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Endocrine System Overview

• Critical for communication and coordination within body
• Hormones regulate bodily activities and communication
• Interconnected with the nervous and immune systems
• Facilitates bidirectional immune-neuroendocrine communication
• Regulates responses to internal and external environmental changes

General Roles of Endocrine System

• Involved in reproductive and central nervous system (CNS) development in the fetus
• Stimulates growth and development during childhood and adolescence
• Facilitates sexual reproduction
• Maintains homeostasis
• Coordinates responses to emergency demands

Endocrine Glands and Their Locations

• Hypothalamus
• Pineal body/Pineal gland
• Pituitary gland
• Thyroid gland
• Parathyroid glands
• Thymus gland
• Adrenal glands
• Pancreas
• Ovaries
• Testes

Structures and Functions of Endocrine Glands

• Endocrine glands produce hormones that control and regulate specific target tissues
• The thyroid gland synthesizes thyroxine, which affects many target tissues
• Exocrine glands secrete substances into ducts that empty into a body cavity or onto a surface, such as salivary glands secreting saliva
• Endocrine glands are ductless, secreting substances directly into the blood
• Adrenal glands produce epinephrine and norepinephrine, releasing them into the bloodstream to regulate the body's response to stress

Thyroid Gland

• Located in the anterior neck, midline, straddling the trachea
• Composed of two encapsulated lateral lobes connected by a narrow isthmus
• Highly vascular
• Produces, stores, and releases thyroxine (T4), triiodothyronine (T3), and calcitonin
• Hormones stimulate cell metabolism and activity, exerting effects on nearly every organ system
• Regulated by a negative feedback cycle

Regulation of Thyroid Hormones (T3 and T4)

• Low circulating levels of thyroid hormone cause the hypothalamus to release thyrotropin-releasing hormone (TRH)
• TRH stimulates the pituitary to produce thyroid-stimulating hormone (TSH)
• TSH signals the thyroid to capture iodine from blood to synthesize, store, and release thyroxine (T4)
• T4 reaches target cells to be converted to triiodothyronine (T3)
• Adequate T4 levels reduce output of TRH and TSH from hypothalamus and pituitary
• Low T4 levels stimulate hypothalamus and pituitary to resume TRH and TSH output
• It affects metabolic rate, caloric requirements, oxygen consumption, carbohydrate and lipid metabolism, growth and developmen, brain function and Nervous system activity

Calcitonin

• Produced in response to high circulating calcium level
• Inhibits calcium absorption and loss from bone
• Increases calcium storage in bone
• Increases renal excretion of calcium and phosphorous
• Calcitonin lowers serum calcium and phosphate levels
• Serves as a counter-mechanism to parathyroid hormone (PTH)

Parathyroid Glands

• Four small, oval structures usually found in pairs behind each thyroid lobe
• Secretes parathyroid hormone (PTH or parathormone) to regulate blood calcium levels
• PTH acts on bone and kidneys, and indirectly on the gastrointestinal (GI) tract
• Low serum calcium or magnesium levels increase PTH secretion
• High serum calcium or active Vitamin D levels decrease PTH secretion

Actions of Parathyroid Hormone (PTH)

• Bone: Resorption of calcium, inhibits bone formation, release of calcium and phosphate into the blood.
• Regulation of Calcium and phosphorus blood.
• Kidneys: Increase calcium reabsorption and phosphate excretion, renal conversion of Vitamin D to active form
• Intestine: Acts indirectly using Vitamin D to enhance intestinal absorption of calcium

Pancreas

• It is anterior to the first and second lumbar vertebrae
• It is long, tapered, lobular, and a soft gland
• Contains the Islets of Langerhans which are the hormone-secreting portion of Pancreas
• Exocrine function produces enzymes important for digestion
• Endocrine function regulates the level of glucose in the blood
• 4 types of hormone-secreting cells:
  • Alpha (α) cells: produce and secrete glucagon.
  • Beta (β) cell produce and secrete insulin and amylin.
  • Delta (D) cells: produce and secrete somatostatin.
  • Gamma (F or PP) cells: secrete pancreatic polypeptide (PP).

