Gland Thyroid Gland

Hormones/Descriptio n 1.Triiodothyronine (T3) andThyroxine (T4)

Functions of hormones Regulate metabolic rate of cells regulate protein,fat,and carbohydrate metabolis act as insulin antagonist Maintain growth hormone secretion and promote skeletal maturation Affect central nervous systems(CNS) development Affect cardiac rate,force and output Affect oxygen utilization Stimulate sympathetic nervous system (SNS) activity

Disorder Hyperthyroidismhypersecretions of thyroid hormones

Treatment Provide rest Provide non-stimulating,quiet,and cool environment Provide high-calorie diet Low-fiber diet Avoid stimulants like caffeine Replace fluid Anti-thyroid medications(Iodides(sski),Thioamides Beta-Blocker:Inderal Calcium channel blockers Surgery:Subtotal Thyroidectomy

Hypothyroidism-defiency of thyroid hormones

2.Throcalcitonin(calici tonin)

Parathyro id hormone s

Parathyroid Hormones

It lowers serum calcium levels It inhibits osteoclastic activity It lowers phosphate levels It decreases calcium and phosphate levels It decreases calcium and phosphorus absorption in GI tract Regulates calcium and phosphorous balance Elevates serum calcium levels by withdrawal of calcium from the bones

Monitor VS.Be alert for changes in heart rate and rhythm,which indicate cardiovascular disorders Monitor daily weights DIET: Low calorie, loe cholesterol, low saturated-fat diet Administer thyroid replacement theraphy:Synthroid,levothroid,levoxyl,thy rolar,thycar,cytomel

Hypoparathyroidism-is hyposecretion of parathormone

Monitor for signs of hypocalcemia and tetany Place client on seizure precaution Administer calcium gluconate/IV for hypocalcemia Diet:High calcium,low phosphorous diet Administer phosphate binder

Administer vitamin D and calcium supplement Monitor for cardiac dysrrhytmias Monitor for urine output Monitor for signs of renal stones Increase fluid intake Administer Lasix(Furosemide) to lower serum calcium levels Administer NSS/IV for hydration Administer calcitonin Administer antihypercalcemic Administer phosphates Parathyroidectomy Surgery:adrenalectomy Administer alpha-adrenergic agent Instruct client to avoid somking, drinking caffeine Promote bed rest Monitor clients for the ff (hypertensive crisis, blood glucose and urine for ketones) For Hyperpituitarism: 1.Surgery : Transphenoidal hypophysectomy. Hypophysectomy is surgical removal of pituitary gland. The incision is made between the upper lip and upper gum. The nursing interventions are as follows: -Keep head of bed elevated, atleast for 2 weeks. To promote venous drainage. -Maintain nasal packing in place and reinforced as needed.

Hyperparathyroidismhypersecretion of PTH

Adrenal medulla

Epinephrine and norepinephrine

Effects of sympathoadrenomedullary response (SAMR)(every function is high and fast, except GI and GU)

Pheochromocytoma-a tumor that originates from the adrenal medulla

Anterior Pituitary

Melanocytestimulating Hormone (MSH)

Structure: peptide Target Tissue: melanocytes in the skin Increased melanin production in melanocytes to make the skin darker in color. It is necessary for pigmentation, e.g. skin, retina (melanin epithelial pigment layer).

Hypersecretion of the hormone results to hyperpigmentation of the skin (etemal tan or bronze appearance of the skin). -Hyposecretion of the hormone results to albinism (hypopigmentation of the skin). It is characterized by absence of the

melanin epithelial pigment of the retina. This results to difficulty in vision during daytime or in the presence of bright light.

Luteinizing hormone (LH)

Structure: Glycoprotein Target Tissue: ovaries in females; testes in males Ovulation and progesterone production in ovaries; testosterone synthesis and support for sperm cell production in testes.

