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The Glands of the Endocrine System

• The glands include the pituitary, thyroid, parathyroid and adrenal glands, the pancreas, and the gonads.

Pituitary Gland

• Known as the hypophysis, it is located in the skull beneath the hypothalamus.
• It is referred to as the master gland as its hormones regulate various body functions.
• It is comprised of two parts: the anterior pituitary (or adenohypophysis) and posterior pituitary (or neurohypophysis).

Anterior Pituitary

• Secretes 6 major hormones.
• Somatotropic cells secrete Growth hormone (GH), or somatotropin; GH stimulates the growth of the body by signaling cells to increase protein production and stimulates the epiphyseal plates of long bones.
• Lactotrophic cells secrete Prolactin (PRL); Prolactin stimulates the production of breast milk.
• Gonadotropic cells secrete Follicle-stimulating hormone (FSH) and Luteinizing hormone (LH); these hormones stimulate the ovaries and testes which are the gonads.
• Thyrotropic cells secrete Thyroid-stimulating hormone (TSH); TSH stimulates the synthesis and release of thyroid hormones from the thyroid gland.
• Corticotropic cells secrete Adrenocorticotropic hormone (ACTH); ACTH stimulates the release of hormones, especially glucocorticoids, from the adrenal cortex.

Posterior Pituitary

• The primary function is to store and release antidiuretic hormone and oxytocin, produced in the hypothalamus.
• Antidiuretic hormone (ADH), or vasopressin, decreases urine production.
• Oxytocin induces contraction of the smooth muscles in the reproductive organs; in women, it stimulates the myometrium of the uterus to contract during labor and induces milk ejection from the breasts.

Thyroid Gland

• The cells within the glandular follicles secrete Thyroid hormone (TH), a general name for two similar hormones: Thyroxine (T4) and Triiodothyronine (T3).
• The primary role of thyroid hormones in adults is to increase metabolism.
• TH secretion is initiated by the release of TSH (thyroid-stimulating hormone) and is dependent on an adequate supply of iodine.
• Calcitonin is also secreted, a hormone that decreases excessive levels of calcium in the blood by slowing the calcium-releasing activity of bone cells and is a marker for sepsis, believed to mediate the inflammatory response.

Parathyroid Glands

• Secrete Parathyroid hormone (PTH), or parathormone.
• PTH secretion increases when calcium levels in the plasma fall.
• PTH controls phosphate metabolism; it acts by increasing renal excretion of phosphate in the urine, decreasing calcium exertion and increasing bone reabsorption to cause the release of calcium from bones.
• Normal levels of vitamin D are necessary to exert these effects on bone and kidneys.

Adrenal Glands

• Sit on top of the kidneys, each gland consists of two parts: an inner medulla and an outer cortex.

Adrenal Medulla

• Produces two hormones, also called Catecholamines: Epinephrine (adrenalin) and Norepinephrine (noradrenalin).
• These are NOT essential to life.
• Epinephrine increases blood glucose levels and stimulates ACTH release; it increases the rate and force of cardiac contractions, constricts blood vessels in the skin, mucous membranes, and kidneys, plus dilates blood vessels in the skeletal muscles, coronary arteries, and pulmonary arteries.
• Norepinephrine increases the heart rate and force of cardiac contractions, and vasoconstricts blood vessels throughout the body.

Adrenal Cortex

• Secretes all corticosteroids.
• These are classified into two groups: Mineralocorticosteroids and Glucocorticoids, and are ESSENTIAL to life.
• Mineralocorticoids release is controlled primarily by Renin.
• Specialized kidney cells release renin to act on angiotensinogen when a decrease in blood pressure or sodium is detected.
• Aniotensinogen is modified by Renin to become angiotensin, which stimulates aldosterone release.
• Aldosterone prompts the distal tubules of the kidneys to release increased amounts of water and sodium back into the circulating blood to increase circulating blood volume/ pressure.
• Glucocorticoids include cortisol and cortisone; these hormones affect carbohydrate metabolism by regulating glucose use in body tissues, mobilizing fatty acids from fatty tissue, and shifting the source of energy for muscle cells from glucose to fatty acids.
• They are released in times of stress.
• Excess glucocorticoids depress the inflammatory response and inhibit the effectiveness of the immune system.

