Endocrine System PDF

ENDOCRINE SYSTEM
HANNAH S. IÑIGO, MAN, RN

Philippine Christian University - Dasmariñas
Objectives:
• To learn the different glands involved in the production of different
hormones in our body.
• To know the functions of the different hormones and how it affects our
bodies.
• To be familiarized with the different illnesses involving hormonal
disfunctions.
The Endocrine System
• The endocrine system is a series of glands that produce and secrete
hormones that the body uses for a wide range of functions. These
control many different bodily functions, including:
• Respiration
• Metabolism
• Reproduction
• Sensory perception
• Movement
• Sexual development
• Growth
• Hormones are produced by glands and sent into the bloodstream to the
various tissues in the body. They send signals to those tissues to tell them
what they are supposed to do. When the glands do not produce the right
amount of hormones, diseases develop that can affect many aspects of
life.
Hormone Producing Glands
1. Hypothalamus:
• The hypothalamus is
responsible for body
temperature, hunger, moods
and the release of hormones
from other glands; and also
controls thirst, sleep and sex
drive.
• The hypothalamus is a small
region of the brain. It’s located
at the base of the brain, near
the pituitary gland.
• The hypothalamus is in control of pituitary hormones by releasing the
following types of hormones:
Thyrotrophic-releasing hormone - is the master regulator of thyroid gland
growth and function. These hormones control the body's metabolic rate, heat
generation, neuromuscular function and heart rate.
Growth hormone-releasing hormone
Corticotrophin-releasing hormone - is the main element that drives the
body's response to stress. It is also present in diseases that cause
inflammation. Too much or too little corticotrophin-releasing hormone can
have a range of negative effects.
Gonadotropin-releasing hormone - causes the pituitary gland in the brain to
make and secrete the hormones 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.
2. Pituitary Gland
• The pituitary gland is a tiny organ, the
size of a pea, found at the base of the
brain. As the “master gland” of the
body, it produces many hormones
that travel throughout the body,
directing certain processes or
stimulating other glands to produce
other hormones. The pituitary gland
makes or stores many different
hormones. The following hormones
are made in the anterior (front part)
of the pituitary gland:
• PROLACTIN:
This hormone stimulates breast milk production after childbirth. When
prolactin is high, it affects the hormones that control the ovaries in women
and testes in men. As a result, high prolactin can affect menstrual periods,
sexual function and fertility.
• GROWTH HORMONE (GH)
This hormone stimulates growth in childhood and plays a role in
maintaining healthy muscles and bone and well-being in adults. It also
affects fat distribution in the body. Too much growth hormone causes a
disease that is called acromegaly. In children, too much growth hormone
causes excessive growth, called gigantism.
• ADRENOCORTICOTROPIN (ACTH)
This hormone stimulates the production of
cortisol by the adrenal glands—small glands
that sit on top of the kidneys. Cortisol, a
"stress hormone," is needed for our
survival. It helps maintain blood pressure
and blood glucose (sugar) levels, and is
produced in larger amounts when we’re
under stress, especially during illness,
surgery, or after injury. Too much ACTH will
result in too much cortisol production; this
is called Cushing’s syndrome or Cushing’s
disease. Low ACTH will result in low cortisol,
called adrenal insufficiency.
• THYROID-STIMULATING HORMONE (TSH)
This hormones stimulates the thyroid gland to produce thyroid hormones,
which regulate the body's metabolism, energy balance, growth, and nervous
system activity. Too much TSH is rare and will cause hyperthyroidism (too
much thyroid hormone). Lack of TSH results in hypothyroidism (not enough
thyroid hormone).
• LUTEINIZING HORMONE
(LH)
This hormone stimulates
testosterone production in
men and egg release
(ovulation) in women.
• FOLLICLE-STIMULATING HORMONE (FSH)
This hormone promotes sperm production in men and stimulates the
ovaries to produce estrogen and develop eggs in women. LH and FSH work
together to enable normal function of the ovaries and testes. Problems with
these hormones affects menstrual periods in women and fertility and sexual
function in both women and men.
• ANTIDIURETIC HORMONE (ADH)
This hormone is also called vasopressin,
it regulates water balance in the body
and sodium levels in the blood. It
conserves body water by reducing the
amount of water lost in urine. Lack of
ADH causes increased urination and
thirst, a condition that is called diabetes
insipidus .
• OXYTOCIN
This hormone causes milk to
flow from the breasts in
breastfeeding women, and
may also help labor to
progress. Oxytocin may also
play an important role in
human behavior and social
interaction and may promote
bonding between a mother
and her child.
3. Parathyroid Gland:
• This gland is vital to proper bone development because it helps control both
calcium and phosphorous levels in the body. The parathyroid gland is actually
a group of four small glands located behind the thyroid gland.
• Parathyroid Hormone
Parathyroid hormone helps prevent low
calcium levels by acting on the bones,
intestine, and kidneys. In the bones, the
hormone triggers the release of calcium
stores from the bones to the blood. This can
lead to bone destruction. In the intestines,
parathyroid hormone helps with vitamin D
metabolism. This, in turn, allows the body to
absorb more of the calcium it digests from
food. In the kidneys the hormone stops the
release of calcium through the urine, while
also increasing vitamin D production.
4. Pancreas:
• The main function of the pancreas is
to maintain healthy blood sugar levels.
It is a large gland located behind the
stomach. It produces insulin,
glucagon, and other hormones.