Gonadotropins (LH and FSH) -Hypersecretion of hormones results to precocious puberty, -Hyposecretion of the hormones results to failure to develop secondary sex characteristics that normally develop at the age of puberty. The manifestations are as follows: Males: -small phallus and testicles. -No growth of body hair -Decreased libido -Impotence -Aspermia Females: -Failure to develop

-Provide frequent oral care with toothettes. To prevent trauma to the incision. -Instruct client to avoid blowing nose and activities that increase ICP. -Administer glucocorticoids and other hormone replacement as prescribed. This may include vasopressin, growth hormone (somatotropin) 2.Radiation therapy as prescribed. 3.Pharmacotherapy Parlodel (Bromocriptine) to lower GH and prolactin levels.

For Hypopituitarism: -Surgical removal of the tumor. -Radiaton therapy -Hormonal replacement therapy (HRT).

Follicle-stimulating hormone (FSH)

Structure: Glycoprotein Target Tissue: Follicles in ovaries in females; seminiferous tubes in males Follicle maturation and estrogen secretion in ovaries; sperm cell production in testes.

breast -No growth of body hair -No ovulation -No menstruation -Infertility Prolactin Structure: Protein Target Tissue: Ovaries and mammary glands in females It is also called mammotropic hormone, lactotropic hormone or luteotropic hormone. It is necessary for breast development and lactation. It regulates reproductive function in males and females. Milk production in lactating women; increased response of follicle to LH and FSH; unclear functions in males -Galactorrhea is characterized by excessive milk production and results from hypersecretion of prolactin. -Absence of milk production during lactation results from hyposecretion of prolactin.

Anterior Pituitary

Growth Hormone (GH)

Stimulates growth tissues of bone and muscle; promotes uptake of amino acids and protein synthesis; promotes breakdown of lipids and release of fatty acids from cells; decreases carbohydrate metabolism; promotes glycogen synthesis and increased blood glucose levels; increased somatomedin production

Giantism

-A condition of abnormally increased height that usually results from excessive cartilage and bone formation at the epiphyseal plates of long bones. Pituitary giantism is a result of excessive production of the GH. -Management: Dopamine agonists, surgery to remove pituitary tumor or radiotherapy -Caused by excess GH secretion in adults and is usually developed late in life -Surgery: transsphenoidal surgery -Medications: somatostatin analogues (SSA), growth hormone receptor antagonists (GHRAs) and dopamine agonists -Radiation: conventional radiation therapy and stereotactic radiosurgery -A condition in which a person is abnormally short. Pituitary dwarfism results when abnormally low levels of GH affect the whole body. Achondroplasia is a condition in which a person with a nearly normal-sized trunk and head has limbs that are shorter than normal. -Surgeries: Limb-lengthening surgery; Inserting metal staples into the ends of long bones (epiphyseal plates) in order to correct the direction in which bones are growing; Dividing a limb bone, straightening it and inserting metal plates to hold it in place; Inserting rods or staples to help correct the shape of the spine; Increasing the size of the opening in the vertebrae to alleviate pressure on the spinal cord -Therapy: Hormone therapy

Acromegaly

Dwarfism

Cushings disease Adrenocorticotropic Hormone (ACTH) Stimulates synthesis and secretion of adrenal cortical (glucocorticoid) hormones

-It is caused by a tumor or excess growth (hyperplasia) of the pituitary gland due to too much ACTH -Management: Surgical removal of the tumor and cortisol replacement treatments -This occurs when the anterior pituitary gland does not produce enough cortisol, and in some cases, aldosterone -Medications: hydrocortisone and fludrocortisone acetate

Addisons disease (hypocotisolism)

Posterior Pituitary

Antidiuretic Hormone (ADH) Oxytocin

Increases water reabsorption by kidney Stimulates contraction of pregnant uterus; milk ejection from breasts after childbirth; unclear function in males

