Endocrine System Hypothalamus

- regulates hunger, thirst, sleep, and body

- is a messenger system in temperature
an organism comprising feedba
Pineal Gland
ck loops of hormones that are
released by - releases melatonin, which regulates daily
internal glands directly into sleep-wake cycle
the circulatory system and that
Pituitary Gland
target and regulate
distant organs. - regulates energy, metabolism, and growth
- a network of glands and organs
Parathyroid Gland
that release hormones into the
bloodstream to regulate bodily - helps regulate calcium and phosphorus in
functions. the blood
- responsible for homeostasis and
hormone production
Thyroid Gland
- regulates energy, metabolism, and growth
Functions of the Endocrine System - produces 3 hormones:
✓ Thyroxine (T4)
- Regulation of metabolism ✓ Triiodothyronine (T3)
- Growth and development ✓ Calcitonin
- Reproduction
- Homeostasis Adrenal Gland
- Response to stress
- controls growth, sugar metabolism, kidney
function, and stress (released epinephrine
and norepinephrine, the fight or flight
hormones)
Pancreas
- aids in the digestion of protein, fats, and
carbohydrates
- produces insulin to control blood sugar
Ovaries
- produces the female hormones
(progesterone and estrogen)
Testes
- produces the male hormones
(testosterone)
 Diagnostic Tests Note!
• 1 hormone has its own
1. Stimulation test – used to assess the target organ
ability of endocrine glands to respond • Prolactin – milk production
to a stimulus, often evaluating gland • Oxytocin – secretes milk
hypoactivity
Ex: ACTH stimulation test
2. Suppression Test – used to evaluate
hyperactivity glands by determining
whether hormonal production
decreases when a suppressive agent
is administered
Ex: Dexamethasone suppression test
3. Radioactive Iodine Uptake (RAIU) –
evaluates thyroid gland function by
measuring iodine uptake from the
bloodstream
4. T3 and T4 uptake test – measures T3
and T4 in the blood to assess thyroid
function HYPOTHALAMUS
T3: 80 – 200 mg/dL
T4: 4.5 – 11.5 mcg/dL Corticotropin - Releasing Hormone (CRH) - regulates
5. TSH Test – measures TSH levels to the body’s response to stress
evaluate pituitary control over the Thyrotropin - Releasing Hormone (TRH) - regulates
thyroid gland the production and release of the thyroid hormones
TSH: 0.4 – 4.3 uIU/mL
6. Thyroid Scan – uses radioactive Gonadotropin - Releasing Hormone (GRH) - causes
isotopes to produce images of the the pituitary gland in the brain to make and secrete
thyroid gland to detect nodules, the hormones luteinizing hormone (LH) and follicle-
tumors, or functional abnormalities stimulating hormone (FSH).
7. HbA1C – measures the average blood Growth Hormone Releasing Hormone (GHRH) -
glucose levels over 2 – 3 months by stimulates synthesis and release of growth hormone
assessing glucose
Non-diabetic: 4 – 5.6% Prolactin Releasing Hormone (PRH) - stimulates the
Diabetic: < 7% release of prolactin from the pituitary gland
8. 24 – hour urine collection – Somatostatin - regulates many bodily functions,
measures hormones or metabolic including the release of other hormones and the
levels excreted in urine over 24 hours activity of the gastrointestinal tract or the growth
to assess endocrine gland function hormone inhibiting hormone
Ex: Catecholamines: <20 mcg/day
(epinephrine) Prolactin Inhibiting Hormone (Dopamine) - suppresses
Ex: Cortisol: 10 – 100 mcg/24 hrs synthesis and secretion of prolactin
(norepinephrine)
 Anterior Pituitary Gland Posterior Pituitary Gland

Adrenocorticotropic Hormone (ACTH) - helps the

body respond to stress Anti-diuretic Hormone (ADH) - allows water
Thyroid-Stimulating Hormone (TSH) - stimulates reabsorption in kidneys
the thyroid gland to produce hormones that Oxytocin - responsible for milk ejection and
regulate metabolism contraction, breasts and uterus
Follicle - Stimulating Hormone (FSH) - stimulates
the testes to excrete testosterone
Luteinizing Hormone (LH) - stimulates the ovaries ENDOCRINAL DISORDERS
to excrete estrogen & progesterone
Growth Hormone (GH) – bones, muscles, and
organs
Gigantism
Prolactin (PRL) - breast
- a rare condition characterized by abnormal linear
Adrenal Glands growth due to the overproduction of GH before the
closure of epiphyseal growth plates during childhood

