Endocrine System

Introduction
The endocrine system is a complex network of glands and hormones working with the
nervous system to maintain homeostasis. Hormones regulate metabolic activities, growth,
development, reproduction, and responses to infection and trauma. Abnormalities in the
endocrine system can lead to illness or death. Treatment focuses on managing hormone
production and secretion.
Communication within the body occurs through:
• Neural signals (electrical/chemical)
• Endocrine signals (hormones in the bloodstream)
Functions of Hormones
• Regulate and integrate metabolic activities.
• Work with the nervous system.
• Facilitate growth, development, and reproduction.
Components of the Endocrine System
Glands
Glands secrete hormones that travel through the bloodstream to target cells and tissues,
producing a specific effect.
Hormones
Chemical substances produced by glands that regulate various bodily functions.
Parts of Endocrine Glands
1. Hypothalamus:
• Member of the forebrain and part of both the endocrine and nervous systems.
• Receives signals from the nervous system and relays them to the pituitary
gland.
• Secretes hormones like ADH and Oxytocin.
• Produces pro-hormones (releasing and inhibiting hormones) that control the release
of pituitary hormones.
• Hormones:
o Corticotropin-releasing hormone (CRH)
o Thyrotropin-releasing hormone (TRH)
o Growth hormone-releasing hormone (GHRH)
o Gonadotropin-releasing hormone (GnRH)
• Action: Controls the release of pituitary hormones.
1. Pituitary Gland (Hypophysis):
• Master gland.
• Anterior Pituitary (adenohypophysis): Produces and secretes hormones that
regulate various physiological processes.
o Hormones:
▪ GH (Growth Hormone): Targets liver, bones, muscles; stimulates IGF
production.
▪ FSH/LH: Targets the reproductive system; stimulates sex hormone
and gamete production.
▪ TSH: Targets the thyroid gland; stimulates thyroid hormone production
(T33, T44).
▪ ACTH: Targets the adrenal cortex; stimulates glucocorticoid
production.
▪ PRL: Targets mammary glands; stimulates milk production.
▪ MSH: Targets the integumentary system (skin); provides protection
against UV radiation.
o Mnemonic: "Go Look For The Adenoma Please"
• Posterior Pituitary (neurohypophysis): Stores and releases hormones produced
by the hypothalamus.
1. Thyroid Gland:
• Butterfly-shaped organ in the lower neck.
o Hormones:
▪ ADH (Vasopressin): Targets kidneys, sweat glands, and circulatory
system; regulates water balance.
▪ Oxytocin: Targets the female reproductive system; stimulates uterine
contractions during childbirth.
• Regulates body metabolism.
• Hormones:
1. Parathyroid Glands:
• Located behind the thyroid gland.
o T33 (Triiodothyronine)
o T44 (Thyroxine)
o Calcitonin: Lowers blood calcium and phosphate levels by inhibiting bone
resorption.
• Regulates the body's blood calcium level.
• Hormone:
1. Adrenal Glands:
• Located on top of the kidneys.
o PTH (Parathyroid Hormone): Regulates calcium levels for muscle contraction
and bone growth.
• Cortex (outer): Produces steroid hormones (adrenal corticosteroids).
o Cortisol
o Aldosterone
• Medulla (inner): Releases catecholamines.
1. Gonads (Testes, Ovaries):
• Releases sex hormones (involved in the development of secondary sex
characteristics).
o Epinephrine/Adrenaline
o Norepinephrine/Noradrenaline
• Male:
o Androgen (Testosterone): Affects the development of male sex organs and
secondary sex characteristics; aids in sperm production.
