Assessment of the Endocrine System

and Care of Patients with Pituitary

and Adrenal Gland Problems
• The following provides a brief overview of the
endocrine system:
• http://www.bing.com/videos/watch/?
q=you+tube+endocrine+system&vid=8E2187FE28FF
3B7A21DD8E2187FE28FF3B7A21DD&FORM=VIRE2
 Endocrine System

• Made up of glands in various tissues and

organs
• Functions with nervous system to regulate
body function to ensure homeostasis by
secreting hormones
• Hormones work by negative feedback, they
cause opposite action of the initial condition
change
• (Figure & Table 64-1, pg. 1413)
Gland locations
• Pancreas-behind stomach-main
function regulate blood sugar,
digestive enzymes secreted also
• Gonads-testes-testosterone,
ovaries-estrogen & progesterone
Pancreas
• Thyroid-located anterior neck two
lobes work together-control
metabolism and regulates serum
calcium
• Parathyroid-four glands found
behind or within the thyroid-
regulates calcium and phosphorus
• Hypothalamus – located beneath
the thalamus on both sides of the
third ventricle in the brain –
secretes hormones that stimulate
or inhibit the release of pituitary
hormones.
 • Pituitary-located at the base of the
brain has two lobes (table 64-2, pg
1415)
• Anterior-control growth, metabolism,
sexual development, & pigment
changes
• Posterior-secretes antidiuretic hormone
• Adrenal-on top of each kidney, outer
(cortex) and inner layer (medulla)
independent function-Cortex-3 zones –
zona glomerulosa-produces
mineralocorticoids which function to
control sodium and potassium, zona
fasciculata and zona reticularis produce
glucocorticoids which control fluids and
electrolytes, as well as androgens &
estrogens
 Catecholamine receptors and effects
Table 64-4, pg 1416
• Adrenal medulla secretes the catecholamines-
epinephrine & norepinephrine-epinephrine
increases heart rate, force of heart
contractions, facilitates blood flow, relaxes
smooth muscles, helps convert glycogen to
glucose in the liver, norepinephrine -has
strong vasoconstrictive effects, thus increasing
blood pressure. (Chart 64-1, pg 1419
Endocrine system changes r/t aging)
 Disorders
• Caused by excess or deficiency of a hormone,
or defect at receptor site.
• Chapter 65 discusses care of patients with
Pituitary and Adrenal Gland Problems
• Hypopituitarism-results in metabolic problems
& sexual dysfunction, can be life threatening if
deficiencies are of ACTH (adrenocorticotropic
hormone) & TSH (thyroid stimulating
hormone)
• Cause varies- tumors, malnutrition(anorexia
nervosa), head trauma, severe hypotension
resulting in infarction
Chart 65-1 pg 1427 key features of deficient
hormones with clinical manifestations
• Assessment- history, physical appearance-
manifestations vary depending on hormone
affected, labs
• Interventions-replace deficient hormone
• Hyperpituitarism- caused by tumors or
hyperplasia, most common are adenomas-benign
tumors- result in overproduction of one of three
hormones
• Prolactin-results in galactorrhea, amenorrhea, &
infertility
• Growth hormone-acromegaly(gigantism)
• ACTH(adrenocoricotropic hormone)-
overstimulates adrenal cortex leads to Cushing’s
disease
Gigantism
• Chart 65-2 pg 1430 key features of
hyperpituitarism
• Assessment-history, manifestation
varies depending on hormone
overproduced, labs
• interventions- drug therapy, surgical
removal of pituitary gland, followed
by hormone replacement therapy
 Posterior pituitary disorders
• Diabetes Insipidus (DI) large volumes of dilute
urine-dehydration is most common
manifestation, from-insufficient production of
ADH, or inability of kidney to respond to ADH,
caused by tumors, trauma, surgery, certain drugs,
treatment drug therapy DDAVP
• Syndrome of inappropriate antidiuretic hormone
SIADH-retention of water-hyponatremia, from
overproduction of ADH, caused by tumors,
trauma, respiratory infections, certain drugs. Tx-
fluid restriction, diuretics, drug therapy
 Disorders of Adrenal Gland
• Adrenal Insufficiency-decreased secretion of
ACTH, due to hypothalamic-pituitary control
dysfunction, or adrenal gland tissue dysfunction,
may occur gradually(Addison’s disease) or quickly
as in adrenal crisis(Addisonian crisis) in which
there is hypoglycemia, hyperkalemia,
hyponatremia, dehydration, & acidosis.
Treatment for Crisis Chart 65-7, pg 1436- Fluids-
often D5, hydrocortisone sodium, insulin drip to
shift potassium, kayexalate.
• Adrenal insufficiency varies in manifestation r/t
degrees of hormone deficiency. Muscle
weakness, fatigue, anorexia, anemia, hyper-
kalemia, hypercalcemia, hypotension, hypo-
natremia, hyperpigmentation. Chart 65-8, pg
1437 key features
• Assessment- history, labs(Chart 65-9, pg 1438
lab profiles for hypo&hyperfunction of Adrenal
Gland. TX hormone replacement, fluid balance,
managing hypoglycemia.
• Adrenal hyperfunction in the adrenal cortex-
hypercortisolism-Cushing’s disease causes
widespread problems, could arrive from adrenal
cortex, anterior pituitary gland, hypothalamus, or
even glucocorticoid therapy used for asthma,
rheumatoid arthritis, org . Key features Chart 65-12,
pg 1441-moon face, buffalo hump, hypertension,
osteoporosis, thinning skin, decreased immune
function, mood swings. Assessment-history, labs. Tx
depends on cause cure possible if pituitary or
adrenal then surgical removal , if caused by drug
therapy focus on preventing complications, closely
monitoring cortisol levels
Cushing’s Disease
• Another adrenal disorder of hyperfunction is
hyperaldosteronism- Conn’s syndrome-
overproduction from one or both adrenal
glands-usually caused benign tumor-results in
hypernatremia, hypokalemia, metabolic
alkalosis. Pt will be hypertensive, c/o headache,
fatigue, muscle weakness. Surgical removal of
adrenals is tx followed by glucocorticoid
replacement therapy.
• Lastly pheochromocytoma – a
catecholamine producing tumor adrenal
medulla, usually benign-produce, store,
release epinephrine & norepinephrine
with wide-ranging adverse effects-
intermittent hypertension episodes
causing severe HA, palpitations, profuse
diaphoresis, flushing, sense of impending
doom. DX 24 hr urine, TX surgery, BP
monitored closely
 References
http://www.emedicine.medscape.com
http://www.nlm.nih.gov/medlineplus/endocrinediseases.html
http://www.endocrineweb.com/
http://www.merckmanuals.com/professional/sec12/ch152/ch152a.html
Ignatavicius, D. and Workman, M. (2010). Medical-Surgical Nursing; Patient-
centered collaborative care (pp. 1412-1447). St. Louis, MO: Saunders
Porth, C. and Marfin, G. (2009). Pathophysiology; Concepts of altered health
states (pp.1008 -1046). Philadelphia, PA: Lippincott Williams & Wilkins