Benign prostatic hyperplasia

-Prostate enlargement often related to high levels of oxytocin -Medications: alpha blockers and 5reductase inhibitors finasteride -Therapies: super-selective intra-prostatic androgen deprivation (SPAD) therapy, transurethral microwave thermotherapy (TUMT) and transurethral needle ablation (TUNA) -Surgery: transurethral resection of the prostate(TURP) -Related to low levels of oxytocin -Treatment: synthetic oxytocin -Management: Apply warm, moist compresses; nipple stimulation; rubs and massages -Related to low levels of oxytocin -Management: SpEd programs, behavioural therapies and speech therapies

Prevention of milk ejection reflex

Autism and autism spectrum disorders

Hypothalamus Gonadotropinreleasing hormone (GnRH)

Increase secretion of luteinizing hormone and follicle-stimulating hormone

Prolactininhibiting hormone (PIH) ProlactinReleasing Hormone (PRH)

Decrease prolactin secretion

1. Central Hypogonadism-reduction or absence of hormone secretions from the sex glands (gonads) -Central hypogonadismthe centers of the brain responsible for control of the gonads (the hypothalamus and pituitary) do not function properly. -S/SX: In men symptoms include muscle loss, sexual dysfunction such as a decreased libido, impotence and decreased volume of ejaculate, low serum testosterone levels, weakness, fatigue, breast enlargement, decreased beard and body hair. Females have delayed breast development, scant pubic and axillary hair, and primary amenorrhea . 1. Prolactinoma--benign pituitary tumor that produces prolactin -this results to

-Mgt: Treatment will depend on the causes of the problem. Tumors can be treated with surgery and radiotherapy. Infection will required antibiotic therapy Nutritional causes require cause specific treatments. Men may require hormonal medication to replace testosterone by patch or injection. Injections of pituitary hormone may be required for men to produce sperm.

-Mgt: Medications: bromocriptine (a dopamine agonist) Bromocriptine may cause tumour shrinkage.

Increase prolatin secretion

hyperprolactinemia -S/SX: (Women) Galactorrhea, Breast tenderness, Decreased libido, Headache, Infertility, Stopping of menstruation not related to menopause, or irregular menstruation, Vision changes (Men) Decreased libido, Gynecomastia, Headache, Impotence, Infertility, Vision changes

The medical treatment may be only partially successful. In such cases, the medications may be combined with surgery or radiation therapy. Surgery is indicated in patients with visual field abnormalities or neurologic symptoms. Trans-sphenoidal microsurgery is the procedure of choice.

PINEAL BODY

Melatonin

Allows the entrainment of the circadian rhythms or the sleep-wake cycle. It also decreases the secretion of GnRH.

Insomnia - reported sleeping difficulties. It may be due to an alteration to a persons sleep-wake cycle, which is controlled by melatonin.

Promote relaxation therapy Eliminate daytime naps sleeping tablets and other sedatives sedatives such as benzodiazepines Diphenhydramine intake as prescribed. Alcohol is often used as a form of selftreatment of insomnia to induce sleep.

Posterior Pituitary Gland

Antidiuretic hormone (ADH)

It is the major control of osmolality (concentration) and body water volume. It increases water reabsorption int he collecting ducts of the kidneys.

1. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

- hypersecretion of ADH -characterized by excessive retention of water by the renal tubules -causes include trauma, stroke, medications and stress -S/SX: Edema, wt. gain, hypertension, dilutional hyponatremia -Mgt: Administer diuretics and Demeclocyline (Declomycin) as prescribed. Restrict fluid intake as prescribed. Monitor VS, cardiac and neurologic status. Monitor I & O, daily wt. and electrolyte levels.

2. Diabetes Insipidus (DI)

-hyposecretion of ADH -characterized by inability of the renal tubules to retain water (water loss) -S/SX: Polyuria (as much as 20L of urine/day), urine is dilute-with low specific gravity, polydipsia, dehydration constipation, retarded growth in children -Diagnostic test: Water Deprivation Test -Mgt: Antidiuretic hormones like Desmopressin acetate Vasopressin Chlorpropramide and thiazide diuretics potentiate the action of vasopressin.