• Diabetes occurs when the pancreas
does not produce enough insulin or
when the body doesn’t use insulin
properly (called insulin resistance).
• Insulin
Essential for life, the hormone insulin regulates many
metabolic processes that provide cells with needed
energy.
Insulin production is regulated based on blood sugar
levels and other hormones in the body. In a healthy
individual, insulin production and release is a tightly
regulated process, allowing the body to balance its
metabolic needs.
Insulin allows the cells in the muscles, fat and liver to
absorb glucose that is in the blood. The glucose serves as
energy to these cells, or it can be converted into fat when
needed. Insulin also affects other metabolic processes,
such as the breakdown of fat or protein.
• Glucagon
Blood sugar levels are an important part of overall health. When blood sugar
levels drop, an individual may feel lethargic. If they drop too low, the
individual may become disoriented, dizzy or even pass out. Blood sugar
control involves a complex system of hormones, and one of those hormones
is glucagon.
Glucagon is a hormone that works with other hormones and bodily functions
to control glucose levels in the blood. It comes from alpha cells found in the
pancreas and is closely related to insulin-secreting beta cells, making it a
crucial component that keeps the body’s blood glucose levels stable.
5. Thyroid Gland:
• Found in both women and men, the thyroid
controls a person's metabolism. It is located in
the front of the neck.
• This gland secretes hormones that govern many
of the functions in your body, such as the way
the body uses energy, consumes oxygen and
produces heat. Thyroid disorders typically occur
when this gland releases too many or too few
hormones. An overactive or underactive thyroid
can lead to a wide range of health problems.
6. Adrenal Glands:
• This gland produces androgens and cortisol. It helps to control blood sugar.
In addition, also helps your body do the following:
Promoting proper cardiovascular function
Helps in how we respond to stress
Properly utilizing carbohydrates and fats
Helps distribute stored fat
Gives you body odor and pubic hair
Promotes healthy gastrointestinal functions
• Cortisol
Cortisol is often called the
"stress hormone" because of
its connection to the stress
response, however, cortisol is
much more than just a
hormone released during
stress.
7. Pineal Gland:
• The pineal gland releases melatonin, which helps the body recognize when it
is time to go to sleep. Researchers continue to learn more about this gland.
• Melatonin
In a healthy, normally functioning individual, melatonin is released in a
rhythmic cycle, with more melatonin produced at night when the light
entering the eyes starts to diminish. The bloodstream carries it to the
different areas of the body, where receptors pick up the melatonin to signal
the need for sleep.
Melatonin is essential to signaling the relaxation and lower body
temperature that help with restful sleep. Levels of melatonin are higher at
night, signaling the body that it is time to rest.
Because it is so connected to sleep, melatonin has been called the "sleep
hormone." However, it is not necessary for sleep, and people can sleep with
inadequate levels of melatonin in the body. That said, the secretion of
melatonin does allow individuals to sleep better.
People do not experience problems with melatonin secreted naturally by
the body. The amount of melatonin produced by the body, whether low or
high, is not associated with any health problems. In fact, in a lifetime,
melatonin levels increase and decrease during the various stages of life.
Low levels of melatonin do not appear to have any serious effects on health
— although it can make sleep difficult to achieve if the levels change.
However, melatonin supplementation as a sleep aid is popular, and
sometimes people will take too much melatonin. This can cause
drowsiness and a reduced core body temperature. Extremely high levels of
melatonin can also contribute to headaches and fatigue. It's also possible
for very large doses of melatonin to affect human reproduction.
8. Ovaries:
• Found in women, this gland produces eggs and sex hormones—
including estrogen, testosterone, and progesterone—which are vital to
reproductive organ development, breast development, bone health,
pregnancy, and fertility.
• Estrogen
is one of two main sex hormones that women have. The other one is
progesterone. Estrogen is responsible for female physical features and
reproduction. Men have estrogen, too, but in smaller amounts.
Estrogen helps bring about the physical changes that turn a girl into a
woman. This time of life is called puberty. These changes include:
Growth of the breasts
Growth of pubic and underarm hair
Start of menstrual cycles
Estrogen helps control the menstrual cycle and is important for childbearing.
Estrogen also has other functions:
Keeps cholesterol in control
Protects bone health for both women and men
Affects your brain (including mood), bones, heart, skin, and other tissues
The ovaries, which produce a woman’s eggs, are the main source of estrogen
from your body. Your adrenal glands, located at the top of each kidney, make
small amounts of this hormone, so does fat tissue. Estrogen moves through
your blood and acts everywhere in your body.
Your body makes three main types of estrogen:
Estradiol (E2): the most common type in women of childbearing age
Estriol (E3): the main estrogen during pregnancy
Estrone (E1): the only estrogen your body makes after menopause (when
menstrual periods stop)
Your estrogen levels change throughout the month. They are highest in the
middle of your menstrual cycle and lowest during your period. Estrogen
levels drop at menopause.
• Progesterone
Progesterone is a steroid hormone belonging to a class of hormones called
progestogens. It is secreted by the corpus luteum, a temporary endocrine
gland that the female body produces after ovulation during the second half
of the menstrual cycle.
 Progesterone prepares the endometrium for the potential of pregnancy
after ovulation. It triggers the lining to thicken to accept a fertilized egg. It
also prohibits the muscle contractions in the uterus that would cause the
body to reject an egg. While the body is producing high levels of
progesterone, the body will not ovulate.
