Chapter 48: Nursing Assessment: Endocrine System

STRUCTURES AND FUNCTIONS

• Hormones exert their effects on target tissue.

• The specificity of hormone–target cell interaction is determined by receptors in a “lock-and-

key” type of mechanism.

• The regulation of hormone levels in the blood depends on a highly specialized mechanism
called feedback.

• With negative feedback, the gland responds by increasing or decreasing the secretion of a
hormone based on feedback from various factors.

• The hypothalamus and pituitary gland integrate communication between the nervous and
endocrine systems.

Anterior Pituitary
• Several hormones secreted by the anterior pituitary are referred to as tropic hormones
because they control the secretion of hormones by other glands.
o Thyroid-stimulating hormone (TSH) stimulates the thyroid gland to secrete thyroid
hormones.
o Adrenocorticotropic hormone (ACTH) stimulates the adrenal cortex to secrete
corticosteroids.
o Follicle-stimulating hormone (FSH) stimulates secretion of estrogen and the
development of ova in the female and sperm development in the male.
o Luteinizing hormone (LH) stimulates ovulation in the female and secretion of sex
hormones in both the male and female.

• Growth hormone (GH) has effects on all body tissues.

• Antidiuretic hormone (ADH) regulates fluid volume by stimulating reabsorption of water

in the kidneys.

• Oxytocin stimulates ejection of milk into mammary ducts and contraction of uterine smooth
muscle.

Thyroid Gland
• The major function of the thyroid gland is the production, storage, and release of the
thyroid hormones, thyroxine (T4) and triiodothyronine (T3).
o Iodine is necessary for the synthesis of thyroid hormones.
o T4 and T3 affect metabolic rate, carbohydrate and lipid metabolism, growth and
development, and nervous system activities.

• Calcitonin is a hormone produced by C cells (parafollicular cells) of the thyroid gland in

response to high circulating calcium levels.

Parathyroid Gland
•The parathyroid glands are four small, oval structures usually arranged in pairs behind
each thyroid lobe. They secrete parathyroid hormone (PTH), which regulates the blood
level of calcium.
Adrenal Gland
• The adrenal glands are small, paired, highly vascularized glands located on the upper
portion of each kidney.
o The adrenal medulla secretes the catecholamines epinephrine (the major hormone
[75%]), norepinephrine (25%), and dopamine.
o The adrenal cortex secretes cortisol, which is the most abundant and potent
glucocorticoid. Cortisol is necessary to maintain life. Its functions include regulation
of blood glucose concentration, inhibition of inflammatory action, and support in
response to stress.
o Aldosterone is a potent mineralocorticoid that maintains extracellular fluid volume.
o The adrenal cortex secretes small amounts of androgens. Adrenal androgens stimulate
pubic and axillary hair growth and sex drive in females.

Pancreas
• The pancreas secretes several hormones, including glucagon and insulin.
o Glucagon increases blood glucose by stimulating glycogenolysis, gluconeogenesis,
and ketogenesis.
o Insulin is the principal regulator of the metabolism and storage of ingested
carbohydrates, fats, and proteins.

Gerontologic Considerations
• Normal aging results in decreased hormone production and secretion, altered hormone
metabolism and biologic activity, decreased responsiveness of target tissues to hormones,
and alterations in circadian rhythms.

• Subtle changes of aging often mimic manifestations of endocrine disorders.

ASSESSMENT
• Hormones affect every body tissue and system, causing great diversity in the signs and
symptoms of endocrine dysfunction.

• Endocrine dysfunction may result from deficient or excessive hormone secretion, transport
abnormalities, an inability of the target tissue to respond to a hormone, or inappropriate
stimulation of the target-tissue receptor.

• Subjective data:
o The nurse should inquire about use of hormone replacements, previous
hospitalizations, surgery, chemotherapy, and radiation therapy (especially of the neck).

• Objective data:
o Most endocrine glands are inaccessible to direct examination.

• Physical examination:
o Clinical manifestations of endocrine function vary significantly, depending on the
gland involved.
o Assessment includes a history of growth and development, weight distribution and
changes, and comparisons of these factors with normal findings.
o Disorders can commonly cause changes in mental and emotional status.
o The nurse should note the color and texture of the skin, hair, and nails. The skin should
be palpated for skin texture and presence of moisture.
 o When inspecting the thyroid gland, observation should be made first in the normal
position (preferably with side lighting), then in slight extension, and then as the patient
swallows some water.
o The thyroid is palpated for its size, shape, symmetry, and tenderness and for any
nodules.
o The size, shape, symmetry, and general proportion of hand and feet size should be
assessed.
o The hair distribution pattern of the genitalia should be inspected.

DIAGNOSTIC STUDIES
• Laboratory tests usually involve blood and urine testing.

• Ultrasound may be used as a screening tool to localize endocrine growths such as thyroid
nodules.

• Laboratory studies may include direct measurement of the hormone level, or involve an
indirect indication of gland function by evaluating blood or urine components affected by
the hormone (e.g., electrolytes).

• Notation of sample time on the laboratory slip and sample is important for hormones with
circadian or sleep-related secretion.

• The studies used to assess function of the anterior pituitary hormones relate to GH,
prolactin, FSH, LH, TSH, and ACTH.

• Tests to assess abnormal thyroid function include TSH (most common), total T4, free T4, and
total T3.