Thymus Gland

Thymosin

-plays an important role in the development and maturation of the immune system

DiGeorge Syndrome

-hyposecretion of thymosin or absence of thymus gland -occurs in children born without a thymus gland. As a result, there is a lack of thymosin production. Thymosin is needed to stimulate the differentiation of T lymphocytes. -S/SX: Little or no immune response. 2. Inability to resist bacterial, viral or fungal infections. 3. A lack of cancer cell surveillance. 4. Inability to reject foreign tissues. -Mgt: DiGeorge syndrome can't be cured, but treatment of problems such as low calcium, surgery for heart problems and thymus cell transplants to restore the

immune system can reduce complications. Educational support and help for the family is vital. Antenatal diagnosis, usually using CVS or amniocentesis, is possible especially when there's a family history or abnormalities on ultrasound scanning. Postnatal diagnosis and counselling is also available for those at risk of passing on the condition. -a tumor originating from the epithelial cells of the thymus. found in 15% of patients with myasthenia gravis -S/SX Thymoma superior vena cava syndrome, dysphagia, cough, or chest pain caused by compression of the surrounding organs by an expansive mass -Mgt:Surgery Chemotherapy,radiotherapy

HYPOTHALAMUS

Growth hormone releasing hormone (GHRH) Somatostatin (Growth hormone inhibiting hormone) Thyrotropin releasing hormone (TRH)

Controls the release of pituitary hormones.

Stimulates the release of TSH (thyroid-stimulating hormone) and prolactin from the anterior pituitary.

Stimulates the pituitary synthesis of Adrenocorticotropic Hormone (ACTH).

Corticotropin releasing hormone (CRH) Gonadotropin releasing hormone (GnRH)

Responsible for the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary. It also triggers the release of pituitary hormones causing the onset of puberty with resulting sexual development and fertility Hypogonadotropic hypogonadism - there is an impaired secretion of gonadotropins, including folliclestimulating hormone (FSH) and luteinizing hormone (LH), and in turn decreased gonadotropin levels and a resultant lack of sex Administration of either a GnRH agonist or a gonadotropin formulation. Hormone replacement therapy with androgens and estrogens in males and females, respectively.

steroid production. It is manifested by delayed, reduced, or absent puberty, low libido, and infertility. Hypothalamic Amenorrhea A condition wherein an event that the hypothalamus stops producing GnRH, which in turn, will reduce the amount of other hormones produced (FSH, LH, and estrogen). Ovulation and menstruation stop, which will result in infertility. Kallmann Syndrome genetic condition which results in the failure or non-completion of puberty. It is characterised by hypogonadism and by a total lack of sense of smell (anosmia) or a heavily reduced sense of smell (hyposmia).

Limitation of strenuous exercise. Avoid excessive weight gain. Hormone or fertility medications.

Hormone replacement therapy Fertility treatments

Male Gonads/Testis

Testosterone

Testosterone DeficiencyIt is made by the interstitial cells of the 1. Erectile dysfunction testes, causes the development of the (sometimes called adult male sex characteristics. It impotence) refers to the promotes the growth and maturation of inability to achieve or the reproductive system organs to maintain an erection prepare the young man for sufficient to complete reproduction. It also causes the sexual intercourse. It can development of the males secondary be organic in origin, sex characteristics(growth beard, meaning it is caused by development of heavy bones and disease, medication, or muscles, and lowering of the voice) as environmental factors well as stimulating the male sex drive. 2. infertility In adulthood, testosterone is necessary 3. low sex drive for continuous production of sperm. In 4. priapism- refers to an cases of hyposecretion, the man abnormal and persistent becomes sterile, such cases are usual penile erection without treated by testosterone injection. Both sexual stimulation. It is the endocrine and exocrine functions extremely painful and may of the testes begin at puberty under the last several hours or even influence of the anterior pituitary days. The client must seek gonadotropic hormones. Testosterone immediate medical production is specifically stimulated by attention. LH. 5. Peyronies disease is an accumulation of plaques or scar tissue along the corpora cavernosa, causing a painful curvature of the penis when erect. This plaque or scar tissue formation is idiopathic and benign.