If the woman does not become pregnant, the corpus luteum breaks down,
lowering the progesterone levels in the body. This change sparks
menstruation. If the body does conceive, progesterone continues to
stimulate the body to provide the blood vessels in the endometrium that will
feed the growing fetus. The hormone also prepares the limit of the uterus
further so it can accept the fertilized egg.
Once the placenta develops, it also begins to secrete progesterone,
supporting the corpus luteum. This causes the levels to remain elevated
throughout the pregnancy, so the body does not produce more eggs. It also
helps prepare the breasts for milk production.
• Progestin
Synthetic steroid hormones with progesterone-like properties.
Progestin is often combined with estrogen, another hormone, to develop
contraceptives such as birth control pills and skin patches.
Progestin is also useful in treating common menopausal symptoms.
Progestins were created to bind to progesterone receptors in the body and
create similar effects as progesterone. Progestin can change the lining of the
uterus and stop the lining from building up. Scientists made progestin
because progesterone isn’t absorbed well when taken as a pill.
Progestin can also be used to treat menopause symptoms such as hot
flashes and vaginal dryness.
Progestin can also be prescribed to treat amenorrhea, endometriosis, and
irregular periods.
9. Testes:
• Found in men, this gland produces
testosterone, which promotes the
growth of the penis as a male gets
older as well as facial and body hair.
It also deepens the voice of a male
at a certain age. Other functions of
testosterone include:
Maintaining sex drive
Promoting production of sperm
Maintaining healthy levels of muscle
and bone mass
• Testosterone
Testosterone is the main sex hormone found in men. It controls male
physical features. The testes (testicles) make testosterone. Women have
testosterone too but in much smaller amounts than in men.
Testosterone helps bring on the physical changes that turn a boy into a
man. This time of life is called puberty. Changes include:
Growth of the penis and testes
Growth of facial, pubic, and body hair
Deepening of the voice
Building muscles and strong bones
Getting taller
Men also need normal amounts of this hormone to make sperm and be
able to have children.
The brain and pituitary gland, a small
gland at the base of the brain, control
production of testosterone by the
testes. From there, testosterone
moves through our blood to do its
work.
Your testosterone levels change from
hour to hour. They tend to be highest
in the morning and lowest at night.
Testosterone levels are highest by age
20 to 30 and slowly go down after age
30 to 35.
Factors That Affect Endocrine Function
1. Aging:
• Despite age-related changes, the endocrine system functions well in most
older people. However, some changes occur because of either damage to
cells during the aging process or medical issues that the aging body
accumulates, or genetically programmed cellular changes. These changes
may alter the following:
Hormone production and secretion
Hormone metabolism (how quickly hormones are broken down and leave the body)
Hormone levels circulating in blood
Target cell or target tissue response to hormones
Rhythms in the body, such as the menstrual cycle
1. Acromegaly
• is a rare but serious condition caused by too much growth hormone (GH) in
the blood.
• GH is released into the bloodstream by the pituitary gland, located at the
base of the brain. The blood carries GH to other parts of the body where it
has specific effects.
• In children, GH stimulates growth and development. In adults, GH affects
energy levels, muscle strength, bone health, and one's sense of well-being.
Too much GH in children is called gigantism and is extremely rare.
Acromegaly in adults occurs mainly in middle-aged men and women.
Acromegaly is a very rare condition.
• How is acromegaly diagnosed?
If acromegaly is suspected, your doctor will do a blood test to check
your level of IGF-1. High IGF-1 levels can mean that your levels of GH
are also high.
Another way to diagnose acromegaly is with an oral glucose tolerance
test. In this test, GH levels in the blood are measured after you drink
sugar water. Normally, the sugar water will make the pituitary gland
stop producing GH and blood levels drop. However, a GH-producing
pituitary tumor will not stop making GH, so the levels of GH in the
blood will not change.
• What are the signs and symptoms of acromegaly?
large hands and feet
thick lips
coarse facial features
a jutting forehead and jaw
widely spaced teeth
Often people with acromegaly sweat a lot.
• Treatment:
 Surgery (removal of pituitary tumor)
Radiation therapy
Medication (The most effective
medications for acromegaly are
somatostatin analogs and a GH
receptor antagonist. Another type of
medication (dopamine agonists) works
for some but not most patients. Some
patients may benefit from a
combination of these medicines.)
or a combination of these options.
2. Polycystic Ovary Syndrome (PCOS)
• Polycystic ovary syndrome(PCOS) is a hormone disorder defined by a group of
signs and symptoms. Signs of PCOS include:
Male hormone (androgen) excess
Elevated testosterone levels in blood
Clinical signs of androgen excess such as acne, hair on face and in male pattern on the
body, and thinning hair on the scalp
• Problems with ovulation
Irregular or absent menstrual cycles
Infertility
• PCOS affects 7–10% of women of childbearing age and is the most common
cause of infertility.
• PCOS is the most common hormonal disorder among women of
reproductive age, but many women don’t know they have it.
• Teens with PCOS may have slightly different signs and symptoms. Irregular
cycles are common in normal girls in the first years after periods start
(menarche). Therefore, signs of ovulation problems for girls include irregular
periods more than 2 years after menarche, absence of cycles for more than
3 months, or never having a first period by the time puberty is completed.
Also, heavy or overly frequent periods may be a sign of problems related to
PCOS.
• What causes PCOS?
The exact causes of PCOS are unknown; there are probably more
than one cause and these may be different between individual girls or
women.
