Endocrine System Hormones and Functions

• The endocrine system consists of glands that secrete products into the body
• Glands secrete products directly into the chemical substances secreted by the endocrine glands
• Hormones are chemical substances secreted by the endocrine glands
• Target cells/ receptors are part of the components

Functions of Hormones

• Regulates and integrates body's metabolic activities
• Works with the nervous system

Endocrine Glands

• The hypothalamus produces and secretes pro-hormones that stimulate or inhibit production/release of pituitary hormones
• Releasing and inhibiting hormones are part of the hormones
• Corticotropin-releasing hormone (CRH) is a releasing and inhibiting hormone
• Thyrotropin-releasing hormone (TRH) is a releasing and inhibiting hormone
• Growth hormone-releasing hormone (GHRH) is a releasing and inhibiting hormone
• Gonadotropin-releasing hormone (GnRH) is a releasing and inhibiting hormone
• Releasing and inhibiting hormones control the release of pituitary hormones

Pituitary Gland (Hypophysis)

• Commonly referred to as the master gland, influences secretion of hormones by other endocrine glands

Anterior Pituitary Hormones

• Somatostatin/ Growth hormone (GH) inhibits growth hormone and thyroid-stimulating hormone
• Somatostatin/ Growth hormone stimulates growth of bone and muscle
• Somatostatin/ Growth hormone promotes protein synthesis and fat metabolism, and decreases carbohydrate metabolism
• Adrenocorticotropic hormone (ACTH) stimulates synthesis and secretion of adrenal cortical hormones
• Thyroid-stimulating hormone (TSH) stimulates synthesis and secretion of thyroid hormones
• Follicle-stimulating hormone (FSH) / Sertoli cell-stimulating hormone (males) affect:
  • Female: stimulates growth of ovarian follicle, ovulation
  • Male: stimulates sperm production
• Luteinizing hormone (LH) / Leydig cell-stimulating hormone (males) affect:
  • Female: stimulates development of corpus luteum, release of oocyte, production of estrogen and progesterone
  • Male: stimulates secretion of testosterone, development of interstitial tissue of testes
• Prolactin prepares female breast for breast-feeding
• Melanocyte-stimulating hormone is part of the hormones

Posterior Pituitary Hormones

• Antidiuretic Hormone (ADH) and Vasopressin increases water reabsorption by kidney
• Oxytocin stimulates the contraction of pregnant uterus, milk ejection from breasts after childbirth

Adrenal Cortex

• The outer portion of the adrenal gland, stimulated by ACTH to produce corticosteroids

Adrenal Cortex Hormones

• Mineralocorticoids (aldosterone) increases sodium absorption and potassium loss by kidney Glucocorticoids (cortisol) affect:
  • Metabolism of all nutrients
  • Regulates blood glucose levels
  • Affects growth
  • Has anti-inflammatory action
  • Decreases effects of stress
• Adrenal androgens have minimal intrinsic androgenic activity, converted to testosterone and dihydrotestosterone in the periphery

Adrenal Medulla

• The center of the adrenal gland reacts to autonomic nervous system signals to release catecholamines

Adrenal Medulla Hormoses

• Epinephrine/Adrenaline serves as neurotransmitters for the sympathetic nervous system
• Epinephrine/Adrenaline prepares the body for fight or flight response by converting glycogen in the liver to glucose and increasing cardiac output
• Norepinephrine/Noradrenaline serves as neurotransmitters for the sympathetic nervous system
• Norepinephrine/Noradrenaline produces effect similar to epinephrine and produces extensive vasoconstriction

Thyroid Gland

• Butterfly-shaped organ located in the lower neck, anterior to the trachea

Thyroid Hormones

• Triiodothyronine (T3) and Thyroxine (T4) increase the metabolic rate and protein and bone turnover
• T3 and T4 regulate cellular metabolic activity
• T3 in produced predominately from peripheral conversion of T4
• T3- Metabolism
• T4- Heat
• Calcitonin lowers blood calcium and phosphate levels
• Calcitonin is secreted in response to high blood calcium levels and inhibits bone resorption

Parathyroid Glands

• Small glands, usually four, surround the posterior thyroid tissue
• Often difficult to locate and may be removed accidentally during thyroid or other neck surgeries

Parathyroid Gland Hormones

• Parathormone (PTH, parathyroid hormone) regulates serum calcium
• Parathormone raises blood calcium levels by increasing calcium resorption from kidney, intestines, and bones

Pancreatic Islet Cells

• A slender, elongated organ lying horizontally in the posterior abdomen behind the stomach

