptake (RAIU)
 Detects hyperthyroidism and
hypothyroidism
 Involves the ingestion of tracer dose
iodine (123 0r 131) followed in 24
hours by a scan of a thyroid gland
 Gradually shrinking your ultimately
destroying the gland leaving the thyroid
unable to produce enough hormones
 is a permanent and more reliable cure
for hyperthyroidism
 Anti-thyroid, limits thyroid hormone
secretion
 Patient with hyperthyroidism exhibit a
high iodine uptake and patient with
hypothyroidism exhibit a very low
iodine uptake.
 High Iodine uptake- Hyperthyroidism
 Low Iodine Uptake- Hypothyroidism
Patient Teaching
 Radioactive dose is small and harmless
 Collect 24 hours urine specimen after
tracer dose is given
 Thyroid scan after 24 hours
 Contraindicated in pregnancy this can
lead to fetal hypothyroidism, mental
retardation and increased malignancy
risk in the infant
 Avoid Sea foods may elevate or alter
the result
 Avoid Drugs that may elevate the
results- Barbiturates, Lithium,
Phenothiazines, topical antiseptics, food
supplement that contain seaweeds,
estrogen, salicylates, amiodarone,
antibiotics, corticosteroids and diuretics
 Avoid Drugs that may decrease the
results- Lugol’s solution, Saturated
Solution of Potassium Iodide, Anti
thyroid, Aspirin, and Anti histamines
 Normal HR; Adequate sleep
 Instruct patient to fast overnight before
administration, food delays absorption.
 It will take several weeks (usually 6
weeks) before Therapeutic effects
become noticeable
 Urine and saliva are slightly radioactive
for 24 hours after administration.
 SE. Metallic taste in the mouth, nausea,
swollen salivary glands.
Thyroid Antibodies
 Indicated to diagnose autoimmune
thyroid diseases both hypothyroid and
hyperthyroid conditions
 Positive anti thyroid antibodies in
autoimmune thyroid disease,
Hashimoto’s thyroiditis, and Grave’s
disease
Serum Thyroglobulin
 Can be measured by radioimmunoassay
 Radioimmunoassay- a technique for
determining antibody levels by
introducing an antigen labeled with a
radioisotope and measuring the
subsequent radioactivity of the
antibody component.
 Used to detect persistence or
recurrence of thyroid carcinoma
Fine Needle Aspiration Biopsy
 A small gauge of needle to get sample
from the thyroid tissue to accurately
detect malignancy
 Initial test for evaluation of thyroid
masses
 Results: Negative- benign, Positive-
malignant, Indeterminate – suspicious,
Inadequate- non diagnostic
Diagnostic Imaging Studies
THYROID SCAN
 Determine the location, size, shape and
anatomic function of TG
 Radioactive iodine (123 and 131)is
taken orally; dose is harmless
 Scanning is done after 24 hours
 Avoid iodine containing foods, dyes and
medication
 Cold nodules- CANCER
 Hot Nodules- BENIGN
ULTRASOUND
 No preparation

