Chapter 45

Assessment and Management of

Patients with Endocrine Disorders

Prepared by: Laverne F. Palencia, RN

 orchestrating cellular interactions

growth & development

metabolism
Endocrine fluid & electrolyte balance

System acid-base balance

adaptation

reproduction
Negative feedback refers to the process of receiving a stimulus and adjusting an output to
regulate an equilibrium.

primary
goals
Major Hormone-Secreting Glands
The Pituitary Gland (hypophysis)
▪ a small, pea-sized gland
located at the base of your
brain below your
hypothalamus.

▪ “master gland”

▪ Divided into anterior and

posterior lobes

▪ Controlled by the
hypothalamus
Pituitary Gland and Hormones Secreted
The Pituitary Gland (hypophysis)
The Pituitary Gland (hypophysis)
Anterior
▪ FSH, LH, prolactin, ACTH,
TSH, GH
▪ Hyper: Cushing’s syndrome,
gigantism, acromegaly
▪ Hypo: dwarfism,
panhypopituitarism
Posterior
▪ ADH, vasopressin
▪ Oxytocin
▪ Hyper: SIADH
▪ Hypo: DI
▪ Tumors: most are benign surgical removal of
▪ Surgery: hypophysectomy the pituitary gland to
treat cancerous or
benign tumors.
What is the difference between SIADH and
DI? With diabetes insipidus, the body has
too little antidiuretic hormone (ADH), and
with SIADH, the body has too much ADH.
Cushing’s Syndrome
• Excessive adrenocortical activity or corticosteroid medications
• Hyperglycemia; central-type obesity with “buffalo hump;” heavy trunk
and thin extremities; fragile, thin skin; ecchymosis; striae; weakness;
lassitude; sleep disturbances; osteoporosis; muscle wasting;
hypertension; “moon-face”; acne; infection; slow healing; virilization in
women; loss of libido; mood changes; increased serum sodium;
decreased serum potassium
• Dexamethasone suppression test
Hypersecretion of the Anterior Pituitary Gland
 Gigantism happens when a child
has high levels of growth
hormone (GH) in their body,
which causes them to grow very
tall. It's caused by a tumor
(macroadenoma) on their
pituitary gland.

Hypersecretion of the Anterior Pituitary Gland

• Acromegaly – hypersecretion of growth
hormone after maturity
• Assessment:
➢Body size enlarged – feet, hands
➢Flat bones enlarged
➢Prognathism
➢Poor coordination
➢Visual field changes

Hypersecretion of the Anterior Pituitary Gland

 Dwarfism
➢hyposecretion of growth hormone before maturity
• Causes:
➢Pituitary tumors
➢Idiopathic hyperplasia
• Assessment:
➢Height below normal, body proportion normal
➢Bone/tooth development retarded
➢Delayed sexual maturity
➢Features delicate

Hyposecretion of the Anterior Pituitary Gland

 Dwarfism
• Management:
➢Monitor growth and development
➢Assess body image
➢Refer for psychological counseling as needed
• Hormone replacement
➢thyroid hormone
➢human growth hormone
➢testosterone

Hyposecretion of the Anterior Pituitary Gland

PITUITARY DISORDERS
• Diagnosis:
➢Growth hormone measured in blood plasma
• Management:
➢Provide safety due to poor coordination
➢Provide emotional support
➢Surgery – hypophysectomy
• Post op care:
➢Elevate head
➢Check neurological status
➢Monitor vital signs
➢Monitor intake and output
➢Provide cortisone replacement therapy
Thyroid Gland
• Thyroid hormones: T3, T4, calcitonin
• Iodine is contained in thyroid hormone
• TSH from the anterior pituitary controls the release of thyroid
hormone
• Controls cellular metabolic activity
• T3 is more potent and rapid-acting than T4
• Calcitonin is secreted in response to high plasma calcium level
and increases calcium deposit in bone
Thyroid Gland and Surrounding Structures
Hypothalamic–Pituitary–Thyroid Axis
Parathyroid Glands

Four glands on the

posterior thyroid gland
Parathyroid Glands
• Parathormone - regulates calcium and phosphorus balance.

▪ Increased parathormone elevates blood calcium by increasing calcium

absorption from the kidney, intestine, and bone
▪ Parathormone lowers phosphorus level
Adrenal Glands
❖Adrenal medulla
▪ Functions as part of the autonomic nervous
system
▪ Catecholamines; epinephrine and
norepinephrine

❖Adrenal cortex
▪ Glucocorticoids
▪ Mineralocorticoids
▪ Androgens
Thyroid Diagnostic Tests
• TSH
• Serum-free T4
• T3 and T4
• T3 resin uptake
• Thyroid antibodies
• Radioactive iodine uptake
• Fine-needle biopsy
• Thyroid scan, radioscan, or
scintiscan
• Serum thyroglobulin
• Refer to Chart 45-2 for
medications that can alter test
results
Thyroid Disorders
• Cretinism
• Hypothyroidism
• Hyperthyroidism
• Thyroiditis
• Goiter
• Thyroid cancer
Hypothyroidism
• Hashimoto Disease
• Chart 45-3
• More than 95% primary dysfunction of the thyroid gland
• Clinical manifestations—Figure 45-5
Question #1
Is the following statement true or false?

