Exocrine Glands

◼ Exocrine glands have ducts that carry their secretory product to a surface. These
glands include the sweat, sebaceous, and mammary glands and, the glands that
secrete digestive enzymes.
Endocrine Glands
◼ The endocrine glands do not have ducts to carry their product to a surface. They are
called ductless glands.

The endocrine glands do not have ducts to carry their product to a surface. They are called
ductless glands.
The word endocrine is derived from the Greek terms "endo," meaning within, and
"krine," meaning to separate or secrete. The secretory products of endocrine glands are
called hormones and are secreted directly into the blood and then carried throughout the
body where they influence only those cells that have receptor sites for that hormone.

The nervous system uses electrical impulses to send messages through neurons while endocrine
glands use hormones to send messages to the target cells through the bloodstream.
The endocrine system is the collection of glands that produce hormones that regulate
metabolism, growth and development, tissue function, sexual function, reproduction, sleep, and
mood, among other things.

▪ The endocrine system is

made up of the endocrine glands
that secrete hormones.
Major glands:
 Pituitary
 Thyroid
 Parathyroid
 Adrenals
 Pancreas (Islets)
 Gonads: ovaries and testes

-Although the hormones circulate throughout the body, each type of hormone is
targeted toward certain organs and tissues, the Merck Manual notes. The
endocrine system gets some help from organs such as the kidney, liver, heart and
gonads, which have secondary endocrine functions. The kidney, for example,
secretes hormones such as erythropoietin and renin.
The thyroid also secretes a range of hormones that affect the whole body.
"Thyroid hormones impact a host of vital body functions, including heart rate, skin
maintenance, growth, temperature regulation, fertility and digestion,

DUCTLESS GLANDS BECAUSE THEY DON’T HAVE THEIR OWN DUCTS TO CARRY THEIR
PRODUCT TO A SURFACE.
Target tissue: with no direct connection between the endocrine gland and the target tissue.
As hormones travel through the body, they can only recognize their target tissue. Each
receptor site type is specific to only one hormone.
Only the correct hormone can connect to the correct receptor.
Once the hormone binds to the site the target tissue will change the tissues activity.

Steroids: from cholesterol

- Steroids and thyroid hormone are hydrophobic and use transport proteins.
Transport proteins also extend half-life.
- The body does not produce enzymes to break down most steroids, thus, steroids and
thyroid hormone can be taken orally. Peptide hormones, however, are quickly
digested in the stomach, necessitating a different route for HRT (e.g. diabetics must
inject insulin).
- Epinephrine, which helps regulate the fight-or-flight response, is an amine hormone.

Many endocrine glands are linked to neural control centres by homeostatic feedback
mechanisms. The two types of feedback mechanisms are negative feedback and positive
feedback. Negative feedback decreases the deviation from an ideal normal value, and is
important in maintaining homeostasis. Most endocrine glands are under the control of negative
feedback mechanisms.

- Keep concentration of hormones in bloodstream constant

- mechanism for regulation of hormone concentration in the bloodstream

The body must maintain homeostasis to respond to environmental changes.

- The endocrine system is responsible for regulating a range of bodily functions

through the release of hormones.
- Hormones are secreted by the glands of the endocrine system, traveling through the
bloodstream to various organs and tissues in the body. The hormones then tell these
organs and tissues what to do or how to function
The pituitary gland or hypophysis is a round structure about 1.27 cm (1/2 inch) in diameter
located on the inferior aspect of the brain.
Commonly referred to as the master gland, the pituitary secretes hormones that control the
secretion of hormones by the endocrine glands.
It is controlled by the hypothalamus.
It is approximately the size of a grape.
It hangs by a stalk from the inferior surface of the hypothalamus of the brain, where it is snugly
surrounded by the “turk’s saddle” of the sphenoid bone.
2 functional lobes:
Anterior pituitary (glandular tissue)
Posterior pituitary (nervous tissue)

- There are two distinct regions in the gland:

- the anterior lobe (adenohypophysis) - The activity of the adenohypophysis is
controlled by releasing hormones from the hypothalamus
- and the posterior lobe (neurohypophysis).. The neurohypophysis is controlled
by nerve stimulation.

Hormones of the Anterior Lobe (Adenohypophysis)

▪ Growth hormone (GH)- is a protein that stimulates the growth of bones, muscles,
and other organs by promoting protein synthesis.
▪ Thyroid-stimulating hormone, or thyrotropin (TSH)- causes the glandular cells
of the thyroid to secrete thyroid hormone.
◼ Adrenocorticotropic hormone (ACTH)- reacts with receptor sites in the cortex of
the adrenal gland to stimulate the secretion of cortical hormones,
particularly cortisol.

