Endocrine System & Adrenal Glands

• The endocrine system maintains and regulates vital functions.
• The endocrine system is used in response to stress and injury.
• The endocrine system manages the body's growth and development.
• The endocrine system affect energy metabolism, reproduction, and fluid, electrolyte, and acid-base balance.

Adrenal Gland

• One adrenal gland sits atop each kidney.
• It regulates sodium and electrolyte balance.
• It affects carbohydrate, fat, and protein metabolism and influences the development of sexual characteristics.
• It sustains the fight-or-flight response.

Adrenal Cortex

• It is the outer shell of the adrenal gland.
• This synthesizes glucocorticoids and mineralocorticoids.
• It secretes small amounts of sex hormones including androgens and estrogens.

Adrenal Medulla

• The inner core of the adrenal gland.
• The medulla functions as part of the sympathetic nervous system.
• It produces epinephrine and norepinephrine.

Adrenal Cortex Hormones

• Glucocorticoids include cortisol, cortisone, and corticosterone.
• The cortex is responsible for glucose and protein metabolism.
• The cortex maintains fluid and electrolyte balance.
• The cortex suppresses the inflammatory response injury and provides a protective immune response to infectious agents.
• The cortex assists with resistance to stress.
• Mineralocorticoids include aldosterone.
• Electrolyte balance is regulated by promoting sodium retention and potassium excretion.

Hypothalamus

• Portion of the diencephalon of the brain that forms the floor and part of the lateral wall of the third ventricle.
• It activates, controls, and integrates the peripheral autonomic nervous system and endocrine processes.
• It has many somatic functions, including body temperature, sleep, and appetite.
• Hormones Released include corticotropin-releasing hormone(CRH), gonadotropin-releasing hormone (GnRH), growth hormone-inhibiting hormone (GHIH), growth hormone-releasing hormone (GHRH), melanocyte-inhibiting hormone (MIH), prolactin-inhibiting hormone (PIH), and thyrotropin-releasing hormone (TRH).

Pituitary Gland

• The master gland, located at the base of the brain.
• The hypothalamus influences function, directly affecting the function of the other endocrine glands.
• It promotes growth of body tissue, influences water absorption by the kidney, and controls sexual development and function.

Thyroid Gland

• Located in the anterior part of the neck.
• It controls body metabolism and growth and produces thyroxine (T4), triiodothyronine (T3), and thyrocalcitonin.

Parathyroid Gland

• Located on the thyroid gland and controls calcium and phosphorus metabolism.
• It produces parathyroid hormone.

Pancreas

• An endocrine gland that located posteriorly to the stomach.
• The islets of Langerhans houses 3 major cell types that secrete glucagon to raise blood glucose levels.
• It also secretes somatostatin to exert a hypoglycemic effect.
• Insulin is secreted into the bloodstream and is important for carbohydrate metabolism.

Ovaries and Testes

• The ovaries are located in the pelvic cavity and produce estrogen and progesterone.
• The testes are located in the scrotum and control the development of the secondary sex characteristics.
• The testes produce testosterone.

Negative-Feedback Loop

• This regulates hormone secretion by the hypothalamus and pituitary gland.
• A hormone's control of cellular function depends on a series of reactions through negative feedback control mechanisms.
• Hormone secretion depends on the body’s need for the final action of that hormone.
• Hormone synthesis is "NEGATIVE FEEDBACK" because the hormone causes the opposite action of the initial condition change.

Diabetes Insipidus (DI) and SIADH

• Anterior Pituitary Gland Manifestations show differing diagnostic indications for DI and SIADH
• DI indications - Loss of fluid/weight, polyuria, low specific gravity, high hematocrit, high serum osmolality/NA, high serum BUN, and low blood volume/pressure
• SIADH indications - Fluid retention weight gain, oliguria, high specific gravity, low hematocrit and serum osmolality/NA/BUN, and high blood volume/pressure

Diabetes Insipidus

• The water deprivation test diagnoses.
• Induce dehydration
• NPO - nothing by mouth/nil per os and therefore no fluids for 4-8 hours.
• Normal results are hypothalamus releases PG, raising antidiuretic hormone ADH by increasing H2
• Results in oliguria

Hypopituitarism

• Conditions include adenoma or benign tumor, surgery from hypophysectomy, autoimmune disorders such as Simmond’s disease (absence of pituitary glands function or panhypophysis), and Sheehan’s syndrome related to fetal complications at birth.
• This leads to decreases growth hormone, TSH, ACTH, FSH, and LH.
• Medical management includes somatrem like protropin, somatropin, humatrope nutropin, and hypophysectomy, which is the surgical removal of the hypophysis.

