endocrine system

endocrine glands

•Pituitary

•Adrenal

•Thyroid

•Parathyroid

•Pancreas

•Ovaries

•Testes

endocrine system functions

•Maintenance & regulation of vital functions

•Response to stress & injury

•Growth & development

•Energy metabolism

•Reproduction

•Fluid, electrolyte, & acid-base balance

go over hypothalamic hypophysial portal system diagram

posterior lobe of pituitary gland production

•ADH (vasopressin, antidiuretic hormone)

•Oxytocin

anterior lobe of pituaitary gland production

•ACTH (adrenocorticotropic hormone)

•TSH (thyroid-stimulating hormone)

•STH (somatotropic growth-stimulating hormone)

•FSH (follicle-stimulating hormone)

•LH (luteinizing hormone)

•PRL (prolactin)

•GH (growth hormone)

•MSH (melanocyte-stimulating hormone)

what is master gland?

pituitary

pituitary gland location

located at base of brain

pituitary gland influenced by?

hypothalamus

pituitary gland function

•Directly affects function of other endocrine glands

•Promotes growth of body tissue

•Influences water absorption by the kidney

•Controls sexual development and function

anterior pituitary disorders

•Acromegaly

•Giantism

•Dwarfism

posterior pituitary disorders

•Diabetes Insipidus

•SIADH (Syndrome of Inappropriate Secretion of Antidiuretic Hormone)

acromegaly

•The hypersecretion of growth hormone (GH) by the anterior pituitary gland

acromegaly occurs in?

middle age, after the closure of the epiphyses of the long bones

acromegaly assessment

•Large hands and feet

•Visual problems

•Headache

•Hyperglycemia

•Hypercalcemia

•Deepened voice

•Thickening and protrusion of the jaw

•Increased hair growth

•Joint pain

•Diaphoresis

•Oily, rough skin

•Menstrual disturbances

•Impotence

acromegaly implementation

•Provide emotional support to client

•Encourage client to express feelings related to altered body image

•Provide frequent skin care

•Provide pharmacological & nonpharmacological interventions for joint pain

•Prepare client for radiation of pituitary gland if prescribed

•Prepare client for hypophysectomy if planned

Giantism or Gigantism

•The hypersecretion of growth hormone (GH) by the anterior pituitary gland

giantism occurs in?

•Giantism occurs in childhood before the closure of the epiphyses of the long bones

assessment giantism

•Overgrowth of long bones

•Increased height in early adulthood

•Deterioration of mental & physical status

giantism implementation

•Provide emotional support to client & family

•Encourage client and family to express feelings related to altered body image

•Prepare client for radiation of pituitary gland, if prescribed

•Prepare client for hypophysectomy, if planned

hypophysectomy & complications

removal of pituitary gland

complications: increased intracranial pressure, bleeding, rhinorrhea & meningitis

hypophysectomy implementation

•Initiate postoperative care similar to craniotomy care

•Assess LOC

•Assess neurological status

•Elevate the HOB

•Administer corticosteroids as prescribed on time

•Avoid water intoxication

•Instruct client to avoid sneezing, coughing, and blowing nose

•Instruct client in the administration of prescribed medications

what should you monitor for for hypophysectomy?

•Monitor for adrenal insufficiency

•Monitor fluids and electrolyte values

•Monitor for temporary diabetes insipidus due to antidiuretic hormone (ADH) disturbances

•Monitor vital signs

•Monitor for increased ICP

•Monitor for bleeding

dwarfism

•The hyposecretion of growth hormone (GH) by the anterior pituitary gland

when does dwarfism occur?

in childhood

dwarfism assessment

•Retarded physical growth

•Premature aging

•Low intellectual development

•Dry skin

•Poor development of secondary sex characteristics

implementation dwarfism

•Provide emotional support to client and family

•Encourage client and family to express feelings related to altered body image

•Prepare to administer hGH (human growth hormone)

diabetes insipidus

•The hyposecretion of antidiuretic hormone (ADH) & a deficiency of vasopressin

diabetes insipidus results in?

