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Module 1
Endocrine Disorders
Assessment of the Endocrine System

Overview................................................... 2
Learning Objectives........................................ 3
Anatomic & Physiologic Overview............................ 4
Glands of the Endocrine System........................ 5
Negative Feedback..................................... 6
Classification & Action of Hormones................... 7
Functions of Endocrine Glands......................... 8
Assessment.................................................15
Health History........................................15
Physical Examination..................................16
Diagnostic Evaluation......................................17
Blood Tests...........................................17
Urine Tests...........................................19
Additional Diagnostic Studies.........................23
Review Questions...........................................26
References.................................................31
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Overview:
It is essential that student nurses should have a comprehensive

understanding of the endocrine disorders. This thorough knowledge prepares

and empowers the student nurse to anticipate, correctly identify and swiftly

intervene or provide safe and quality holistic care to patient’s diagnosed

with endocrine disorders.

For the body to function properly, its various parts and organs must

communicate with each other to ensure that a constant internal environment

(i.e., homeostasis) is maintained. Communication among various regions of

the body also is essential for enabling the organism to respond

appropriately to any changes in the internal and external environments. The

nervous system generally allows rapid transmission (i.e., within fractions

of seconds) of information between different body regions. Conversely,

hormonal communication, which relies on the production and release of

hormones from various glands and on the transport of those hormones via the

bloodstream, is better suited for situations that require more widespread

and longer lasting regulatory actions. Thus, the two communication systems

complement each other. In addition, both systems interact: Stimuli from the

nervous system can influence the release of certain hormones and vice versa

(Hiller-Sturmhöfel & Bartke, 1998).

The endocrine system plays a vital role in orchestrating cellular

interactions, metabolism, growth, reproduction, aging, and response to

adverse conditions (Porth, 2015 as cited in Hinkle & Cheever, 2018).This

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interconnected network of glands is closely linked with the nervous and

immune systems, regulating the functions of multiple body organs( Hinkle &

Cheever, 2018).

Module Learning Objectives:

After a successful completion of this module, you should be able to:

 Identify the different glands of the endocrine system.

 Classify the hormones according to their structure.

 Describe the functions of each of the endocrine glands and their

hormones.

 Discuss the essential components of the health history and physical

examination which are necessary for diagnosis and management of the

endocrine disorders.

 Explain the purpose/s, interpretation, and the nursing

responsibilities of the different diagnostic studies for the

validation of the endocrine disorders.

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Anatomic and Physiologic Overview

The endocrine system involves the release of chemical transmitter

substances known as hormones. These substances regulate and integrate body

functions by acting on local or distant target sites. Hormones are generally

produced by the endocrine glands but may also be produced by specialized

tissues such as those found in the gastrointestinal (GI) system, the kidney,

and white blood cells. The GI mucosa produces hormones (e.g., gastrin,

enterogastrone, secretin, and cholecystokinin) that are important in the

digestive process; the kidneys produce erythropoietin, a hormone that

stimulates the bone marrow to produce red blood cells; and the white blood

cells produce cytokines (hormonelike proteins) that actively participate

in inflammatory and immune responses.

The endocrine system has a unique relationship with the immune and the

nervous systems. Chemicals such as neurotransmitters (e.g. Epinephrine)

released by the nervous system can also function as hormones when needed.

The immune system responds to the introduction of foreign agents by means

of chemical messengers (cytokines), and is also subject to regulation by

adrenal corticosteroid hormones (Porth, 2015).

Glands of the Endocrine System

The endocrine system is composed of the pituitary gland, thyroid gland,

parathyroid glands, adrenal glands, pancreatic islets, ovaries, and testes

(see Fig. 1). Most hormones secreted from endocrine glands are released
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directly into the bloodstream. However, exocrine glands, such as sweat

glands, secrete their products through ducts onto epithelial surfaces or

into the GI tract.

Figure 1. Major hormone-secreting glands of the endocrine system.

