ENDOCRINE SYSTEM

The ANATOMY of the Endocrine System

The endocrine system is composed of ductless glands that release their
hormones directly into the bloodstream
The Hypothalamus controls most of the endocrinal activity of the pituitary
gland
The pituitary gland controls most of the activities of the other endocrine
glands
The Hypothalamus
This part of the DIENCEPHALON is located below the thalamus and is
connected to the pituitary gland by a stalk
The PHYSIOLOGY of the Endocrine System: Hypothalamus
Secretes RELEASING HORMONES for the pituitary gland
Secretes OXYTOCIN that is stored in the Posterior pituitary gland
Secretes Anti-Diuretic Hormone or VASOPRESSIN that is stored also in the
posterior pituitary gland
The Pituitary Gland
Is a gland located below the hypothalamus at the base of the brain
The optic chiasm passes over this structure
Is divided into two parts- the anterior or adenohypophysis and the
posterior or the neurohypophysis

Anterior Pituitary secretes the following hormones:

1. Growth hormone
2. Prolactin
3. Gonadotrophins- LH and FSH
4. Stimulating hormones and trophic hormones
ACTH
TSH
MS
Posterior Pituitary stores and releases
1. OXYTOCIN 2. ADH/Vasopressin
The THYROID gland
Located in the anterior neck lateral to the trachea
Contains two lobes connected by the isthmus
Microscopically composed of thyroid follicles where the hormones are
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 produced and stored
The PHYSIOLOGY of the Endocrine System: Thyroid
Produces the thyroid hormones by the thyroid follicles:
1. Tri-iodothyronine or T3
2. Tetra-iodothyronine or thyroxine or T4
The Parafollicular cells secrete CALCITONIN
The PARAthyroid glands
Located at the back of the thyroid glands
Four in number
Secretes PARATHYROID hormone (PTH) that controls calcium and
phosphorus levels
The ANATOMY of the Endocrine System
The Adrenal Glands
Located above the kidneys
Composed of two parts- the outer Adrenal Cortex and the inner Adrenal
medulla

Adrenal Cortex
Secretes three types of STERIOD hormones
1. Glucocorticoids- like Cortisol, cortisone and corticosterone
2. Mineralocorticoids- like Aldosterone
3. Sex hormones- like estrogen and testosterone

Adrenal Medulla
Essentially a part of the SYMPATHETIC autonomic system
Secretes Adrenergic Hormones:
1. Epinephrine 2. Nor-epinephrine
The Pancreas
This retroperitoneal organ has both endocrine and exocrine functions
The endocrine function resides in the ISLETS of Langerhans
The islets have three types of cells- alpha, beta and delta cells
The ALPHA cells secrete GLUCAGON
The BETA cells secrete INSULIN
The DELTA cells secrete SOMATOSTATIN
The GONADS- Ovaries
These two almond-shaped glands are found in the pelvic cavity attached

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 to the uterus by the ovarian ligament
The GONADS- Testes
These two oval-shaped glands are found in the scrotum
Gonads
The Ovaries contains Granulosa and Theca cells which secrete
ESTROGEN and Progesterone
The testes contains Leydig cells that secrete Testosterone

COMMON LABORATORY PROCEDURES

Hormone Levels Assay
These are blood examinations fro the levels of individual hormones
Measurements can also be done after stimulation and suppression of
the secretions- Stimulation and Suppression tests
Hormone Levels of T3/T4
Usually done to diagnose hypo/hyperthryroidism
If T3 is elevated, T4 is elevated and TSH is depressed- Primary
HYPERthyroidism
If T3 is depressed,T4 is depressed and TSH is elevated- Primary
HYPOthyoidism
Radio-Active iodine uptake (RAI)
This is a thyroid function test to measure the absorption of the
injected iodine isotope by the thyroid tissue
Increased uptake may indicate HYPERfunctioning gland
Decreased uptake my indicate HYPOfunctioning gland
Thyroid Scan
Performed to identify nodules or growth in the thyroid gland
RAI is used
Pretest- Check for pregnancy, Thyroid medication may be withheld
temporarily. NPO,
Post-test- Ensure proper disposal of body wastes
FASTING BLOOD GLUCOSE
Aids in the diagnosis of Diabetes
Pre-test; NPO for 8 hours
Normal FBS- 80-109 mg/dL
GLUCOSE tolerance test
Aids in the diagnosis of DM

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 Pre-test: Provide high-carbohydrate foods x 3 days, instruct to avoid
caffeine, alcohol and smoking, NPO 10 hours prior to test
Post-test: avoid strenuous activity for 8 hours
Normal OGTT
Glycosylated Hemoglobin A 1-C
Blood glucose bound to RBC hemoglobin
Reflects how well blood glucose is controlled for the past 3 months
FASTING is NOT required!
Normal level- expressed as percentage of total hemoglobin
N- 4-7%
Good control- 7.5%or less
Fair control- 7.5 % to 8.9%
Poor control- 9% and above

