The Endocrine System

Endocrine system

• A system of glands, each of which secretes a type of hormone into the bloodstream to regulate
the body.

• The endocrine system is an information signal system like the nervous system.

• Hormones regulate many functions of an organism, including mood, growth and development,
tissue function, and metabolism.

• The endocrine system is made up of a series of ductless glands that produce chemicals called
hormones.

Major endocrine gland

1. Hypothalamus

• is located in the lower central part of the brain.

• This part of the brain is important in regulation of satiety, metabolism, and body temperature.
In addition, it secretes hormones that stimulate or suppress the release of hormones in the
pituitary gland.

• Many of these hormones are releasing hormones, which are secreted into an artery (the
hypophyseal portal system) that carries them directly to the pituitary gland.

2. Pineal body

• The pineal body, or pineal gland, is located in the middle of the brain.

• It secretes a hormone called melatonin, which may help regulate the wake-sleep cycle of the
body.

3. Pituitary gland

• located at the base of the brain beneath the hypothalamus and is no larger than a pea.

• It is often considered the most important part of the endocrine system because it produces
hormones that control many functions of other endocrine glands.

• When the pituitary gland does not produce one or more of its hormones or not enough of them,
it is called hypopituitarism.

• The pituitary gland is divided into two parts: the anterior lobe and the posterior lobe.

The anterior lobe produces the following hormones, which are regulated by the hypothalamus:

A. Growth hormone

• Stimulates growth of bone and tissue (growth hormone deficiency in children results in growth
failure. Growth hormone deficiency in adults results in problems in maintaining proper amounts
of body fat and muscle and bone mass.

B. Thyroid-stimulating hormone (TSH)

• Stimulates the thyroid gland to produce thyroid hormones

C. Adrenocorticotropin hormone (ACTH)

• Stimulates the adrenal gland to produce several related steroid hormones

D. and E. Luteinizing hormone (LH) and follicle-stimulating hormone (FSH)

 • Hormones that control sexual function and production of the sex steroids, estrogen and
progesterone in females or testosterone in males

F. Prolactin

• Hormone that stimulates milk production in females

The posterior lobe produces the following hormones, which are not regulated by the hypothalamus:

A. Antidiuretic hormone (vasopressin) - Controls water loss by the kidneys

B. Oxytocin - Contracts the uterus during childbirth and stimulates milk production

• The hormones secreted by the posterior pituitary are actually produced in the brain and carried
to the pituitary gland through nerves. They are stored in the pituitary gland.

4. Thyroid gland

• Secretes the following hormones:

• Triiodothyronine

• Thyroxine (tetraiodothyronine)

• Calcitonin

5. Parathyroid gland

Secretes the hormone:

• Parathyroid hormone

6. Adrenal gland

• The adrenal glands are triangular-shaped glands located on top of each kidney.

• The adrenal glands are made up of two parts.

• The outer part is called the adrenal cortex, and the inner part is called the adrenal medulla.

• The outer part produces hormones called corticosteroids, which regulate the body's
metabolism, the balance of salt and water in the body, the immune system, and sexual function.

7. Thymus

• A specialized organ in the immune system.

• Thymus is responsible for the production of T- lymphocytes (T cells), which are critical cells of the
adaptive immune system.

8. Reproductive gland

The reproductive glands are the main source of sex hormones.

• In males, the testes, located in the scrotum, secrete hormones called androgens; the most
important of which is testosterone.

• In females, the ovaries, located on both sides of the uterus, produce estrogen and progesterone
as well as eggs.

9. Pancreas

• The pancreas is an elongated organ located toward the back of the abdomen behind the
stomach.
• The pancreas has digestive and hormonal functions. One part of the pancreas, the exocrine
pancreas, secretes digestive enzymes.

• The other part of the pancreas, the endocrine pancreas, secretes hormones called insulin and
glucagon.

• These hormones regulate the level of glucose (sugar) in the blood.

Assessment of the Endocrine System

Anatomy and Physiology Review

• Hypothalamus

• Pituitary glands

• Gonads

• Adrenal glands

• Thyroid gland

• Parathyroid gland

• Pancreas

Endocrine Changes Associated with Aging

• Increased antidiuretic hormone

• Decreased ovarian function

• Decreased glucose tolerance

• Decreased peripheral metabolism

Assessment Techniques

• History • Personal history

• Demographic data • Diet history

• Family history and genetic risk • Socioeconomic status

• Current health problems including any changes in the following:

• Energy levels • Sexual and reproductive

functions
• Elimination
• Physical appearance

Physical Assessment

• Examine for the following:

• Prominent forehead or jaw • Vitiligo

• Round or puffy face • Striae

• Dull or flat expression • Hirsutism

• Exophthalmos
Palpation

• Thyroid glands and testes can be examined by palpation.