Reference: Hinkle & Cheever, 2018, p. 3971

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The endocrine glands are composed of secretory cells arranged in minute

clusters known as acini. A rich blood supply provides a vehicle for the

hormones produced by the endocrine glands to enter the bloodstream rapidly.

The amount of circulating hormones depends on their unique function and the

body’s needs. In the healthy physiologic state, hormone concentration in

the bloodstream is maintained at a relatively constant level. To prevent

accumulation, these hormones must be inactivated continuously by a negative

feedback system so that when the hormone concentration increases, further

production of that hormone is inhibited. Conversely, when the hormone

concentration decreases, the rate of production of that hormone increases.

Negative feedback is the mechanism for regulating hormone

concentration in the bloodstream. When the hormone concentration increases,

further production of that hormone is inhibited. Conversely, when the

hormone concentration decreases, the rate of production of that hormone

increases.

Classification and Action of Hormones

Hormones are classified into four categories according to their structure

:( 1) amines and amino acids (e.g., epinephrine, norepinephrine, and thyroid

hormones); (2) peptides, polypeptides, proteins, and glycoproteins (e.g.,

thyrotropin-releasing hormone [TRH], follicle-stimulating hormone [FSH],

and growth hormone [GH]); (3) steroids (e.g., corticosteroids, which are

hormones produced by the adrenal cortex or their synthetic equivalents);

and (4) fatty acid derivatives (e.g., eicosanoid, retinoids) (Porth, 2015).
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Although most hormones released by endocrine glands can be transported to

distant target sites for action, some hormones never enter the bloodstream.

Some hormones act locally in the area where they are released; this is

called paracrine action (e.g., the effect of sex hormones on the ovaries).

Others may act on the actual cells from which they were released; this is

called autocrine action (e.g., the effect of insulin from pancreatic beta

cells on those cells) (Lazar & Birnbaum, 2016).

Hormones can alter the function of the target tissue by interacting

with chemical receptors located either on the cell membrane or in the

interior of the cell. For example, peptide and protein hormones interact

with receptor sites on the cell surface, resulting in stimulation of the

intracellular enzyme adenyl cyclase. This causes increased production of

cyclic 3′,5′-adenosine monophosphate (AMP). The cyclic AMP inside the cell

alters enzyme activity. Thus, cyclic AMP is the “second messenger” that

links the peptide hormone at the cell surface to a change in the

intracellular environment. Some protein and peptide hormones also act by

changing membrane permeability and act within seconds or minutes. The

mechanism of action for amine hormones is similar to that for peptide

hormones (Porth, 2015).

Steroid hormones, because of their smaller size and higher lipid

solubility, penetrate cell membranes and interact with intracellular

receptors. The steroid–receptor complex modifies cell metabolism and the

formation of messenger ribonucleic acid (mRNA) from deoxyribonucleic acid

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(DNA). The mRNA then stimulates protein synthesis within the cell. Steroid

hormones require several hours to exert their effects, because they exert

their action by the modification of protein synthesis.

A. Functions of Endocrine Glands

1. Major endocrine glands include pituitary, thyroid, parathyroid,

adrenals, pancreas, and gonads.

2. Endocrine glands secrete chemicals (hormones) directly into the

bloodstream and have a direct or indirect effect on the metabolism of water

and electrolytes.

3. Hormones regulate the internal environment in the body.

4. Some hormones target specific tissues, and others affect a variety of

tissues and cells of the body.

5. Hormone concentration in the blood is regulated by negative feedback

mechanisms.

6. Hormones are classified as steroid hormones (cortisone), peptides

(insulin), and amine hormones (epinephrine).

7. Functions and structure are affected by lack of blood supply, infection,

tumor growth, overstimulation, and overgrowth.