• Female:
1. Pancreas:
• Located in the upper part of the abdomen.
o Estrogen: Affects the development of female sex organs and secondary sex
characteristics.
o Progesterone: Regulates the endometrium of the uterus and maintains
pregnancy.
• Controls blood sugar levels.
• Hormones:
1. Kidneys:
• Paired organs located on either side of the vertebral column.
o Insulin (beta cells): Lowers blood glucose.
o Glucagon (alpha cells): Increases blood glucose concentration.
o Somatostatin (delta cells): Delays intestinal absorption of glucose.
• Hormones:
1. Pineal Gland:
• Small cone-shaped gland located in the brain.
o 1,25-Dihydroxy vitamin D (Calcitriol): Active form of vitamin D; regulates
calcium and phosphate homeostasis.
 o Renin: Activates the renin-angiotensin-aldosterone system.
o Erythropoietin: Increases red blood cell production.
• Hormone:
1. Thymus Gland:
• Large in infants/children, decreases in size through adulthood.
o Melatonin: Regulates sleep patterns.
• Hormone:
o Thymosin
Hormone Quick Reference
• Women's Hormone: Estrogen
• Mother's Hormone: Progesterone
• Men's Hormone: Testosterone
• Stress Hormone: Cortisol
• Sleep Hormone: Melatonin
• Growth Hormone
• Milk Hormone: Prolactin
• Erythropoietin
SIADH vs. DI
Key Points
• Both conditions relate to ADH (anti-diuretic hormone/vasopressin) secretion, which
regulates water retention.
• SIADH and DI present oppositely: SIADH retains water, while DI loses water.
• Diabetes Insipidus and Diabetes Mellitus are separate and unrelated conditions.
ADH
• Produced in the hypothalamus.
• Secreted/stored by the posterior pituitary gland.
• Function: Causes the body to retain water and constrict blood vessels.
• Acts on the kidneys.
• Too much ADH: Water retention.
• Too little ADH: Water loss through urination.
Mnemonic
• SIADH: Soaked Inside (Increased ADH).
• DI: Dry Inside (Decreased ADH).
SIADH
• Includes excessive ADH secretion from the pituitary gland.
• Retains fluids and develops dilutional hyponatremia.
• Etiology/Risk Factors: Malignant tumors (lung cancer), infections (meningitis, GBS).
• S/Sx: Fluid overload, hyponatremia, neurologic symptoms (headache, mental status
changes, lethargy, irritability), hypertension, seizures, confusion, anorexia, low urine
output (concentrated).
• Diagnosis: Vasopressin test (↑), Plasma osmolality and serum sodium (↓), UA
(elevated urine sodium and osmolality).
• Management:
o Medications:
▪ Demeclocycline (Declomycin): ADH inhibitor.
▪ Loop Diuretics (Lasix).
o Nursing:
▪ IV hypertonic saline solution.
▪ Monitor I&O, weight.
▪ Fluid restriction.
▪ Eliminate underlying cause.
▪ Safety precautions for confusion.
Diabetes Insipidus (DI)
• A deficiency of ADH or vasopressin.
• Neurogenic DI, Nephrogenic DI
• Etiology/Risk Factors: Transient form
• S/Sx: Polyuria (4-24 L per day), polydipsia, dehydration, hypernatremia, hypotension,
tachycardia.
• Diagnosis: Plasma osmolality and serum sodium levels (↑), Water (fluid) deprivation
test, Vasopressin test (↓).
• Management:
o Medications:
▪ Desmopressin (DDAVP): Treatment of choice.
▪ Clofibrate: Antidiuretic effect.
▪ Chlorpropamide and thiazide diuretics: Potentiate vasopressin action.
o Nursing:
▪ Provide a safe environment.
 ▪ Monitor for signs of dehydration.
▪ Monitor I&O, weight, and specific gravity of urine.
▪ Instruct to increase oral fluids.
▪ Avoid foods/liquids that produce diuresis.
▪ Administer IV hypotonic fluids.
Thyroid Gland Disorders
Goiter
•