Androgen excess (male hormone excess), seen in 60-80% of girls and
women with PCOS, is a key problem in the disorder and likely comes
from ovaries in most women. Insulin resistance or elevated insulin
levels may worsen androgen excess. Abnormalities in how the brain
or pituitary gland communicate with the ovaries may also lead to
androgen overproduction. Other hormones from the ovary or fat
tissue may also be involved.
• PCOS seems to be inherited. Female relatives or children of patients with
PCOS are at increased risk for having PCOS.
• Environmental risk factors, including low birth weight, rapid weight gain in
infancy, early pubic hair and puberty development, childhood obesity,
excess adult weight, and unhealthy lifestyle, are also important and may
interact with genes to lead to PCOS (called epigenetics).
• What health conditions can occur along with PCOS?
Many women with PCOS have decreased sensitivity to insulin, the
hormone that regulates glucose (sugar) in the blood. This condition,
known as insulin resistance, is a major risk factor for type 2 diabetes.
Women with PCOS often have type 2 diabetes, which occurs more
frequently in women with PCOS. Signs of insulin resistance include
weight gain (especially around the waist), acanthosis nigricans (skin
thickening around the neck, armpits, belly, button, and other
creases), and skin tags.
The combination of type 2 diabetes mellitus, low HDL levels (good
cholesterol), and high levels of LDL and triglycerides (bad cholesterol
and blood fat) in women with PCOS may increase the risk of heart
attack or stroke in women with PCOS.
Women with PCOS who are overweight or obese can also develop a
condition called obstructive sleep apnea, when breathing stops
repeatedly during sleep. This condition can worsen the insulin
resistance and cardiovascular problems of women with PCOS.
Women with PCOS may also develop fat accumulation in the liver (non-
alcoholic fatty liver disease), which can lead to liver damage (non-alcoholic
steatohepatitis) and fibrosis over time.
Because of irregular menstrual cycles and lack of ovulation, the lining of the
uterus may not shed as often as it should. Left untreated, this may increase
the risk of cancer of the uterine lining (endometrium).
Adolescents and women with PCOS are also at higher risk for depression and
anxiety. Women with PCOS, especially who are overweight, may experience
pregnancy complications, including gestational diabetes, preterm delivery, or
pre-eclampsia.
• How is PCOS diagnosed?
Along with irregular periods, the first signs of PCOS may be the growth of
facial and male-patterned body hair, thinning scalp hair, acne, and weight
gain. Weight gain, however, is not always present. Normal-weight women can
also have PCOS.
In addition to assessing signs and symptoms of PCOS, medical providers take
a medical history, perform a physical exam, and check blood hormone levels
(including testosterone). They may also perform an ovarian ultrasound. Other
tests looking for complication of PCOS may also be done, such as glucose
tolerance test or a mental health screening survey.
• How is PCOS treated?
While PCOS is not curable, symptoms are treatable with medications and
changes in diet and exercise. Hormonal imbalances can be treated with birth
control pills, androgen blocking medications, or medications that help the
body use insulin better. Medications that help the body respond better to
insulin may also be helpful. For women whose infertility problems are not
resolved with lifestyle changes alone, medications that improve ovulation
(fertility drugs) may be helpful.
3. Hirsutism
• Hirsutism is excessive growth of "male"
pattern hair that appear on the face,
back, chest, abdomen, and thighs in
women. Hirsutism is common and is
usually a sign of an underlying endocrine
disorder, most commonly, polycystic
ovary syndrome (PCOS). In women with
PCOS, weight gain probably contributes
to its development or worsening. There
are available treatments that can help
decrease and slow hair growth to
improve overall quality of life.
• Hirsutism may be caused by other disorders of male hormone
overproduction, but these are not common. Medications such as anabolic
steroids that contain male hormones can cause hirsutism.
• When a woman has hirsutism but does not have high levels of androgens, this
is called “idiopathic hirsutism” because the specific cause of the excessive
hair growth cannot be identified.
• How is Hirsutism Treated?
Most women start with an oral contraceptive (birth control pill) and if they
are not pleased with the improvement after six months, a second medication
called an antiandrogen can be added. All birth control pills work about the
same for hirsutism.
Direct hair removal methods like electrolysis or laser removal are also very
effective, but more than one treatment is required and it is expensive.
Women should stay on their medication when they do laser to prevent the
hair from growing back. Laser therapy works best for women with light skin
and dark hair. Complications are more common in women with dark skin, or
of Middle Eastern and Mediterranean descent. These women should have a
consultation with a specialist before considering laser treatments.
• Some studies have found weight loss is associated with slight improvement
in unwanted hair growth. Women with hirsutism and PCOS should consider
making lifestyle changes to improve their overall health. Diagnosis and
treatment are important for preventing other problems from underlying
medical conditions causing the androgen excess.
4. Cushing Syndrome
• is a disorder with physical and mental changes that result from having too
much cortisol in the blood for a long period of time. Cortisol is a steroid
hormone produced by the adrenal glands, located above the kidneys. In
normal amounts, cortisol helps the body:
Respond to stress
Maintain blood pressure and cardiovascular function
Keep the immune system in check
Convert fat, carbohydrates, and proteins into energy
• What causes Cushing syndrome?
The most common cause of Cushing syndrome exogenous Cushing
syndrome due to people taking cortisol-like medications such as prednisone.