Hyperpituitarism

• Conditions include adenoma, but a malignant tumor.
• This leads to increases growth hormone, TSH, ACTH, FSH, and LH.
• Medical management includes bromocriptine like Parlodel and octreotide such as sadostatin.

Craniotomy and Transsphenoidal surgery

• Craniotomy means surgical removal of the section of the skill, which is more aggressive and more at risk for infection.
• Transsphenoidal surgery is performed using endoscopy and a small surgical instrument.

Post Hypophysectomy Management

• Avoid straws, commercial mouthwash, frequent toothbrushing, sneezing with mouth open, vigorous flossing, and blowing the nose.
• Gargle with saline or baking soda solution, perform gentle and infrequent flossing, and use toothette tooth cleaners.

Hypopituitarism

• There is a life long HRR hormone replacement needed, but WOF - watch out for diabetes insipidus, Addisonian or adrenal crisis, and other hypopituitarism disorder.

CSF Leak

• CSF leak can lead to Rhinorrhea or leaking of clear fluids from the nose. Have this investigated by collecting a sample that may have a halo sign (+) for glucose. Report frequent swallowing and Notify HCP immediately.

Increased ICP

• WOF - watch out for severe headache and decreased LOC.

Monitoring and Support

• Nurses should meticulously care for skin.
• Medications include Desmopressin, Lypressin, and Vassopresin using the z track method or Demeclocycline via the IV as well as loop diuretics or osmotic drugs.
• Principles of HRT or hormone replacement therapy.

Thyroid Hormones

• Iodine is essential for TH or Thyroid hormone synthesis
• Thyrotropin is a thyroid stimulating hormone

Calcitonin

• Decreases calcium level in the blood.
• It promotes Ca storage in the bones and causes deposition in the bones
• Reduces calcium plasma level when blood supply is high

Thyroxine (T4)

• A weak hormone that maintains body metabolism at a stable state

Triiodothyronine (T3)

• 5x more potent than T4
• It has a more rapid metabolism action is seen in hyperthyroidism as TSH decreases and TH increases

Monitoring and Support

• Nurses support a patient with meticulous skin, meds, HRT
• They should also follow precautions such as monitoring vital signs as well as CBC and differential count while also reporting any sign of infections.
• Beta Adrenergic Blockers such as Propanolol, metropolol, atenolol, or carevedilol may be needed following Iodine Solution from Pre-op options of Lugol’s (strong iodine sol) or Saturated solution of Potassium Iodine (SSKI).

Post Op Complication And Nsg Mng

• Assess front, back, and side of the neck for bleeding.
• Ensure Semi fowler's position or put neck at a neutral position to test airway patency as well as swelling/edema/hematoma.
• Tracheostomy set, suction machine, and O2 should be bedside
• These are measures if hypocalcemia is high by Monitoring for s/sx of early hypocalcemia involving numbness and paresthesia.
• Maintain calcium level and Check for (+) Chvostek and Trousseau's sign beside Calcium gluconate.

Parathyroid Gland

• Responses are related to parathyroid hormone, that releases calcium in the blood.
• Low parathyroid activity causes hereditary factors, Autoimmune issues, total thyroidectomy, or Atrophy of the parathyroid.
  • That is due to Inflammation trauma or tumor of the tissue.
• High parathyroid activity is often caused by Hereditary factors, benign Adenoma, and cancerous mass.
• Furthermore that is caused by Hyperplasia of the parathyroid gland with Overcompensation due to Vit D deficiency

HYPOparathyroidism

• Causes Increase in neuroexcitability that comes with muscle cramps Tetany, and (+) Chvostek and Trousseau’s sign leading to Airway constriction with Laryngospasm and bronchospasm and the PRIORITY: Airway
• Nurses should give Calcium supplements that treat SE and Constipation, with supplement Vitamin D. It may improve GIT absorption for increase.