failure of tubular reabsorption of water in the kidneys

diabetes insipidus assessment

•Polyuria of 4 - 24 L per day

•Polydipsia

•Dehydration

•Decreased skin turgor, dry mucous membranes

•Inability to concentrate urine

•A low urinary specific gravity of 1.006 or less

•Fatigue

•Muscle pain & weakness

•Headache

•Postural hypotension

•Tachycardia

implementation diabetes insipidus

•Monitor vital signs, neurological & cardiovascular status

•Monitor electrolyte values

•Administer vasopressin (Pitressin) or DDAVP (desmopressin) as prescribed

•Monitor I & O, weight, specific gravity of urine

•Instruct client to avoid foods or liquids with a diuretic-type action

•Maintain intake of adequate amounts of fluids

•Instruct client in administration of medications as prescribed

•Instruct client to wear Medic-Alert bracelet

Syndrome of Inappropriate Secretion of ADH (SIADH)

•A disorder of the posterior pituitary gland in which a continued release of the antidiuretic hormone (ADH) occurs

Syndrome of Inappropriate Secretion of ADH (SIADH) results in?

water intoxication

Syndrome of Inappropriate Secretion of ADH (SIADH) assessment

•Changes in LOC

•Mental status changes

•Weight gain

•Hypertension

•Signs of fluid volume overload

•Tachycardia

•Anorexia

•Nausea and vomiting

•Hyponatremia

Syndrome of Inappropriate Secretion of ADH (SIADH) implementation

•Monitor vital signs

•Monitor neurological status

•Monitor cardiac status

•Protect the client from injury

•Monitor I&O

•Obtain daily weights

•Restrict water intake as prescribed

•Monitor fluid and electrolyte balance

•Administer diuretics and IV fluids as prescribed

adrenal gland location

rests upon each kidney

adrenal gland functions

•Regulates sodium & electrolyte balance

•Affects carbohydrate, fat, & protein metabolism

•Influences development of sexual characteristics

•Sustains “fight or flight ” response

adrenal cortex

•Outer shell of adrenal gland

adrenal cortex synthesizes:

•Glucocorticoids (cortisol)

•Mineralocorticoids (aldosterone)

•Secretes small amounts of sex hormones (androgens, estrogens)

adrenal medulla

•Inner core of adrenal gland

•Works as part of sympathetic nervous system

adrenal medulla produces:

1. epinephrine

2. norepinephrine

disorders of adrenal cortex

•Addison’s disease

•Cushing’s syndrome

•Aldosteronism (Conn's syndrome)

adrenal medulla disorder

•Pheochromocytoma

addisons disease

•Hyposecretion of adrenal cortex hormones (glucocorticoids: cortisol) & mineralocorticoids: aldosterone)

condition is fatal if untreated

addisons disease assessment

•Weakness

•GI disturbances

•Weight loss

•Emotional disturbances

•Bronze pigmentation to skin

•Electrolyte imbalances

•Hyponatremia

•Hyperkalemia

•Hypotension

•Hypoglycemia

•Elevated BUN

go over primary vs secondary adrenal insufficiency chart

addisons disease implemetation

•Monitor vital signs

•Monitor weight and I&O

•Maintain fluid and electrolyte balance

•Monitor for infection

•Observe for Addisonian crisis secondary to stress, infection, trauma, surgery

addisons disease instruction

•Instruct client in a high-protein, high-carbohydrate diet

•Instruct client in the avoidance of stress

•Instruct client to avoid individuals with an infection

•Instruct client in the need for lifelong corticosteroids

•Instruct client to avoid over-the-counter medications

•Instruct client to avoid strenuous exercise

•Instruct client to wear a Medic-Alert bracelet

addisonian crisis

•A life-threatening disorder caused by acute adrenal insufficiency

•It is precipitated by infection, trauma, stress, or surgery

•Can cause hyponatremia, hyperkalemia, hypoglycemia, and shock

addisonian crisis

•Severe headache

•Severe abdominal, leg, and lower back pain

•Generalized weakness

•Irritability and confusion

•Severe hypotension

Shock

addisonian crisis implementation

•Monitor vital signs

•Monitor neurological status, noting irritability and confusion

•Monitor I&O

•Administer IV fluids as prescribed to restore electrolyte balance

•Administer adrenocorticosteroids as prescribed on time schedule

•Protect client from infection

•Maintain bedrest and provide a quiet environment

cushings sydrome

•A condition resulting from the hypersecretion of glucocorticoids from the adrenal cortex

•Can result from the prolonged administration of corticosteroids

cortisol secretion graph

hypercortisolism graph

cushings syndrome assessment

•Obesity with thin extremities

•Moon face

•Buffalo hump

•Fragile skin that easily bruises

•Hirsutism (masculine characteristics in female)