• Auscultation is used to establish baseline vital signs and to assess cardiac rate and rhythm.

• Assess client’s coping skills for endocrine dysfunction; referral to social service agency may be
required.

Laboratory Tests

• Stimulation/suppression tests

• Assays

• Urine tests

• Tests for glucose

• Radiographic examinations

• Other diagnostic tests

Interventions for Clients with Pituitary and Adrenal Gland Problems

Hypopituitarism

• Deficiency of one or more anterior pituitary hormone results in metabolic problems and sexual
dysfunction.

• Growth hormone stimulates the liver to produce substances known as somatomedins that
enhance growth activity.

• Collaborative Management

• Assessment

• Interventions include:

– Replacement of deficient hormones

– Androgen therapy for virilization; gynecomastia can occur

– Estrogens and progesterone

– Growth hormone

Hyperpituitarism

• Hormone oversecretion occurs with pituitary tumors or hyperplasia

• Neurologic symptoms may occur.

• Galactorrhea, amenorrhea, and infertility can result.

• Gigantism is the onset of growth hormone hypersecretion before puberty.

• Acromegaly is the onset of growth hormone hypersecretion after puberty.

• Disturbed Body Image

• Interventions include:

– Nonsurgical management:
 • Drug therapy

• Radiation therapy

– Surgical management:

• Preoperative care

• Operative procedure

• Postoperative Care

• Monitor neurologic response.

• Observe for complications.

• Assess for postnasal drip.

• Teach client to avoid coughing early after the surgery.

• Assess for meningitis.

• Replace hormones and glucocorticoids as needed.

• Sexual Dysfunction

• Interventions for hyperpituitarism:

– Identification of specific client problems with sexual expression.

– Drug therapy to supplement hormones as needed.

Diabetes Insipidus

• Water metabolism problem caused by an antidiuretic hormone deficiency

• Diabetes insipidus is classified as:

– Nephrogenic

– Primary

– Secondary

– Drug-related

• Assessment

• Diabetes insipidus related to dehydration

• Increase in frequency of urination and excessive thirst

• Dehydration and hypertonic saline tests used for diagnosis of the disorder

• Urine diluted with a low specific gravity (<1.005)

• Interventions

• Oral chlorpropamide

• Desmopressin acetate intranasally

• Early detection of dehydration and maintenance of adequate hydration

• Lifelong vasopressin therapy for clients with permanent condition of diabetes insipidus

• Syndrome of Inappropriate Antidiuretic Hormone Secretion

• Vasopressin is secreted even when plasma osmolarity is low or normal.

• Feedback mechanisms do not function properly.

• Water is retained, resulting in hyponatremia (decreased serum sodium level).

Interventions

• Fluid restriction

• Drug therapy: diuretics, hypertonic saline, demeclocycline

• Safe environment

• Neurologic assessment every 4 hours

Adrenal Gland Hypofunction

Addisonian crisis

• Clinical manifestations include:

– Decreased pigmentation

– Decreased body hair

– Hypoglycemia

– Blood volume depletion

– Hyperkalemia, which can cause cardiac arrest

Interventions

• Promote fluid balance and monitor for fluid deficit.

• Record weight daily.

• Ensure fluid balance.

• Assess vital signs every 1 to 4 hours, assess for dysrhythmias or postural hypotension.

• Monitor laboratory values to identify hemoconcentration.

• Give cortisol and aldosterone replacement therapy.

