Chapter45 2

Chapter 45: Assessment and Management of Patients with Endocrine Disorders

Endocrine System Overview

• Role: Vital in orchestrating cellular interactions, metabolism, growth, reproduction, aging, and response to adverse conditions.

• Mechanisms: Operates primarily through negative feedback loops.

• Types of Hormones:

  • Amines and Amino Acids

  • Peptides, Polypeptides, Proteins, and Glycoproteins: Act on cell surface.

  • Steroids: Act inside the cell.

  • Fatty Acid Derivatives

Clinical Considerations

• Key Questions When Assessing Glands:

  • What is the gland's function and what does it secrete?

  • What signs indicate hypersecretion? (Hyper)

  • What signs indicate hyposecretion? (Hypo)

Major Hormone-Secreting Glands

Pituitary Gland (Hypophysis)

• Anterior Pituitary Hormones:

  • FSH, LH, Prolactin, ACTH, TSH, GH

  • Hypersecretion: Can lead to Cushing’s syndrome, gigantism, and acromegaly.

  • Hyposecretion: Can lead to dwarfism and panhypopituitarism.

• Posterior Pituitary Hormones:

  • ADH and Oxytocin

  • Hypersecretion (SIADH) and Hyposecretion (DI).

  • Tumors are mostly benign; options for surgery include hypophysectomy.

Thyroid Gland

• Hormones: T3, T4, and Calcitonin.

• Iodine: Essential component of thyroid hormones.

• Function: Regulates metabolic activity controlled by TSH from the anterior pituitary.

• Action of Hormones:

  • T3 is more potent and rapid-acting than T4.

  • Calcitonin aids in bone calcium deposition in response to high plasma calcium levels.

Thyroid Diagnostic Tests

• TSH, Serum-free T4, T3, T4, T3 Resin Uptake, Thyroid Antibodies, Radioactive Iodine Uptake, Fine-Needle Biopsy, Thyroid Scan.

• Note: Some medications can alter test results.

Thyroid Disorders

• Common Disorders:

  • Cretinism, Hypothyroidism, Hyperthyroidism, Thyroiditis, Goiter, Thyroid Cancer.

Hypothyroidism

• Common Causes: Hashimoto Disease and primary dysfunction.

• Symptoms:

  • Intolerance to cold, receding hairline, facial edema, extreme fatigue, thick tongue, slow speech, dry skin, and weight gain.

• Clinical Manifestations: May include muscle aches, constipation, and menstrual disturbances.

Hyperthyroidism

• Common Cause: Graves Disease.

• Symptoms:

  • Nervousness, rapid pulse, heat intolerance, tremors, weight loss, exophthalmos, increased appetite.

• Higher Incidence: Affects women 8 times more than men.

Hyperthyroidism Management

• Medical Treatment:

  • Radioactive iodine therapy, medications (such as Propylthiouracil), and surgery (subtotal thyroidectomy).

Parathyroid Glands

• Function: Regulates calcium and phosphorus balance through parathormone.

• Hyperparathyroidism:

  • Occurrence is higher in women; symptoms may include muscle weakness, fatigue, and constipation.

  • Treatment often includes parathyroidectomy and hydration therapy.

Hypoparathyroidism

• Causes: Can be due to abnormal parathyroid development, surgical removal or autoimmune response.

• Symptoms: Tetany, numbness, anxiety, and ECG changes.

• Management: Increase serum calcium through various treatments including IV calcium gluconate and vitamin D supplementation.

Adrenal Glands

• Functions:

  • Adrenal Medulla: Part of the autonomic nervous system; secretes catecholamines (epinephrine, norepinephrine).

  • Adrenal Cortex: Responsible for glucocorticoids, mineralocorticoids, and androgens.

Addison's Disease (Adrenocortical Insufficiency)

• Symptoms: Muscle weakness, GI symptoms, dark pigmentation, hypotension.

• Management: Based on diagnostic tests (adrenocortical hormones, ACTH). Treatment may include steroids and supportive care.

Cushing’s Syndrome

• Causes: Excessive adrenocortical activity or corticosteroid medications.

• Symptoms: Hyperglycemia, muscle wasting, hypertension, mood changes, and moon face appearance.

• Diagnosis: Dexamethasone suppression test is frequently used.

Nursing Interventions for Endocrine Disorders

• General Assessment: Health history, physical assessments, and diagnosis of potential complications.

• Planning and Goals: Set realistic patient-centered goals.

• Monitoring: Patients' symptoms, education, and managing interventions effectively.