•Mood swings

•Muscular weakness

•Signs of infection

•Signs of osteoporosis

•Hypertension

•Hypokalemia

•Hyperglycemia & glycosuria

•Elevated white blood cells

•Sodium and water retention

cushings syndrome monitor:

•Monitor I&O

•Monitor weight

•Monitor glucose levels and urinary glucose

cushings syndrome implementation:

•Provide good skin care

•Allow client to discuss feelings related to body appearance

•Provide high-protein, low-calorie diet with potassium supplements

•Prepare client for adrenalectomy if prescribed

•Prepare client for radiation if prescribed

•Administer hormone replacement therapy as prescribed

•Administer steroids as prescribed if adrenalectomy was performed

•Administer chemotherapeutic agents as prescribed

•Instruct client in the administration of medications as prescribed

•Instruct client to avoid infection and, stress

•Instruct client in measures for adequate nutrition and rest

aldosteronism graph

aldosteronism (conn’s syndrome)

•hypersecretion of aldosterone from the adrenal cortex of the adrenal gland

•Due to an adrenal lesion that is usually benign

assessment aldosteronism

•Generalized weakness

•Increased thirst, nocturia, and polyuria

•Edema

•Weight gain

•Headache

•Hypertension

•Positive Chvostek’s sign

•Increased urinary aldosterone

•Hypokalemia

•Hypernatremia

•Metabolic alkalosis

aldosteronism monitor

•Monitor vital signs

•Monitor weight

•Monitor I&O

•Monitor for positive Chvostek’s sign

•Monitor electrolytes

aldosteronism implementation

•Assess muscular strength

•Maintain sodium restriction as prescribed

•Administer potassium supplements as prescribed

•Administer antihypertensives, such as spironolactone (Aldactone) as prescribed

•Prepare client for surgical removal of tumor if prescribed

pheochromocytoma

•catecholamine-producing tumor usually found in the adrenal gland but also may be found in the abdomen

typically a benign tumor but can be malignant

pheochromocytoma causes:

hypersecretion of the hormones of adrenal medulla and the secretion of excessive amounts of epinephrine and norepinephrine

treatment of pheochromocytoma

primary treatment: surgical excision of adrenal gland is the primary treatment

•Symptomatic treatment is initiated if surgical excision is not possible; however, the complications associated with pheochromocytoma include hypertensive retinopathy and nephropathy, myocarditis, CHF, increased platelet aggregation, and CVA

•Death can occur from shock, CVA, renal failure, dysrhythmias, and dissecting aortic aneurysm

pheochromocytoma assessment

•Hypertension and headaches

•Hypermetabolism

•Diaphoresis

•Palpitation & tachycardia

•Apprehension

•Emotional instability

•Hyperglycemia and glycosuria

•Pain in the chest or abdomen with nausea & vomiting

•Weight loss

•Fatigue and exhaustion

pheochromocytoma implementation

•Monitor vital signs

•Monitor cardiovascular, neurological, and renal status

•Monitoring for hypertensive attacks such as hypertension can precipitate a CVA or sudden blindness

•Keep phentolamine (Regitine) at the bedside for hypertensive crisis

•Prepare to administer an alpha-adrenergic blocking agent, phenoxybenzamine (Dibenzyline), as prescribed to control blood pressure

•Be alert to stimuli that can precipitate a paroxysm, such as increased abdominal pressure, micturition, and vigorous abdominal palpation

•Avoid opiates preoperatively as they can precipitate a hypertensive crisis

•Monitor urine for glucose and acetone

•Promote rest and nonstressful environment

•Provide a diet high in calories, vitamins, and minerals

•Prohibit caffeine-containing beverages and food

adrenalectomy

surgical removal of an adrenal gland

what is necessary with a bilateral adrenalectomy?

lifelong steroid replacement

what is necessary with unilateral adrenalectomy?

Temporary steroid replacement, up to 2 years

what drops as a result of adrenalectomy?