Pancreas

• Functions as both, an endocrine gland producing hormones, and an exocrine gland producing digestive enzymes.
• Endocrine cells of the pancreas produce hormones that regulate carbohydrate metabolism.
• These are clustered in structures called pancreatic islets (or Islets of Langerhans).
• Pancreatic islets have at least 4 different cell types: alpha, beta, delta and F:
• Alpha cells produce Glucagon, which decreases glucose oxidation and promotes an increase in blood glucose level.
• Beta cells produce Insulin, which decreases blood glucose levels.
• Delta cells secrete Somatostatin, which inhibits the secretion of glucagon and insulin by the alpha and beta cells.
• F cells secrete pancreatic polypeptide, which is potentially inhibitory of the pancreas’s exocrine activity

Gonads

• Testes are the gonads in men, and Ovaries are the gonads in women.
• These organs are the primary source of steroid sex hormones and are important in regulating body growth and promoting the onset of puberty.

Overview of Hormones

• Hormones are chemical messengers secreted by endocrine organs, exerting their action on specific target cells, and regulate tissue responses.
• Hormone levels are controlled by the pituitary gland via feedback mechanisms; in positive feedback mechanisms, increasing levels of one hormone will cause another gland to release a hormone.
• Stimuli for hormone release are classified as Hormonal, Humoral, or Neural.
• Hypothalamic hormones stimulate the anterior pituitary to release hormones in Hormonal release.
• In Humoral release, serum level fluctuations in certain ions and nutrients stimulate specific endocrine glands to release hormones to bring those levels back to normal.
• Nerve fibers stimulate in Neural release.

Health Assessment Interview

• Analyze the onset, characteristics and course, severity, precipitating and relieving factors, and any associated symptoms, noting the timing and circumstances for endocrine problems.
• Some questions to ask include:
  • "Describe the swelling you noticed in the front of your neck. When did it begin? Have you noticed any changes in your energy level? If so, describe them."
  • “When did you first notice that your hands and feet were getting larger?”
  • "Have you noticed that your appetite has increased even though you have lost weight?"
• Any changes should be explored such as difficulty swallowing, increased or decreased thirst, appetite, and/or urination; visual changes, sleep disturbances; altered patterns of hair distributions; changes in menstruation; changes in memory or ability to concentrate; and changes in hair and skin texture.

Physical Assessment

• Palpate the thyroid gland for SIZE AND CONSISTENCY.
• Enlargement may be seen in patients with Graves disease or a Goiter.
• Multiple metabolic disorders may be seen in multiple nodules, whereas only one cyst may indicate a cyst or tumor.
• Assessments include:
• Inspection of the integument/skin, hair and nails, facial appearance, reflexes, and musculoskeletal system.
• Measuring and monitoring trends in height, weight, and vital signs.