Hormones

• Chemical substances synthesized and secreted by endocrine glands.
• Paracrine action affects locally on nearby cells (e.g. action of sex steroids on ovary)
• Autocrine action: affect on cell produces it (e.g. insulin secreted from pancreas inhibits further insulin release from same cell)
• Secretion in small amounts at variable but predictable rates
• They are controlled via Regulation by feedback systems
• Able to bind to specific target cell receptors
• Control varied physiological activities: E.g. reproduction, response to stress/injury, electrolyte balance, energy metabolism, growth, maturation, aging, regulating nervous and immune systems

Glucagon

• Increases blood glucose
• Provides fuel for energy during fasting states
• Provides fuel for energy when ingested glucose is not readily available

Function of Insulin

• Key hormone, principal regulator of metabolism
• Regulates the storage of ingested carbohydrates, fats, and proteins
• Facilitates glucose transport across cell membranes
• It is Responsible for how ingested nutrients are used for energy and stored (Metabolism)

Pathophysiology of Insulin and Glucagon Secretion

• A reciprocal negative feedback loop maintains normal blood glucose levels
• Low blood glucose, protein ingestion, and/or exercise glucagon synthesized and is released from alpha cells
• Increased blood glucose through catabolism stimulates
  • Glycogenolysis the breakdown of glycogen into glucose
  • Formation of glucose from noncarbohydrate molecules
  • Ketogenesis is the breakdown of fatty acids which produce ketone bodies
• Mechanisms carefully modulate insulin secretion to prevent hypo and hyperglycemia:
  • Increased blood glucose stimulates insulin synthesis and secretion
  • Decreased blood glucose and glucagon inhibit insulin secretions

Endocrine System Assessment: Health History - Subjective Data

• Personal/family history: conditions, surgeries, hospitalizations, treatments, medications
• Eyes, ears, nose, mouth, and throat: blurred or double vision, difficulty swallowing, enlarged neck
• Overall health status: changes in appetite, weight, activities, and fatigue
• Neurological issues: increased nervousness and stress, anxiety, memory, and concentration changes
• Gastrointestinal: bowel changes and constipation
• Cardiovascular: heart palpitations
• Genitourinary: nocturia, kidney stones, water at bedside
• Endocrine: temperature regulation
• Female reproductive: menarche, menstrual cycle, fertility, children born/ weight, gestational diabetes and menopause.
• Musculoskeletal: shaky hands, difficulty holding things
• Male reproductive health: changes in the ability to have an erection and fertility.
• Intergumentary: change in hair distribution, skin color or texture
• ADLs: activity, mobility, sleep/rest, relationships, coping/stress, occupational health, selfcare, or health promotion.

Endocrine System Assessment: Objective Data

• Vital signs and height/weight
• Integumentary: color & texture of skin, hair & nails, hair distribution, pigmentation, ecchymosis, palpate for moisture
• Mental/emotional status: orientation, alertness, memory, affect, personality, anxiety, appropriateness of dress, speech pattern
• Neck: position, swallowing, trachea midline, symmetry, bulging over thyroid
• Thorax: shape, skin, gynecomastia in men, auscultate lung and heart sounds, signs of fluid overload/heart failure
• Head/face: size, contour, facial symmetry; eye position, symmetry, shape, movement, edema; buccal mucosa, teeth, tongue size & movements
• Extremities: size, shape, symmetry, proportion of hands/feet; skin, lesions/edema; muscle strength deep tendon reflexes; tremors in upper extremities
• Abdomen: contour, symmetry, color, skin condition, auscultate bowel sounds
• Genitalia: hair distribution; palpation of testes, clitoral enlargement

Common Blood and Urine Lab Tests

• TSH: usually first diagnostic test for thyroid dysfunction; most sensitive method
• T4 Total: total serum level of T4, useful in evaluating thyroid function and monitoring thyroid therapy
• Free T4: active component of total T4, better indication of thyroid function (level remains constant)
• T3: serum levels of T3, helpful to diagnose hyperthyroidism if T4 levels are normal
• PTH: evaluates hypercalcemia or hypocalcemia, results interpreted with serum calcium level
• Total serum calcium: helps detect bone and parathyroid disorders
• Cortisol (blood): amount of total cortisol in serum evaluates status of adrenal cortex function
• Cortisol (urine): free (unbound) cortisol with suspected hyper- or hypo function of adrenal gland evaluates hypercortisolism
• ACTH: plasma level of ACTH determines if under/overproduction of cortisol caused by adrenal or pituitary dysfunction
• Calcitonin: serum calcitonin, helpful with the diagnosis of medullary thyroid cancer.
• CBC (RBC, WBC, platelets, Hg, hematocrit, MCV) electrolytes, BUN, Cr.
• Thyroid peroxidase antibodies suggest autoimmune origin of hypothyroidism disorder Elevated cholesterol and triglyceride levels, anemia, increased creatine kinase level may be related to hypothyroidism