•Catecholamine levels drop as a result of surgery, which can result in cardiovascular collapse, hypotension, and shock, and the client needs to be monitored closely

•Hemorrhage can also occur due to the high vascularity of the adrenal glands

pre adrenalectomy

•Prepare client for surgical procedure

•Monitor electrolytes and correct electrolyte imbalances

•Assess for dysrhythmias

•Monitor for hyperglycemia

•Protect client from infections

•Administer steroids as prescribed

post adrenalectomy monitor:

•Monitor vital signs

•Monitor I&O, and if urinary output is less than 30 mL per hour, notify the physician, as this may be indicative of impending shock and renal failure

•Monitor daily weights

•Monitor electrolytes

•Monitor for signs of shock and hemorrhage, particularly during first 24 to 48 hours

•Monitor for paralytic ileus, as manifested by abdominal distention and pain, nausea, vomiting, diminished or absent bowel sounds, as paralytic ileus can develop from internal bleeding

post adrenalectomy

•Assess dressing

•Administer IV fluids as prescribed to maintain blood volume

•Administer pain medication as prescribed, remembering that meperidine (Demerol) can cause hypotension

•Administer steroid replacement as prescribed

•Instruct client in the importance of steroid therapy following surgery

thyroid gland located

•in the anterior part of the neck

thyroid gland function

•Controls the rate of body metabolism & growth

•Produces thyroxine (T₄), triiodothyronine (T₃), and thyrocalcitonin

•Follicular cells produce…

2 thryroid hormones

thyroxine =

•tetraiodothyronine = T4

•Contains 4 atoms of iodine

Triiodothyronine =

•T3

•Contains 3 atoms of iodine

thyroid hormones regulate

•Oxygen use & basal metabolic rate

•Cellular metabolism

•Growth & development

parafollicular cells:

C cells

produce hormone

calcitonin

calcitonin

•Helps regulate calcium homeostatsis

control of thyroid hormone secretion

1.Low levels of T3 and T4 or low metabolic rate stimulate the hypothalamus to secrete thyrotropin releasing hormone (TRH)

2.TRH enters the hypophyseal portal veins and is carried to the anterior pituitary gland, where it stimulates thyrotrophs to secrete thyroid stimulating hormone (TSH)

3.TSH stimulates almost all aspects of thyroid follicular cell activity, including iodide trapping, hormone synthesis and secretion, and growth of follicular cells

4.Thyroid follicular cells release T3 and T4 into the blood until the metabolic rate returns to normal

5.An elevated T3 inhibits release of TRH and TSH

link between atp demand and thyroid hormones

increase ATP demand (cold environment, hypoglycemia, high altitude, pregnancy) you increase secretion of thyroid hormones

hyperthyroid initial S/S

Goiter
Nervousness / Irritability
Palpitations (tachycardia)
Unexplained weight loss
Diarrhea
Sleep disturbances (insomnia)
Vision changes (exopthalmos)
Amenorrhea / oligomenorrhia

hyperthyroid later S/S

Tremor
Muscle weakness & fatigue
Dyspnea
Dependent edema
Impaired mentation (confusion)

hyperthyroid incidental S/S

Heat intolerance
Diaphoresis
Increased appetite

hypothyroid initial S/S

Depression & loss of concentration
Dry skin (Pruritis)
Cold intolerance
Myalgias
Somnolence & fatigue
Menorrhagia

hypothyroid later S/S

Goiter
Unexplained weight gain
Constipation
Myxedema
Memory loss / impairment

hypothyroid incidental S/S

Bradycardia
Habitual abortion / sterility
Impotence
Anorexia

primary hypothyroidism lab values

increased TRH

increased TSH

low T3/T4

secondary hypothyroidsim lab values

increase TRH

decrease TSH

decrease T3/T4

tertiary (hypothalamus) hypothyroidism

TRH: low

TSH: low

T3/T4: low

hyperthyroidism pruimary lab values

TRH: low

TSH: low

T3/T4: high

secondary hyperthyroidism lab values

TRH: low

TSH: high

T3/T4: high

tertiary hyperthyroidism lab values

TRH: high

TSH: high

T3/T4: high

Radioactive Iodine Uptake (RAI)

thyroid function test that measures the absorption of the iodine isotope to determine how the thyroid gland is functioning

with RAI, amount of radioactivity is measured ??? after ingestion of capsule

measured 2, 6, and 24 hours after ingestion of the capsule

normal value of RAI is

5% to 35% in 24 hours

elevated values of RAI are indicative of?

hyperthyroidism, thyrotoxicosis, decreased iodine intake, or increased iodine excretion

decreased values of RAI indicate?

a low T4, the use of antithyroid medications, thyroiditis, myxedema, or hypothyroidism