Cortisol - helps the body respond to stress and • Affected organ: Pituitary Gland
danger, also known as stress hormone
• Affected hormone: GH ↑ (Increase in Growth
Aldosterone - regulate salt and water in the body Hormone)
Androgen - group of hormones that regulate the
development and maintenance of male and female • Causes:
sex characteristics - pituitary adenoma
- Genetic mutations
Epinephrine - plays an important role in your body's - hypothalamic tumors
fight-or-flight response or adrenaline
• S/sx
Norepinephrine - helps the body respond to stress
- excessive height for age
and exercise
- large hands and feet
Thyroid Glands - enlarged facial features
- joint pain - muscle weakness
- Hyperhidrosis (excessive sweating)
- fatigue
Triiodothyronine (T3) - helps regulate many bodily
functions, including metabolism, heart rate, and
• Dx Test
growth.
1. MRI of the pituitary gland
Thyroxine (T4) - plays vital roles in metabolism, heart 2. Serum IGF-1 levels
and muscle function, brain development, and IGF - 1 (same molecular structure as insulin)
maintenance of bones
• Surgical Intervention
Calcitonin 1. Transsphenoidal surgery - to remove the pituitary
tumor
2. Radiation therapy - to reduce tumor size and GH
secretion overtime
 • Pharmacological Mgt
1. Somatostatin analog - inhibits GH secretion by • Causes:
mimicking somatostatin - Hypothalamus or pituitary gland dysfunction
Ex. - Achondroplasia (genetic mutation)
Octreotide (2-3 shots per day) (subcutaneous)
Lantreotide (1 shot per 4 weeks) (IM) • S/sx
- short limbs with a normal sized trunk
2. GH receptor antagonist - blocks GH action at - large head with a prominent forehead
- bowed leg or spinal abnormalities
the receptor level, reducing IGF-1
- delayed puberty and growth milestones
Ex. Pegvisomant
- poor muscle development and reduced energy
3. Dopamine agonist - suppresses GH secretion
• Dx Test
Ex. Cabergoline 1. Measurement and growth charting
2. Genetic testing
• Nsg Int 3. Xrays of the skeleton
- Monitor growth patterns and physical changes 4. MRI of the pituitary
- Assess for visual disturbances or changes (eyes
may be affected • Medical Mgt
- Educate on medication adherence 1. Growth hormone therapy
- promote nutritional support 2. Corrective surgery for spinal deformities
- provide emotional support
• Pharmacological Mgt
• Pathophysiology 1. Recombinant GH - promotes linear growth and
increases muscle mass
Ex. Somatropin

• Nsg Int
- Monitor growth patterns and developmental
milestones
- provide education on GH therapy
- promote physical support prevent complications
- encourage balanced diet (calcium & protein-rich
foods)

• Pathophysiology

Dwarfism
- a condition characterized by short stature due to
various genetic, hormonal and nutritional factors

• Affected organ: Pituitary gland

• Affected hormone: GH
 2. Thiazide diuretics - used in Nephrogenic DI
Note! Paradoxical - opposite of MOA in the kidney
Ex. Hydrochlorothiazide
• Proportional - upper and lower body is the
3. NSAID - enhances renal response to ADH Ex.
same in size
Indomethacin
• Disproportional - upper and lower body is
different in size
• Nsg Int
• If diagnosed with gigantism & dwarfism, it is
- Monitor fluid balance (Hypotonic)
irreversible
- Assess for signs of dehydration
- Educate patient on desmopressin
Diabetes Insipidus - Monitor electrolyte levels
- Encourage fluid intake
- a disorder characterized by the inability of the
kidneys to conserve water, leading to excessive • Pathophysiology
urination

• Affected Organ: Hypothalamus and Pituitary

Gland

• Affected Hormone: ADH

• Causes:
- Central DI (starts in hypothalamus or pituitary
gland)
- Nephrogenic DI (starts in the kidney)
- Gestational DI (occurs in pregnancy)

• S/sx
- Polyuria (1-20L/day)
- Polydipsia
- fatigue - Dehydration
- Hypernatremia

• Dx Test
Note!
1. Serum osmolality
Serum osmolality: high • Urine Specific Gravity – ability of kidneys to
2. Urine specific gravity: low concentrate the urine
3. ADH test • Central Venous Pressure - total amount of
4. Serum sodium: elevated blood returning to the heart

