Endocrine Glands and Hormones

Endocrine Glands and Hormones

• The pituitary gland (hypophysis) consists of the adenohypophysis and neurohypophysis.
• The adenohypophysis releases growth hormone, adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), prolactin, follicle-stimulating hormone (FSH), and luteinizing hormone (LH).
• The neurohypophysis releases antidiuretic hormone (vasopressin, ADH) and oxytocin.
• The thyroid gland releases triiodothyronine (T3), thyroxine (T4), and calcitonin.
• The adrenal gland has a cortex and a medulla.
• The adrenal cortex releases mineralocorticoids (aldosterone), glucocorticoids (cortisol), and sex hormones.
• The adrenal medulla releases adrenaline and noradrenaline.
• The parathyroid glands release parathyroid hormone.
• The pancreas releases insulin and glucagon
• The testes release testosterone.
• The ovaries release estrogen and progesterone.

Preparing Patients with Endocrine Disorders for Diagnostic Procedures

• GUK (blood glucose) is assessed with a one-time determination taken while fasting from a finger prick or biochemical collection.
• Multiple GUK determinations (GUK profile) require explaining the procedure, its purpose, and encouraging cooperation, also taken from a finger prick.
• Glucose tolerance tests (OGTT) involve withholding medications, not performing the test three days before or after menstruation, lasting two hours.
• OGTT also requires 12 hours of fasting before the test, explaining the process, encouraging cooperation, remaining still during the two-hour test, and abstaining from eating, drinking, and smoking.
• For OGTT, one blood sample is drawn before the test, then glucose dissolved in water is consumed, and blood is sampled again.
• Thyroid hormones T3, T4, and TSH are continuously secreted, allowing measurement regardless of the time of day or menstrual cycle.
• When taking thyroid hormone replacement, it should not be taken before the blood draw, but after.
• No fasting is required.
• FSH, LH, estrogen (E2), and progesterone (P4) levels depend on the menstrual cycle.
• Blood for FSH, LH, and E2 is taken on days 3-5 of the cycle.
• Blood for P4 is taken on days 21-23 of the cycle.
• In cases of absent menstrual cycles for more than three months, blood can be drawn but avoid collecting blood during menstruation.
• A 30-minute rest period is needed before collection.
• Cortisol and ACTH secretion depends on the time of day and stress levels, so rest is necessary.
• For cortisol testing, fasting is required.
• An IV line is inserted half an hour before the blood draw to avoid stress.
• Blood is drawn in the morning at 8 AM, half an hour after IV line insertion.
• The procedure is repeated at night between 11 PM and midnight; cortisol is also measured in 24-hour urine.
• For ACTH testing, an IV is inserted half an hour before the blood draw.
• Blood is drawn at 8 AM into an EDTA-containing tube, kept in a refrigerator with ice, and transported to the lab.
• For prolactin testing, an IV line is inserted one hour before the blood draw, and the patient rests.
• PSA (prostate-specific antigen) requires fasting.

Additional Preparation

• It is recommended to avoid prostate biopsy, sexual activity, or bicycling before the test.
• If a DRE (digital rectal exam) was performed, wait at least five days.
• Renin and aldosterone in blood and aldosterone in 24-hour urine require explaining the test procedure and the importance of cooperation and monitoring diuresis.
• The patient should rest lying down from 8 PM to 8 AM and remain fasting in the morning.
• After the blood draw at 8 AM, the patient walks until 10 AM, when blood is drawn again in a standing position.
• Catecholamines, metanephrine and normetanephrine require explaining the test procedure and importance of cooperation and collecting urine in prepared containers.
• For three days before the test, avoid citrus fruits, chocolate, cakes, vanilla, alcohol, coffee, and tea because they can interfere with the test.
• On the day of urine collection, avoid coffee and alcohol.
• Urine should be stored in a cool and dark place during collection.

Preparation for Instrumental Tests

• For mammography, explain the procedure and note that it’s somewhat uncomfortable but not painful.
• It’s best to perform on days 5-8 of the menstrual cycle.
• Avoid deodorants, antiperspirants, and lotions on the day of the exam and bring previous mammography and breast ultrasound results.
• For breast and thyroid ultrasounds, the patient lies down, the examination area is freed from clothing, and gel is applied for better conductivity.
• For gynecological ultrasounds, transabdominal requires drinking five glasses of water prior to the examination for a full bladder and transvaginal requires an empty bladder and avoiding vaginal suppositories several days prior.
• Thyroid punctures require explaining the procedure, discussing iodine allergies, and ensuring the patient remains still, and the procedure is monitored by ultrasound.
• Thyroid scintigraphy requires explaining the test, remaining fasting, avoiding if pregnant or breastfeeding and drinking plenty of water after.
• Bone densitometry is painless but also requires removing metal jewellery.

Diagnostic Procedures: Hypothalamus, Adenohypophysis, and Neurohypophysis

• Laboratory tests determine levels of specific hormones in plasma and urine. Hormone testing includes stimulation and suppression tests and measuring basal hormone levels.
• Structural changes are diagnosed via CT and MRI.

Diagnostic Procedures: Thyroid Gland

• Lab blood tests involve measuring T3 and T4 (thyroid) and TSH (pituitary), used to diagnose hyper or hypothyroidism, using one biochemical sample.
• The presence of elevated cholesterol and CPK, LDH and AST enzymes suggests hypothyroidism.
• Instrumental tests involve thyroid scintigraphy, a type of nuclear medicine imaging used to assess thyroid gland structure and function.