DISORDERS OF THE ENDOCRINE GLAND

Disorders are generally grouped into:

1. HYPER- when the gland secretes excessive hormones
2. HYPO- when the gland does not secrete enough hormones
Hyper and Hypo can be classified as PRIMARY when the Gland itself is the
problem or SECONDARY when the pituitary or the hypothalamus is
causing the problem
HYPOPITUITARISM
Hyposecretion of the anterior pituitary gland
CAUSES: Congenital, Post-partal necrosis, infection and tumor
PATHOPHYSIOLOGY: Depends on the major hormone/s depleted
ASSESSMENT Findings
1. Retarded physical growth due to decreased GH- dwarfism
2. Low intellectual development
3. poor development of secondary sexual characterisitcs
NURSING INTERVENTIONS
1. provide emotional support to the family
2. encourage client and family to express feelings
3. administer prescribed hormonal replacement therapy

HYPERPITUITARISM
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The hypersecretion of the gland
also called ACROMEGALY/GIGANTISM
CAUSES: tumor, congenital
PATHOPHYSIOLOGY
Depends on the hormone/s that is/are increased
ASSESSMENT FINDINGS
1. Increased growth- Gigantism or Acromegaly
2. large and thick hands and feet
3. Visual disturbances
4. Hypertension, hyperglycemia
5. Organomegaly

NURSING INTERVENTION
1. provide emotional support to clients and family
2. provide frequent skin care
3. prepare patient for surgery- removal of pituitary gland

NURSING INTERVENTIONS
Post-operative care
1. Monitor VS, LOC and neurologic status
2. Place patient on Semi-Fowler’s
3. Monitor for Increased ICP, bleeding, CSF leakage
4. instruct patient to AVOID sneezing, coughing and nose-blowing
5. Monitor development of DI- measure I and O
6. Administer prescribed medications- antibiotics, analgesics and steroids
DIABETES INSIPIDUS
A hyposecretion of ADH
CAUSES: Conditions that increase ICP, Surgical removal of post pit, tumor
PATHOPHYSIOLOGY
Decreased ADH- failure of tubular reabsorption of water- increased
urine volume

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ASSESSMENT findings
1. Polyuria of more than 4 liters of urine/day
2. Polydipsia
3. Signs of Dehydration
4. Muscle pain and weakness
5. Postural hypotension and tachycardia

DIAGNOSTIC TEST
1. Urinary Specific gravity- very low, 2. Serum Sodium levels- high
1.006 or less
NURSING INTERVENTIONS
1.Monitor VS, neurologic status and cardiovascular status
2. Monitor Intake and Output
3. Monitor urine specific gravity
4. Provide adequate fluids
5. Administer Chlorpropamide or Clofibrate as prescribed to increase the
action of ADH if decreased
6. Administer VASOPRESIN. Desmopressin or Lypressin. Pitressin is given
IM

SIADH
Hypersecretion of ADH abnormally
CAUSES: tumor, paraneoplastic syndromes
PATHOPHYSIOLOGY: Increased ADH- water reabsorption- water
intoxication, hypervolemia
DIAGNOSTIC TEST
1. urine specific gravity is increased
2. Hyponatremia
3. CBC shows hemodilution

ASSESSMENT findings
1. Signs of Hypervolemia
2. Mental status changes
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3. Abnormal weight gain
4. hypertension
5. Anorexia, Nausea and Vomiting
6. HYPOnatremia
NURSING INTERVENTIONS
1. Monitor VS and neurologic status
2. provide safe environment
3. Restrict fluid intake (less than 500cc/day)
4. Monitor I and O and daily weight
5. Administer Diuretics and IVF carefully
6. Administer prescribed Demeclocycline to inhibit action of ADH in the
kidney

DISORDERS OF the ADRENAL GLAND

HYPOSECRETION: ADDISON’S DISEASE
Decreased secretion of adrenal cortex hormones, especially
glucocorticoids and mineralocorticoids
CAUSE: tumor, idopathic
PATHOPHYSIOLOGY
Decreased Glucocorticoids- decreased resistance to stress
Decreased mineralocorticoids- decreased retention of sodium and water
ASSESSMENT Findings for Addison’s disease
1. Weight loss
2. GI disturbances
3. Muscle weakness, lethargy and fatigue
4. Hyponatremia
5. hyperkalemia
6. hypoglycemia
7. dehydration and hypovolemia
8. Increased skin pigmentation

