Comprehensive Study Notes on Endocrine System Chapter 39

Endocrine Glands and Hormone Imbalances

Balanced Levels in the Body

• The body strives for balance in all aspects, including fluid levels and blood sugar.

• The key is to understand what each hormone does when the body is balanced.

  • When a gland is hyperactive, all the things it does are elevated.

  • When a gland is hypoactive, all the things it does are decreased.

  • This approach avoids memorizing separate symptoms for hypoactivity and hyperactivity.

Example: Thyroid Gland

• The thyroid gland regulates metabolism, temperature, and hunger.

  • In hyperthyroidism:

    • Temperature is elevated.

    • Metabolism and hunger are elevated.

  • In hypothyroidism:

    • Temperature is decreased.

    • Metabolism and hunger are decreased.

Hormone Issues

• Issues can arise from production/secretion problems or tissue sensitivity problems.

  • Production/secretion issue: The hormone is not being produced or secreted appropriately.

  • Sensitivity issue: The tissue affected has a sensitivity issue (e.g., insulin resistance).

Finding the Root Cause of Endocrine Disorders

• It's crucial to identify why an endocrine disorder is occurring.

• In order to do this we need to find out:

  • Is it the hormone level?

  • Is the gland not functioning correctly?

  • Is the body resistant to the hormone?

Primary vs. Secondary Disorders

• Primary disorder: The disorder stems from the gland itself being out of balance.

  • Example: Hypothyroidism caused by a diseased thyroid gland.

• Secondary disorder: The disorder is caused by a problem outside of the gland, such as an imbalance in a tropic hormone.

  • Example: Thyroid stimulating hormone (TSH) imbalance where the thyroid gland releases the hormone, but TSH tells the thyroid whether to release more or pull back.

  • Tropic hormones stimulate glands to release their hormones.

  • If the thyroid is working fine, but the thyroid stimulator is not telling it to release more hormone, that's where the problem lies.

The Role of TSH

• TSH is released by the pituitary gland.

• If thyroid levels are low, TSH should be high to stimulate the thyroid to release more hormone.
  This is a feedback mechanism.

• Analogy: Insulin and glucagon where insulin is secreted when blood is high and glucagon secreted when blood glucose is low.

• If thyroid levels are low and TSH is also low, then the problem lies with the TSH, not the thyroid gland.

• If TSH is working, but the thyroid isn't releasing hormone, then the thyroid gland is the problem.

Implications for Treatment

• If the thyroid gland is not releasing hormone, thyroid medication (pharmaceutical version of thyroid hormone, Synthroid) is needed.

• If the pituitary gland (TSH) has a problem, it needs to be investigated to see what the problem is; there might be a tumor or nodule affecting its function.

Thyroid Nodules and Tumors

• Thyroid tumors and nodules increase with age.

• They are usually benign and can be removed, but they can still cause problems.

• Benign means cancer-free, not problem-free.

• Living without a thyroid is possible with medication.

Importance of Correcting Thyroid Issues

• Thyroid issues are usually easy to correct.

• However, if left uncorrected, hypo- and hyperthyroidism can be fatal.

• Metabolic functions operate under a metabolic function; if hyperdrive or not working, means many things are affected

Antidiuretic Hormone (ADH)

• Antidiuretic hormone (ADH) helps the body to hold fluids in the body.

  • Low levels may cause an increase or an inappropriate release of urine.

  • High levels may cause a decrease or prevent release of urine.

• Too little ADH:

  • Leads to increased urine output (diabetes insipidus).

  • Kidneys do not reabsorb water.

  • Results in 3-15 liters of urine output per day.

  • Urine is clear because the kidneys are not concentrating it.

  • Causes:

    • Pituitary gland tumor.

    • Head traumas.

    • Surgery.

    • Drugs.

  • Treatment:

    • Fluid replacement with hypotonic saline (0.45%) to avoid overloading the body with salt.
      (0.45 \% \text{ saline})

    • Synthetic ADH (vasopressin) via IV or subcutaneous injection.

    • Long-term synthetic ADH (desmopressin).

  • Signs/Symptoms

    • Polyuria: excessive urination

    • Polydipsia: extreme thirst.

    • Nocturia: nighttime urination, also called "nocturnal polyuria," can be a symptom of polyuria.

    • Dilute urine

    • Dehydration

    • Hypovolemic shock

    • Prerenal acute kidney injury (due to lack of perfusion).

    • Death.

  • Nursing Considerations:

    • Monitor fluid levels and replace as needed.

    • Be aware of the patient's thirst.

    • Monitor Is and Os- intake and output- for the patient.

• Too much ADH:

  • Leads to syndrome of inappropriate ADH (SIADH), which causes an inability to pee.

  • Causes water retention and hyponatremia.

  • Causes:

    • Nervous system disorders.

    • Cancers.

    • Pulmonary diseases.

    • Drugs: cystic fibrosis, COPD, antipsychotic meds, histamines.

  • Signs/symptoms:

    • Weight gain.

    • Little to no urine output.

    • Dilutional hyponatremia.

    • Muscle cramps and weakness.

    • Brain swelling, seizures and death.

  • Treatment:

    • Treat the underlying cause.

    • Administer hypertonic saline to move fluid.

    • Admin hypo-osmolar fluids.

    • Administer oral sodium tablets

    • Administer Lasix to remove the excess fluid

    • Vaprisol or conivaptan (ADH inhibitors). Blocking the ADH from working

Water Deprivation Test

• Deprive the patient of water for up to six hours.

• Test body weight and urine osmolality hourly.

• If urine remains diluted and the patient loses weight, suspect diabetes insipidus.

