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endocrine system
The collection of glands that produce hormones to regulate various bodily functions, including metabolism, growth, and mood.
glands (endocrine)
are organized groups of specialized cells that secrete hormones directly into the bloodstream to communicate within the body
hormones
chemical messengers working within the endocrine system to communicate within the body
act to increase or decrease metabolic processes when they react with their specific receptor sites on target cells
types of endocrine glands
adrenal cortex, intestines, kidneys, ovaries, pancreas, parathyroid, pineal, placenta, pituitary, testes, stomach, thyroid
hypothalamus
“master gland”
regulates both nervous and endocrine responses to internal and external stimuli, including body temperature, thirst, hunger, water retention, blood pressure, respiration, reproduction, and emotional reactions
receives input from all areas of the brain and special senses involving the cranial nerves
anterior pituitary gland
lobe of the pituitary gland that produces stimulating hormones as well as growth hormone, prolactin, and melanocyte-stimulating hormone
diurnal rhythm
response of the hypothalamus and then the pituitary and adrenals to wakefulness, sleeping, and light exposure
A resulting peak response of increased ACTH and adrenocortical hormones occurs sometime early in the morning, around 6 to 9 a.m. This high level of hormones then suppresses any further CRH or ACTH release. The corticosteroids are metabolized and excreted slowly throughout the day and fall to low levels by evening. At this point, the hypothalamus and pituitary sense low levels of the hormones and begin the production and release of CRH and ACTH again. This peaks around midnight, and the cycle starts again
hypothalamic-pituitary axis
interconnection of the hypothalamus and pituitary gland to regulate levels of certain endocrine hormones through a complex series of negative feedback systems
negative feedback system
control system in which increasing levels of a hormone lead to decreased levels of releasing and stimulating hormones, leading to decreased hormone levels, which stimulates the release of releasing and stimulating hormones; allows tight control of the endocrine system
hormones released into the anterior pituitary
neuroendocrine system
the combination of the nervous and endocrine systems, which work closely together to maintain regulatory control and homeostasis in the body
pituitary gland
gland found in the sella turcica of the brain; produces hormones, endorphins, and enkephalins and stores two hypothalamic hormones
posterior pituitary
lobe of the pituitary that receives antidiuretic hormone and oxytocin via nerve axons from the hypothalamus and stores them to be released when stimulated by the hypothalamus
releasing hormones or factors
chemicals released by the hypothalamus into the anterior pituitary to stimulate the release of anterior pituitary hormones
releasing factors/hormones produced by the hypothalamus
´Growth hormone (GH)-releasing hormone
´Thyrotropin-releasing hormone (TRH)
´Gonadotropin-releasing hormone (GnRH)
´Corticotropin-releasing hormone (CRH)
´Prolactin (PRL)-releasing hormone
growth hormone-releasing hormone
a hormone produced by the hypothalamus that stimulates the anterior pituitary to release growth hormone.
thyrotropin releasing hormone (TRH)
stimulates the anterior pituitary gland to release thyroid-stimulating hormone (TSH)
plays a crucial role in regulating the body's metabolism by influencing the secretion of thyroid hormones (T3 and T4) from the thyroid gland
Gonadotropin-releasing hormone (GnRH)
a hormone produced by the hypothalamus that stimulates the anterior pituitary to release luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are essential for reproductive function.
Corticotropin-releasing hormone (CRH)
a hormone produced by the hypothalamus that stimulates the anterior pituitary to release adrenocorticotropic hormone (ACTH), which plays a key role in the stress response and regulating cortisol levels.
prolactin-releasing hormone (PRL)
a hormone produced by the hypothalamus that stimulates the anterior pituitary to release prolactin, which is important for milk production and reproductive functions.