Imaging Diagnostics

• MRI: visualize the central nervous system (CNS), bony spine, joints, extremities, and breasts.
• CT scan with contrast: detect presence of a tumor.
• Ultrasonography: evaluate thyroid nodules, determine if fluid-filled (cystic) or solid tumor.
• Thyroid Scan: evaluate nodules, radioactive isotopes given PO/IV, scanner passes over thyroid, records radiation emitted benign nodules as warm spots (take up radionuclide), malignant tumours as cold spots (tend not to take up radionuclide).
• Radioactive iodine Uptake (RAIU): measures thyroid activity/function, useful for the evaluation of solitary thyroid nodules, radioactive iodide taken, PO/IV, scanner measures uptake by the thyroid gland at several time intervals (i.e. 2- and 4-hour intervals and at 24 hours).

Thyroid Gland Disorders

• Thyroid hormones regulate energy metabolism, growth, and development
• Disorders of the thyroid gland include: enlargement (goiter), benign and malignant nodules, inflammation (thyroiditis), hyperfunctioning and hypofunctioning states

Hyperthyroidism

• Hyper-activity of the thyroid gland, increased synthesis, and release of thyroid hormones

Hypothyroidism

• Hypo-activity of the thyroid gland, insufficient circulating thyroid hormones

Causes of hyperthyroidism

• Graves' disease; Toxic nodular goitres; Thyroiditis

Causes of Hypothyroidism

• Iodine deficiency most common cause worldwide
• Atrophy of thyroid gland most common in Canada
• Amiodarone or Lithium use
• Treatment for hyperthyroidism such as surgical removal
• Discontinuing thyroid hormone therapy
• Destruction of the thyroid gland such as autoimmune diseases Hashimotos thyroiditis or Graves disease

Hyperfunction of the thyroid 51.6

• Effects of increased metbolism and tissue sensativity to SNS
• Symptoms of excess circulating hormones
• Cardiovascular angina; atrial fibrillation, palpitations, dysrhythmias; bounding, rapid pulse; cardiac hypertrophy; increased cardiac Output increased, rate, and force of cardiac contractions; systolic hypertension, systolic murmurs
• Inspiratory dyspnea on mild extetion and increased respitrary rate
• Gastrointestinal diarrhea frequent defecation; hepatomegaly, increased appetite, thirst; increased bowel sounds, increased peritalsis splenomegaly; weight loss
• Skin: finger clubbing, diaphoresis, fine, silky hair; premature greying male hair loss; palmar erythema, thin, brittle nails from nails bed (warm, smooth and moist skin)
• Musculosketal: dependents edema; fatigue, muscle weakness osteoporosis: proximal muscle wasting
• Nervous- personailty changes, irritability, depression, apathy, fatigue, insomnia, exhaustion: hyper-flexia tendon reflexes, difficulty focusing, fine tremor to tongue, inability to concentrate, agitation, restlessness, delirium and stupor
• Reproductive: amenorrhea, libido, erectile dysfunction in males, menstrual irragulations
• Otehr - Goitre: basal temperature, heat interolerence

Hypofunction of the thyroid

• Cardiovascular - Anemia, cardiac heartropy, decreased rate, distant heart sounds; increased capillary fragility; varied changed blood pressure increased risk angina
• Respiratory: Decreased Capacity.
• Gastrointestinal - Celiac disease, constipation; decreasedappetite; weight-grain; scaled Tongue; Nausea and vomiting
• Integumentary - Decreased Sweating: Dry, Sparse, Coarse Hair; Dry Thick, Inelastic, Cold Skin; Generalized Interstitial Edema, Pallor: Poor Turgor of Mucosa, Puffy Face; Thick, Brittle Nails
• Muskeskeletal-Arthralgia; Fatigue, Muscular aches and Pains, Slow Movements, Weakness
• Nervous:Disorientation, Confusion and Memory Impairment
• Reproductiveo Prolonged Menstruel Periods amenorrehea
• Other:Goitre; Increased sensitivity to opioids/barbiturates HearingImpairment;

Hyperthyroidism: Interprofessional Care

• Aim to block negative effects of thyroid hormones & stop over-secretion
• Diagnostics: History, ECG. lab tests.
• Radiation therapy
• Medication- Anti Thyroid medication Beta-andrenergic blockers(Popranol)
• Nutrition- Frequent meals, high calories.