NURSING INTERVENTIONS
1. Monitor VS especially BP
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2. Monitor weight and I and O
3. Monitor blood glucose level and K
4. Administer hormonal agents as prescribed
5. Observe for ADDISONIAN crisis
6. Educate the client regarding lifelong treatment, avoidance of strenuous
activities, stress and seeking prompt consult during illness
7. Provide a high-protein, high carbohydrate and increased sodium intake

ADDISONIAN CRISIS
A life-threatening disorders caused by acute severe adrenal insufficiency
CAUSES: Severe stress, infection, trauma or surgery
PATHOPHYSIOLOGY
Overwhelming stimuli- mobilize body defense- decreased stress
hormones- inadequate coping
ASSESSMENT Findings for Addisonian Crisis
1. Severe headache
2. Severe pain
3. Generalized weakness
4. Severe hypotension
5. Signs of Shock

NURSING INTERVENTIONS
1. Administer IV glucocorticoids, usually hydrocortisone
2. Monitor VS frequently
3. Monitor I and O, neurological status, electrolyte imbalances and blood
glucose
4. Administer IVF
5. Maintain bed rest
6. Administer prescribed antibiotics

HYPERSECRETION: CUSHING’S DISEASE

A condition resulting from the hypersecretion of glucocorticoids from the
adrenal cortex

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CAUSES: Pituitary tumor, adrenal tumor, abuse of steroids
PATHOPHYSIOLOGY: Increased Glucocorticoids- exaggerated effects of
the hormone
ASSESSMENT FINDINGS for Cushing
1. generalized muscle weakness and wasting
2. truncal obesity
3. moon-face
4. buffalo hump
5. easy bruisability
6. Reddish-purplish striae on the abdomen and thighs
7. Hirsutism and acne
8. Hypertension
9. hyperglycemia
10. Osteoporosis
11. Amenorrhea

DIAGNOSTIC TEST
1. Serum cortisol level
2. Serum glucose and electrolytes

NURSING INTERVENTIONS
1. Monitor I and O , weight and VS
2. Monitor laboratory values- glucose, Na, K and Ca
3. Provide meticulous skin care
4. Administer prescribed medications like aminogluthetimide to inhibit
adrenal hyperfunctioning
5. Prepare client for surgical management- pituitary surgery and
adrenalectomy
6. protect patient from infection

Hypersecretion: CONN’S DISEASE

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Hypersecretion of Aldosterone from the adrenal cortex
CAUSES: pituitary tumor, adrenal tumor
PATHOPHYSIOLOGY: Increased Aldosterone- exaggerated effects
ASSESSMENT findings in CONN’S disease
1. Symptoms of HYPOkalemia
2. hypertension
3. hypernatremia
4. Headache, N/V
5. Visual changes
6. Muscles weakness, fatigue and nocturia

DIAGNOSTIC TEST
1. Urine gravity- low
2. Serum Sodium- high
3. Serum Potassium- low
4. Increased urinary Aldosterone

NURSING INTERVENTIONS
1. Monitor VS, I and O and urine sp gravity
2. Monitor serum K and Na
3. Provide Potassium rich foods and supplements
4. Administer prescribed diuretic- Spironolactone
5. Maintain sodium-restricted diet
6. Prepare patient for possible surgical interventions

Hypersecretion: Pheochromocytoma
Increased secretion of epinephrine and nor-epinephrine by the adrenal
medulla
CAUSE: tumor
PATHOPHYSIOLOGY: Increased Adrenergic hormones- exaggerated
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sympathetic effects
ASSESSMENT Findings in Pheochromocytoma
1. Hypertension
2. Severe headache
3. Palpitations
4. Tachycardia
5. Profuse sweating and Flushing
6. Weight loss, tremors
7. Hyperglycemia and glycosuria

NURSING INTERVENTIONS
1. Monitor VS especially BP
2. Monitor for HYPERTENSIVE crisis
3. Avoid stimulation that can cause increased BP
4. Administer Anti-hypertensive agents like alpha-adrenergic blockers-
Phenoxybenzamine
5. Prepare Phentolamine for hypertensive crisis
6. Monitor blood glucose and urine glucose
7. promote adequate rest and sleep periods
8. provide HIGH calorie foods and Vitamins/mineral supplements
9. Prepare patient for possible surgery

DISORDERS OF the THYROID GLAND

HYPOsecretion: HYPOTHYROIDISM
A hypothyroid state characterized by decreased secretions of T3 and T4
CAUSES: Hypofunctioning tumor, IDG, Pituitary tumor, Ablation therapy,
Surgical removal of thyroid
PATHOPHYSIOLOGY: Decreased T3 and T4- decreased basal metabolism
ASSESSMENT findings for Hypothyroidism
1. Lethargy and fatigue
2. Weakness and paresthesia
3. COLD intolerance
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4. Weight gain
5. Bradycardia, constipation
6. Dry hair and skin, loss of body hair
7. Generalized puffiness and edema around the eyes and face
8. Forgetfulness and memory loss
9. Slowness of movement
10. Menstrual irregularities and cardiac irregularities