Female Gonads/

Estrogen

Management: 1. Oral Medications. Oral medications include sildenafil citrate (Viagra) and tadalafil (Cialis). These medications are vasodilators taken in pill form that help the penis to fill with blood. 2. Vasoactive Intracorporeal Pharmacotherapy. Medications, such as papaverine, alprostadil, or prostaglandin Ej. (Caverject, Edex), can be used to induce an erection. The client self-injects a vasodilating medication into the penis. 3. Mechanical Devices. Mechanical devices, such as vacuum erection devices or vacuum constriction devices, are noninvasive. They create an erection by mechanically pulling blood into the penis. 4. Penile Implants. Several types of devices can be implanted in the penis to help the client achieve and maintain an erection. 5. Priapism can be difficult to treat, and sometimes treatment may be unsuccessful. The goal is to improve the venous drainage of the corpora cavernosa while preventing ischemia that may result in impotence. Injection of a solution of phenylephrine into the corpora cavernosa may reverse priapism. Cavernostomy with a butterfly needle (to allow drainage) and irrigation may be used, or surgery may be required. 6. Treatment for peyronies disease includes oral medications: aminobenzoate potassium (Potaba), vitamin E, and nonsteroidal antiinflammatory drugs (NSAIDs). The plaque or scar tissue may be removed by surgery. primarily estrone and estradiol, 1. Osteoporosis: Estrogen replacement therapy during produce by the Graafian follicles of the Osteoporosis is commonly menopause protects bone mass and helps

Ovaries

Progesterone

ovaries, stimulate the development of associated with protect against the risk of osteoporotic the secondary sex characteristics in menopause, just like mood fractures. females(primarily growth and swings and hot flashes. 2. For PCOS: a. educate the patient about the maturation of the reproductive organs Menopause is marked by use of oral contraceptives to normalize and the appearance of hair in the pubic the rapid loss of estrogen. hormone levels and axillary regions). In addition, the The role estrogen play in b. healthy diet and exercise to lose weight estrogens work with progesterone to bone loss can best be c. oral insulin-sensitizing drugs such as prepare the uterus to receive a described in terms of a metformin may be prescribed fertilized egg. This results in cyclic battle between 3. HRT combination therapy changes in the uterine lining which is osteoclasts(bone called the menstrual cycle. Estrogens absorbing cells) and also help maintain pregnancy and osteoblasts (bone prepare the breasts to produce milk producing cells). Estrogen (lactation). However, the placenta and is on the side of the not the ovaries is the source of the osteoblasts, but as the estrogens at this time. estrogens diminish, the osteoblasts are acts with estrogen to bring about the discouraged from menstrual cycle. During pregnancy, it producing more bone. As quiets the muscles of the uterus and so such, the osteoclasts win that an implanted embryo will not be by absorbing more bone aborted and helps prepares breast than is being produced by tissue for lactation. Progesterone is the osteoblasts. produced by another grandular 2. Ovarian Cancer: structure of the ovaries, the corpus Ovarian cancer is an luteum. extremely serious, but rare, disease. Its symptoms usually dont become apparent until the cancer has progressed into the later stages. Symptoms of ovarian cancer include: persistent abdominal pain, indigestion, bloating, abnormal uterine bleeding,