Pancreatic Islets Hormones

• Glucagon (alpha cells) increases blood glucose concentration by stimulation of glycogenolysis and gluconeogenesis
• Glycogenolysis is the breakdown of stored glucose
• Gluconeogenesis is the production of new glucose from amino acids and other substances
• Insulin (beta cells) lowers blood glucose by facilitating glucose transport across cell membranes of muscle, liver, and atipose tissue
• Somatostatin (delta cells) delays intestinal absorption of glucose

Kidney

• Paired organs located on either side of the vertebral column, between the 12th thoracic and 3rd lumbar vertebrae in the posterior abdomen behind the peritoneum
• 1,23-Dihydroxy vitamin D stimulates calcium absorption from the intestine
• Renin activates renin-angiotensin-aldosterone system
• Erythropoietin increases red blood cell production

Testes

• Male gonads
• Two almond-shaped organs suspended inside the scrotum, primary function is for reproduction
• Androgen (testosterone) affects development of male sex organs and secondary sex characteristics and aid in sperm production(steroid hormone)

Ovaries

• Female gonads
• Two almond-shaped organs located at the anterior pelvis, primary function is for reproduction
  • Estrogen affects development of female sex organs and secondary sex characteristics (steroid hormones)
  • Progesterone regulates the endometrium of the uterus and maintains pregnancy(steroid hormones)

Gigantism (Anterior Pituitary Disorder)

• Oversecretion of GH that results in gigantism in children, person may be 7 or even 8 feet tall
• Gigantism is usually noticed at puberty when the epiphyseal plate is still open
• Causes enlargement of bones of head, hands & feet
• Caused by a tumor of somatotrophs (signs of increased ICP)

Diagnostic Tests for Gigantism:

• CT and MRI checks
• Blood checks serum levels of pituitary hormones

Clinical Manifestations of Gigantism:

• More than 7 feet tall
• Weak and lethargic
• Severe headaches
• Visual disturbance
• Diplopia- double vision
• Loss of color discrimination
• Decalcification of the skeleton

Management of Gigantism

Pharmacological:

• Bromocriptine (Parlodel)- dopamine antagonist
• Octreotide (Sandostatin)- synthetic analog of GH
• Hypophysectomy surgical

Acromegaly

• An excess of Growth hormone in adults, results in bone and soft tissue deformities and enlargement of the viscera without an increase in height
• Diagnostic tests include CT & MRI , Serum levels of pituitary hormones
• Clinical manifestations include transverse enlargement of bones, broad skull, protruding jaw, prognathism, broadening of hands/feet and thickening heel pads
• Symptoms include enlarged tongue, soft tissue enlargement of the brain/heart/internal organs and coarse features.

Acromegaly Management

• bromocriptine (Parlodel) is a dopamine antagonist in Pharmacological Management
• Ocreotide (Sandostatin) - is a synthetic analogue of GH in Pharmacological Management
• Surgical Management includes Hypophysectomy
• Nursing Management monitors post surgical clients for Hemorrhage, transient diabetes insipidus and rhinorhea which may indicate cerebrospinal leak
• Nursing Management Monitors Adrenal/Thyroid insufficiencies, infection especially meningitis and visual disturbances & monitor for cardiovascular/neurologic problems

What is Hypophysectomy?

• A partial or complete removal of the pituitary gland
• Approaches may include transfrontal, subcranial, oronasal transphenoidal

Hypophysectomy: Nursing care after operation includes

• Insulin therapy
• Medication to treat peptic ulcer
• Blood glucose monitoring & Assessment of stools for blood
• Deep breathing is taught before surgery
• Head of bed is raised for at least 2 weeks to decrease pressure on the sella turcica and to promote drainage

Others Nursing Duties after surgical removal:

• Observe for post-nasal drip and check for glucose
• Patient is cautioned against engaging in activities that increases ICP (intra cranial pressure)
• Measure I & O (intake & output) & daily weight

Dwarfism

• Generalized limited growth resulting from insufficient secretion of growth hormone during childhood
• Diagnostic tests include X-ray. Computed tomography and MRI and Blood sample
• Clinical manifestations Include: overweight for height, underdeveloped jaw, abnormal teeth position, high voice and delayed puberty

Dwarfism management

• Pharmacological Management with: Somatrem (Protropin) and Somatropin (Humatrope)
• Nursing interventions included: help with psychological support and acceptance for alterations of body image and assist in ambulation & avoid high impact activities