These drugs are used to treat inflammatory disorders such as asthma and
rheumatoid arthritis. They also suppress the immune system after an organ
transplant. This type of Cushing syndrome is temporary and goes away after
the patient has finished taking the cortisol-like medications.
Endogenous Cushing syndrome, in which the adrenal glands produce
too much cortisol, is uncommon. It usually comes on slowly and can
be difficult to diagnose. This type of Cushing syndrome is most often
caused by hormone-secreting tumors of the adrenal glands or the
pituitary, a gland located at the base of the brain. In the adrenal
glands, the tumor (usually non-cancerous) produces too much
cortisol. In the pituitary, the tumor produces too much ACTH—the
hormone that tells the adrenal glands to make cortisol. When the
Cushing syndrome is due to a pituitary tumor, it is called Cushing
disease.
• What are the signs and symptoms of Cushing syndrome?
Weight gain, especially in the upper body
Rounded face and extra fat on the upper back and above the collarbones
High blood sugar (diabetes)
High blood pressure (hypertension)
Thin bones (osteoporosis)
Muscle loss and weakness
Thin, fragile skin that bruises easily
Purple-red stretch marks (usually over the abdomen and under the arms)
Depression and difficulties thinking clearly
Too much facial hair in women
• How is Cushing syndrome diagnosed?
Three tests are commonly used to diagnose Cushing syndrome. One of the
most sensitive tests measures cortisol levels in the saliva between 11:00
p.m. and midnight. A sample of saliva is collected in a small plastic container
and sent to the laboratory for analysis. In healthy people, cortisol levels are
very low during this period of time. In contrast, people with Cushing
syndrome have high levels.
Cortisol levels can also be measured in urine that has been collected over a
24-hour period.
In another screening test, people with suspected Cushing syndrome have
their cortisol levels measured the morning after taking a late-night dose of
dexamethasone, a laboratory-made steroid. Normally, dexamethasone
causes cortisol to drop to a very low level, but in people with Cushing
syndrome, this doesn’t happen.
• How is Cushing syndrome treated?
Exogenous Cushing syndrome goes away after a patient stops taking the
cortisol-like medications they were using to treat another condition. Your
doctor will determine when it is appropriate for you to slowly decrease and
eventually stop using the steroid medication. These medications need to be
stopped gradually.
For endogenous Cushing syndrome, the initial approach is almost always
surgery to remove the tumor that is causing high cortisol levels. Although
surgery is usually successful, some people may also need medications that
lower cortisol or radiation therapy to destroy remaining tumor cells. Some
people must have both adrenal glands removed to control Cushing
syndrome.
5. Diabetes Mellitus
• Diabetes occurs when the pancreas, a gland behind the stomach, does not
produce enough of the hormone insulin, or the body can't use insulin
properly. Insulin helps carry sugar from the bloodstream into the cells. Once
inside the cells, sugar is converted into energy for immediate use or stored
for the future. That energy fuels many of our bodily functions.
• Types of Diabetes Mellitus
Type 1 diabetes occurs when the pancreas makes very little or no insulin.
People with type 1 diabetes must take insulin every day to replace the insulin
their bodies are not making. This form of the disease is most often seen in
children. It used to be called or juvenile diabetes, but it can occur at any age.
Type 2 diabetes is the most common form of the disease, affecting 90–95%
of people with diabetes. In type 2 diabetes, the body is resistant to the
action of insulin, meaning it cannot use insulin properly, so it cannot carry
sugar into the cells. Although the body makes some insulin, it is not enough
to overcome this resistance. You are more likely to develop type 2 diabetes if
you are overweight, have a family history of diabetes, or have a history of
diabetes during pregnancy. Other groups more likely to have the disease are
people over age 45 and non-Caucasians. A simple blood test can tell you if
you have diabetes.
Gestational Diabetes is a temporary form of diabetes that can occur when a
woman is pregnant. Gestational diabetes often has no symptoms, so most
women are tested for blood sugar problems at some point in their
pregnancy. If a woman has high blood sugar, she will have to follow a special
diet for the rest of the pregnancy. In some cases, she may also need to take
insulin. About 3–5% of pregnant women develop gestational diabetes.
Gestational diabetes occurs more often in African Americans, Native
Americans, Hispanic Americans, Asian Americans, women with a family
history of diabetes, and those who are overweight. Although this form of
diabetes usually disappears after the baby is born, more than half of women
with gestational diabetes develop type 2 diabetes later in life.
• How do you get screened for diabetes?
Fasting blood glucose test (FBG/ FBS). Blood is drawn in the morning after
you go without food overnight or for at least 8 hours.
Oral glucose tolerance test (OGTT). This test is also done in the morning
after going without food overnight or for at least 8 hours. Blood is drawn
before you drink 8 ounces of a sugar solution and 2 hours after. This test is
more precise but less convenient than the FBG test.
Hemoglobin A1C test (A1C/ HbA1C).This test shows what your average
blood glucose levels have been over the past 2–3 months. You can eat and
drink normally before the test.
• Management
Whether or not you need diabetes medications or insulin, adopting a
healthy lifestyle that includes eating well, losing weight if needed,
exercising, limiting alcoholic beverages, and not smoking will help you
better manage your diabetes.
• Treatment/ Medication
 Metformin
Insulin
• How to Prepare for Hypoglycemia
Your heart is racing, your head aches, you feel shaky, and you’re in a cold
sweat. Your blood glucose is dropping to a dangerously low level, and you’re
feeling the effects. With diabetes, it’s essential to always be ready for
hypoglycemia, or low blood glucose. It could save your life.