inhibiting factors produced by the hypothalamus
GH-releasing inhibiting factor (somastatin), prolactin-inhibiting factor (PIF), antidiuretic hormone (ADH) and oxytocin (stored in the posterior pituitary)
connection of hypothalamus to pituitary gland
- vascular capillary network carries hypothalamic-releasing factors directly into the anterior pituitary
- neurological network delivers ADH and oxytocin to the posterior pituitary for storage
- hormones are released as needed by body when stimulated by the hypothalamus
- negative feedback systems
major anterior pituitary hormones
Growth hormone (GH)
Adrenocorticotropic hormone (ACTH)
Follicle-stimulating hormone (FSH)
Luteinizing hormone (LH)
Prolactin (PRL)
Thyroid-stimulating hormone (TSH)
adrenal cortex
outer layer of the adrenal gland; produces glucocorticoids and mineralocorticoids in response to adrenocorticotropic hormone (ACTH) stimulation; also responds to sympathetic stimulation
adrenal medulla
inner layer of the adrenal gland; a sympathetic ganglion, it releases norepinephrine and epinephrine into circulation in response to sympathetic stimulation
adrenal glands
paired endocrine glands located on top of each kidney
inner core - adrenal medulla - part of the SNS
outer core - adrenal cortex - produces corticosteroids
actions of adrenocortical hormones
Increasing the blood volume (aldosterone effect)
Causing the release of glucose for energy
Slowing the rate of protein production in most cells and increasing protein breakdown
Mobilizing fatty acids into plasma
Decreasing the activities of the inflammatory and immune systems (which preserves energy)
suppresses immune system to make people feel better
replacement therapy for people with adrenal insufficiency
adrenocortical agents
corticosteroids that include androgens, glucocorticoids, and mineralocorticoids
play a role in regulating metabolism, immune response, and inflammation
affect potassium, sodium, and water levels in the body
corticosteroids
steroid hormones produced by the adrenal cortex; they include androgens, glucocorticoids, and mineralocorticoids
helps the body preserve energy for the fight-or-flight response and maintain fluid balance
glucocorticoids
steroid hormones released from the adrenal cortex; they increase blood glucose levels, fat deposits, and protein breakdown for energy
mineralocorticoids
steroid hormones released by the adrenal cortex; they cause sodium and water retention and potassium excretion
aldosterone secreted by the adrenal gland
process of corticosteroid release
adrenal cortex responds to adrenocorticotropic hormone (ACTH) released from the anterior pituitary. ACTH in turn responds to corticotropin-releasing hormone (CRH) released from the hypothalamus.
diurnal rhythm
Addison’s Disease
LOW and SLOW—> bp, weight, temp, hair, mood, sodium, glucose, periods; and skin hyperpigmentation.
a disorder characterized by insufficient production of adrenal hormones, particularly cortisol and aldosterone
hyponatremia, hyperkalemia(due to lack of aldosterone to excrete K+) , tachycardia (compensation)
causes of adrenal insufficiency
Can occur if person does not produce enough ACTH, adrenal glands do not respond to ACTH, when a gland is damaged, secondary to surgical removal, or prolonged uses of corticosteroid hormones
Cushing’s Syndrome
HIGH temp, bp, weight, glucose and sodium, face (moon face), risk for fractures, hair (hairy body/ hirsutism)
a disorder caused by excessive cortisol production, often due to a tumor or prolonged use of corticosteroids, leading to symptoms such as weight gain, purple striae, and hypertension.
adrenal crisis
a life-threatening condition resulting from severely low cortisol levels, often triggered by stress, illness, or sudden withdrawal from corticosteroids.
exhaustion, hypotension, fluid shift, shock, death
treatment for adrenal crisis
Involves immediate administration of intravenous hydrocortisone or other glucocorticoids, along with fluid resuscitation and electrolyte management to stabilize the patient.
glucocorticoid drugs
Prednisone, Cortisone, Hydrocortisone, Dexamethasone, Methylprednisolone
glucocorticoids - actions
enter target cells and bind to cytoplasmic receptors; initiate many complex reactions responsible for anti-inflammatory and immunosuppresive effects
glucocorticoids - indications
relieves discomfort and inflammation (IBS, arthritis)
used in conjunction with other immunosuppressant medications to inhibit transplant rejection
cancer
when combined with mineralocorticoids, adrenal insufficiency
glucocorticoids - cautions
pts with acute infections not treated with antibiotics
diabetes because glucose levels become elevated
pts with peptic ulcers — can worsen
pregnancy and lactation
must be slowly tapered to avoid adrenal insufficiency if taken for more than 10-14 days
what time of day are glucocorticoids normally taken?
Typically in the morning to mimic the body's natural rhythm of cortisol production.
adverse effects of glucocorticoids
risk for diminished growth in children due to suppression of the HPA
hyperglycemia and retention of sodium and water—> weight gain, edema, hypertension, fluid overload
osteoporosis, peptic ulcers, infection
adrenal insuffiencency
mood disturbances
will not heal as quickly / altered skin integrity due to decreased protein synthesis
glucocorticoids - drug-drug interactions
NSAID or alcohol, potassium depleting agents, vaccines, anticoagulants
mineralocorticoid drugs
fludrocortisone, hydrocortisone, prednisolone, prednisone, cortisone
mineralocorticoids - actions & indicatons
actions: increases sodium reabsorption in renal tubule, leading to sodium and water retention and potassium excretion; increase blood volume and blood pressure.