Enlargement of the thyroid gland, causing visible swelling in the neck.

• Causes:
o Iodine deficiency
o Hashimoto's disease
o Graves' disease
o Thyroid nodules
o Thyroid cancer
o Pregnancy
o Inflammation
• Risk Factors:
o Lack of dietary iodine
o Female gender
o Pregnancy and menopause
o Age
o Family medical history
o Medications
o Radiation exposure
• Complications:
o Airway obstruction
o Voice box obstruction
• Classifications:
o Toxic Goiter: Associated with hyperthyroidism.
o Nontoxic Goiter: Associated with normal or insufficient thyroid hormone levels.
• Types of Goiter:
 o Endemic (Iodine-Deficient) Goiter:
▪ Most common type
▪ Caused by iodine deficiency
▪ Treatment: Supplementary iodine, iodized salt, SSKI
o Nodular Goiter:
▪ Enlarged thyroid gland with one or more nodules
▪ Causes: Iron deficiency, autoimmune, genetic factors
▪ Some are malignant or with a hyperthyroid state
o Thyroid Cancer:
▪ Malignancy of the thyroid gland
▪ Treatment: Surgery - thyroidectomy, radiation therapy
Hyperthyroidism
•

High secretion of thyroid hormones.

•

T33, T44, Calcitonin.

• Diagnostic Exams:
o Medical History and Physical Exam
o Blood tests - T33, T44 levels, TSH
o Imaging test- Thyroid Scan, CT/MRI
• Signs and Symptoms:
o Weight loss
o Heat intolerance
o Tachycardia
o Hypertension
o Diarrhea
o Smooth skin
o Soft hair
o Cardiac dysrhythmias: A-fib
o Personality changes: irritable, moody, insomnia
o Irregular menstruation in women
• Causes:
 o Grave's Disease: Autoimmune disorder due to TSI (thyroid stimulating
immunoglobulin)
▪ S/Sx (UNIQUE):
▪ Exophthalmos
▪ Goiter
▪ Pretibial myxedema
o Toxic Nodular Goiter (TNG): Growths of nodular goiters that cause
hypersecretion of thyroid hormones.
o Thyroiditis: Inflammation of the thyroid gland.
o Too much iodine.
• Nursing Interventions:
o Keep the patient comfortable: cool, quiet environment, calm.
o Obtain daily weights.
o Monitor EKG, heart rate, blood pressure.
o Educate about medications and treatment (radioactive iodine therapy and
thyroidectomy).
o Monitor for Thyroid Storm: life-threatening that presents with exaggerated
signs/symptoms of hyperthyroidism, such as fever, fast heart rate, HPN.
• Medications:
o Antithyroid meds- block the thyroid gland's ability to produce thyroid
hormones.
▪ methimazole (Tapazole)- can't be used in the first tri of pregnancy
▪ propylthiouracil (PTU)- safe for preggy, however, increase risk of liver
failure
o Beta blockers (propranolol)- block the effects of adrenaline and other stress
hormones on the body.
o Radioactive iodine: destroys the thyroid gland overtime and is a permanent
cure compared to medications.
• Treatment:
o Thyroidectomy: Removal of the thyroid gland
Parathyroid Gland Disorders
Hypoparathyroidism
•

Low production of parathyroid hormone (PTH) by the parathyroid gland.

• S/Sx of Hypoparathyroidism ("PTH"):
 o P: Paresthesia
o T: Tetany
o H: Hypocalcemia and Hyperphosphatemia
• Nursing Interventions:
o Monitor calcium and phosphate levels
o Monitor the airway due to tetany and seizures
o Ensure the patient eats a diet high in calcium
• Medical Management:
o IV Calcium (if very low):
o Oral calcium with Vitamin D: Calcium Carbonate
Hyperparathyroidism
•

Excessive secretion of parathyroid hormone by the parathyroid gland causes

HYPERcalcemia and HYPOphosphatemia
• Signs and Symptoms:
o Bones fractures (osteoporosis)
o Calculi formation
o Constipation
o Frequent urination
o EKG changes: short QT interval
• Nursing Interventions
o Monitor vitals, EKG, renal stones (strain urine), calcium and phosphate levels
o Monitor intake and output and fluid status
o Diet: low calcium and high in phosphate
Adrenal Gland Disorders
Cushing's Syndrome vs. Cushing's Disease
•

Cushing's Disease: Excessive cortisol caused by a tumor on the pituitary gland, leading to
excessive ACTH release (inside source).
•

Cushing's Syndrome: Excessive cortisol resulting from tumors or problems with the
adrenal glands or long-term use of corticosteroids (outside source).
• Signs & Symptoms of Cushing's ("STRESSED"):
 o Skin fragile (thinner)
o Truncal obesity
o Reproductive issues
o Elevated BP
o Striae on abdomen/back/thighs
o Sugar high: polyuria/polydipsia
o Excessive body hair
o Decreased potassium (hypokalemia)
• Nursing Management:
o Preoperative Care:
▪ Request a dietary consultation to discuss with the client about a diet
high in vitamins and proteins. If hypokalemia exists, include foods high
in K.
▪ Use careful medical and surgical asepsis when providing care and
treatments.
▪ Monitor the results of lab tests of electrolytes and glucose levels.
▪ Teach the client to turn, cough, and perform deep-breathing exercises.
o Postoperative Care:
▪ Take and record v/s, measure I and O, and monitor electrolytes on a
frequent schedule.
▪ Assess body temperature, WBC levels, and wound drainage. Change
dressings using sterile technique.
Addison's Disease
•

Hyposecretion of Aldosterone & Cortisol.