B. Pituitary Gland

1. Round structure located on the inferior aspect of the brain

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2. The anterior lobe regulates production of several hormones,

including the growth hormone, thyroid-stimulating hormone (TSH), and

adrenocorticotropic hormone.

a. Growth hormone plays a role in growth of bones, muscles, and

cells and affects carbohydrate, protein, and fat metabolism.

b. Thyroid-stimulating hormone (TSH) is necessary for growth and

function of the thyroid gland and controls release of thyroid

hormones.

c. Adrenocorticotropic hormone (ACTH) controls release of

glucocorticoids and adrenal androgens from the adrenal +cortex.

C. Thyroid Gland

1. Butterfly-shaped organ in the lower neck anterior to the trachea

2. Releases hormones T4 (thyroxine), T3 (triiodothyronine), and

calcitonin

3. T4 plus T3 make up the thyroid hormone.

4. T4 and T3 contain iodine molecules bound to amino acids.

5. T4 and T3 synthesized and stored in the thyroid are bound to

proteins until released into the blood.

6. Iodine ingested orally is absorbed into the blood in the

gastrointestinal (GI) tract, where it is picked up by the thyroid

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gland, concentrated in the gland, and reacts with tyrosine to form

thyroid hormones.

7. The major role of thyroxine (T4) is to regulate metabolism so that

O2 consumption and heat production keep pace with the body’s needs and

activities.

8. By controlling metabolism, thyroxine has a role in regulating:

a. Growth and development

b. Carbohydrate, fat, and protein metabolism

c. Reproduction

d. Vitamin requirements

e. Resistance to infection

9. Production of thyroxine is dependent on ingestion of sufficient

protein and iodine and on release of the thyroid stimulating hormone

from the anterior pituitary gland.

10. Calcitonin is released when there are high levels of plasma

calcium, causing calcium to be deposited in bones.

D. Parathyroid Gland

1. Four small glands either attached to or embedded in the posterior

aspect of the thyroid gland.

2. Secretes the hormone parathormone.

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3. Parathormone causes an increase in plasma calcium ions and decrease

in plasma phosphate ion concentration (inverse relationship).

E. Adrenal Glands

1. Two small structures that cap the top of the kidneys

2. Inner portion is the medulla; outer portion is the cortex

3. Medulla functions as part of the autonomic nervous system and

secretes the catecholamine hormones epinephrine (adrenalin) and

norepinephrine.

4. Action of epinephrine is to respond to “fight or flight” by

converting liver glycogen to glucose for energy, boosting the O2

carrying capacity of the blood, and increasing cardiac output.

5. Action of norepinephrine is to produce extensive vascular

constriction, causing marked increase in blood pressure (BP)

6. Adrenal cortex secretes:

a. Mineralocorticoids (aldosterone— main one)

b. Glucocorticoids (cortisol—most important one)

c. Androgenic adrenocorticoids (17 ketosteroids)

d. Aldosterone has a major role in concentration of Na+ in the

body, acting on renal tubules to cause increased sodium

retention, secondary H2O retention, and K+ excretion. These

actions sustain normal BP and cardiac output.

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e. Cortisol promotes gluconeogenesis (converts amino acids and

fats to glycogen) and influences protein catabolism, and is used

extensively for inflammation and allergic reactions.

f. Androgens oppose the catabolic effects +of glucocorticoids and

have sexual -effects of masculinization.

F. Pancreas

1. Has an exocrine function and an endocrine function

2. Endocrine function is controlled by the alpha and beta cells of the

islets of Langerhans.

3. Alpha cells synthesize glucagon, which raises blood sugar by

promoting conversion of glycogen to glucose in the liver.

4. Beta cells synthesize insulin, which lowers blood sugar by promoting

transport of glucose into the cells.

5. Insulin plays a key role in the metabolism of carbohydrates, fats,

and protein by:

a. Stimulating active transport of glucose into the muscle and

adipose tissue cells.

b. Regulating the rate at which carbohydrates are burned by the

cell for energy.

c. Promoting conversion of glucose to glycogen for storage in the

liver.
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d. Promoting conversion of fatty acids into fat, which can be

stored as adipose tissue.

e. Stimulating protein synthesis within the tissues.