MRI
 Test cannot be done in clients with
metal implants (pacemakers,
arthroplasties, skull plates)
 Ask for allergy to contrast media
CT SCAN
 if with contrast medium, note for
allergy history
Diagnostic For Parathyroid Disorders
1. Total Serum Calcium (8.5-10.5mg/dl)
 Venous blood is collected
 Increased- Hyperparathyroidism
 Decreased- Hypoparathyroidism
2. PTH Radioimmunoassay
 Venous blood is collected
 NV: 11-51 pg/mL
 Increased- Hyperparathyroidism
 Decreased- Hypoparathyroidism
 When elevated in conjunction with
serum calcium levels, this is the most
specific test for Hyperparathyroidism.
TEST for Adrenal Medullary Disorders
1. VANILLYMANDELIC ACID TEST (VMA TEST)
 VMA is a metabolite of epinephrine
 NV- 0.7- 6.8mg/24hr
 24 hour urine collection is collected
 Avoid the following- Coffee, Chocolate,
Tea, Bananas, Vanilla, Aspirin
2.TOTAL PLASMA CATHECOLAMINE
CONCENTRATION
 To detect the level of cathecholamine
levels
 Supine position
 Butterfly needle is inserted 30 minutes
before specimen is collected- to
prevent elevation of cathecholamine
levels by stress and venipuncture
 Epinephrine- 100pg/ml or 590pmol/L
 Noradrenaline- 100-550pg/ml
3. CLONIDINE SUPPRESSION TEST
 Clonidine (Catapress)- a central acting
adrenergic blocker suppresses the
release of cathecholamines
 In PHEOCHROMOCYTOMA- clonidine
does not suppress the release of
cathecholamines
 Normal response- 2-3 hrs after a single
dose of clonidine.
 The total cathecholamine value
decreases at least 40% from the client’s
baseline
4. CT scan, MRI, Ultrasound
 To locate pheochromocytoma
TEST for PANCREATIC DISORDERS
1. FBS/FBG
 Detects DM
 Normal value: 70-110mg/dl
 A blood sugar level of more than
140mg/dl for two consecutives readings
 Preparation: Instruct the client to be on
NPO
2. Two Hour Post Prandial Blood Sugar/ 2hrs
PBBS
 Initial venous blood is withdrawn
 100 gm of CHO in diet is taken from the
client
 2 hours after meal, blood is withdrawn-
blood sugar returns to normal level
3. Oral Glucose Tolerance Test/ OGTT
 Done when FBS and 2hr PBBS are
BORDERLINE
 Take high CHO diet (200-300g) for 3
days
 Avoid alcohol, coffee or smoking for 36
hours before the test
 NPO for 8-12 hours
 Initial blood specimen or urine is
collected
 150-300 gm of glucose per orem or IV is
given
 Series of blood specimen is collected
after administration of glucose (30
minutes, 1 hr, 2hrs, if required 3hrs, 4
hrs, 5 hrs after)
 If glucose is higher than normal at 1 to 2
hours after ingestion or injection of
glucose and are SLOWER than
Normal to return to fasting levels, DM is
confirmed.
4. HbA1C/ Glycosylated Hgb
 The Most accurate indicator of DM
 It reflects serum glucose for the past 3-
4 months
 Glycated hemoglobin is a form of
hemoglobin that is chemically linked to a
sugar. Most monosaccharides, including
glucose, galactose and fructose,
spontaneously bond with hemoglobin,
 when present in the bloodstream of
humans

 Normal Value: 4%-7% for Non Diabetics

 The goal for the client with DM is 7.5%
or less
 If there are excess glucose in the blood
 Glucose is attached to hemoglobin
 Hgb is a component of RBC that has a
lifespan of 90-120 days
 Nursing Preparation: NPO 6-8 hours
prior to procedure
Water Deprivation Test
 the patient is deprived of fluids under
strict medical supervision for 8-12 hours
or 3%-5% of the body weight is lost
 Weight the patient frequently
 frequent (q2h) monitoring of plasma
and urine osmolality follows.
 The test is generally terminated when
plasma osmolality is >295 mOsm/kg or
the patient loses ≥3.5% of initial body
weight.
 DI is confirmed if the plasma osmolality
is >295 mOsm/kg and the urine
osmolality is <500 mOsm/kg or the
urine specific gravity is decrease.
 jjjjjj
 SIADH
 Inappropriate continued release of ADH in the absence of
stimuli resulting water intoxication/excessive water
retention by the kidney tubules.
 More water will be reabsorbed by the kidneys leading to
decrease urine output and fluid overload.
 as the fluids build up in the blood stream, Osmolality
decreases and the blood becomes diluted
 Feedback system is impaired and posterior pituitary
continues to release ADH
 Renal tubules continue to reabsorb free water regardless
of the serum osmolality
 Excessive activity of the neurohypophyseal system r/t
brain disease
Diabetes Insipidus (DI)
 Hyposecretion of ADH/Deficit of ADH
 Inability of the kidneys to retain water/
 water deficit
 absence of ADH allows the filtered water to excreted in the
urine instead of being reabsorbed, and the patient excrete
large quantities of urine
 Disordered regulation of water balance due to impaired
urinary concentrating ability secondary to inadequate
secretion of ADH or resistance to ADH.
Central/Neurogenic
 Inadequate secretion of ADH due to loss or malfunction of
neurosecretory neurons that make up the posterior pituitary.
 Vasopressin Sensitive