◼ Gonadotropic hormones - react with receptor sites in the gonads, or ovaries and
testes, to regulate the development, growth, and function of these organs.
 ◼ Prolactin hormone - promotes the development of glandular tissue in the
female breast during pregnancy and stimulates milk production after the birth of the
infant.

▪ Follicle stimulating hormone (FSH)- Ovarian follicle maturation, stimulates estrogen

and sperm production

-ACTH controls the production of another hormone called cortisol. Cortisol is made by the
adrenal glands, two small glands located above the kidneys. Cortisol plays an important role in
helping you to: Respond to stress.

Hormones of the Posterior Lobe (Neurohypophysis)

◼ Antidiuretic hormone (ADH)- promotes the reabsorption of water by

the kidney tubules, with the result that less water is lost as urine.
◼ Oxytocin- causes contraction of the smooth muscle in the wall of the uterus.

-Growth hormone fuels childhood growth and helps maintain tissues and organs
throughout life.
-Prolactin causes the breasts to grow and make milk during pregnancy and after birth.
Prolactin levels are normally high for pregnant women and new mothers.
-The main function of adrenocorticotropic hormone is to stimulate your adrenal glands
to release cortisol. Cortisol is an essential hormone that affects almost every organ
and tissue in your body.
- The pituitary gland makes thyroid stimulating hormone (TSH). TSH tells your thyroid
how much thyroid hormone it needs to make. If the thyroid hormone levels in your
blood are too low, your pituitary gland makes larger amounts of TSH to tell your thyroid
to work harder.

- Why are FSH and LH called Gonadotropic hormones?

- Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are called

gonadotropins because stimulate the gonads - in males, the testes, and in females,
the ovaries. They are not necessary for life, but are essential for reproduction.

POSTERIOR PITUITARY
- Oxytocin is a natural hormone that manages key aspects
of the female and male reproductive systems, including
labor and delivery and lactation, as well as aspects of
human behavior.
What does ADH hormone do?

- A hormone that helps blood vessels constrict and helps the kidneys control
the amount of water and salt in the body. This helps control blood pressure
and the amount of urine that is made.
-

THYROID GLAND
▪ Is a butterfly-shaped organ located in the lower neck, anterior to the trachea.
▪ The blood flow to the thyroid is very high (about 5ml/min per gram of thyroid
tissue.
▪ It is a fairly large gland consisting of two lobes joined by a central mass, or isthmus.
The gland is about 5 cm long and 3 cm wide and weighs about 30 g
Easily palpated during PE

THYROXINE (T4)
TRIIODOTHYRONINE (T3)- It plays an important role in the body's control of
metabolism (the many processes that control the rate of activity in cells and
tissues
INC METABOLIC ACTIVITY OF ALL CELLS
STIMULATES FAT, PROTEIN AND CARBO METABOLISM
THYROCALCITONIN
LOWERS SERUM CALCIUM LEVELS AND ELEVATES PHOSPHATE LEVEL; OPPOSITE
EFFECT FR THAT OF PTH
- T3 denotes the active thyroid hormone whereas the T4 denotes the
precursor of the thyroid hormone produced by the thyroid gland. Thus, T3
and T4 are the two forms of thyroid hormone that control metabolism. T3 is
known as triiodothyronine while T4 is known as thyroxine
PARATHYROID GLAND
PARATHORMONE (PTH)
INC. CALCIUM LEVELS AND DECREASES PHOSPHATE LEVELS
INC. RESORPTION OF BONES
-
- The parathyroid hormone produced by the thyroid glands
helps maintain the right balance of calcium in the
bloodstream and in tissues that depend on calcium for
proper functioning.

ADRENAL CORTEX
GLUCOCORTICOIDS (PRIMARILY CORTISOL)-SUGAR
PROMOTES CARBO, PROTEIN AND FAT CATABOLISM
INCREASES TISSUE RESPONSIVENESS TO OTHER HORMONES
MINERALOCORTICOIDS (ALDOSTERONE) – SALT
TENDS TO INC SODIUM RETENTION AND POTASSIUM EXCRETION
ANDROGENS (MALE HORMONE)- SEX
GOVERNS CERTAIN SEX CHARACTERISTICS
ALL CORTICOIDS ARE IMPORTANT FOR DEFENSE AGAINST STRESS OR INJURY
In simple terms, a negative feedback loop means that as something increases, the production of
whatever is causing the increase slows down. When blood concentrations of thyroid
hormones increase above a certain threshold, TRH-secreting neurons in the hypothalamus
are inhibited and stop secreting TRH.
The release of oxytocin from the posterior pituitary gland during labor is an example of
positive feedback mechanism. Oxytocin stimulates the muscle contractions that push the baby
through the birth canal. The release of oxytocin result in stronger or augmented contractions
during labor
The term corticosteroids refer to steroid hormones secreted by the adrenal cortex.
Corticosteroids are involved in a wide range of physiologic systems such as stress response,
immune response, regulation of inflammation, carbohydrate metabolism, protein catabolism,
blood electrolyte levels, and behavior. The principal mineralocorticoid is aldosterone, which
acts to conserve sodium ions and water in the body. Renin is a hormone made by the kidneys.
It controls the production of another hormone called aldosterone, which is made in the adrenal
glands.