6. The rate of insulin secretion is regulated by blood sugar levels.

7. Carbohydrates are the body’s preferred fuel as well as its most

immediate source of energy.

8. If the body cannot burn carbohydrates, it will convert fat first

and then protein.

9. Body will burn carbohydrates rather than fats and protein if:

a. Carbohydrate intake is adequate.

b. Sufficient insulin is present to get glucose into the cells.

c. Reserve stores of glycogen are present.

10. Carbohydrate metabolism involves:

a. Active transport of glucose into the cells and the release of

energy.

b. Storage of glucose not immediately needed for energy as

glycogen and fat.

c. Conversion of glycogen back to glucose whenever blood glucose

level drops.
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d. Conversion of fats and proteins to glucose or glycogen

whenever these two carbohydrate substances are depleted and

energy is needed.

Reference: Smeltzer, Bare, Hinkle, & Cheever, 2010)

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Assessment

Health History

Although specific endocrine disorders are often accompanied by

specific clinical symptoms, more general manifestations may also occur. A

thorough health history and review of systems are necessary for diagnosis

and management of these disorders. Patients should be asked if they have

experienced changes in energy level, tolerance to heat or cold, weight,

thirst, frequency of urination, fat and fluid distribution, secondary

sexual characteristics such as loss or growth of hair, menstrual cycle,

memory, concentration, sleep patterns, and mood, as well as vision changes,

joint pain, and sexual dysfunction. It is important to document (1) the

severity of these changes, (2) the length of time the patient has

experienced these changes, (3) the way in which these changes have affected

the patient’s ability to carry out activities of daily living, (4) the

effect of the changes on the patient’s self-perception, and (5) family

history.

The physical examination should include vital signs; head-to-toe

inspection; and palpation of skin, hair, and thyroid. Findings should be

compared with previous findings, if available. Physical, psychological, and

behavioral changes should be noted. Examples of changes in physical

characteristics on examination may include appearance of facial hair in

women, “moon face,” “buffalo hump,” exophthalmos (abnormal protrusion of

one or both eyeballs), vision changes, edema, thinning of the skin, obesity
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of the trunk, thinness of the extremities, increased size of the feet and

hands, edema, and hypo- or hyperreflexia. The patient may also exhibit

changes in mood and behavior such as nervousness, lethargy, and fatigue

(Weber & Kelley, 2014).

Physical Examination

1. Exophthalmus (hyperthyroidism)

2. Hyperpigmentation of the skin (Addison’s disease)

3. Hard, nonpitting edema (myxedema)

4. Delayed healing (diabetes mellitus)

5. Enlarged physical features (acromegaly or Cushing’s syndrome)

6. Excessive growth (gigantism)

7. Alterations in hair texture (thyroid) or amount (ovarian or adrenal

conditions)

8. Vital sign changes—increased temperature and heart rate

(hyperthyroidism), increased heart rate and blood pressure

(pheochromocytoma)

Diagnostic Evaluation

A variety of diagnostic studies are used to evaluate the endocrine system.

The nurse educates the patient about the purpose of the prescribed studies,

what to expect, and any possible side effects related to these examinations
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prior to testing. The nurse notes trends in results that provide information

about disease progression as well as the patient’s response to therapy.

Blood Tests

Blood tests determine the levels of circulating hormones, the presence of

autoantibodies, and the effect of a specific hormone on other substances

(e.g., the effect of insulin on blood glucose levels). The serum levels of

a specific hormone may provide information to determine the presence of

hypofunction or hyperfunction of the endocrine system and the site of

dysfunction. Radioimmunoassays are radioisotope-labeled antigen tests that

are commonly indicated blood tests used to measure the levels of hormones

or other substances (Sluss & Hayes, 2016).