Endocrine Assessments

• Inspect skin color; color should be even and appropriate.
• Hyperpigmentation may be seen in patients with Addison disease or Cushing syndrome.
• Acanthosis nigricans, a darkening of skinfolds, could indicate prediabetes and type 2 diabetes.
• A yellowish cast might indicate hypothyroidism.
• Purple striae and bruising may exist in the patient with Cushing syndrome.
• Extremely short stature may indicate dwarfism; deficient pituitary growth hormone is one cause.
• Extremely large bones may indicate acromegaly due to excessive growth.
• Assess texture, distribution, and condition of nails and hair.
• increased pigmentation of the nails is often seen in patients with Addison disease.
• Dry, thick, brittle nails and hair may be apparent in hypothyroidism.
• Thin, brittle nails and thin, soft hair may be are possible in hyperthyroidism.
• Hirsutism may be present in Cushing syndrome.
• Inspect the symmetry and form of the face.
• Forms and structures may point an abnormality such as Acromegaly.
• Exophthalmos may be seen in hyperthyroidism.
• Palpate Thyroid Gland
• The thyroid may be enlarged in patients with Graves disease or a goiter.
• a single enlarged nodule suggests malignancy.
• Assess motor function and deep tendon reflexes
• Increased reflexes may be seen in hyperthyroidism; decreased reflexes may be seen in hypothyroidism.
• Test for sensory function
• Peripheral neuropathy and paresthesia may exist in diabetes, hypothyroidism, or Acromegaly.
• Musculoskeletal Assessment.
• The patient's ability to contract, (carpal spasm.) and their lateral facial muscles from depleted calcium levels. (chvostek.)
• Short stature may indicate dwarfism.
• Extremely large bones may indicate acromegaly, caused by excessive growth hormone.

Older Adult Assessment Considerations

• Those over 45 should be screened for diabetes every 3 years, and those with prediabetes should be tested annually.
• Reduced vitamin D levels and calcium can be a debilitating endocrine issue, vitamin D reduction can be correlated with dementia and a decline in cognitive function.
• Low levels of vitamin D leads to dementia, and deficient calcium leads to hip fracture, osteoperosis, and mortality.

Health Promotion

• Prevention of Type 2 Diabetes:
• Control your weight and increase your physical activity to prevent type 2 diabetes.
• Eat nutritiously with your family.
• Join a community health fair for diabetes screening.
• Prevention of Bisphenol A (BPA):
• Support families to recognize the BPA contents in household containers and get rid of them.

Thyroiditis

• Glandular Inflammation, which is often due to a viral infection and becomes chronic, can promote infection that will destroy the thyroid gland.

Thyroid Crisis

• Excessive hyperthyroidism is rare today. Those affected:
  • People that are untreated or have a stressful existence from infection, trauma, and the thyroid gland from medication,
  • This situation is very detrimental with life threatening factors that can save the body. Treatment includes:
• Cooling without aspirin to avoid the temperature with the fever.
• replacing fluids, glucose, and electrolytes as well as treating respiratory distress by administering oxygen.
• Cardio function will need stabilizing and TH secretion and synthesis should be decreased.

Hyperthyroidism (Signs and Symptoms)

• Those with graves disease usually develop goiters, or have hyperthyroid manifestations.
• Eyes and eyeballs will lead to forward displacement and forward protrusion.
• Blurry vision, photophobia, Diplopia, eye pain can be linked.
• Corneal Dryer, irritation, and infection may come apparent from the inability to fully cover the eye.
• Additional symptoms:
  • Fatigue
  • Issues sleeping
  • Uncontrollable tremors
  • Mental changes
• Older can show signs of heart conditions, like atrium fibralation, and chest pains.

Thyroid Crisis (manifestations)

• High body temperature of 102 to 106 degrees high agitation,
• Psychosis,
• Unregulated seizures are common with: Cardiac problems and,
• Gastrointestinal distress.

Thyroid Crisis TREATMENTS

• Cooling the body while steering clear of "aspirin" meds, adding electrolytes to replace loss, and stabilizing cardio function. Reduce TH secretion as well.

Graves Disease Labs

• Elevated TA levels with reduced TSH (<3g/ML), it is possible with primary hyperthyroidism.
• T3 and T4 levels will be elevated with radioactive iodine.

Hypoparathyroidism medication

• NO pregnancy med.
• Keep an eye for hypo meds; hair falling changes for body adjustments.
• Report the mentioned problems to a physician.
• Don't quit abruptly, to avoid more problems.