Glucocorticoid hormones regulate essential body functions in mammals, control cell

metabolism, growth, differentiation, and apoptosis.
Cortisol- It helps control the body's use of fats, proteins and carbohydrates; suppresses
inflammation; regulates blood pressure; increases blood sugar; and can also decrease bone
formation.
The pinealocytes synthesize the hormone melatonin and secrete it directly into
the cerebrospinal fluid, which takes it into the blood. Melatonin affects reproductive
development and daily physiologic cycles.
MELATONING- SLEEP HORMONE

Pancreas- This gland has an exocrine portion that secretes digestive enzymes that
are carried through a duct to the duodenum.
▪ The endocrine portion consists of the pancreatic islets, which
secrete glucagons and insulin.
▪ Alpha cells in the pancreatic islets secrete the hormone glucagons
in response to a low concentration of glucose in the blood.
▪ Beta cells in the pancreatic islets secrete the hormone insulin in response to a
high concentration of glucose in the blood.

Pineal Glands or pineal body or epiphysis cerebri

The Islets of Langerhans.

Explanation:
Within the pancreas, there are isolated clusters of endocrine gland cells called the Islets of
Langerhans (named after Paul Langerhans, a German physician who discovered them in 1869).
These clusters release various important hormones that assist digestion. These hormones
include insulin, glucagon, somatostatin, ghrelin, etc.

INSULIN – PROMOTES METABOLISM OF CARBO, PROTEIN AND FAT THUS

DECREASING BLOOD GLUCOSE
GLUCAGON – MOBILIZES GLYCOGEN STORES, THUS RAISING BLOOD
GLUCOSE LEVELS
SOMATOSTATIN – DECREASES SECRETION OF INSULIN, GLUCAGONS,
GROWTH HORMONE AND SEVERAL GI HORMONES (GASTRIN, SECRETIN)
▪ This gland has an exocrine portion that secretes digestive enzymes that are
carried through a duct to the duodenum.
▪ The endocrine portion consists of the pancreatic islets, which
secrete glucagons and insulin.
▪ Alpha cells in the pancreatic islets secrete the hormone glucagons in response to a
low concentration of glucose in the blood.
▪ Beta cells in the pancreatic islets secrete the hormone insulin in response to a high
concentration of glucose in the blood.
▪ delta cells secrete somatostatin
The primary function of the thymus gland is to train special white blood cells called T-
lymphocytes or T-cells. White blood cells (lymphocytes) travel from your bone marrow to your
thymus. The lymphocytes mature and become specialized T-cells in your thymus. After the T-
cells have matured, they enter your bloodstream
 GONADS

◼ primary reproductive organs, are the testes in the male and the ovaries in the
female.
◼ responsible for producing the sperm and ova.
◼ they also secrete hormones and are considered to be endocrine glands.
◼ Androgens- male sex hormones
◼ Testosterone- secreted by the testes and small amount by the adrenal cortex

Male gonads (Testes)

▪ The paired oval testes of the male are suspended in a sac, the scrotum, outside the pelvic
cavity.
▪ Produces male sex hormones (sperm) or androgens.
▪ Hormone:
Testosterone

Female gonads (Ovaries)

▪ Paired almond-sized organs located in the pelvic cavity
▪ Produces female sex cells or ova
▪ Hormones:
❖ ESTROGEN
✓ Estrone
✓ Estradiol
❖ PROGESTERONE

Estrogens promotes:

• The development of the breasts

• Distribution of fat evidenced in the hips, legs, and breast
• Maturation of reproductive organs such as the uterus and vagina
Progesterone causes the uterine lining to thicken in preparation for pregnancy. Together,
progesterone and estrogens are responsible for the changes that occur in the uterus during
the female menstrual cycle.

In addition to the major endocrine glands, other organs have some hormonal activity as
part of their function. These include the thymus, stomach, small intestines, heart,
and placenta.