Serum Osmo below 280 mOsm/L Nephrogenic

 water excess  Inadequate response by the kidneys to ADH. A disorder of
 Amount of particles or solute is too small in proportion to renal tubular function resulting in the inability to respond to
the amount of water OR ADH in absorption of water.
 Too much water for the amount of solute  Vasopressin Resistant

CAUSES OF SIADH Dispogneic

 Trauma  Suppression of ADH secondary a defect or damage to the
 Stroke thirst mechanism located in the hypothalamus resulting in
 Hodgkin’s disease increased fluid intake or psychogenic causes
 Stress
 Pancreatic cancer Normal Serum Osmolality
 Lung Cancer  280-295 mOsm/L blood
 Drugs
Serum Osmo above 295 mOsm/L
CLINICAL MANIFESTATION  water deficit
-Mental confusion- initial sign  Concentration is too great or
-Edema- over retention of water  Water concentration is too little
-Weight gain- over retention of water
-Oliguria- More water will be reabsorbed by the kidneys CAUSES OF DI
leading to decrease urine output and fluid overload.  drugs-cause abnormalities secretion of ADH(clonidine, dilatine
-Hypertension- vasopressin causes vasoconstriction  Injury –cause abnormalities in ADH secretion
-Concentrated Urine  Kidney failure- less common cause to respond to ADH
-Hallucination  Lesion such as tumor, removal of PG, aneurysm, thrombus
-Anorexia and infection can interfere with ADH transport or release.
-Absent Tendon Reflex
-Dilutional hyponatremia- excessive retention of water CLINICAL MANIFESTATION
-N/V  POLYURIA- most common sign, 20L-30L of urine/day
-Weakness  POLYDIPSIA- extreme thirst and consumption of water.
-Cramps  Weight loss
-Seizures  Hypotension
LABORATORY DATA  Diluted
 Serum Na-low Na below 120mEq/L  Dehydration
 Hypo osmolality-below 280 mOsm/L  Constipation
 High specific gravity- higher 1.025  Dizziness

NURSING DIAGNOSIS
 Fluid volume excess r/t excessive amount of ADH LAB DATA
 Altered elimination pattern r/t decrease urine output  Serum Na- High 147mE/L, Hypernatremia
 Altered Nutrition  Hyperosmolality-above 290mOSm/L
 Disturbed Thought Process  H2o Deprivation test- Fluids are withheld for 4-18 hrs. If no
 Fluids and Electrolytes Imbalance increase urine concentration, it confirms DI.
 Low specific gravity-below 1.005- urine is diluted
INTERVENTIONS
NURSING DIAGNOSIS
 Fluid restriction-500ml-1000ml/day
 Fluid volume deficit r/t decrease secretion of ADH
 Assess for signs of hyponatremia- 3% NS may be given
 Altered Fecal elimination pattern r/t to constipation
 Diuretics- to reduced body fluids
INTERVENTIONS
 Demeclocycline- inhibit ADH. DOC. Produce water diuresis
 Maintain adequate fluid intake
 Monitor V/S, cardiac and neurologic status- Water
 Monitor urine specific gravity
intoxication may cause CHF and increase ICP
 Administer desmopressin acetate intranasal- affects
 Monitor I and O
prolonged Anti diuretic activity/long acting
 Weigh daily- Same time each day, same scale, same
 Lypressin-short acting nasal spray vasopressin
clothes.
 Administer VASOPRESIN- to control fluid balance and prevent
dehydration