Care of the Client with Problems

Related to the Endocrine

System
Earl Francis R. Sumile, RN
Instructor, College of Nursing
University of Santo Tomas
 Endocrine System
• Pituitary
• Thyroid
• Parathyroid
• Thymus
• Adrenal
• Pancreas
• Gonads
 1. Pituitary Gland
A. Anterior lobe
– Adenohypophysis
– Releases and synthesizes hormones
B. Posterior lobe
– Neurohyphosis
– Does not produce but stores and releases
 A. Anterior Pituitary
Gonadotropic or Somatropic Hormone
– Stimulates growth of body tissues or bones
Thryrotropic or Thyroid Stimulating Hormone
(TSH)
– Stimulates thyroid gland and secretions
c. Adreno-Cortico Tropic Hormone (ACTH)
– Stimulates steroid production by adrenal cortex
d. Melanocyte Stimulating Hormone (MSH)
– Stimulates pigmentation
 A. Anterior Pituitary
e. Luteinizing Hormone (LH)
- In females, ovulation and luteinization of ovarian
follicles
f. Follicle Stimulating Hormone (FSH)
- Growth of ovarian follicle in females
- Spermatogenesis in males
g. Interstitial Cell Stimulating Hormone (ICSH)
- In males, production of testosterone
h. Prolactin
- Stimulates mammary tissues and lactation
 B. Posterior Pituitary
a. Anti-Diuretic Hormone (ADH) or
Vasopressin
- Reabsorption of water
- Decreases urinary output
b. Oxytocin
- Ejection of milk
- Uterine contraction
- Sperm transport
 2. Thyroid
Thryroxin T4
– Metabolism (catabolic phase)
Triiodothryronin T3
– Cellular metabolism
c. Thryrocalcitonin
– Calcium balance
 3. Parathyroid
a. Parathormone
– Regulates calcium and phosphate levels
 4. Thymus
a. Thymosin
– Incubator of T-lymphocytes
– Cornered mainly with:
Growth
Maturation
Metabolic processes
Reproduction of target cell or tissue
 5. Adrenal
A. Cortex
a. Glucocorticoids
– Gluconeogenesis
– Regulates blood sugar by conserving glucose and
cortisone
b. Mineralocorticoids
– Aldosterone, corticosterone
– Regulates electrolyte balance by Na retention and
K excretion
c. Androgens and Estrogens
– Secondary sex characteristics
 5. Adrenal
B. Medulla
a. Epinephrine or Adrenaline
– Increases blood pressure
– Increases cardiac rate
– Dilates bronchioles
 6. Pancreas
A. Islets of Langerhans
a. Insulin
Hypoglycemic agent
Metabolism of carbohydrates, proteins and fats
b. Glucagon
Hyperglycemic agent
Mobilizes glycogen stores
Increases blood glucose level
 7. Gonads
A. Ovaries
a. Estrogen and Progesterone
Stimulates development of secondary sex
characteristics
B. Testes
a. Testosterone
For normal functioning of male reproductive
organs
Development male secondary sex characteristics
 Nursing Assessment
a. Nursing history
b. Growth and Development
– Developmental history
c. Sexual functioning
– Loss of libido
– Impotence
– Menstrual cycle or irregularities
d. Hair growth; Voice
e. Changes in the skin
f. Emotional state
g. Nutritional state
 Physical Assessment
• Inspection 2. Palpation- e.g.
• Height thyroid gland
• Weight • Size
• Body stature • Shape
• Muscle wasting • Symmetry
• Hair growth and • Tenderness
distribution • Growth
• Skin pigmentation
 Pituitary Gland
Diagnostic Assessment
1. Hematologic
Interrelated with adrenal and gonads
2. Radiologic
Skull; CT; MRI; Pneumoencephalography
• Water Deprivation Test- no water 4-18 hrs
(+) diabetes insipidus- ↑in volume, no ↑ in urine
osmolality; ↓specific gravity
Disorders of the Pituitary Gland
Hyperpituitarism
a. Gigantism
b. Acromegaly
Hypopituitarism
a. Dwarfism
b. Diabetes Insipidus
 1. Hyperpituitarism
oversecretion because of pituitary tumor
A.Gigantism
• sustained hypersecretion of growth hormone
in children
• General overgrowth of long bones, skeleton
and tissue
• Marked increase in height and weight
 1. Hyperpituitarism
B . Acromegaly
 sustained hypersecretion of growth hormone in
adults after epiphyseal closure
• Bone grows wider and thicker
• Extremities are enlarged
Soft tissues on hands or feet enlarged and coarse
• Prognathism
Lengthened lower jaw
• Bridge of nose broader
 Nursing Assessment
a. Oily skin and excessive sweating
• Hypertrophy of sebacious gland
b. Thickening of vocal chords
• Voice change
c. Visual impairment
• Pressure on visual pathway
d. Headache, diplopia, blindness, lethargy
e. Gonadotropic hormone increased
• Sexual promiscuity in children
f. Increased prolactin
• Amenorrhea and galactorrhea
 Management of
Hyperpituitarism
Management of choice
• Surgery (removal of tumor) transpheinoidal
hypophysectomy
Nursing interventions post op:
– Proper oral hygiene; no brushing; encourage use of
H2O2 1;1 gargle
– No chewing on affected site
– No rough/coarse food
– No sneezing and blowing of nose for 2 weeks
– No dentures for 10 days
 2. Hypopituitarism
• deficiency of pituitary hormones
• Panhypopituitarism
When both both anterior and posterior lobes fail to secrete
hormones
Causes:
– Hypophysectomy
– Nonsecreting pituitarytumors
– Pituitary dwarfism
– Postpartum pituitary necrosis
– Functional disorders
Starvation, anorexia nervosa, severe anemia, GI disorders
 A. Dwarfism
 Secondary to congenital lack of growth
hormone or space occupying tumors
• Retardation of growth on 1st year, chubby
• Lack muscular development, delayed puberty