Indications: replacement therapy for adrenal insufficiency; salt-wasting adrenogenital syndrome
mineralocorticoids - cautions
people with severe hypertension, HF, or cardiac disease because of the increased BP
high sodium take —> hypernatremia
pregnancy and lactation
presence of any systemic infection, which could be exacerbated due to suppression of the immune system
mineralocorticoids - adverse effects
(related to sodium and water retention)
headache, edema, hypertension, HF, arrythmias, weakness, hypokalemia, allergic reactions
nursing interventions for adrenal insufficiency
IV hormones - hydrocortisone
IV NS for dehydration
electrolyte replacement
monitor vitals
biphosphonates
A class of drugs used to prevent and treat osteoporosis by inhibiting bone resorption and increasing bone density.
calcitonin
A hormone produced by the thyroid gland that helps regulate calcium levels in the blood by inhibiting bone resorption and promoting calcium excretion by the kidneys.
puts calcium into bones and lowers blood calcium levels.
not regulated by HPA, controlled by the cellular level
hypoparathyroidism
A condition characterized by insufficient production of parathyroid hormone, leading to low calcium levels in the blood
iodine
important dietary element used by the thyroid gland to produce thyroid hormone
metabolism
rate at which cells burn energy
myxedema
a severe form of hypothyroidism characterized by swelling of the skin and underlying tissues, often associated with thyroid hormone deficiency.
paget’s disease (thyroid disorder)
a chronic bone disorder that causes enlarged and deformed bones, commonly affecting the pelvis, skull, and spine.
parathormone (PTH)
a hormone produced by the parathyroid glands that regulates calcium levels in the blood and bone metabolism.
postmenopausal osteoporosis
condition in which dropping levels of estrogen allow calcium to be pulled out of the bone, resulting in a weakened and honeycombed bone structure
thioamides
drugs used to prevent the formation of thyroid hormone in the thyroid cells, lowering thyroid hormone levels
antihypercalcemic agents: adverse effects
flushing of the face and hands, skin rash, nausea and vomiting, urinary frequency
antithyroid agents: adverse effects
thyroid suppresssion
hypothyroidism
goiter (enlargement of thyroid)
Bulging Eyes
thyroxine
thyroid hormone that is converted to triiodothyronine in the tissues; it has a half-life of 1 week
thyroid gland
- produces Triiodothyronine(T3) and and Thyroxine (T4)
- regulates metabolism and calcium levels in the body.
Triiodothyronine (T3)
- converted from T4
- more potent than T4
- regulates metabolism, growth, development, and body temperature.
Thyroxine (T4)
primary hormone produced by iodine
regulates metabolism, growth, development, and body temperature.
mechanism of thyroid hormone release
involves the hypothalamus releasing Thyrotropin-releasing hormone (TRH), which stimulates the anterior pituitary gland to release Thyroid-stimulating hormone (TSH). TSH then stimulates the thyroid gland to produce and secrete T3 and T4.
functions of thyroid hormone
heat production and body temp
regulate growth and development'
regulate rate of metabolism
oxygen consumption and cardiac output
blood volume
enzyme system activity
metabolism of carbs, fats, and proteins
characteristics of hyperthyroidism
HIGH and HOT
using a lot of energy —> weight loss
agitation and confusion
fever
high HR/BP
grape eyes
anxiety
goiter
diaphoresis
high GI —> diarrhea
dry hair
heat intolerance
nursing interventions for hyperthyroidism
high calorie diet; small, frequent meals
avoid high fiber, caffeine, and spicy foods
characteristics of hypothyroidism
LOW and SLOW
low BP/RR/temp
puffy face
depressed — > low mood
lethargic / low energy
weight gain due to low metabolism
hair loss (alopecia)
low libido
irregular menstration
nursing interventions for hypothyroidism
include a low-calorie diet; monitor weight; provide education on medication adherence; encourage regular exercise; avoid cold environments.
causes of hyperthyroidism
grave’s disease
iodine excess
levothyroxine excess
causes of hypothyroidism
low dietary iodine
pituitary tumor
thyroidectomy
Hashimoto’s disease (autoimmune thyroid disease)
thyroid hormones - drugs
Levothyroxine, Liothyronine
thyro
thyroid hormones - actions and indications
actions: increase the metabolic rate of body tissues, increasing oxygen consumption, respiration, heart rate, growth and maturation, and the metabolism of fats, carbohydrates, and proteins
indications: replacement therapy in hypothyroid states, treatment of myxedema coma, suppression of TSH in the treatment and prevention of goiters, and management of thyroid cancer
when should thyroid hormones be taken?