Thyroid-Stimulating Hormone Test

A serum immunoassay test for measuring serum TSH concentrations. This

test is useful for monitoring thyroid hormone replacement therapy and for

determining whether disorder is in the thyroid gland, pituitary gland, or

hypothalamus. Elevated levels indicate primary hypothyroidism and low

levels indicate hyperthyroidism. Prior to the test, it is essential to

inquire the client as to the use of products that contain iodine, such as

medications, food supplements, and topical antiseptics, which will alter

results.
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Serum Free Thyroxine (FT4)

This test directly measures free (unbound) thyroxine and is useful in

confirming an abnormal TSH. Prior to the test, the client should be asked

regarding the use of products that contain iodine, such as medications,

food supplements, and topical antiseptics, which will alter results.

Fasting Blood Sugar

This test is used to determine the presence of excessive glucose when

the client has symptoms of diabetes mellitus. A fasting plasma glucose of

126 mg/dl or higher on two consecutive tests is significant for a diagnosis

of diabetes mellitus. It is essential to instruct the client not to have

any caloric intake for at least 8 hours prior to the procedure. For the

postprocedure, the client is instructed that he/she may resume food and

fluids.

Oral Glucose Tolerance Test

This is a test in which the client drinks a concentrated glucose

solution followed by a blood glucose determination 2 hours later. A blood

glucose level of 200 mg/dl or higher 2 hours after the glucose ingestion

is significant for a diagnosis of diabetes mellitus.

Preprocedure

a. Three days before the test: A diet high in carbohydrates (200–300

g) is eaten each day for 3 days.

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b. Day before the test: NPO for 10 hours before the test except for

water

c. Day of the test: Client is given a specified amount of glucose (75

g or 100 g) as a lemon-flavored or glucola solution after fasting

blood and urine samples are obtained. Blood and urine samples obtained

at 30 minutes, 1 hour, and 2 hours

Postprocedure

Monitor the client for clinical manifestations of hyperglycemia and

hypoglycemia. Test may take up to 5 hours to complete.

Urine Tests

Urine tests are used to measure the amount of hormones or the end products

of hormones excreted by the kidneys. One-time specimens or, in some

disorders, 24-hour urine specimens are collected to measure hormones or

their metabolites. For example, urinary levels of free catecholamines

(norepinephrine, epinephrine, and dopamine) may be measured in patients

with suspected tumors of the adrenal medulla (pheochromocytoma). Several

disadvantages related to urine tests that must be considered are that

patients may be unable to urinate at scheduled intervals and that some

medications or disease states may affect the test results (Porth, 2015).

Radioactive Iodine (RAI) Uptake

This test measures the rate of absorption of a tracer dose of 123I

in the thyroid gland. Thyroid gland normally takes up 5% to 35% of tracer

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dose in 24 hours. There will be high uptake seen in hyperthyroidism while

low uptake in hypothyroidism. Drugs may increase or decrease results. Thus,

prior to the test, client will be asked as to the use of products that

contain iodine, such as medications, food supplements, and topical

antiseptics, which will alter results (Gauwitz, 2015). The patient may be

instructed, by medical direction, to restrict foods, medicines, or

supplements containing iodine for one week before the study. Examples of

restricted items include iodized salt, prepared or processed foods high in

iodized salt, seaweed, kelp, shellfish; thyroid or anti-thyroid

medications; vitamins and dietary supplements (Nursing Central, n.d.).The

client is instructed in the 24-hour urine collection procedure. Client

needs to know that the tracer dose is small and harmless. On the day of the

test, the client is given 123I capsule. Then, 24-hour urine collection is

started after the tracer dose is given. Thyroid is scanned at intervals of

2, 6, and 24 hours after the tracer dose is given.

Nursing Implications for the Radioactive Iodine (RAI) Uptake test (Nursing

Central, n.d.)

Before the Study: Planning and Implementation

Teaching the Patient What to Expect

 Inform the patient this test can assist in assessing thyroid function.

 Pregnancy is a general contraindication to procedures involving

radiation. Explain to the female patient that she will be asked the

date of her last menstrual period and pregnancy testing may be

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performed to determine the possibility of pregnancy before she is

exposed to radiation.