Hyperprolactinimia

• Prolactin-secreting tumors
• Amenorrhea & Galactorrhea

Male

• Gynecomastia
• Decreased sex drive & impotence

SIADH

• Syndrome of Inappropriate Antidiuretic Hormone (SIADH) excessive ADH secretion from the pituitary gland even in the face of subnormal serum osmolality
• Patients cannot excrete dilute urine, retain fluids, and develop a sodium deficiency known as dilutional hyponatremia
• Causes *
• Bronchogenic carcinoma
• Severe pneumonia & Pneumothorax
• Malignant tumors
• Causes cont*
• Head injury
• Brain surgery or tumor
• Infection & Some medications

SIADH- diagnostic tests

• Decreased serum osmolality ( < 280mOsm/kg) & Elevated ADH level (NV: 0-4.7pG/mL)
• Plasma osmolality & serum sodium levels are decreased
• Serum ADH level is elevated

SIADH- Clinical manifestations

• Decreased urine output & Weight gain
• Altered mental status headache, confusion, lethargy, seizures, and coma in severe hyponatremia
• Delayed deep tendon reflex
• Management includes eliminating the underlying cause

DI

• Diabetes Insipidus- deficiency of ADH (vasopressin )
• Causes*
• Head trauma & Brain tumor
• Surgical ablation/ irradiation of the pituitary gland & Infections of the central nervous system causes
• Tumor (metastatic, lymphoma of the breast or lungs)
• Failure of Renal Tubules
  • To respond to ADH nephrogenic (hypokalemia, hypercalcemia, lithium)

DI- Clinical Manifestation

• Excessive thirst 2 to 20L of fluid intake daily & Dilute urine with a specific gravity of 1.001 to 1.005
• Dehydration & Nocturia
• Weight loss & Tachycardia
• Hypotension & Weakness
• DI- Diagnostic testing*
• Plasma osmolality and elevated Serum sodium levels
• Water deprivation test: to demonstrate inability for the kidneys to concentrate urine
• Vasopressin test: Kidney can concentrate urine if ADH is given to differentiate

DI- management

• Management: Desmopressin (DDAVP) administered with mild salt depletion
• Thiazide diuretics & Prostaglandin inhibitor for nephrogenic DI
• Nursing management Replace fluids, patient must intake in response to need of thirst
• Teach patients about follow ups & emergencies; demonstrate use of meds
• Advise the patient to wear medical ID

Goiter

• Thyroid tumors or enlargement sufficient to visible swelling in the neck
• Classify as Toxic accompanied by hyperthyroidism and Non-Toxic associated w euthyroid

Types of Goiters.

• Endemic iodine deficiency (most common type) caused by iodine deficiency

Treatment

• Supplementary iodine & use iodized salt
• Nodular Goiter: Areas of hyperplasis that slowly increases in size
• Can cause Local pressure symptoms in the thorax
• Thyroid cancer caused by external radiation of the neck (infancy and childhood)

Hyperthyroidism

• Results from an excessive stimulation of thyroid gland by circulating immunoglobins
• Results in an over excessive output of thyroid hormones
• Manifestations include tremors, heat intolerance diaphoresis along with irregular heart beat
• Bulging eyes are referred to as: Exophthalmos
• Thrill at the anterior neck / Bruit at the anterior neck

Hyperthyroidism management

• radioactive therapy used to destroy overactive thyroid cells
• Antithyroid meds block the utilization and synthesis of iodine by interfering
• Adjunctive therapy: iodine or iodide compounds helps reduce vascularity of the thyroid gland

Surgical management

• subtotal thyroidectomy helps remove about five sixths of the thyroid

Nursing management

• Improving nutritional status by discouraging highly seasoned foods and stimulants and encouraging consumption of high protein foods
• Encourage the patient to have a calm and un-cluttered approach
• Monitor the patients to provide care and protection for their eyes

HYPOTHYROIDISM

• State of insufficient serum thyroid hormone caused by autoimmune thyroiditisi
• Myxedema: severe hypothyroidism
• Clinical manifestations: hair loss, brittle nails, dry skin, numbness along with a subnormal body temp

More Clinical Manifestations of HYPOTHYROIDISM Includes

• Bradycardia
• Thickened skin & personality changes
• Enlarged tongue & cold intolerance, also the loss of self-esteem

Management

• Synthetic levothyroxine
• prevention of cardiac dysfunction & prevents further medication interactions
• Nursing management helps manage fatigue through conversation and non-stressful activities also helping with cold intolerance

Hyperparathyroidism

• overproduction of parathormone resulting in the development of renal calcui

Clinical Manifestations

• fatigue / apathy and muscle weakness
• Patient could be affected by cardiac dysrhythmias

Diagnostic testing

• Elevated serum calcium, elevated concentrations of parathormone showing in the X-Ray bone changes