Thyroid hormones should be taken on an empty stomach, typically 30 to 60 minutes before breakfast, to enhance absorption and effectiveness.
**LEVO
thyroid hormones - contraindications and cautions
thyrotoxicosis
acute MI
hypoadrenal conditions such as addison’s disease
thyroid hormones - drug-drug interactions
Catecholamines
Insulin, digoxin
Oral anticoagulants
thyroid hormones - adverse effects
symptoms of hyperthyroidism
Tremors, headache, nervousness, palpitations, tachycardia, allergic skin reactions, loss of hair in the first few months of therapy in children, diarrhea, nausea, vomiting.
antithyroid agents
thioamides and iodine solutions
block the production of thyroid hormone and to treat hyperthyroidism
thioamides - actions and indications
actions: prevent the formation of thyroid hormone in the thyroid cells, which lowers the serum levels of thyroid hormone; partially inhibit conversion of T3 from T4
indications: treatment of hyperthyroidism
thioamides - drugs
Methimazole and Propylthiouracil (PTU)- Prevent Thyroid Up
iodine solutions - actions and indications
actions: high doses block thyroid function; Potassium iodide is used to treat overactive thyroid and to protect the thyroid gland from the effects of radiation from inhaled or swallowed radioactive iodine.
indications: hyperthyroidism
iodine solutions - drugs
strong iodine solution, potassium iodide (Thyrosafe, Thyroshield), and sodium iodide
what should you monitor for when taking antithyroid medications?
bruising
swelling of the neck —> associated with untreated hyperthyroidism of immediately post radioactive iodine treatment.
hyperglycemia (increased insulin resistance / decreased glucose metabolism)
adverse effects of thioamides
Effects of thyroid suppression; GI effects
adverse effects of iodine solutions
hypothyroidism
iodism (metallic taste and burning in the mouth, sore teeth and gums, diarrhea, cold symptoms, and stomach upset), staining of teeth, skin rash, and the development of goiter.
thioamides drug-drug interactions
Oral anticoagulants, theophylline, metoprolol, propranolol, digitalis
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actions of PTH
Stimulation of osteoclasts or bone cells to release calcium from the bone
Increased intestinal absorption of calcium
Increased calcium reabsorption from the kidneys
Stimulation of cells in the kidney to produce calcitriol, the active form of vitamin D, which stimulates intestinal transport of calcium into the blood
Which hormones work to maintain calcium homeostasis in the body?
Parathyroid hormone (PTH) and calcitonin.
How does magnesium affect PTH secretion?
by mobilizing calcium and inhibiting the release of PTH when concentrations rise above or fall below normal.
causes of hypoparathyroidism
can include surgical removal of the parathyroid glands, autoimmune disease, or genetic disorders affecting gland function.
treatment of hypoparathyroidism
typically involves calcium and vitamin D supplementation to manage low calcium levels.
causes of hyperparathyroidism
can include tumors of the parathyroid glands, vitamin D deficiency, or chronic kidney disease leading to secondary hyperparathyroidism.
excessive production of PTH
treatment of hyperparathyroidism
Calcifediol (Calderol)*** is a vitamin D3 analog that is used to treat secondary hyperparathyroidism in adult patients with stage 3 or 4 chronic kidney disease and serum total 25-hydroxyvitamin D levels less than 30 ng/mL.
Parathyroid disorders
Paget’s Disease, Postmenopausal Osteoporosis
Paget’s Disease
condition of overreactive osteoclasts that are eventually replaced by enlarged and softened bony structures
symptoms of Paget’s Disease
deep bone pain, headaches, and hearing loss and usually have cardiac failure and bone malformation.
signs and symptoms of hypocalcemia
include muscle cramps, tingling in the fingers, and seizures. It can also lead to cardiac arrhythmias and bone pain.
signs and symptoms of hypercalcemia
may include nausea, vomiting, constipation, confusion, and muscle weakness. Severe cases can lead to kidney stones and cardiac issues.
antihypoglycemic agents
Recombinant human PTH analogs, Synthetic vitamin D analog: Calcitirol (Rocaltrol); Parathyroid hormone–related peptide: Abaloparatide (Tymlos)