 Review the procedure with the patient. Address concerns about pain and

explain that there may be moments of discomfort or pain experienced

if an IV line is inserted to allow infusion of fluids such as saline,

anesthetics, sedatives, radionuclides, medications used in the

procedure, or emergency medications.

 Explain that an I-123 will be administrated orally (pill form).

 Explain that the procedure is performed in a nuclear medicine

department by a health-care provider (HCP) who specializes in this

procedure, with support staff, and takes approximately 15 to 30 min.

 Explain that the radionuclide poses no radioactive hazard and rarely

produces adverse effects.

 Advise that delayed images may be needed 2 to 24 hour later and that

the patient may leave the department and return later to undergo

delayed imaging.

 Reassure the patient that the radionuclide poses no radioactive hazard

and rarely produces adverse effects.

 Instruct the patient to remove jewelry and other metallic objects from

the area to be examined.

 Baseline vital signs and neurological status are recorded. Protocols

may vary among facilities.

 Positioning for this procedure is in a sitting or supine position in

front of a radionuclide detector.

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 Explain that once the study is completed, the needle or catheter is

removed and a pressure dressing applied over the puncture site.

After the Study: Potential Nursing Actions

Avoiding Complications

 Establishing an IV site and injection of radionuclides are invasive

procedures. Complications are rare but include risk for allergic

reaction (related to contrast reaction), hematoma (related to blood

leakage into the tissue following needle insertion), bleeding from

the puncture site (related to a bleeding disorder or the effects of

natural products and medications with known anticoagulant,

antiplatelet, or thrombolytic properties), or infection (which

might occur if bacteria from the skin surface is introduced at the

puncture site). Monitor the patient for complications related to

the procedure (e.g., allergic reaction, anaphylaxis, bronchospasm).

Immediately report symptoms such as fast heart rate, difficulty

breathing, skin rash, itching, or chest pain to the appropriate HCP.

Observe/assess the needle/catheter insertion site for bleeding,

inflammation, or hematoma formation.

Treatment Considerations

 Explain that the radionuclide is eliminated from the body within 6

to 24 hr. Advise the patient to drink increased amounts of fluids

for 24 to 48 hour to eliminate the radionuclide from the body,

unless contraindicated.

 Instruct the patient to resume usual diet, as directed by the HCP.

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 Provide instruction in the care and assessment of the site.

 Explain that application of cold compresses to the puncture site

may reduce discomfort or edema.

24-Hour Urine for Free Catecholamines

This is a test involving collection of a 24-hour urine for the

evaluation of the free catecholamines, metanephrines (MN), and

vanillylmandelic acid (VMA)—the metabolic end products of epinephrine and

norepinephrine. It is useful in diagnosing pheochromocytoma, a tumor of the

adrenal medulla. Prior to the test: the client is asked as to prior

ingestion of foods such as coffee, tea, bananas, chocolate, vanilla, and

aspirin, which will alter test results. Obtain special bottles from the

laboratory for the 24-hour urine collection. Instruct the client in the

procedure for 24-hour urine collection. After the procedure, the urine is

transported to the laboratory in a properly labeled container.

Additional Diagnostic Studies

Stimulation tests are used to confirm hypofunction of an endocrine

organ. The tests determine how an endocrine gland responds to the

administration of stimulating hormones that are normally produced or

released by the hypothalamus or pituitary gland. If the endocrine gland

responds to this stimulation, the specific disorder may be in the

hypothalamus or pituitary. Failure of the endocrine gland to respond to

this stimulation helps identify the problem as being in the endocrine gland

itself.
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Thyroid-Stimulating Hormone Test

This is a serum immunoassay test for measuring serum TSH

concentrations. It is useful for monitoring thyroid hormone replacement

therapy and for determining whether disorder is in the thyroid gland,

pituitary gland, or hypothalamus. Elevated levels indicate primary

hypothyroidism. Low levels indicate hyperthyroidism. Prior to the test: the

client is asked as to the use of products that contain iodine, such as

medications, food supplements, and topical antiseptics, which will alter

results.