• Over secretion of adrenocorticotropic hormone (ACTH) or the

growth hormone results in Graves disease.
Hyperthyroidism
➢Graves disease (most common cause); thyrotoxicosis: excessive
output of thyroid hormone (thyroid storm)
➢Autoimmune disorder
➢Affects women eight times more than men
• Clinical manifestations:
• Nervousness; rapid pulse; heat intolerance; tremors; skin flushed,
warm, soft, and moist; exophthalmos; increased appetite; weight
loss; elevated systolic BP; cardiac dysrhythmias
• Figure 45-6
Hyperparathyroidism
• Incidence: Primary hyperparathyroidism occurs two to four
times more often in women
• Manifestations: the patient may have no symptoms or may
experience signs and symptoms resulting from involvement of
several body systems. Apathy, fatigue, muscle weakness, nausea,
vomiting, constipation, hypertension, and cardiac dysrhythmias
may occur
• Treatment: surgical removal of abnormal parathyroid tissue,
hydration therapy
Hypoparathyroidism
Causes:
• Abnormal parathyroid development
• Destruction of the parathyroid glands (surgical removal or
autoimmune response)
• Vitamin D deficiency
Clinical manifestations:
• Tetany, numbness, tingling in extremities, stiffness of hands and
feet, bronchospasm, laryngeal spasm, carpopedal spasm, anxiety,
irritability, depression, delirium, ECG changes
Tetany, Chvostek and Trousseau Sign
• Tetany: general muscle hypertonia, with tremor and spasmodic or
uncoordinated contractions occurring with or without efforts to make
voluntary movements
• Chvostek sign: a sharp tapping over the facial nerve just in front of the
parotid gland and anterior to the ear causes spasm or twitching of the
mouth, nose, and eye
• Trousseau sign: carpopedal spasm is induced by occluding the blood flow
to the arm for 3 minutes with a blood pressure cuff
Adrenocortical Insufficiency
• Addison’s disease; adrenal suppression by exogenous steroid use
• Muscle weakness, anorexia, GI symptoms, fatigue, dark pigmentation of
skin and mucosa, hypotension, low blood glucose, low serum sodium,
high serum potassium, apathy, emotional lability, confusion
• Addisonian crisis
• Diagnostic tests: adrenocortical hormone levels, ACTH levels, ACTH
stimulation test
Medical Management of Hypo- and
Hyperthyroidism
• Hypothyroidism
• Pharmacologic; Supportive
• Hyperthyroidism
• Radioactive 131I therapy
• Medications:
• Propylthiouracil and methimazole
• Sodium or potassium iodine solutions
• Dexamethasone
• Beta-blockers
• Surgery; subtotal thyroidectomy
Thyroidectomy
• Treatment of choice for thyroid cancer
• Modified or radical neck dissection, possible radioactive iodine to
minimize metastasis
• Preoperative goals: reduction of stress and anxiety to avoid
precipitation of thyroid storm
• Preoperative education: dietary guidance to meet patient’s
metabolic needs, avoidance of caffeinated beverages and other
stimulants, explanation of tests and procedures, and head and
neck support used after surgery
Question #2
Which medication blocks synthesis of thyroid hormone?

A. Dexamethasone
B. Methimazole
C. Potassium iodide
D. Sodium iodide
Management of Hypoparathyroidism
• Increase serum calcium level to 9 to 10 mg/dL
• Calcium gluconate IV
• Pentobarbital to decrease neuromuscular irritability
• Parathormone may be administered; potential allergic reactions
• Quiet environment; no drafts, bright lights, or sudden movement
• Diet high in calcium and low in phosphorus
• Vitamin D
Management of Hyperparathyroidism

• Parathyroidectomy
• Hydration therapy—fluid intake of 2000 mL or more daily
• Maintain mobility
• Don’t restrict calcium
• Parathyroidectomy is surgery to remove the parathyroid glands
or parathyroid tumors
Hypercalcemic Crisis
• Occurs with extreme elevation of serum calcium levels
• Results in neurologic, cardiovascular, and kidney symptoms that
can be life threatening
• Treatment:
• Rapid rehydration with large volumes of IV isotonic saline fluids
• Combination of calcitonin and corticosteroids is administered in
emergencies to reduce the serum calcium level by increasing calcium
deposition in bone
Question #3
Is the following statement true or false?

A patient in acute hypercalcemic crisis requires close monitoring

for life-threatening complications and prompt treatment to reduce
serum calcium levels.
Nursing Interventions for the Patient with
Hyperthyroidism

• Maintaining adequate cardiac output

• Improving nutritional status
• Enhancing coping measures
• Improving self-esteem
• Maintaining normal body temperature
• Monitoring and managing potential complications
• Patient education
Nursing Interventions for the Patient with
Cushing’s Syndrome
• Maintaining adequate cardiac output
• Decreasing risk of injury and infection
• Promoting skin integrity
• Improving body image
• Improving coping
• Monitoring and managing potential complications
• Addisonian crisis
• Patient education
Nursing Process: Endocrine Disorders

• Assessment
• Health history; physical assessment (general and system specific)
• Diagnosis
• Nursing diagnosis; collaborative problems/potential complications
• Planning and Goals
• Nursing interventions
• Monitor for increasing severity of symptoms
• Patient education
• Evaluation
Thank you!
Laverne F. Palencia, RN
palencia.laverne@g.cu.edu.ph