Plan of action for hyperthyroidism

• Serum calcium levels must reduce the increase of mild fluids, to continue activity

Hypothyroidism

• Goiter
• Water Retention
• Weight accumulation
• Constipation,
• Dyspnea
• Muscle fatigue, slow senses

Iodine Deficiency

• TH secretion and synthesis may affect production which lithium and other drugs may occur with.

Hashimoto Thyroid

• Autoimmune disorder where tissue starts to destroy body cells.

Reduce constipation

increase fluid intake of to 2,000 ml of favorite drinks, and increase fiber with,

• Beans
• Fruits
• Brown rice.

Reduce Activity

with what's comfortable.

Levothyroxine

• The treatment of choice, a Sodium (T4), will improve blood levels, to increase metabolic rate, heart regulation, and temperature.
• A patient will need a full hour before eating, especially with food and medicine
• These can amplify the effects of anticoagulant therapy.
• Take 30 minutes during light insomnia.

Hypothyroidism

• Lack of calcium will lead to spasm of muscles and hands
• Muscle spasms can be affected around the mouth and fingertips.
• Integumentary affects are brittle nails, loss of hair and flaky skin can be expected.

Addison

Signs and Symptoms:

• Reduced sugar levels
• Bronze and spotted skin
• Weakness
• Vomiting or diarrhea

Assessments:

• History of health must be check for lost weight, dark coloring, and mental desire, as well as physical stamina,

Addison Crisis Intervention

• Quickly replace of fluids and glucocorticoid within treatment.
• To do this it is important to have a large output/input balance
• Check signs of dehydration with mucous membrane checks, skin tension checks.
• Weight checks and cardiovascular checks will need checking

Syndromes of Inappropriate Hormone

• Lack of Sodium levels
• Thirst, confused and irritating personality
• Cerebral edema, loss of bodily productivity.

Diabetes

• ADH insufficiency is type 1, this causes intense thirst and hunger, and a loss for bodily function/urine .

Type 2 Diabetes Complications

• Older individuals can inherit problems from blood sugar leading to hyperglycemia, or renal malfunctions along with premature death
• Diabetes test should start around age 45, every 3 years along with proper treatment to start.
• The lack of vitamin D leads to deterioration issues and bones start to fail as well.

Sick Day Management

• Surgery and illness leads to high blood sugar due to metabolic issues, which affect insulin intake and hyperglycemia.
• Monitor blood sugar every 3 hours, check urine every four and stay on top of medication to hydrate with water as well. Call health provider if:
• Fever last longer than 2 days or if vomiting, you can keep anything down with high sugar or large amounts of of keytones

Hemoglobin

• 2-5% is normal, and diagnostic tests will have a greater of 6.6%
• 5.7%-6% lead to possible diabetes and disease

Anti-diabetic

• Medication to help with blood pressure in the body and blocking is high cough levels happen.

Skeletal Muscle

• The tendons connect to bones in the affected joints.
• Movement can be managed consciously.
• Parallel multi cells that contract are called fibers.

Functional Properties:

• Responds to the stimuli.
• Contractions that force the muscles to shorten with stimuli.
• The movements causes a lot of pain.
• Continuous beats give a good muscle reaction.

Classify function:

• Synarthroses that gives immobile joints to the body.
• Diarthroses make movements that happen freely
• Immovable joints, will assist the ligaments in mobility

1401, 1403, Musculoskeletal Assessment; Assessment for abnormality that causes acute flexion for 60 secs.

• The fingers may be in great pain or Numb, carpal tunnel comes to account under assessment. Consider Genetics involving Muscle Dystrophy and Sclerosis issues.
• Talk the health of relatives or hereditary genetics that can affect the skeletal features.

Bone Ages Factors for Changes;

• Lowers mineral and bone density that is common.
• The bones that thinner can put the joints at risk at the high level fractures in trauma.
• Loss of mobility has increased to help the body fight.
• Nerve responses can increase to help the body fight, so it is best to stay active to help the body.

1406 EMG Measure the electrical features that come with at contracting of muscles.