Gastrin- This hormone stimulates the production of hydrochloric acid and

the enzyme pepsin, which are used in the digestion of food.
secretin and cholecystokinin. Secreting stimulates the pancreas to produce a
bicarbonate-rich fluid that neutralizes the stomach
acid. Cholecystokinin stimulates contraction of the gallbladder, which releases bile. It
also stimulates the pancreas to secrete digestive enzyme.

The placenta develops in the pregnant female as a source of nourishment and gas
exchange for the developing fetus. It also serves as a temporary endocrine gland. One of
the hormones it secretes is human chorionic gonadotropin,

HYPOTHALAMUS
▪ The hypothalamus is located at the base of the brain
▪ The hypothalamus secretes hormones that stimulate or suppress the release of
hormones in the pituitary gland

The hypothalamus is located at the base of the brain, near the optic chiasm where the optic
nerves behind each eye cross and meet. The hypothalamus secretes hormones that
stimulate or suppress the release of hormones in the pituitary gland, in addition to
controlling water balance, sleep, temperature, appetite, and blood pressure.

The function of the hypothalamus is to maintain your body’s internal balance, which is known as
homeostasis.
▪ Heart rate and blood pressure
▪ Body temperature
▪ Fluid and electrolyte balance, including thirst
▪ Appetite and body weight
▪ Glandular secretions of the stomach and intestines
▪ Production of substances that influence the pituitary gland to release
hormones
▪ Sleep cycles

DISORDERS

Anterior Pituitary

HYPERPITUITARISM
▪ Having an overactive pituitary gland is called hyperpituitarism
▪ Hormone oversecretion that occurs with pituitary tumors
▪ Tumors occur most often in the anterior pituitary cells that produce GH, Prolactin
(PRL) and ACTH
 ▪ Hormone over secretion that occurs with pituitary tumors
- can impact many of your body's functions such as skin pigmentation, puberty, growth, thyroid
activity, sexual function, reproduction, and breast milk production in women.

Growth Hormone Disorders

Gigantism/ Acromegaly/ Dwarfism
◼ Overproduction of growth hormone causes excessive growth. In children, the
condition is called gigantism. In adults, it is called acromegaly.
▪
▪ Gigantism:
 before puberty causes rapid growth in length of all bones
Dwarfism is short stature that results from a genetic or medical condition. Dwarfism is generally
defined as an adult height of 4 feet 10 inches (147 centimeters) or less. The average adult height
among people with dwarfism is 4 feet (122 cm). Many different medical conditions cause
dwarfism.

Many different medical conditions cause dwarfism. In general, the disorders are divided
into two broad categories:

• Disproportionate dwarfism. If body size is disproportionate, some parts of the

body are small, and others are of average size or above-average size. Disorders
causing disproportionate dwarfism inhibit the development of bones.

• Proportionate dwarfism. A body is proportionately small if all parts of the body are
small to the same degree and appear to be proportioned like a body of average stature.
Medical conditions present at birth or appearing in early childhood limit overall growth and
development.

When the pituitary gland is overactive, it secretes excessive amounts of some hormones, usually
due to the presence of a benign (noncancerous) tumor

You can live without your pituitary gland as long as you take medication to replace the pituitary
hormones that you're missing. The pituitary gland hormones are very important for maintaining
several bodily functions. An untreated lack of all the pituitary hormones is life-threatening

Diabetes Insipidus- is a rare disorder that causes the body to make too much urine.
▪ Assessment:
 Polyuria > 200 ml/hr
Sp gravity < 1.004
 Polydipsia, severe dehydration
Fatigue, tachycardia
 Hypernatremia

What causes diabetes insipidus?

◼ Diabetes insipidus is usually caused by problems with a hormone called
VASOPRESSIN.
◼ Problems with a part of your brain that controls thirst can also cause diabetes
insipidus.
 ◼ Specific causes vary among the four types of diabetes insipidus: central,
nephrogenic, dipsogenic, and gestational.
◼ CENTRAL- an autoimmune disorder, the body doesn’t make enough vasopressin called the
antidiuretic hormone.

◼ NEPRHOGENIC- your body makes enough vasopressin but your kidneys don’t respond to the
hormone as they should.

◼ DIPSOGENIC- a problem with your hypothalamus causes you to feel thirsty and drink more
liquids

◼ GESTATIONAL- when the mother’s placenta makes too much of an enzyme that breaks down her
vasopressin.

Who is more likely to have diabetes insipidus?