• Nursing management
• Injection of growth hormone
 B. Diabetes Insipidus
 Passage of excessive amounts of highly diluted
urine
• Diagnostic Assessment
• (+) water deprivation test
• Nursing Management
• Surgery (removal of tumor)- transphenoidal
hypophysectomy
• Pitressine tannate- vasopressin tannate in oil
• Salt and protein restricted diet
 Adrenal Gland
• Diagnostic Assessment:
1. Adrenal cortex functions
a. Hematologic level of steroids
• cortisol, aldosterone, and testosterone level
b. Urinary level- 24 hr urine collection
• 17-ketosteroid test
2. Adrenal medulla function
Vanillylmandelic acid VMA- 24 hrs. urine
collection
Disorders of the Adrenal Cortex
Addison’s Disease- chronic adreno-cortical
insufficiency
• Nursing assessment:
1. Aldosterone deficiency
• Polyuria, dehydration, hypotension,
decreased cardiac output
2. Glucocorticoid deficiency
• Hypoglycemia, weakness, exhaustion,
anorexia, weight loss,nausea, vomiting
Disorders of the Adrenal Cortex
Nursing assessment:
1. Androgen deficiency
• Decreased pubic hair
• Increased melanin stimulating hormone,
increased adenocorticotropic hormone-
cortisol deficiency-external tan or bronzed
appearance
 Addison’s Crisis
Causes
• surgery, pregnancy, injury, infection, salt loss,
second degree profuse diaphoresis
• Sudden profound asthenia
• Severe abdominal, back and leg pain
• Hyperpyrexia followed by hypothermia
• Peripheral vascular collapse, coma
• Renal shutdown
 Nursing management:
• Hydrocortisone (solu-cortef) IV
• Monitor vital signs
• Prevent infection
• Daily weight
• Electrolyte balance
• High carbohydrate and protein diet
Disorders of Adrenal Cortex
Aldosteronism- aldosterone excess
• Primary (Conn’s syndrome)
• Secondary
• Results from the presence of exogenous
conditions that stumulates renin-angiotensin-
aldosterone system
 Nursing Assessment
a. Muscular weakness, paralysis, edema
b. Intermittent paresthesia
c. Increased cardiac output, increased K
• ECG changes
d. Diminished deep tendon reflexes
e. Increased blood volume
f. Decreased concentrating kidney ability
g. Polyuria, polydipsia, nocturia
 Nursing Management
a. K-sparing diuretics
b. K replacement
c. Na restriction
 Disorders of Adrenal Cortex
Cushing’s syndrome
overactivity of adrenal glands with
hypersecretion of glucocorticoids