• Measure ADH levels after administering hypertonic saline or fluid restriction.

• In a normal person, ADH levels should increase after fluid restriction.

Growth Hormone Disorders

• Too little growth hormone leads to:

  • Short stature.

• Too much growth hormone leads to:

  • Gigantism (in children).

  • Acromegaly (in adults).

Growth Hormone Deficiency

• Growth hormone (somatotropin) affects bones, cartilage, and soft tissue.

• Secreted by the anterior pituitary.

  • Causes:

    • Pituitary tumors.

    • Heredity.

    • Psychosocial factors (neglect, severe emotional stress).

    • Malnutrition.

  • Signs/symptoms when deficient in childhood:

    • Children only grow to be about three to four feet.

• Signs/symptoms when deficient in adulthood
  * Fatigue and weakness
  * Excess body fat
  * Decreased muscle and bone mass
  * Sexual dysfunction
  * Headaches and psychological stress

Acromegaly

• Occurs in adults.

• Bones grow in width but not length.

• Organs and connective tissues enlarge.

• Internal organs and glands enlarge.

• Causes an impaired intolerance for carbs, so elevated levels of blood glucose.

  • Signs/symptoms:

    • Change in shoe and ring size.

    • Enlarged nose, jaw and brow

    • Teeth displacement

    • Difficulty speaking and swallowing

    • Sleep apnea

    • Headaches, sexual dysfunction

    • Development of diabetes to high level of blood sugar.

• Treatment:

  • Tumor removal.

    • Take hormone replacement

    • take supplements for life if the pituitary glad has been removed

Hypophysectomy (Pituitary Gland Removal)

• Small incision under the upper lip to access the pituitary gland in the sphenoid sinus, which is located in the sinus cavity to avoid disturbing the brain tissue.

• Postoperative actions to avoid:

  • Coughing, sneezing, nose blowing

  • Straining for bowel movements

  • Bending from the waist.

  • Minimize the raising intracranial pressure on surgical site

• Other Considerations:

  • Post-operative nasal packing.

  • Test strips to test for glucose to that cerebrospinal fluid leakage is not found on dressing.

  • Teach them to blow their nose gently, take stool softeners, and be careful brushing their teeth.

Thyroid Disorders

• Hypothyroidism: Deficiency in thyroid hormone; decreased metabolic rate.
  * What medication is prescribed? : Levothyroxine.

  • Primary Hypothyroidism: The thyroid gland, thyroid fails to produce when it is told. The gland itself is the problem.

  • Secondary Hypothyroidism: TSH low and isn't stimulating enough. Not enough thyroid hormone. *Thyroid-stimulating hormone

    (TSH)*
    

  • Tertiary- TRH which is called thymotropin releasing hormone tells the TSH to be present. 3 issues: Primary, secondary or tertiary.

  • Causes:

    • Congenital

    • Inflammation of the thyroid (thyroiditis).

    • Iodine deficiency

    • Autoimmune disorders (Hashimoto's thyroiditis).

    • Medical treatments: Medical professionals who don't follow up on the patients, and taking too much or thyroid levels not checking

      • It is essential that you teach your patients to monitor their thyroid levels. Check your thyroid levels!!

    • Lithium (used to treat bipolar disorder causes reduction of thyroid hormone since the lithium binds to the same protein receptor that thyroid hormone does. Check TSH levels is people are taking Lithium). Or, if someone has hyperthyroidism, Lithium is not good. Have them switch drugs!

  • Signs/symptoms:

    • everything is low and slow
      *Low and slow,
      Low. This is all caused by the thyroid!
      Fatigue
      Bradycardia
      Mental dulness,
      Cold intolerance,
      Hypoventilation,
      Dry skin, hair,

    • Weight gain.

    • Heart failure.

    • Hyperlipidemia.

    • Myxedema: Non-pitting edema of the face, hands, and feet.

• Myxedema: Can lead to a coma from all the levels dropping so low. Metabolic rate can drop drop so low so the coma will developed. Can happen in a hyperthermic patient, less than 95 degrees.

• Decreased vital signs.
  *Level consciousness down to coma
  Respiratory failure
  Decreased Cardiac output
  Leads to perfusion- kidney issues
  *Leads to death*
  *T3 and T4 are low and the TSH is high *
  Hypothyroidism, is a high thyroid- stimulation hormone (TSH)

  • - Primary , the thyroid gland fails to produce. TSH is telling ti the gland to do it

    • secondary- the TSH will be low. It feels to stimulate the release of the thyroid hormone
      Mysema - is non pitting edema of the face, hands - leads to coma Because the metallic rate is low and you need emergency to save this person Test levels! What happened when you got so low that you were in comma? -they either were taking too much. If one day thyroid in that way or maybe they had to merge with I don't either and had to feel them. So maybe she has a tool around, so then she was that must be my body. So you didn't want so test our levels! Treatment: give synthroid which are the fake thyroids Give Warming blanket to avoid the hypothermic state Hypertension -warm them up -IV fluids because they are low Treat what need to be treated

• Hyperthyroidism: Too much thyroid hormone; increased metabolic rate.
  What do everything opposite, hyperactive!

  Restless, 
  
  Increase heart rate
    Diarrhea
  , More conscious ,again restless, hypoactive
  

  Get sweating
  and Heat Intolerance
  And always hyper or in respiratory
  Then for the weight is weight loss - is what's going on.

Heart failure . But it is not bradycardia, caused from, but increase from a tachycardia
Treatment:
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Adrenal Cortex Harmone Issues

Addison and Cushions
Treatment:
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