PANCREAS

Glucagon

and pain during sexual intercourse. 3. Ovarian Cysts: Ovarian cysts are fluid-filled sacs that affect women of all ages, though mostly women of child-bearing age. Cysts are very commonand they can range in size from a pea to a grapefruit. The majority of cysts are harmless, though larger cysts (those larger than 5 cm in diameter) may need to be surgically removed because large cysts can twist the ovary and disrupt its blood supply. 4. Polycystic Ovary Syndrome: Polycystic means many cysts. Overproduction of androgens interfere with the development of eggs and their release from the female ovaries. PCOS is a leading cause of infertility. This pancreatic hormone helps to Hyposecretion of glucagon Glucagon is administered by injection to elevate your blood sugar levels. When - chronic hypoglycemia counteract diabetic hypoglycaemia. levels of sugar in your blood declines, A decreased ability to your pancreas produces glucagon, secrete glucagon from which stimulates the liver to produce pancreatic alpha cells has more glucose. As a result, your blood been associated with glucose levels return to normal. chronic hypoglycemia. Other contributing factors

 Insulin

Lowers blood glucose by facilitating glucose transport across cell membranes of muscle, liver and adipose tissue

to this condition would be: a. A beta cell tumor b. Defect in the mechanism releasing glucose from the liver. c. Addison's disease - low levels of corticosteroids which enhance glucose production. d. Hyposecretion of growth hormone 2. Cancers of alpha cells (glucagonomas) are one situation known to cause excessive glucagon secretion. DIABETES - Continuous subcutaneous insulin MELLITUS infusion, insulin pump - Hyperglycemia - Control of total caloric intake, blood - Glycosuria, polyuria, glucose level, and normalization of lipids dehydration and BP - Diabetic ketoacidosis (abdominal pain, N/V, hyperventilation, fruity breath odor, altered LOC)

Adrenal Glands

Adrenal Medulla 1. Epinephrine

fight or flight Increase RR Metabolic rate decreases Force of muscular contraction improves Onset of muscular fatigue delayed Reduced blood supply to the bladder and intestines, their muscular walls relax, sphincters contract Vasoconstriction leading to increase in BP Increase blood flow through coronary arteries and decreases HR Increase rate and depth of breathing Relaxation of smooth muscle in the intestinal walls

2. Norepinephrin e

PHEOCHROMOCYT OMA - Benign tumor that originates from chromaffin cells of adrenal medulla - Cause of high blood pressure - S/Sx:Headache, vertigo, blurring of visiom, tinnitus, air hunger and dyspnea, BP, HR ADDISONS DISEASE - Adrenocortical insufficiency - Therapeutic use of cortecosteroids - S/Sx:Muscle weakness, anorexia, GI symptoms, fatigue, emaciation, dark pigmentation of mucous membranes and skin, BP, blood glucose, serum Na, serum K - Addisonian crisis CUSHINGS SYNDROME - Excessive adrenocortical hormone

- Bed rest with head of bed elevated to promote an orthostatic decrease in BP - Alpha adrenergic blocking agents, smooth muscle relaxant - Adrenalectomy

- Place in recumbent position with legs elevated - Hydrocortisone/IV - Glucocortecoids prevents addisonian crisis

- Transsphenoidal hypophysectomy - Adrenalectomy - Adrenal enzyme inhibitor

Adrenal Cortex 1. Cortecosteroid s a. Glucocortic oids (e.g. cortisol, corticosterone, cortisone)

Utilization of CHO, CHON, Fats Normal response to stress Anti-inflammatory Regulation of fluid balance Male sex hormones

- Adrenalectomy - Spironolactone (Aldactone) Provide rest periods

b. Mineraloco rticoids

(e.g. aldosterone) c. Androgens

- Caused by use of corticosteroid medications - S/Sx:Oversecretion of glucocorticoids and androgens, central type obesity, buffalo hump, thin extremities PRIMARY ALDOSTERONISM - Hypersecretion of aldosterone - Hypokalemia(muscle weakness, fatigue), alkalosis, BP, polyuria, polydipsia