It becomes severe when levels are below 40 mg/dL. People with severe
hypoglycemia are not able to function because physical and mental changes
occur.
Certain diabetes medicines raise the risk of developing hypoglycemia. These
medicines include insulin and sulfonylureas. In fact, for people with
diabetes, nearly one in five hospitals stays is due to severe hypoglycemia.
If you don’t have noticeable symptoms, this is called hypoglycemia
unawareness. It’s most common in people taking insulin who have
chronically low blood glucose. If your glucose numbers are often in the 60s,
but you don’t feel any changes, talk with your healthcare provider. The more
you know, the better prepared you can be when hypoglycemia happens.
• Wear an emergency medical identification tag.
• Identify hypoglycemia. Be alert for signs of hypoglycemia. They may vary
depending on how low your glucose levels go.
• Be ready to act quickly. Check your blood glucose. If it's below 70 mg/dL,
you need to act right away. There is an easy way to remember what to do.
Just think about the number 15: Consume 15 grams of a fast-acting sugar
source. This could be glucose tablets or gel. Or it could be fruit juice, regular
(not diet) soda, or hard candies.
• Recheck your blood glucose after 15 minutes. If it is 70 mg/dL or above, eat
a meal or snack. If it is low, repeat the steps above.
• Keep extra glucose testing supplies on hand for these kinds of situations.
You may need to test multiple times if your glucose level drops or changes
frequently.
• For severe symptoms: If your blood glucose falls very low, you may be
unable to swallow a fast-acting sugar source. You might have a seizure or
become unconscious. Emergency glucagon is the rescue medicine for this
situation. Glucagon is a hormone that works with other hormones to control
glucose levels.
• Manage frequent changes in blood glucose. Your healthcare provider
may set target ranges for your blood glucose at various times of the
day. Check your blood glucose as recommended. The results can help
you make appropriate adjustments to your diet, exercise, or
medicine, which can lead to better control of your diabetes.
• Stay calm. Panicking can only make things worse. Remind yourself
that you've already prepared to handle this situation.
• Get an emergency glucagon kit. Glucagon is the only emergency
rescue treatment for severe hypoglycemia. It should always be kept
nearby and may need to be administered by a family member, friend,
or caregiver, especially if you are disoriented or unconscious.
• Plan the quickest route to an emergency facility.
• Keep important phone numbers visible.
• Diabetes Complications
The high blood sugar of mismanaged diabetes can result in
dangerous complications. Diabetes is the most common cause of
blindness, kidney failure, and non-traumatic amputation of the toes,
feet, or legs. Mismanaged diabetes can also lead to heart disease,
stroke, and the nerve damage and decreased blood flow that can
lead to amputation. People with diabetes may have life-threatening
reactions to extremely high blood sugar, as well as extremely low
blood sugar caused by diabetes medications.
Keeping your glucose levels close to normal will greatly lower your chances
of developing long-term complications. If you already have complications,
keeping your glucose levels close to normal will help keep these problems
from getting worse.
 Diabetic Neuropathy
 Diabetic Retinopathy
 Hypoglycemia
 Kidney Disease
 Heart Disease
6. Hyperthyroidism
• Hyperthyroidism is a condition in which the thyroid gland is overactive and
produces too much thyroid hormone. If left untreated, hyperthyroidism can
lead to other health problems. Some of the most serious involve the heart
(rapid or irregular heartbeat, congestive heart failure) and the bones
(osteoporosis).
• What causes hyperthyroidism?
Graves disease is the most common cause of hyperthyroidism. It occurs
when the immune system attacks the thyroid gland, causing it to enlarge and
make too much thyroid hormone. It typically runs in families with a history of
thyroid disease or other autoimmune conditions. Some people with Graves'
disease also develop swelling behind the eyes that causes the eyes to bulge
outward.
• What are the signs and symptoms of hyperthyroidism?
Feeling too hot
Increased sweating
Muscle weakness
Trembling hands
Rapid heartbeat
Tiredness/fatigue
Weight loss
Diarrhea or frequent bowel movements
Irritability and anxiety
Eye problems, such as irritation or discomfort
Menstrual irregularities
Infertility
• How is hyperthyroidism diagnosed?
 Thyroid Stimulating Hormone (TSH) Test: TSH is a hormone released from
your pituitary gland when there is not enough thyroid hormone in the system.
TSH will be low if there is too much thyroid hormone (hyperthyroidism).
Free T4 and total T3 test: T3 and T4 are thyroid hormones and these will be
high in hyperthyroidism.
It is important to know that biotin can interfere with the testing of thyroid
function in many labs, and you should check with your doctor to see if you
should stop your biotin supplement beforehand.
• To determine the type of hyperthyroidism you have, your doctor may do
different tests:
A thyrotropin receptor antibody test (TRAb) which can be elevated in Graves disease.
A radioactive iodine uptake test to measure how much iodine your thyroid collects
from the bloodstream (certain conditions have low uptake and others have high
uptake)
A thyroid ultrasound to look at size of the thyroid and if there nodules
• How is hyperthyroidism treated?