Hyperthyroidism: Nursing interventions

• Diagnose and plan reduce stamina after diagnoses
• Health assement
• Avoid series of treatment
• Maintain balance
• Assess if goals have been fullfilled in the therapeutic plan

Throidectomy

Indications:

• Lare goitre cause the compression of trachea
• Not responding to antihytrioic
• Preferred thyroidectomy removed 90 & of yhiroid portion-
• Minimality invasive
• Post Operation: Damge to inarvertin, Haamorrhange.

Thyroidectomy: Nursing Interventions

• Oxygen-Sunction Equipmen and and
• Aessess Q2 hrs for 24 hrs irregular breathing,s
• Head support with pilllow avoid suture
• Monitor vital signs + appreehsion signs
• Assess Speak
• Control pain nasea

Thyroidectomy: Patient Teaching

• Comfort measure breathing _ _ incision is important + medication and care of the infusion is important
• Overextration should be avoided support whing
• Watc for breathing diffculties
• Avoid Colaraic

Hyperthyoidism Complication:

• Rare, Acute Condition: Life-Threating Emergency.*
• Manifestations Intensify,
  • Causes of Infection.
  • Health Condition: -- Severd: Heart-falirue, shock, restlessness, siezures, Nausea, Vomitting, diarrhoea.

Treatment for hyperthyroidism :

Monitor for cardiac dysrhythmias and decompensation

• Ensure oxygenation and IV fluid. Maintain adequate support and reduce edema

Hypothyroidism. Interprofessional Cure

• Goal: To reatore thyroid safety
• DiagnostiC: Physical EXam + Seum T3-T4 Levels. +Monitor thyroid hormone levels and adjust dosage +Nutritional therapy: For weight loss.

Patient and Family Teaching Goal is to prevent sideeffects + To make patients safe, and to have routine with the

Nursing Interventions:

Monitor for signs of a myxedema coma: REQUIRES: ACute care needs and

• Skin Integrity: Check for skin breakdown and sedation
• Evaluate patients overdose

Provide Written Instructions, frequent repetition, assess comprehension

Signs of overdose, when and how to contact provider

Medical: Medical emergency, requires, sudden progression to hyothermia

• Treatemtn: infection and cold with mediations

Hypoparathyroidism vs. Hyperparathyroidism

• Hyperparathyroid-Inaprotairely increased Parathroid Hormone +PTH
• Hypo parathyoridsm-Characterized by Low PTH

Hypertunction Parathyoidsim:

Dysrhyths, Hyper Tension; Anorexia etc.

• Hypofunction of thyroid parathyroidism:*
• Decreased cardaic output: Abdominal cramps, fecal

Hyperparathyroidism

• Skeletal -Backacehe osteporsis
• Enourolagical Memory Inpairment-Irritability
• High Levels Calcium in urine

Nursing intervention

• Annual Examination* + Avoid ambulation with High diet _Medations * * Bisphosphonates autotransplatnin of parathroryed patients
• Hypo Parathyroidism Patient recieve is smiliar those of tyrodeytamy patient
• tetnty levels is related a decreased level of calcium

Hypoparathyroidism

• Maintain normal seurum clacium levels
• Correcrlow mg levels

Diabates

• Prediabeses= Stage between normal homestati
• Fasting or 3 -4 hr Level normal, lower than
• Low Glucose level increased Dm development

Type 1 or type 2 diabate

• High Glucose
• Insulin
• Hyperosmoatity Synorome

Manifestations

• Type 1*: frequent urination high intake high hunger; Weigthloss. Fatique
• Type 2* Non-specific symptoms * - May have classic

Diagnositics of DM

• haemoglobin A13 test
• Fastin plasma glucose level
• Randumcasual plasma glucose level

Medial Teatment

• Regular

• podiatrist

• dietican

• prscibition

• Reduce-

• Promde Weight Loss.

• Delay Onset and Progressions

Nutrition

• Diet
• Blood SugarMonitoring
• excercise

Self-Mointorung

• *Patient and famly teaching: Encourages the patient to follow all instruction " Testing instruction-

_Wash hands with soap- If its not enought to draw enough alcohol, to draw-Use all fingers and have a lancet + Dispose the lance"

• Oral Medication and Insulin therapy
• _Insulin therapy*_-Rangin from one to four injection. Goal- to achieve neal glow level If pateing are sick you need to follow what is right by then

Patients treated to Antihypercglycemia

• Effect Therapy-Symotms and records should be checked regularily
• Advetse: Hyopgalcymea episodes

Diabetes : Nursing diagoses

Patient with new diagnoses of Diabetes

• Patient with new diagnoses of Diabetes :

• High education to patient* .

• High Self Management

• Follow instructions

• Provide support

• A client reports pain at the incision site 8 hours after a: