Endocrine System: Glands, Hormones and Disorders

Endrocrine System Part 1

• Outlines location, function, and correlation to diagnostic assessment to endocrine function.
• Discusses management and plans of nursing care for pituitary disorders.
• Describes epidemiology of thyroid disorders and correlates with diagnosis used to confirm thyroid disorders.

Parts of Endocrine System

• Includes endocrine glands like the hypothalamus, pituitary, adrenals, thyroid, parathyroid, gonads and islet cells of the pancreas.

Endocrine Hormones

• Secreted directly into the blood system, and its functions correlate to hormone levels within the blood.
• Endocrine disorder classifications are: Primary, Secondary, Tertiary, and Quaternary.
• Primary dysfunction is at the endocrine gland.
• Secondary dysfunction is at the anterior pituitary gland.
• Tertiary dysfunction is at the hypothalamus.
• Quaternary dysfunction is when target tissues are unable to respond to secreted hormones.

Functions of Endocrine System

• Coordinates sexual functioning, blood glucose control, metabolism, and growth and development.
• Under or overproduction can cause endocrine dysfunction.

Endocrine Anatomy and Physiology

• Functions are linked to the nervous system and regulated by negative feedback loop.

Hypothalamus

• Located beneath the thalamus.
• Secreted hormones work on the endocrine glands.

Pituitary Gland - Anterior

• The anterior pituitary is regulated by the hypothalamus and secretes hormones.
• Secretes gonadotropin hormones: follicle-stimulating and luteinizing hormone.
• Thyroid-stimulating hormone (TSH), Adrenocorticotropic hormone (ACTH), prolactin and growth hormones, plus melanocyte-stimulating hormone are all secreted from the anterior pituitary.

Pituitary Gland - Posterior

• Composed of nerve fibers and responsible for the neuroendocrine reflexes.
• Secretes antidiuretic hormone (ADH) and oxytocin.

Adrenal Glands

• Cortex is 90% of the gland and it secretes mineralocorticoids, glucocorticoids and androgens.
• The Medulla is controlled by the sympathetic nervous system (SNS) and it secretes epinephrine and norepinephrine.
• Epinephrine and Norepinephrine are also produced by the SNS, meaning the adrenal medulla is not essential to life.

Thyroid Gland

• Located in the anterior neck underneath the cricoid cartilage.
• Produces triiodothyronine (T3), thyroxine (T4), and thyrocalcitonin.
• T3/T4 regulates heart rate and contractility, respiration rate and depth, plus oxygen and glucose intake by cells. Glycolysis, gluconeogenesis, protein synthesis, catabolism, and metabolization of fatty acids also regulated by T3/T4, oxidation of free fatty acids, and cholesterol and phospholipids.

Parathyroid Gland

• Partially embedded in the thyroid gland and can be found above the hyoid bone on occasion.
• It secretes the parathyroid hormone (PTH).
• PTH increases serum calcium through bone reabsorption, stimulates renal reabsorption of calcium and activates vitamin D.
• It also decreases serum phosphate by reabsorption of phosphate in kidneys, bone resorption, and small intestine absorption.

Gonads

• Sexual development and function is based on hormones secreted from the sex organs.
• Testes and Ovaries.
• Both are controlled by tropic hormones released by the anterior pituitary gland.
• Males: FSH & LH = testosterone and for females, FSH & LH = estrogen and progesterone.

Pancreas

• Located in the upper left quadrant of the abdomen and have endocrine and exocrine functions.
• Islet cells control blood glucose with insulin and glucagon.

Assessment of the Endocrine System

• Involves a history, paying special attention to family history.
• Physical assessment using inspection, auscultation and palpation.
• Palpate the thyroid and testes for size, shape, symmetry, and any nodules or change in texture.

Diagnostic Studies Used in Endocrine System

• Includes lab and imaging tests.
• Serum hormone levels with TSH, T3 and T4 levels.
• Stimulation and suppression testing.
• Use the scan (CT, X-ray, MRI).

Pituitary Gland Disorders

• Classified into anterior and posterior disorders.
• Anterior disorders: Hypopituitarism and hyperpituitarism.
• Posterior disorders: Diabetes Insipidus (DI) and Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Hypopituitarism - Pituitary Insufficiency

• Hyposecretion of hormones from the anterior pituitary gland can result in decreased body functions.
• Rare disorder that affects less than 200,000 individuals within the U.S.
• Causes of compression or inflammation of the pituitary that are secondary to a tumor.
• Deficiencies in anterior pituitary hormones can lead to changes in metabolic or sexual function. Official pathology can be determined based on decreased hormone levels.
• Decreased adrenocorticotropic hormone (ACTH) leads to decreased release of aldosterone and cortisol.
• Lack of thyroid stimulating hormone (TSH) decreases thyroid hormone.
• Lack of luteinizing Hormone (LH) and Growth Hormone (GH) lead to changes in sexual and reproductive functioning.

Clinical Manifestations

• Decreased levels of T3 & T4 leads to a decrease in metabolic rate, weight gain, thinning of hair, and decreased libido.
• Females with hypopituitarism experience irregular menses or amenorrhea with decreased ovulation.
• Males will have decreased testosterone production.

Diagnosis

• Dependent on the suspected missing hormone.
• Includes hormonal studies like the ACTH stimulation test, and testing of and TSH, FSH, LH, prolactin, and GH.
• CT/MRI to rule out brain or pituitary gland tumors.

Medications and management

• Used to restore hormone levels to normal range.
• Hormone replacements include corticosteroids, thyroid hormones and testosterone or estrogen.
• Supportive therapies include electrolyte replacement, Vitamin D, and calcium.

Complications of Hypopituitarism

• Deficient anterior pituitary hormones can lead to hypotension and circulatory issues relating to ACTH's affect on producing aldosterone.
• Fluid loss through the kidneys occurs, thus sodium is lost due to kidney function.
• Panhypopituitarism: Hyposecretion of all hormones from the hypothalamus.
• Lack of ACTH results in inability to maintain fluid volume and circulatory collapse.
• Decreased metabolism can occur through the deficiency of TSH. Women also face risks of HTN and DVT, with treatments using estrogen therapy.

Nursing Management

• Includes assessments and analysis dependent on hormone deficiency.
• Nursing diagnoses/problems include fluid volume deficit, risk for injury, impaired mobility, hypoglycemia, hyponatremia, hyperkalemia and osteoporosis.

Nursing Interventions

• Involves assessment of vitals, serum glucose levels, changes in fertility and signs of decreased bone density.
• Nursing Actions/Techings include safety measures, increased vit D & Calcium.
• Hormone replacement and collabratation with physical therapy should be performed.
• Also consult with a dietician, and teach clinical manifestations and importance of taking hormone supplements in the morning.

Hyperpituitarism - Pituitary Hypersecretion

• Related to hypersecreting tumors and higher incidences in female patients. Can be in children or adults and is linked genetically.
• Pathophysiology is secondary to hypersecretion of hormone.

Clinical Manifestations

• Female clinical manifestations; -Hypogonadism & Increased body fat
• Male clinical manifestations; Coarse facial features and decrease bone density

Diagnosis

• Focuses on the affected hormone or target cell affected by increased hormone.
• Through acth Stimulation test and measurement of TSH, FSH, LH, Prolactin and GH, plus if patient is experiencing Tumor?

Medications

• Treats symptoms.
• Can focus on reducing the hypersecretion of hormones, while targeting specific glands or cells.

Surgical Interventions

• Transsphenoidal Hypophysectomy. Sublabel transeptal approach.
• Endoscopic Approach and Stereotactic Radiosurgery.

Complications

• Hyperglycemia can occur thru increase ACTH.
• Can result to organ overgrowth or hypertrophy via growth hormone.
• Liver, hearts, and kidneys can be affected depending on the degree of overgrowth, with more sensitive patients experiencing issues thru nerve entrapment or surgival complications.

Nursing Management

• Conduct patient assessment or nursing diagnoses related to the over-secretion of hormones- and their related health-deficits.
• Nursing interventions should be assessed and monitored like vital signs, or neurological function through I/O function, neurovascular status, & overall physical health.

Diabetes Insipidus (DI)

• Epidemiology includes approx 30% of DI cases are Idiopathic.
• Classifications and secretion: central w/ decreased ADH, and kidneys are resistant to ADH and the inability to concentrate urine causes and loss of water.

Pathophysiology

• Minimal or no production in hypothalamus, meaning ADH can not be produced in the pituitary glands.

Clinical Manifestation

• Occurs with high serum sodium and hematocrit.
• Hypovolemia with hypotension & tachycardia and Fluid volume deficit occurs.

Diagnosis

• Serum and Urine electrolytes are imbalanced, along with changes in fluid concentration and volume.

Fluid Management

• Dextrose and IV solutions may be administered based on consciousness.

Medication

• Desmopressin, oral fluids, ADH etc, for the fluid concentration

Complications

• Includes shock (hypovelemic), dehydration, hypernatremia, and need for hormone replacement.

Nursing Management

• Electrolyte and heart assessments are needed.
• Assessment of the fluid, electrolyte imbalances, and renal function.
• Administer appropriate diuretics and monitor vital signs.
• Administer appropriate IV, oral fluids and hormone balance fluids to keep volume accurate.

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

• Increases the risk of fluid due to medication or brain neck masses.

Pathophysiology

• ADH imbalances may need fluid balance for a variety of causes within this.

Signs

• Headaches, cerebral edema, and seizures may need to be monitored.

SIADH

• Diagnosis through fluid level and function as fluids fluctuate.

Medications

• Antibiotics and vasopressin may need to be included to level sodium and fluid levels.

Nursing interventions

• Includes vital signs, urine specific gravity, urine osmolality, serum potassium levels and serum volume.

HYPOTHYROIDISM

• An anterior pituitary gland and hypothalamus, due to their location, might cause this.
• This occurs in autoimmune, thyroid surgery, or radioactive iodine therapy for those that may be affected.

Manifestation

• Patient myxedema comes with Cardiac alterations.
• Cardiac arrest may occur as well due to changes from myxedema.

Diagnostic

• TSH with relation to T3 and T4, along with thyroid testing may be assessed.

Interventions

• Thyroid checks and hormone replacement.
• Take medication as directed with long-term treatment.

Complications

• Decreased cardiac function or respiratory function.
• Coma may need to be considered

Management

• Assess hands, feet, shoulders, and eyes.
• Weight must be taken as well.
• Provide all interventions assessed.
• Teaching, medication, and therapy need to be administered.

HYPERTHYROIDISM

• Occurs in females than that of males
• Affects overactive thyroid gland
• Autoimmune

Manifestation

The patient may see vision issues, swelling, and weight lose.

• They may have chest pain or heart rate decrease.

Interventions

• The patient may have medications to decrease vision and maintain respiratory support.
• Interventions vary, with monitoring and controlling.
• Priority will be determined by clinical presentation

Thyroid Storm

• Poorly managed hyperthyroidism.
• Includes tachycardia, fever, HTN, tremors or any changes of mental and muscle.

Treatment

• Assess the clinical history to determine thyroid damage to treat
• May need to assess the medication and therapy used for treatment

Overview of the endocrine system, including glands like the pituitary, thyroid, and adrenals. Discusses hormone secretion, functions, and the classification of endocrine disorders (primary, secondary, tertiary, quaternary). Covers diagnostic assessments and nursing care for pituitary and thyroid disorders.