Treatment for hyperthyroidism will depend on its cause, your age and physical
condition, and how serious your thyroid problem is. Sometimes, only observation is
needed, but most of the time, some treatment is helpful. Available treatments include:
 Antithyroid medications. These drugs lower the amount of hormone the thyroid gland
makes. The preferred drug is methimazole. For pregnant or breastfeeding women,
propylthiouracil (PTU) may be preferred. Because PTU has been linked to greater side
effects, it is not used routinely outside of pregnancy. Both of these drugs control, but
may not cure, hyperthyroidism. These medications have important side effects that
should be discussed with your doctor.
 Radioactive iodine. This treatment will cure the thyroid problem, but usually
leads to permanent destruction of the thyroid. You will likely need to take
thyroid hormone pills for the rest of your life to provide normal hormone
levels. This treatment is generally tolerated very well, but can worsen Graves
eye disease if it is present.
 Surgery. Surgical removal of the thyroid gland (thyroidectomy) is a permanent
solution, but not usually preferred, because of the risk of damage to the
nearby parathyroid glands (which control calcium levels in the body) and to
the nerves to the larynx (voicebox). Doctors may recommend surgery when
either antithyroid medication or radioactive iodine therapy would not be
appropriate.
 Beta blockers. These drugs (such as atenolol) do not lower thyroid
hormone levels, but can control many troubling symptoms, especially
rapid heart rate, trembling, and anxiety.
 If hyperthyroidism is caused by too much thyroid (levothyroxine)
medication, then your doctor may have you decrease your dose.
7. Hypoparathyroidism
• Your parathyroid glands are four pea-sized glands located in your
neck that make parathyroid hormone (PTH). They play an important
role in bone development and control the amount of calcium in the
blood. You can get hypoparathyroidism when you have too little PTH.
This can happen if your parathyroid glands get damaged during
surgery on your thyroid gland, throat, or neck. Sometimes one or
more parathyroid glands are removed if they’re making too much
PTH. Hypoparathyroidism also can be hereditary (runs in families).
Other causes include:
Autoimmune disease (when your body’s defense system attacks your own
cells)
Radiation therapy to your head or neck (e.g. as part of therapy for cancer)
Low levels of magnesium (a mineral) in the blood
Damage of parathyroid glands due to inflammatory disorders:
 Sarcoidosis: is a disease characterized by the growth of tiny collections of
inflammatory cells (granulomas) in any part of your body — most commonly the
lungs and lymph nodes. But it can also affect the eyes, skin, heart and other organs.,
 Amyloidosis: is a rare disease that occurs when an abnormal protein, called amyloid,
builds up in your organs and interferes with their normal function. Amyloid isn't
normally found in the body, but it can be formed from several different types of
protein.
Mineral buildup (copper or iron)
Transiently due to severe illness
• What are the symptoms of hypoparathyroidism?
Muscle spasms, cramps, and/or pain in your legs, feet, stomach, or face
Weakness
Hair loss
Dry hair and dry skin
Tingling in your fingers, toes, and lips
Pain with menstrual periods
Headaches
Memory problems
Depression
• What health problems can hypoparathyroidism cause?
When children have hypoparathyroidism, they might grow poorly, have tooth
problems such as delayed tooth development or a lot of cavities, and have
slow mental development.
In adults, hypoparathyroidism can lead to kidney problems (such as kidney
stones, kidney failure), heart problems, and calcium deposits in the brain.
Calcium in the brain can cause tremors, slowed movement, balance
problems, and seizures.
• Hypoparathyroidism can be linked to other health problems, such as
cataracts, Addison disease (problems with your adrenal glands), and
pernicious anemia (low vitamin B12 levels).
• Calcium requirements increase in pregnancy to meet the needs of the
developing baby, mainly during the 3rd trimester. Hypoparathyroidism
during pregnancy can increase the risk of preterm labor or miscarriage in
the mother and respiratory distress (difficulty to breath) in the baby.
• How is hypoparathyroidism diagnosed?
Your doctor will do a blood test to check levels of calcium, phosphorus,
magnesium, and PTH. You also might have a urine test to show how much
calcium you are losing in your urine.
• What is the treatment for hypoparathyroidism?
You will take calcium and vitamin D supplements to keep your blood calcium
levels normal. Depending on the cause of your hypoparathyroidism, you may
need to take the supplements for the rest of your life. PTH replacement
therapy is also available in injectable form. Your doctor may prescribe PTH
therapy if your calcium level in the blood does not normalize or you continue
having symptoms, despite taking large doses of calcium and vitamin D
supplements. Injecting PTH may decrease the need to take too many calcium
and vitamin D supplements. Your doctor might also give you medicines, such
as diuretics (water pills) to prevent too much calcium from leaving your body
in your urine. Your doctor will check your blood levels regularly.
• During pregnancy your doctor will closely monitor your calcium,
phosphorous, magnesium levels and kidney function.
• You might need to follow a diet high in calcium and low in phosphorus. A
registered dietitian can help you plan a special diet.
Good Sources of Calcium: Milk, yogurt, cheese, collard greens, and foods with added
calcium, such as cereal and soy drinks.
Good Sources of Vitamin D: Salmon, shrimp, and milk with vitamin D. Vitamin D is
also made in your skin when you spend time in the sun.
Foods High in Phosphorus (to avoid): Protein foods such as meat, milk, hard cheeses,
whole grains, dried peas and beans, nuts, and chocolate.
8. Hypothyroidism
• Hypothyroidism means you have too little thyroid hormone. Another term is
an “under-active thyroid.” Hypothyroidism is the most common thyroid
disorder. It occurs more often in women and people over age 60.
Hypothyroidism tends to run in families.