• Medical mgt Syndrome of Inappropriate Antidiuretic Hormone

Secretion (SIADH)
1. ADH replacement (Desmopressin)
2. Low sodium diet and Thiazide - a condition where excessive secretion of ADH
3. Fluid replacement occurs, leading to water retention
• Affected organs: Hypothalamus and PPG
• Pharmacological Mgt
1. Desmopressin - reduces urine output and • Affected hormone: ADH
corrects dehydration
Vasopressinase - absorbs anti-diuretic • Causes:
hormone - CNS (trauma, head injury, stroke, brain
tumors)
- Medications (antidepressants, antipsychotics)
• S/sx:

- Confusion, headache, irritability Hypothyroidism

- Weight gain
- hypertension and bounding pulse
- a condition characterized by a deficiency of
- decreased urine output
thyroid hormones (T3 & T4), resulting in
- dilutional hyponatremia
decreased metabolic rate

• Dx Test:
• Affected organs: Hypothalamus, APG and
1. Serum sodium: low
Thyroid gland
2. Serum osmolality: low
3. Urine osmolality & specific gravity, elevated
• Affected hormones: T3 and T4
4. ADH levels: elevated
• Causes:
• Medical mgt:
1. Primary Hypothyroidism (thyroid gland dysfunction)
1. Fluid restriction
- Hashimoto's thyroiditis (autoimmune - antibodies
2. Hypertonic saline
are attacking the thyroid gland)
- iodine deficiency
• Pharmacological mgt:
- Thyroidectomy (removal of thyroid gland)
1. Demeclocycline - reduces renal sensitivity to
ADH, anti-microbial agents
2. Secondary Hypothyroidism (pituitary dysfunction)
2. Vasopressin Receptor Antagonist - blocks ADH
- insufficient TSH production
action, promotes water excretion without sodium
loss
3. Tertiary Hypothyroidism (hypothalamic dysfunction)
Ex. Tolvaptan
- insufficient TRH production
3. Loop Diuretics (Furosemide) - promote diuresis
and correct hyponatremia
• S/sx:
- Fatigue, lethargy, weakness
• Nsg Int:
- weight gain
- Monitor fluid balance
- depression, memory issues, and slow speech
- Assess neurological status (ask for alertness)
- Bradycardia, hypotension
- Implement fluid restriction (800-1000ml/day)
- cold intolerance
- Monitor lab values
- dry skin, brittle nails, hair loss
- Provide patient education
- constipation, abdominal distention

• Pathophysiology
• Dx Test:
1. Serum free T4: Low
2. Antithyroid antibodies: positive (Hashimoto's
thyroiditis)
3. Thyroid scan: structural abnormalities

• Medical mgt:
1. Thyroid hormone replacement therapy
2. Monitor and treat complications
3. lodine supplementation
 • Pharmacological Mgt: - Pituitary tumors (rare)
1. Levothyroxine (Synthroid) - first line treatment
for hypothyroidism • S/sx:
- unexplained weight loss
2. Liothyronine (Cytomel) - T3 replacement - may - Increased sweating
cause insomnia - heat intolerance
- tachycardia
[Link] softeners - restlessness, irritability, tremors
- thin, fragile skin
• Nsg Int: - muscle weakness
- Monitor vital signs - frequent bowel movements
- promote a warm environment - exopthalmos
- Educate the patient on levothyroxine - enlarged thyroid
- encourage high-fiber diet
- monitor signs of overmedication • Dx Test:
1. Serum TSH: low (negative feedback mechanism)
• Pathophysiology 2. Serum free T4 and T3: Elevated
3. RAIU: increased
4. Thyroid antibodies: positive (Grave's disease)
5. Thyroid UTZ: structural abnormalities

• Medical mgt:
1. Antithyroid medications -blocks the synthesis
of thyroid hormones.
lodine therapy - destroys overactive thyroid
tissue
2. Radioactive iodine therapy- destroys
overactive thyroid tissue
3. Thyroidectomy - done in pt. With large goiter
or cancer

• Pharmacological mgt:
1. Methimazole (Tepizole) - blocks iodine
incorporation to inhibit thyroid hormones
synthesis
2. Propylthiouracil (PTU) - inhibits thyroid
hormone synthesis and block conversion of T4
Hyperthyroidism to T3
3. Beta-lockers (Propanolol) - symptomatic relief
- a condition characterized by an for cardiac manifestations
overproduction of thyroid hormones,
leading to increased T3 and T4 • Nsg Int:
- Monitor vital signs
• Affected organs: APT and Thyroid gland - provide quiet environment
- Educate on medication adherence
• Affected hormones: T4 and T3 - Monitor for THYROID STORM
- promote eye care to pt. with Grave's
• Causes: disease
- Grave's disease (autoimmune)
- Toxic nodular goiter
- Thyroiditis
- Excessive iodine intake
• Pathophysiology