Suppression tests are used to detect hyperfunction of an endocrine

organ. They determine if the organ is not responding to the negative

feedback mechanisms that normally control secretion of hormones from the

hypothalamus or pituitary gland. Suppression tests measure the effect of

an given exogenous dose of the hormone on the endogenous secretion of the

hormone or on the secretion of stimulation hormones from the hypothalamus

or pituitary gland.

Imaging studies include radioactive scanning, magnetic resonance

imaging (MRI), computed tomography (CT), ultrasonography, positron emission

tomography (PET), and dual-energy x-ray absorptiometry (DEXA) (Porth,

2015).
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Thyroid Scan

This test employs radioisotope and scintillation detector or

other device to provide an image of the thyroid gland that identifies the

location, size, shape, and function of the thyroid gland. 123I most common

isotope used. Prior to the test: the client is asked regarding the use of

products that contain iodine, such as medications, food supplements, and

topical antiseptics, which will alter test results. Also, the client is

asked regarding radiographic studies using contrast media within the

previous 3 months because they may alter test results. The client is

instructed to be on nothing per Orem (NPO) status after midnight a day

prior to the test. On the day of the test, a radioisotope administered by

the radiologist. After the procedure, the client may resume food and fluids.
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REVIEW QUESTIONS:
1. After consuming a banana split, which hormones would be expected to
increase?

A. Prolactin
B. Glucagon
C. Insulin
D. Parathyroid Hormone

2. After having a double-bacon cheeseburger with a milkshake, which of

the following hormones would NOT be expected to increase?

A. Secretin
B. Insulin
C. Cholecystokinin
D. Glucagon

3. Which of the following hormones would bind to receptors located on the

inside of a cell?

A. Testosterone
B. Follicle-Stimulating Hormone
C. Prolactin
D. Growth Hormone

4. Which of the following accurately describes thyroid hormone?

A. Released from the anterior pituitary

B. Binds to receptors on the outside of the cell
C. Derived from cholesterol
D. Binds to receptors on the inside of the cell

5. Which of the following is a physiological function that is mediated by

a hormone released by the posterior pituitary?

A. Maturation of the egg and sperm

B. Decrease in calcium levels
C. Water retention
D. Increase in thyroid hormone level
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6. Hormones travel through the blood stream and bind to receptors located
on target cells. Which of the following would NOT bind to transmembrane
proteins on the target cells?

A. Estrogen
B. Prolactin
C. Insulin
D. Antidiuretic Hormone

7. Which of the following hormones would be expected to increase if you

were studying all day for a test and skipped breakfast and lunch?

A. Glucagon
B. Growth Hormone
C. Insulin
D. Calcitonin

8. Which hormone increases basal metabolic rate in the body?

A. Thyroid Hormone
B. Parathyroid Hormone
C. Secretin
D. Glucagon

9. Growth factors and histamine are chemical agents released in small

amounts that act locally on neighboring cells. Which of the following
best describes the function of growth factors and histamine?

A. Endocrine function
B. Autocrine function
C. Paracrine function
D. None of the above

10. Which of the following is both an endocrine and exocrine gland?

A. Thyroid Gland
B. Adrenal Glands
C. Parathyroid Glands
D. Liver

11. The primary role of the parathyroid gland is:

A. To maintain metabolic homeostasis

B. To regulate serum calcium levels
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C. To send hormonal signals to other endocrine organs

D. To receive hormonal signals from the hypothalamus

12. Antibodies directed against pancreatic cells result in these cells’

destruction. What laboratory abnormality might be seen in this
scenario?