• Symptoms may include:
Tiredness/sluggishness
Mental depression
Feeling cold
Weight gain (only 5–10 pounds or 2–4 kg)
Dry skin and hair, as well as hair loss
Constipation
Menstrual irregularities
• These symptoms are not unique to hypothyroidism. A simple blood test can
tell whether the symptoms are due to hypothyroidism or some other cause.
People with mild hypothyroidism may not have any symptoms at all.
• What causes hypothyroidism?
In adults, Hashimoto's disease is the most common cause of hypothyroidism in
industrialized countries (iodine deficiency is the most common cause in the rest of the
world). In Hashimoto, your immune system attacks and damages your thyroid, so it
can't make enough thyroid hormone. Hypothyroidism can also be caused by
radioactive iodine treatment or surgery on the thyroid gland, which are used to treat
other types of thyroid disorders. A problem with the pituitary gland is another rare
cause. Congenital hypothyroidism is present from birth and occurs when the thyroid
gland does not develop properly.
• How can hypothyroidism affect your health?
• In adults, untreated hypothyroidism leads to poor mental and physical
performance. It also can cause high blood cholesterol levels that can lead to
heart disease. A life-threatening condition called myxedema coma can
develop if severe hypothyroidism is left untreated.
• Myxedema coma: is a rare, life-threatening clinical condition that
represents severe hypothyroidism with physiologic decompensation. [3, 4]
The condition usually occurs in patients with long-standing, undiagnosed
hypothyroidism and is most often precipitated by infection, cerebrovascular
disease, heart failure, trauma, or drug therapy. Patients with myxedema
coma are generally severely ill, with significant hypothermia and depressed
mental status.
• Patients with myxedema coma should be treated in an intensive care unit with
continuous cardiac monitoring. Initial steps in therapy include airway management,
thyroid hormone replacement, glucocorticoid therapy, and supportive measures.
• Signs and symptoms of myxedema coma. Physical findings may include the
following:
Hypothermia
Hypotension
Bradycardia
Decreased pulse pressure, normal systolic pressure, elevated diastolic pressure
Decreased respiratory rate
Periorbital puffiness
Macroglossia
Coarse or thinning hair
Thyroid is commonly small
Slow respiratory rate
Signs of pleural effusion
Soft or distant heart sounds, diminished apical impulse, pericardial effusion
Abdominal distention due to ascites
Diminished or absent bowel sounds due to ileus
Bladder distension
Cold extremities, nonpitting edema of the upper and lower extremities
Cool, pale, dry, scaly, and thickened skin
Dry, brittle nails
Ecchymoses, purpura
Confusion, stupor, slow speech, delayed reflexes, seizures, coma
• Diagnosis of hypothyroidism is especially important in pregnancy. Untreated
hypothyroidism in the mother may affect the baby's growth and brain
development.
• All babies are tested at birth for hypothyroidism. If not treated promptly, a
child with hypothyroidism could have an intellectual disability or fail to grow
normally.
• Hypothyroidism and Heart Health
Studies show that hypothyroidism can also increase the risk for heart
disease. The thyroid hormones affect heart rate and the how much blood is
pumped by the heart. Hypothyroidism also increases the risk for higher levels
of “bad” cholesterol, triglycerides, and other fats related to heart disease. In
addition, pericardial effusion (fluid around the heart) and congestive heart
failure (inability of the heart to pump blood forward) are possible heart
conditions that might develop with severe hypothyroidism.
• Other potential problems may include high blood pressure, heart
enlargement, increased strain on the heart and stiffness of blood vessel
walls, as well as a low heart rate.
• To lower the risk of heart-related problems due to hypothyroidism, it's
important to schedule routine checkups and monitor your blood pressure, as
well as your cholesterol levels.
• If left untreated, problems can occur from heart disease. This may include:
Congestive heart failure
Heart attack
Stroke
Peripheral artery disease
Sudden cardiac arrest
• Heart-related problems due to hypothyroidism can be treated. It's important
to make regular appointments with your doctors to check your blood
pressure and cholesterol levels. You may also consider asking your doctor if
medication to treat heart problems is needed.
• How is hypothyroidism diagnosed?
Blood tests can measure your levels of thyroid-stimulating hormone (TSH)
and thyroid hormone (T4). You have hypothyroidism when you have high
TSH and low T4 levels in your blood. In very early or mild hypothyroidism,
TSH will be high but T4 may be normal. In this case, your doctor may
measure the thyroid levels more frequently to determine if hypothyroidism
develops over time. When the cause of hypothyroidism is Hashimoto
disease, blood tests can detect anti-thyroid antibodies that attack the
thyroid.
• How is hypothyroidism treated?
• Hypothyroidism is treated with thyroid hormone medication, taken as a pill.
Levothyroxine is the drug of choice. It is a synthetic (laboratory-made) form
of T4 that is identical to the T4 the thyroid naturally makes.
• Most people need thyroid hormone replacement for life. If the brand or
dosage needs to be changed, you should have blood tests for TSH done
again. Your dose will be adjusted based on your TSH tests. Over time, doses
of thyroid hormone that are too high can lead to bone loss, abnormal heart
function, and abnormal heart rhythms. Doses that are too low may not
relieve your symptoms. Dose adjustment may be necessary over your
lifetime, including during pregnancy. You can discuss dose changes during
your regular check-ups with your doctor.

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ENDOCRINE SYSTEM

HANNAH S. IÑIGO, MAN, RN

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