Adrenal Gland Hyperfunction

• Cushing’s syndrome

• Pheochromocytoma

Clinical manifestations:

• buffalo hump, enlarged trunk, acne, muscle wasting, weakness

• Hirsutism, clitoral hypertrophy, and male pattern balding in women

Nonsurgical Management

• Drug therapy gives temporary relief: mitotane, aminoglutethimide, metyrapone

• Radiation therapy

Surgical Management

• Total hypophysectomy
 • Preoperative care

• Operative procedure

• Postoperative care

– Preventing skin breakdown

– Pathologic fractures

– Gastrointestinal bleeding

Hyperaldosteronism

• Conn's syndrome

• Interventions include:

– Surgery when potassium levels are normal

– Drugs to increase potassium levels

– Glucocorticoid replacement to prevent adrenal crisis

Pheochromocytoma

• Catecholamine-producing tumors that arise in chromaffin cells

• Intermittent episodes of hypertension or attacks varying in length from a few minutes to several
hours

• Main treatment: surgery

• Treatment of hypertension to reduce stressors

• Diet rich in calories, vitamins, and minerals

Interventions for Clients with Problems of the Thyroid and Parathyroid Glands

Hyperthyroidism

 Thyrotoxicosis

 Graves’ disease, the most frequent causes: goiter, exophthalmos, pretibialedema

Laboratory assessment

 Thyroid scan

 Ultrasonography

 Electrocardiography

Drug Therapy

 Radioactive iodine therapy; not used in pregnant women

◦ Additional drug therapy may be needed.

◦ Implement radiation precautions.

◦ Monitor regularly for changes in thyroid function.

Surgical Management

 Surgery possible in absence of good response to drug therapy.

 Postoperative care for:

◦ Hemorrhage

◦ Respiratory distress

◦ Hypocalcemia and tetany

◦ Laryngeal nerve damage

◦ Thyroid storm or thyroid crisis

Infiltrative Opthalmopathy

 Provide symptomatic treatment.

 Treatment of hyperthyroidism does not correct eye and vision problems of Graves’ disease.

 Elevate the head of bed at night.

 Instill artificial tears.

 Treat photophobia with dark glasses.

 Give steroid therapy.

 Provide diuretics.

Hypothyroidism

 Decreased metabolism from low levels of thyroid hormones

 Myxedema coma a rare, serious complication

 Mostly a result of thyroid surgery and radioactive iodine treatment of hyperthyroidism

 Clinical manifestations

 Decreased Cardiac Output

 Interventions:

◦ Monitor circulatory status.

◦ Monitor for signs of inadequate tissue oxygenation.

◦ Monitor for changes in mental status.

◦ Monitor fluid status and heart rate.

◦ Administer oxygen or mechanical ventilation, as appropriate.

Ineffective Breathing Pattern

 Interventions:

◦ Observe and record rate and depth of respirations.

◦ Auscultate the lungs.

◦ Assess for respiratory distress.

◦ Assess the client receiving sedation for respiratory adequacy.

Disturbed Thought Processes

 Interventions:

◦ Assess lethargy, drowsiness, memory deficit, poor attention span, and difficulty
communicating.

◦ These problems should decrease with thyroid hormone treatment.

◦ Provide a safe environment.

◦ Provide family teaching.

Myxedema Coma

 Coma, respiratory failure, hypotension, hyponatremia, hypothermia, hypoglycemia

 Emergency care

Thyroiditis

 Inflammation of the thyroid gland

 Three types of thyroiditis: acute, subacute (granulomatous), and chronic (Hashimoto’s disease)
—the most common type

 Dysphagia and painless enlargement of the gland

 Nonsurgical management, drug therapy

 Surgical management

Thyroid Cancer

 Papillary, follicular, medullary, and anaplastic

 Collaborative management

 Surgery treatment of choice: thyroidectomy

 Suppressive doses of thyroid hormone for 3 months after surgery

 Study performed after drugs are withdrawn

Hyperparathyroidism

 Parathyroid glands: calcium and phosphate balance

 Hypercalcemia and hypophosphatemia

 Nonsurgical management:

◦ Diuretic and fluid therapy

◦ Drug therapy: phosphates, calcitonin, calcium chelators

 Surgical Management

 Parathyroidectomy preoperative care:

◦ Client stabilized; calcium levels normalized

◦ Studies: bleeding and clotting times, CBC

◦ Teaching: coughing, deep-breathing exercises, neck support

 Operative procedures
(Continued)

 Postoperative care includes:

◦ Observe for respiratory distress.

◦ Keep emergency equipment at bedside.

◦ Hypocalcemic crisis can occur.

◦ Recurrent laryngeal nerve damage can occur.

Hypoparathyroidism

 Decreased function of the parathyroid gland

 Iatrogenic hypoparathyroidism

 Idiopathic hypoparathyroidism

 Hypomagnesemia

 Interventions: correcting hypocalcemia, vitamin D deficiency, and hypomagnesemia