Purpose of Thyroid Scintigraphy

• Helps assess thyroid gland function, identify hyper or hypothyroidism, detect hot or cold nodules, evaluate goitre, and detect thyroid cancer metastasis.
• Radioactive iodine 131 accumulates in the thyroid gland, enabling the detection of inactive, cold areas and toxic nodules.
• Iodine accumulation measures approximately at 2, 24 and 48 hours post-administration.
• With normal thyroid function, 50% of iodine can be retained after 24 hours; hyperthyroidism has higher retention values, and hypothyroidism has lower retention values (less than 15%).

Thyroid Ultrasound, Needle Biopsy

• Thyroid ultrasound is painless, harmless, and provides immediate insight into structural changes.
• Thyroid puncture, guided by ultrasound, is performed in aseptic conditions by aspirating the tissue for analysis
• After a needle biopsy, the puncture is smeared on a glass slide, labelled with a requisition for cytological analysis and will reveal the type and characteristics of malignancies Diagnostic Procedures: Adrenal Glands
• Along with clinical presentations, monitoring of electrolytes (sodium, potassium), urea, GUK, sedimentation rate, and eosinophils is conducted.
• For suspected tumours, CT, MRI, and adrenal scintigraphy are performed.
• Hormone values are tracked: cortisol, ACTH, renin, and aldosterone in blood and aldosterone in 24-hour urine.

Important Info Regarding Cortisol

• Cortisol is a stress hormone with fluctuating levels: highest in the morning, decreasing during the day, and lowest at midnight.
• Disrupted secretion leads to increased body weight, menstrual cycle disturbances in women, and elevated levels irrespective of stress.
• Renin regulates blood pressure, and aldosterone increases sodium reabsorption and potassium secretion in urine.
• Testing for renin and aldosterone in blood and aldosterone in 24-hour urine.
• Requires a specialized procedure: the test is completed by a nurse, and the patient must be co-operative.
• The patient must rest lying down from 8 PM to 8 AM, remaining fasting in the morning, with samples required on ice because EDTA for renin and heparin for aldosterone.

Diagnostic Procedures: Mammary Glands

• For breast and ovarian/testicular diseases, a clinical history is relevant
• Physical exams include inspection, palpation and ultrasound.
• Anamnesis, lab results, UZV are key, along with hormonal lab readings and other hormones tested, such as gonadotropins, ovarian hormones, prolactin, thyroid, etc
• Mamogram radiological tests are effective but may be uncomfortable
• Clinical breast ultrasound can confirm abnormalities and locate malignancies
• Biopsies should be accompanied by prior radiological and UZV findings

Diagnostic Procedures - Other Scans

• Gynecological UZV are non-invasive and can assess the abdomens
• Testicular disease needs DRP, UZV, and tumor marker blood tests
• Bone density exams assess risk habits with radiowaves to observe thickness over a short period, during which the patient lies prone
• Endocrine tumors may need Mamos, CT, UZV, MRI, scintigraphy, or other operations
• PHD tests, cytology, or liquid samples may determine certain cancers such as CA125s

Lab Results in Diabetes

• Glycemia refers to GUK
• Hyperglycemia refers to increased GUK, while hypoglycemia refers to decreased GUK
• Glycosuria refers to glucose in the urine, while ketonuria is keytones in the urine, and keytonemia is keytones in the blood
• Diabetes can be diagnosed with GUK over 10 mmol or consistently elevated
• Blood screens can offer quick orientation or need venal samples, and should record accurate readings
• Hemoglobin tests assess glycemic thresholds for 8-12 weeks over 6%
• Ketone detection and arterial blood analysis through the AB system helps to determine acidose

Lab Procedures in Diabetes

• Lab analysis may show glycosuria
• Patient must be educated on urine and its importance
• Blood glucose can be drawn in pre- and post-meal samples
• Kidney and liver conditions as well as physical exertion may factor in

Hypothyroidism and Hyperthyroidism

• Hypothyroidism refers to not enough metabolism and hormone output, and hyperthyroidism refers to too much
• Risks include autoimmune conditions and stimuli differences
• Hypothyroidism comes with many complications and diagnostic testing measures clinical results and hormone samples
• Treatments include administering eutirox
• Key observation for thyroids is apparent in skins

Thyroid observation

• Skin can be paler with Hipo, or warm with hiper
• Hair may be more brittle with Hipo
• Face swells more with Hipo
• Fatigue is increased with Hipo
• Thyroid storms need fast doctor intervention
• Patients are often disinterested in taking care of themselves, and need help maintaining temperatures
• Treatment options for both problems vary greatly

Diabetes Diagnostic Tests

• Key lab tests observe sugar (glucose) levels
• Hyperglycemia requires different care and analysis
• Treatment for diabetic conditions involves maintaining activity levels
• Good testing will improve treatment quality, as blood and urea can affect diagnosis

Diabetics in Insulin Treatments

• High-quality and often self-applied (with help) insulin is a primary method
• Insulin comes in many types and brands
• Insulin needs to be analyzed for effectiveness frequently
• The ABS system comes into play for several other key blood indicators

Injections and Insulin

• Injections must be well managed with insulin Blood must be measured often and precisely
• Needles can cause some problems as well

More About Diabetes

• Diet has an impact on Diabetes, and high-quality nutrition is important
• Blood is also a factor in many outcomes
• Other conditions may come as a result

Managing Diabetes

• Education must be delivered on key issues so that treatment can have maximum effect.
• Edema may create several symptoms as well

Additional Steps for managing diabetes

• Many issues may arise for the unprepared Complications will worsen outcomes
• Many steps must be followed
• Many key lab factors can determine outcomes
• High glucose numbers will make outcomes less likely