Etiology:
Adrenal tumor, adrenal hyperplasia, ectopic
adrenocorticotropic hormone-secreting tumor,
intake of synthetic glucocorticoids- iatrogenic
cushing’s syndrome
 Nursing Assesment
a. Persistent hyperglycemia- Leads to diabetes
mellitus
b. Protein tissue wasting- Stunted growth in
children
c. Capillary fragility- Ecchymosis
d. Osteoporosis- Pathogenic fractures; kyphosis;
height loss
e. Potassium depletion- Hypokalemia, arrythmias
 Nursing Assesment
a. Sodium and water retention- edema and
hypertension
b. Abnormal fat distribution- moon face
• Buffalo hump- cervico-dorsal fat pad on
neck truncal obesity with slender limbs
Increased susceptibility to infection
Increased production of androgens- mild
virilism, acne, thinning of scalp and hair and
hirsutism
 Nursing management
a. Surgery
• hypophysectomy, adrenalectomy, total or
bilateral
b. Irradiation
c. Pharmacotherapeutics
• Chlorophenyl dichloroethane (DDD);
aminoglutethimide (elipten); metyrapone
(metapirone)-long term
 Disorders of the Adrenal
Medulla
• Pheochromocytoma
• Tumor which results in ypersecretion of
adrenal medulla
• Typically benign; curable if detected early
• Precipitating factors: pregnancy and stress
 Nursing Assessment and
Management
• Nursing Assessment
• Hypertension- main symptom
• Persistent, fluctuating, pounding headache
• Sweating palpitations, nausea or vomiting
• Hyperglycemia and glycosuria
• Shock-like state
Pupils dilate, cold extremities, diaphoresis
• Management or choice
• Surgical excision
 Thyroid Gland
• Iodine regulates body metabolism (oxygen
consumption and heat production)
• Regulate growth and development
TSH- from anterior pituitary stimulates thyroid
gland to release thyroxine, triiodothyromine,
thyrocalcitonin
Euthyroid- normal thyroid function and
secretion
 Diagnostic Assessment:
• Thyroid function
• Serum thryroxine
• Serum triiodothyronine
• Triiodothyronin (T3) resin uptake test
• Radioactive iodine (131I) uptake and excretion test
• Serum TSH
• Thyrotropin- releasing hormone
• Serum cholesterol- increase in patients with
myxedemia or hypothyrodism
 Diagnostic Assessment
h. PBI (Protein Bound Iodine)- measures the
amount of iodine binded in blood protein.
• Preparation: no food or drug containing iodine 24
hours before the test
i. BMR (Basal Metabolic Rate)- indirect measure
of amount of oxygen consumed in the body
under basal conditions during given time.
• Preparation: proper sleep or rest night before the
preocedure
• Fasting for 6-8 hours
• Done before getting out of bed
Disorders of the Thyroid Gland
Goiter- enlargement of the Thyroid Gland
Etiology
a. lack of iodine
• (simple goiter), pregnancy, lactation, iodine deficient areas
• Intake of too much goitrogenic foods
• Nutritional goitrogens that inhibit thyroxine production
• Such as cabbage, soybeans, peanuts, spinach, peaches,
radish, strawberries
c. Inflammation- thyroiditis
d. Thyroid cancer
 Nursing Management
a. Prevention
• Iodized salt, avoid goitrogenic foods
Lugol’s solution or Potassium Iodide
Saturated Solution (KISS)
• Dose comes in drops; mixed with cold water and
given with a straw
c. Thryroid hormone replacement
• Watch for thyrotoxicosis
• Tachycardia, increase appetite, diarrhea,
sweating, tremor, palpitations, shortness of breath
Disorders of the Thyroid Gland
Hyperthyroidism; Grave’s Disease
(Basedow’s disease)
• Excessive production of T3 or T4 or both
• Toxic diffuse goiter or exophthalmic goiter
Incidence: females
 Nursing Assessment
Agitated, nervous, irritable
Goiter (excessive thyroid hormone in
blood)
Heat intolerance
Increased appetite
Amenorrhea
Exophthalmus
• Abnormal protrusion of eyes
 Nursing Management
a. Antithyroid therapy
• To suppress thyroid secretions
• Prophylthiouracil PTU; methimazole tapazole
b. Iodine- lugol’s solution or KISS
• To decrease the vascularity and size of the thyroid
c. Radioactive Iodine Therapy
• to middle aged and elderly clients
 Nursing Management
d. Surgery
• When patient is euthyroid
• Post-operative
• Semifowler’s position when conscious
• tracheostomy set at bedside
• Ambulate 2nd post-operative day
 Nursing Management
Complications
• Hemorrhage
• Check dressings by sliding hand on the
patient’s nape
• Respiratory obstruction
• Laryngeal edema- observe for sudden
difficulty in breathing
• Keep tracheostomy set at bedside
 Nursing Management: complications
• Accidental injury to the laryngeal nerve
• Watch for decreasing voice
• Hypocalcemia or tetany
• Accidental removal of parathyroid gland
• (+) Chovstek’s sign
• Spasms of the facial muscles when tapped
• (+) Troussaeu’s sign
Carpopedal spasms upon constriction of
the extremities
 Nursing Management: complications
• Management on Hypocalcemia
• Increase Ca – 100% sol of calcium carbonate
or gluconate or calcium lactate
• Calcium supplement and Vit D
 *Thyroid storm
Overactivity of thryroid characterized by
increased temperature, severe tachycardia,
delirium, dehydration and irritability, hypotension