•

A disorder resulting from destruction or dysfunction of the adrenal cortex.

•

The result is a chronic deficiency of cortisol, aldosterone, and adrenal androgens

accompanied by skin pigmentation.
• Signs & Symptoms of Addison's Disease:
o Low "STEROID" hormones
▪ Sodium & Sugar are low, Salt cravings
▪ Tired and muscle weakness
 ▪ Electrolyte imbalance of high Potassium and high Calcium
▪ Reproductive changes
▪ low blood pressure
▪ Increased pigmentation of the skin
• Nursing Management of Addison's Disease
o Watching glucose and K++ level
o Administer medications to replace the low hormone levels of cortisol and
aldosterone
▪ For replacing cortisol:
▪ ex: Prednisone, Hydrocortisone
▪ For replacing aldosterone:
▪ ex: Fludrocortisone aka Florinef
o Wearing a medical alert bracelet
o Eat diet high in proteins and carbs, and make sure to consume enough
sodium
o Avoid illnesses, stress, strenuous exercise
Pancreas Disorders: Diabetes Mellitus
•

Key Players: Glucose, Insulin, Glucagon, Pancreas, Liver

• Types of Diabetes Mellitus:
o Type 1:
▪ The beta cells located in the islet of Langerhans don't work (been
destroyed) therefore the body doesn't release anymore insulin.
▪ Risk factors: Genetic, auto-immune (virus) NOT RELATED TO
LIFESTYLE
▪ TX: The patient MUST USE INSULIN.
▪ What do patients look like clinically? - young and thin
o Type 2:
▪ cells quit responding to insulin. INSULIN RESISTANCE leading to
hyperinsulinemia.
▪ TX: diet and exercise
▪ What do patients look like clinically? - overweight, adult aged
• Assessment Findings of DM:
1. Polyuria: (frequent urination)
 • Hyperglycemia: Three P's:
2. Polydipsia: very thirsty
3. Polyphagia: very hungry
• Other Assessment findings of the Diabetic Patient
o Slow wound healing
o blurry vision
o Glycosuria
o Acetone smell of breath-*type 1
o Rashes on skin DRY and itchy, repeated vaginal infections
▪ Complications of Diabetes Mellitus:
• Hypoglycemia: Blood glucose less than 60 mg/dL or drops rapidly from an elevated
level.
o Treatment: Need simple carbs if they can eat, or if unconscious IV D50
• DKA (Diabetic Ketoacidosis):
o No insulin, so they burn ketones.
o Signs and Symptoms of DKA: N&V, excessive thirst, hyperglycemia, acetone
breath- fruity smell, Kussmaul breathing- Why? How?
o Treatment:
▪ D-DHN first- (.09 % NSS)
▪ K-kill the sugar SLOWLY- to prevent low sugar
▪ A - Add K++ during IV insulin
• HHNS Hyperglycemic hyperosmolar nonketotic syndrome
o This presents with hyperglycemia without the breakdown of ketones
o S/Sx:
▪ H- Highest sugar (over 600+)
▪ Higher fluid loss & extreme DHN
▪ H-Head change- LOC, Confusion, Neuro manifestations
▪ No ketones, NO acid (NO Fruity breath/ketones)
▪ Slower Onset and Stable K++ (3.5-5.0)
o TX:
▪ H-Hydration-0.9% NS 1st, then HYPOtonic
▪ S-Stabilize Sugars (Insulin)
• Organ Problems:
 o Hardens the vessel
o can develop heart disease, strokes, hypertension, neuropathy, poor wound
healing
▪ Diabetes Nursing Management
• Nurse's role: educating, monitoring, and administering medications
• Diet
o Low carbs, good high fiber
• Diabetic feet
o Clean, Dry, Injury Free