Hyperthyroidism

• Will see a decrease in neuroexcitability related to fractured bone, especially at the back as NI causes bone issues and kidney stones related to renal colic, cool moist skin, Anorexia, fever, Agitation and memory impairment with an Increase Ca in the blood
• Support patient, and use meds according to Doctors recommendation on patient nutrition and diet.

Adrenal Gland

• Addison's has low (Cortisol and aldosterone)
• Cushing has high cortisol and aldosterone.
• Norepinephrine and Epinephrine are hormones secreted by Adrenal Medulla.

Addison's disease

• Characterized by weight loss ,thin with hypotension
• Diagnosed by lowered levels of serum cortisol, ACTH, glucose, and sodium
• Diagnosed by higher levels of urine sodium, serum K /Urine K
• Diet to increase NA and decrease K while lifelong HRT is needed

Cushing's disease

• Characterized by a classic Moon face or buffalo hump with Truncal obesity and HTN
• Diagnosed by raised levels of serum cortisol, ACTH, glucose, and sodium
• Diagnosed by lowered levels of Urine Na and K Serum K /Urine K
• Support patient and help them reduce glucose Na as well as increase the levels of K in their Diet using lifelong HRT to monitor adrenal activity

Pheochromocytoma

• Adenoma Medulla Tumor that causes high amount of catecholomine
• Can be diagnosed by Palpitation/Tachycardia, Hypertension, and sweating
• Nurses should Avoid HTN Crisis and not palpate the abdomen

Diabetes Mellitus

• Not well managed can lead to High Triglyceride as seen in Race
• Diabetes has two forms that include the genetically predisposed Type 1 that is a juvenile onset and Brittle while Type 2 is maturity that onset with obesity typically during times of genetic pressure.
• DM1 has hereditary origins, but DM2 has a lot of risk factors that can trigger Obesity due to genetics or an external virus that may also be linked to carbon tetrachloride toxicity.
• DM 1 has noticeable signs that are 3Ps - weight Loss anorexia and blurry vision; whereas DM 2 has glucose, as well as weight and can put a patient is DKA if ketones are due to cell damage

Multiple Sclerosis

• An immune-mediated, progressive demyelinating disease of the central nervous system.
• Demyelination causes destruction of myelin, the fatty and protein material that surrounds certain nerve fibers in the brain and spinal cord.
• Demyelination results in impaired transmission of nerve impulses.
• Sensitized T- and B lymphocytes cross the blood–brain barrier, where they check the CNS for antigens before they leave, but sensitized T cells remain in CNS and promote the infiltration of other agents that damage the immune system.
• The immune system attack leads to inflammation that destroy myelin and oligodendroglia cells that produces myelin in the CNS
• A patient will experience fatigue, depression, weakness, numbness, and difficulties with coordination, loss of balance, spasticity, pain, and blurring of vision, diplopia, scotoma, and total blindness.

Types of MS

• Relapsing remitting is characterized by clearly acute attacks with full recovery
• Primary progressive is characterized by disease showing progression of disability from onset, but minor improvements are seen.
• Secondary Progressive MS shows begins with an initial RR course, followed by progression of variable rate in which the nurse may discover relapses as well .

Myasthenia Gravis

• Is an autoimmune disorder affecting the myoneural junction
• Symptoms include limited muscle weakness
• Monitor breathing patters
• Chest pt may help to drain of fluid for breathing

GULLAIN BARRE syndrome

• autoimmune attacking the peripheral nerve
• causes symmetrical weakness, diminishes reflexes

Parkinson’s Disease

• Slowly progressing neurologic movement disorder that leads to disability.
• This is caused by destruction of dopaminergic neural cells in the substantia nigra in the basal ganglia that is caused by a depletion of dopamine stores,
• There is an excess in Acth and causes impairment that slows the body.
• S/s Tremom Rigidity, Bradykinesia, and Postural changes.