Nursing management:
• Cool darkened quiet room
• Antipyretic oral or parenteral antithyroid drug followed
by K iodine; corticosteroids, propanolol- to relieve
heart arrythmias
 Hypothyroidism
• Cretinism
• Usually silent baby
• Severe hypothyroid condition of infancy due
to deficiency of thyroid hormone synthesis
during fetal life or soon after birth
 Hypothyroidism
• Nursing assessment:
a.Physical and mental retardation
b.Shunted stature
c.Wide open mouth and lolling tongue
d.Small eyes and half closed with swollen lids
e.Stolid expressionless face
f. Squat figure
g.Muddy dry skin
 Hypothyroidism
Myxedema- deficiency in thyroid synthesis in adult
• Asymptomatic to full blown
• Nursing management:
• Fatigue and apathetic
• Obesity: puffy and edematous with course features
• Dry and sparse hair, dry flaky skin
• Severe intolerance to cold decreased metabolic rate
• Fecal impaction, hypersensitive to narcotics,
barbiturates, and anesthetics
• MANAGEMENT:
• Hormone therapy for life (synthroid, cytomel)
 Pancreas- Islets of Langerhans
• Controls endocrine functions

• Insulin- from beta cells- fat or protein

metabolism- hypoglycemic agent
• Glucagon- from alpha-cells- hyperglycemic
agent
 Diabetes Mellitus
Chronic disorder of carbohydrate metabolism
(imbalance between the supply and demand)