A. Depressed serum calcium

B. Elevated serum glucose
C. Depressed serum sodium
D. Elevated serum calcium

13. Hormones secreted by the hypothalamus would be classified as:

A. Intracrine
B. Autocrine
C. Paracrine
D. Endocrine

14. All of the following are true of posterior pituitary hormones

EXCEPT:

A. They include direct and tropic hormones

B. They are released from the posterior pituitary
C. A nerve signal from the hypothalamus stimulates their release
D. They include antidiuretic hormone and oxytocin

15. The concentration of hormones in the bloodstream is regulated by:

A. Production of receptor antagonists

B. Indirect growth-promoting effects
C. Nutritional signals to the endocrine gland
D. Positive and negative feedback loops

16. All of the following are endocrine glands EXCEPT:

A. adrenal glands
B. sebaceous glands
C. pineal glands
D. pituitary glands
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17. Hormones that enter target cells and bind to receptors in the
nucleus are called

A. steroid hormones
B. water soluble hormones
C. peptide hormones
D. second messengers

18. The hormones regulating blood calcium levels are:

A. insulin and glucagon

B. glycogen and parathyroid hormone
C. parathyroid hormone and calcitonin
D. estrogen and progesterone

19. All of the following are hormones of the anterior pituitary EXCEPT:

A. human growth hormone (GH)

B. follicle-stimulating hormone (FSH)
C. parathyroid hormone(PTH)
D. thyroid-stimulating hormone (TSH)

20. Antidiuretic hormone and oxytocin are stored and released by the

A. posterior pituitary gland

B. anterior pituitary gland
C. thyroid gland
D. adrenal gland

21. Calcitonin is a hormone of the

A. adrenal cortex
B. thyroid gland
C. pituitary gland
D. thymus gland

22. Mineralcorticoids

A. are produced in the adrenal cortex

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B. are steroid hormones

C. help regulate the homeostasis of sodium and potassium
D. all of the above

23. Which of the following hormones are responsible for the "fight-or-
flight" response?

A. epinephrine and norepinephrine

B. insulin and glucagon
C. estrogen and progesterone
D. thyroxin and melatonin

24. The gland which can be classified as an endocrine and an exocrine

gland is the:

A. thyroid
B. thymus
C. pancreas
D. pituitary

25. Glucagon

A. accelerates the conversion of glycogen into glucose

B. slows down glucose formation from lactic acid
C. decreases the conversion of glycogen into glucose
D. speeds up protein synthesis within cells
Practice Quiz
Site:
http://www2.yvcc.edu/Biology/230Modules/BIOL230Modules/multi_dropquiz/gla
nds.html

References
Gauwitz, D. F. (2015). Complete Review for NCLEX- RN (2nd Edition).
Stamford, Connecticut, United States: Cengage Learning.

Hiller-Sturmhöfel, S., & Bartke, A. (1998). The endocrine system: an

 31

overview. Alcohol health and research world, 22(3), 153–164.

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761896/

Hinkle, J.L., & Cheever, K. H (2018). Brunner & Suddarth’s textbook of

medical –surgical nursing (14th Edition). China: Wolters Kluwer.

Nursing Central. (n.d.). Radioactive Iodine Uptake. Retrieved from

https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-
and-Diagnostic-Tests/425325/all/Radioactive_Iodine_Uptake

Smeltzer, S.C., Bare, B.G., Hinkle, J.L., & Cheever, J. H. (2010). Brunner
&
Suddarth’s Textbook of Medical –Surgical Nursing (12th Edition).
Philadelphia, PA: Wolters Kluwer Health / Lippincott Williams &
Wilkins.

Video Sources

 https://www.youtube.com/watch?v=0GSRbmcNh3A (Overview & Anatomy &

Physiology/Endocrine System Part 1)
 https://www.youtube.com/watch?v=vLCg_kyuyw4 (Overview of the
Endocrine System)
 https://www.youtube.com/watch?v=NOV0OuYxB7g (Human Endocrine System
Made Simple- Endocrinology Overview♥♥♥
 https://www.youtube.com/watch?v=K1y36Atqi-Y (Human Endocrine System
Made simple Part 2)