Complications

• Hypercalcemic crisis can occur, resulting in a neurological/cardiovascular and renal threats
• Management includes Antacids and stool softeners

Hyperparathyroidism management

• Phosphate therapy & Calcitonin with cytotoxic agents
• Surgical management may include a Parathyroidectomy

Hypoparathyroidism

• Inadequate secretion of parathormone after interruption of the blood supply or surgical removal of parathyroid gland tissue
• Clinical manifestations include Tetany, numbness,broncospasm, laryngospasm, seizures and cardiac dysrhythmia
• Diagnostic tests include reduced levels of serum calcium and serum phosphate increased levels

Hypoparathyroidism-Management

• Give the patient IV Calcium if tetany occurs and or Aluminum Carbonate
• Nursing management Encourage a diet high in calcium and also low in phosphorus

Pheochromocytoma

• A form of Hypertension, treatable by surgery that originates from the cell of the adrenal medulla

Clinical Manifestations

• Palpitations and vertigo, blurring vision and hypertension

Management of Pheohromocytoma

• Pharmacological Management: Antihypertesive- alpha-adrenergic blocking agents

Addison's disease

• Adrenocortical Insufficiency- inadequate to meet the patients needs with cortical hormones
• Clinical manifestations: Muscle weakness and fatigue, emaciation and anorexia

Diagnostic Tests

• Low serum sodium levels
• Increased serum Potassium level
• Characterized by cyanosis

Management of ADs-DISEASE

• Hydrocortisone/ Solu- cortef administered by IV
• Nursing management: select foods w High sodium

Cushings disease description

• excessive rather than deficient adrenal cortical activity caused by the use of corticosteroids

Clinical Manifestations

• Buffalo Hump & easy bruising of skin

Diagnostic tests

• Dexamethosone suppression test increasing serum sodium

Management includes

• Radiation of the pituitary gland along w establishing protective environment

Diabetes Mellitus: Description

• Metabolic diseases characterized by hyperglycemia resulting in defects in insulin secretion/action or both
• Risk Factors:*
• Fam Hb diabetic, obesity, race, age and Hpn
• Classification*
• Diabetes Mellitus with: types 1 and two, gestational diabetes
• Diagnosis*
• With Symptoms, fasting plasm/ oral glucose tests

Criteria for Diagnsing Diabetes Mellitus

• A symptoms of diabetes plus casual plasma glucose above 200 and /or
• Fasting plasma glucose greater than 126 mg for at least 8 hours
• or a 2 hour postprandial elevated glucose 2hr glucose during oral glucose tolerance test

Type 1 Diabetes Mellitus

• Characterized by destruction of the pancreas beta cells with an abnormal immunologic response

-Type 2 Diabetes: Problems

• Insulin resistances , insulin sensitives & impaired insulin secretion

Type 2 Diabetes: Management

• Daily caloric distribution to meet specific nutritional needs
• Recommend that the person increases amount of fiber and lowers their alcohol intake

Testing for Ketones

Signals a deficiency of Insulin

Oral Anti-diavbetics Agents

• Sulfonylurea- increase insulin in receptors
• Thiazolidinediones- stimulates a better insulin action

Causes of Morning Hyperglycemia

• Insulin waning. Dawn phenomenon, Somogyi effect,

Storing of Insulin injections

• All injections must include cleaning rotation of of body site
• Use a special type of sharp container
• In case of overdoes, that can be reversed by glucagon or food injection
• Patient must carry ID cards to show they're receiving diabetes treatment
• Refrain from eating high calorie foods

Hypoglycemia

• When blood glucose is less then 50-60
• Mild- signs*
• Tremors, sweating
• sever- signs*
• disorient, sz , loss con

Management: hypoglycemic episodes

• Inject glucagon
• Eat carbohydrate snack

Clinical manifestations:

• Diaphoresis, Blurred Vision
• Low pH :increased level of creatinine

Hyperglycemic Hyperosmolar Nonketotic syndrome (HHNS)

• Alters sensors w min ketosis

Nursing management

• Start fluid with NS solutions

HHNS vs DKA

• HHNS is more common in patients with diabetes, however, there are numerous differences between the two
• HHNS- is often caused by a physiological event usually with severe hyper levels
• DKA caused by omission of injections w patients that present with elevated Bun

Explore the function of hormones like insulin, 1,25-Dihydroxy vitamin D, and testosterone. Understand their effects on blood glucose levels, calcium regulation, and the development of sex characteristics. Delve into the role of the hypothalamus and pituitary gland in endocrine control.