endocrine

ENDOCRINE SYSTEM OVERVIEW

  • Major Glands:

    • Hypothalamus

    • Pituitary gland

    • Thyroid gland

    • Adrenal glands

    • Pancreas

    • Ovaries/Testes

PITUITARY GLAND

Anterior Pituitary (MASTER GLAND)

  • Hormones:

    • Growth hormone (GH)

    • Prolactin

    • Adrenocorticotropic hormone (ACTH)

    • Thyroid-stimulating hormone (TSH)

    • Follicle-stimulating hormone (FSH)

    • Luteinizing hormone (LH)

ACROMEGALY (↑ GH)

  • Cause:

    • GH-secreting pituitary adenoma

  • Key Concept:

    • Develops slowly over years

  • Clinical Manifestations:

    • Enlarged hands, feet, and face

    • Prominent jaw

    • Thickened soft tissues

    • Joint pain, arthritis

    • Muscle weakness

    • Carpal tunnel/peripheral neuropathy

    • Enlarged tongue

    • Deep voice

    • Sleep apnea

    • Vision changes (due to optic nerve pressure)

    • Diabetes mellitus (due to GH antagonizing insulin)

  • Diagnosis:

    • GH levels

    • MRI/CT (to detect tumor)

  • Treatment:

    • Surgery (hypophysectomy)

    • Radiation therapy

    • Medications:

    • Octreotide → ↓ GH

    • Bromocriptine/Cabergoline → ↓ GH secretion

    • Pegvisomant → blocks effects of GH

HYPOPITUITARISM (↓ pituitary hormones)

  • Causes:

    • Tumor

    • Autoimmune disorder

    • Infection

    • Trauma/surgery/radiation

  • Manifestations:

    • Depends on which hormones are ↓

    • Early signs: headache, vision changes

    • ↓ GH → short stature

    • ↓ FSH/LH → ↓ libido, infertility

    • Low energy, obesity

  • Diagnosis:

    • MRI/CT imaging

    • Hormone levels (TSH, T3, T4, etc.)

  • Treatment:

    • Lifelong hormone replacement:

    • GH (Somatropin)

    • Corticosteroids

    • Levothyroxine

PITUITARY SURGERY (Hypophysectomy)

  • Key Nursing Care:

    • Keep head of bed (HOB) elevated to 30°

    • Monitor:

    • Vision changes

    • Neurological status

    • Input & Output (I&O)

    • Electrolytes (for Diabetes Insipidus (DI) or Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH))

    • Watch for cerebrospinal fluid (CSF) leak (halo sign, glucose test)

    • Avoid:

    • Coughing, sneezing, straining

    • Brushing teeth for approximately 10 days

    • Important:

    • Lifelong hormone replacement required

POSTERIOR PITUITARY

  • Hormones:

    • Antidiuretic hormone (ADH, regulates water balance)

    • Oxytocin

SIADH (Too much ADH)

  • Causes:

    • Small cell lung cancer

    • Head trauma

    • Certain drugs

    • Tumors

  • Pathophysiology:

    • Water retention leading to dilutional hyponatremia

  • Clinical Manifestations:

    • Thirst

    • Fatigue

    • Muscle cramps

    • Headache

    • Confusion, lethargy

    • Seizures, coma (if Na < 120 mEq/L)

  • Treatment:

    • Fluid restriction

    • Furosemide (loop diuretic)

    • Demeclocycline (blocks ADH action)

    • Severe cases:

    • Hypertonic saline

    • Conivaptan / Tolvaptan

    • Warning:

    • Correct sodium levels slowly (≤ 8–10 mEq/day)

DIABETES INSIPIDUS (Too little ADH)

  • Types:

    • Central DI → ↓ ADH production

    • Nephrogenic DI → kidneys do not respond to ADH

  • Clinical Manifestations:

    • Polyuria (large urine output)

    • Polydipsia

    • Low urine specific gravity (< 1.005)

    • Low urine osmolality

    • Increased serum osmolality

    • Hypernatremia

    • Weakness → risk of shock

  • Treatment:

    • Hydration (hypotonic fluids, D5W)

    • DDAVP (desmopressin, a synthetic ADH)

    • Carbamazepine

    • Low sodium diet

    • Indomethacin

SIADH vs DI (HIGH YIELD)

SIADH

Diabetes Insipidus

ADH

High

Low

Urine

Concentrated

Dilute

Serum Na

Low

High

Fluid status

Overloaded

Dehydrated

MEMORY AID:

  • SIADH = "Soaked Inside"

  • DI = "Dry Inside"

THYROID GLAND

  • Function:

    • Thyroxine (T4) and Triiodothyronine (T3) → regulate metabolism

    • TSH → inversely related to T3/T4 levels

  • Classic Sign:

    • Goiter

HYPERTHYROIDISM (FAST)

  • Causes:

    • Graves disease

    • Toxic nodular goiter

    • Thyroiditis

    • Excess iodine

    • Tumors

  • Clinical Manifestations:

    • Weight loss

    • Heat intolerance

    • Tachycardia, palpitations

    • Dysrhythmias

    • Nervousness

    • Diarrhea

    • Increased metabolism

GRAVES DISEASE (AUTOIMMUNE)