Types:
• Type I- insulin dependent (!DDM or juvenile diabetes)
• Type II- non-insulin dependent (NIDDM or maturity
onset)
 Nursing Assessment
• Polyuria
• Water not reabsorbed by renal tunules because
osmotic activity of glucose
• Polydipsia
• Severe dehydration, causes thirst
• Polyphagia
• Tissue breakdown and wasting causes starvation
Weight loss (IDDM)- no glucose available to
cells, therefore body breaks down fat and
protein stores for energy
 Diagnostic Assessment
Hematologic studies
Fasting Blood Sugar (FBS)-
N=80-120 mgs%
Post Prandial Blood Sugar (PPBS)
Ability to dispose of glucose load in 2 hrs
N= 150%
Oral Glucose Tolerance Test (OGTT)
Prep: NPO 10-12 hrs; baseline sugar in blood and urine;
100gms glucose diet is given; blood or urine is taken after 30
mins; 1 hr; 1 ½ hrs and 2 hrs after- N=150mgs/dl
Glucosylated HGB
Glucose bonds to hemoglobin – measures blood glucose
levels120 days
N= 3.5-8.5%
 Diagnostic Assessment
Urine test
a. Benedict’s test
• use of benedict’s solution
b. Clinitest
• use of clinitest tablet
c. Testape-
• use of tes-tape
d. Diastix-
• use of urine strip
 Nursing Management
• Activity (exercise)
• Diet
• Drugs
• A. Oral hypoglycemics
• Triggers the islets of langerhans to produce insulin;
sulfonylureas
b. First generation- Orinase, Tolinase, Diabenese,
Dymelor
c. Second generation- Diabeta, Glucotrol, Micronase
 Nursing Management
Complication (oral hypoglycemic):
HHNK- hyperglycemic, Hyperosmolar, Non-
Ketotic Coma
• Non-insulin dependent diabetics who have enough
insulin but unable to use insulin to combat
hyperglycemia
• Nursing Assessment
• Same as DKA but no kussmaul breathing and
acetone breath
 Nursing Management
B. Insulin- Lower blood sugar by transport of
glucose to cells and inhibits conversion of
glucogen to glucose

Type Insulin Color Peak

Rapid acting Regular Clear 2-4 hrs
Semilente Cloudy 2-4 hrs
Intermediate NPH Cloudy 6-8 hrs
acting Lente Cloudy 6-8 hrs
Long acting Protamine/Zinc Cloudy 18+ hrs
Ultralente Cloudy 8-12 hrs
Premixed Humulin 50/50 Cloudy 2-8 hrs
(NPH/Req) Humulin 70/30 Cloudy 2-12 hrs
 Nursing Management
 Complications (insulin)
Tissue hyperthrophy or atrophy or lipodystrophy
Diabetic Ketoacidosis
• Fatty acids are broken down to ketone bodies because of
absolute or relative deficiency in insulin
 Etiology
• too little insulin dose
• Omitting insulin dose
• Increase need for insulin due to surgery, trauma, pregnancy,
puberty, or febrile illness
• Insulin resistance secondary to development of insulin
antibodies or severe emotional stress
 Nursing Management
 Nursing Assessment
a. Polyuria, thirst, nausea or vomiting, dry mucus
membrane, cracked lips
b. Hot flushed skin, weight loss
c. Abdominal pain, and rigidity (Na deficiency)
d. Kussmaul respirations
e. Acetone breath
f. Weakness, paralysis, paresthesia
g. Hypotension, oliguria, coma, stupor
h. ABG’s, metabolic acidosis, with compensated
respiratory alkalosis
 Nursing Management
 Nursing management:
• Insulin
• IVF-NS or1/2 NS
• K phosphate when urine is adequate
• Na HCO3, if pH < 7.0
Hypoglycemia (insulin reaction)
Etiology:
a. Overdose of insulin or sulfonylurea
b. Omission of meals or eating less than prescribed
food
c. Overexertion without compensating with increase in
carbohydrates
d. Nutritional and fluid imbalance secondary to nausea
and vomiting
 Hypoglycemia
Nursing assessment:
• Headache, weakness, irritability, apprehension
• Lack of muscular coordination
• Diaphoretic
• Behaves in bizarre, psychotic fashion
• Palor, bradycardia, visual disturbances
• Alterations in mental or level of consciousness
• Confusion or hallucinations
 Hypoglycemia
 Nursing management
• Candy, glucose paste, sugar cubes, orange
juice if awake
• D50W IVP or glucagon
• Epinephrine, steroids, diaoxide if with insulinemia
 Long term complications
• Degenerative vascular changes
• Atherosclerosis
• Microangiopathy- major hallmark of DM
destruction of small blood vessels (eyes and
kidneys)
• Ocular disorders
• Blurred vision
• Cataracts
• Diabetic retinopathy
• -major cause of blindness in diabetes
4.Retinal detachment
 Long term complications
1. Kidney disease
• Current pyelonephritis
• Nephropathy (kimmelsteil-wilson syndrome)
2. Neuropathy
• Peripheral nerve degeneration
3. infections