◼ People of all ages can develop diabetes insipidus. You are more likely to develop the condition if
you1,2

◼ have a family history of diabetes insipidus

◼ had brain surgery or a major head injury

◼ take medicines that can cause kidney problems, including some bipolar disorder medicines
and diuretics

◼ have metabolic disorders (high blood calcium or low blood potassium levels

◼ The main complication of diabetes insipidus is dehydration, which happens when your body
loses too much fluid and electrolytes to work properly.

◼ If you have diabetes insipidus, you can usually make up for the large amount of fluids you pass
in your urine by drinking more liquids. But if you don’t, you could quickly become dehydrated.

◼ The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a disorder of

impaired water excretion caused by the inability to suppress the secretion of antidiuretic
hormone (ADH).

◼ If water intake exceeds the reduced urine output, the ensuing water retention leads to the
development of hyponatremia.

◼ Assessment:

◼ Low urine, sp gravity > 1.025

◼ fluid retention,weight gain,distended neck v.

◼ Hyponatremia

◼ Nausea, vomiting, abd cramps

◼ Headache, convulsion, seizure, coma

 ◼ Diagnosis

◼ serum sodium levels < 134 mEq/L

◼ serum osmolality < 280 mosm/kg

◼ urine specific gravity > 1.025

◼ Treatment

◼ Fluid restriction

◼ Hypertonic saline IV

◼ Demeclocycline (Declomycin)- induced nephrogenic diabetic insipidus

Hyperthyroidism (Graves’ Disease), Thyrotoxicosis

- happens when the thyroid gland makes too much thyroid hormone. This condition also is called
overactive thyroid.
▪ Excessive output of thyroid hormones
 Common: women, peak 30 – 40 yrs
▪ Causes:
 Autoimmune (Grave’s): enlarged gland
 Tumors
Diagnostic tests

 Increased T3 (Triiodothyronine)- (NV:60-181 ng/dl)

 Increased T4 (Thyroxine)- (NV: : 4.5 – 10.9 mcg/dl)

 Decrease TSH
  Radioactive Thyroid Scan: increased (hot spots)

 EKG: note tachycardia

 Management:

 Cool, sedative

 Well-balanced meal

 Eye drops, dark glasses, HOB elevated

 Antithyroid Agents, propranolol (inderal)

 Radiation: Iodine 131

 Thyroidectomy

Antithyroid Agents

▪ Inhibits thyroid hormone: thioamides

 Propylthiouracil (PTU): PO

 Methimazole (Tapazole): PO

 carbimazole (Neo-Mercazole)

DRUG THERAPY

Iodine preparations:

▪ Lugol’s Solution

▪ SSKI (saturated sol of potassium iodide)

▪ Potassium iodide tabs, solution, and syrup

PREOPERATIVE TEACHING

▪ Teach support neck

 Reduces strain on suture line

▪ Rest voice

 Expect hoarseness

▪ Post-Op:

 Analgesics, Ice collar, IV fluids

 VS, I&O
  Keep tracheotomy, Semi-Fowler’s

 Humidified oxygen, suction

 Diet: fluids (cold/ice) then soft

 Limited talking , hoarseness common

 Assess for voice changes: injury to the recurrent laryngeal nerve

▪ Post-Op Cont.

 Monitor complications:

Hemorrhage:

Tetany: calcium levels

Crisis/Storm: temperature

Edema: noisy breathing

TETANY

▪ accidental removal of the parathyroid gland

▪ This disturbs the Ca metabolism

▪ RISK: laryngospasm, airway obstruction

▪ TREAT: IV calcium gluconate or calcium chloride

Thyroid Storm, Thyroid Crisis

▪ Risks:

 Infection, surgery, radioactive iodine

▪ Assessment:

 Tachycardia (> 130), Hypertension

 Increased temp, agitation/anxiety

 N/V, diarrhea

▪ Management:

 PTU large doses then SSKI

 Hypothermia blanket, acetaminophen

 Propranolol (Inderal) and digoxin IV

  O2, fluids

HYPOTHYROIDISM

▪ Slow deterioration of thyroid function

 Common: women

▪ Causes:

 Autoimmune (Hashimoto’s)

 Iodine deficiency

 Thyroidectomy, Antithyroid meds

▪ Blood levels thyroid hormones low: dec T3, T4

 Decreased metabolic rate

 Hypothalamus and anterior pituitary gland make stimulatory hormones (TSH) as

compensation: Increased TSH

 Thyroid gland enlarges forming goiter

▪ Decreased metabolism

 Increased sleeping (14-16 hr), lethargic, apathetic (blank expression), drowsy, poor
memory/attention span

 Cold intolerance

 Generalized weakness, slow movement

▪ Muscle aches, Paresthesias

 Anorexia, constipation

 Decreased libido, difficulty becoming pregnant,

changes in menses (women); impotence