  • Pathophysiology:

    • Antibodies stimulate TSH receptors, leading to increased T3/T4 production

  • Signs:

    • Goiter

    • Bruit

    • Exophthalmos (bulging eyes)

    • Weight loss

    • Palpitations

HYPERTHYROID TREATMENT

  • Medications:

    • Propylthiouracil (PTU)

    • Methimazole

    • Beta blockers (e.g., propranolol, atenolol)

  • Other Treatments:

    • Radioactive iodine therapy

    • Thyroidectomy (surgical removal of the thyroid)

  • Nursing Tips:

    • High-calorie diet (4000–5000 kcal/day)

    • Avoid spicy foods

    • Radiation precautions for 7 days:

    • Private toilet

    • Sleep alone

    • Avoid children and pregnant women

THYROID STORM (EMERGENCY)

  • Triggers:

    • Surgery, infection, trauma

  • Symptoms:

    • Tachycardia

    • Hyperthermia (temperature of 102–104°F)

    • Seizures

    • Vomiting/diarrhea

    • Shock, coma

  • Treatment:

    • ABCs (Airway, Breathing, Circulation)

    • Oxygen

    • Beta blockers

    • Antithyroid medications

    • Cooling blanket

POST-THYROIDECTOMY CARE

  • Monitor for:

    • Hypocalcemia (risk of parathyroid damage) leading to:

    • Tetany

    • Muscle cramps

    • Airway obstruction

    • Hematoma (check behind neck)

  • Keep necessary resuscitation tools at bedside:

    • Oxygen device

    • Suction

    • Tracheostomy kit

HYPOTHYROIDISM (SLOW)

  • Clinical Manifestations:

    • Fatigue

    • Weight gain

    • Cold intolerance

    • Depression

    • Myxedema (puffy face)

MYXEDEMA COMA (EMERGENCY)

  • Signs:

    • Hypothermia

    • Hypotension

    • Hypoventilation

  • Treatment:

    • IV thyroid hormone

HASHIMOTO’S THYROIDITIS

  • Cause:

    • Autoimmune disorder

  • Labs:

    • ↑ TSH

    • ↓ T3/T4

  • HYPOTHYROID TREATMENT:

    • Levothyroxine

    • Instructions:

    • Take in the morning, before eating

    • Monitoring:

    • Heart rate

    • Blood pressure

    • Chest pain

PARATHYROID

HYPERPARATHYROIDISM (HIGH Ca)

  • Pathophysiology:

    • ↑ parathyroid hormone (PTH) → ↑ calcium, ↓ phosphorus

  • Manifestations:

    • Bone pain

    • Weakness

    • Fatigue

    • Kidney stones

  • Diagnosis:

    • ↑ calcium (> 10 mg/dL)

    • ↑ PTH

    • ↓ phosphorus

  • Treatment:

    • Surgery

    • Hydration

    • Loop diuretics

    • Bisphosphonates

    • Cinacalcet

HYPOPARATHYROIDISM (LOW Ca)

  • Cause:

    • Lack of PTH (often post-surgery)

  • Manifestations:

    • Tetany

    • Muscle cramps

    • Dysrhythmias

  • Treatment:

    • Calcium replacement

    • Dietary considerations:

    • Dairy products

    • Leafy greens

    • Beans, tofu

ADRENAL GLANDS

  • Hormones:

    • Cortisol (stress, glucose metabolism)

    • Aldosterone (sodium/potassium balance)

    • Androgens

CUSHING SYNDROME (TOO MUCH CORTISOL)

  • Causes:

    • Steroid use

    • Tumors

  • Clinical Manifestations:

    • Weight gain

    • Moon face

    • Buffalo hump

    • Hyperglycemia

    • Thin skin

  • Treatment:

    • Treat underlying cause

    • Decrease steroid use

    • Medications:

    • Ketoconazole, Mitotane

ADDISON DISEASE (TOO LITTLE CORTISOL)

  • Cause:

    • Autoimmune disorder

  • Clinical Manifestations:

    • Weight loss

    • Weakness

    • Nausea

    • Hyperpigmentation

    • Salt craving

ADDISONIAN CRISIS (EMERGENCY)

  • Cause:

    • Sudden steroid withdrawal

    • Stress

  • Signs:

    • Severe hypotension

    • Shock

  • Teaching:

    • Never stop steroids abruptly

    • Stress dosing may be needed

ADDISON TREATMENT

  • Components:

    • Hormone replacement therapy

    • Management of fluid and electrolyte balance

    • Monitoring of blood pressure and weight

ULTRA HIGH-YIELD NCLEX SUMMARY

  • PITUITARY:

    • Acromegaly = ↑ GH → BIG features

    • Hypopituitarism = ↓ all pituitary hormones

  • ADH:

    • SIADH = too wet (lower Na levels)

    • DI = too dry (higher Na levels)

  • THYROID:

    • Hyperthyroidism = FAST symptoms

    • Hypothyroidism = SLOW symptoms

  • PARATHYROID:

    • Hyperparathyroidism = ↑ calcium

    • Hypoparathyroidism = ↓ calcium

  • ADRENAL:

    • Cushing syndrome = too much cortisol

    • Addison disease = too little cortisol