NURSING INTERVENTIONS
1. Monitor VS especially HR
2. Administer hormone replacement: usually Levothyroxine-should be
taken on an empty stomach
3. Instruct patient to eat LOW calorie, LOW cholesterol and LOW fat diet
4. Manage constipation appropriately
5. Provide a WARM environment
6. Avoid sedatives and narcotics because of increased sensitivity to these
medications
7. Instruct patient to report chest pain promptly

HYPERfunctioning: HYPERTHYROIDISM
Called GRAVE’S DISEASE
A hyperthyroid state characterized by increased circulating T3 and T4
CAUSES: Auto-immune disorder, toxic goiter, tumor
PATHOPHYSIOLOGY: Increased hormone activity- increased Basal
Metabolism
ASSESSMENT Findings for Hyperthyroidism
1. Weight loss
2. HEAT intolerance
3. Hypertension
4. Tachycardia and palpitations
5. Exopthalmos
6. Diarrhea
7. Warm skin

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8. Diaphoresis
9. Smooth and soft skin
10. Fine tremors and nervousness
11. Irritability, mood swings, personality changes and agitation

NURSING INTERVENTIONS
1. Provide adequate rest periods
2. Administer anti-thyroid medications that block hormone synthesis-
Methimazole and PTU
3. Provide a HIGH-calorie diet
4. Manage diarrhea
5. provide a cool and quiet environment
6. Avoid giving stimulants
7. Provide eye care
8. Administer PROPRANOLOL for tachycardia
9. Administer IODIONE preparation- Lugol’s solution and SSKI to inhibit the
release of T3 and T4
10. Prepare clients for Radioactive iodine therapy
12. Prepare patient for thyroidectomy
13. Manage thyroid storm appropriately

THYROID STORM
An acute LIFE-threatening condition characterized by excessive thyroid
hormone
CAUSE: Manipulation of the thyroid during surgery causing the release of
excessive hormones in the blood
ASSESSMENT Findings for Thyroid Storm
1. HIGH fever
2. Tachycardia, Tachypnea
3. Systolic HYPERtension
4. Delirium and coma
5. Severe vomiting and diarrhea
6. Restlessness, Agitation, confusion and Seizures

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NURSING INTERVENTIONS
1. Maintain PATENT airway and adequate ventilation
2. Administer anti-thyroid medications such as Lugol’s solution,
Propranolol, and Glucocorticoids
3. Monitor VS
4. Monitor Cardiac rhythms
5. Administer PARACETAMOL ( not Aspirin) for FEVER
6. Manage Seizures as required. Provide a quiet environment

THYROIDECTOMY
Removal of the thyroid gland
PRE-OPERATIVE CARE - Thyroidectomy
1. Obtain VS and weight
2. Assess for Electrolyte levels, glucose levels and T3/T4 levels
3. Provide pre-operative teaching like coughing and deep breathing,
early ambulation and support of the neck when moving
4. Administer prescribed medications

POST-OPERATIVE CARE - Thyroidectomy

1. Position patient: Semi-Fowler’s
2. Monitor for respiratory distress- apparatus at bedside- tracheostomy
set, O2 tank and suction machine!
3. Check for edema and bleeding by noting the dressing anteriorly and at
the back of the neck
4. LIMIT client talking
5. Assess for HOARSENESS
6. Monitor for Laryngeal Nerve damage – Respiratory distress, Dysphonia,
voice changes, Dysphagia and restlessness
7. Monitor for signs of HYPOCALCEMIA and tetany due to trauma of the
parathyroid
8. Prepare Calcium gluconate
9. Monitor for thyroid storm

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 DISORDERS OF the PARATHYROID GLAND
Hypofunctioning: HYPOPARATHYROIDISM
Hyposecretion of parathyroid hormone
CAUSES: tumor, removal of the gland during thyroid surgery
PATHOPHYSIOLOGY: Decreased PTH- deranged calcium metabolism
ASSESSMENT Findings for HypoParaThyroidism
1. Signs of HYPOCALCEMIA
2. Numbness and tingling sensation on the face
3. Muscle cramps
4. (+) Trosseau’s and Chvostek’s signs
5. Bronchospasms, laryngospasms, dysphagia
6. Cardiac dysrhythmias
7. Hypotension
8. Anxiety, irritability ands depression

NURSING INTERVENTIONS
1. Monitor VS and signs of HYPOcalcemia
2. Initiate seizure precautions and management
3. Place a tracheostomy set. O2 tank and suction at the bedside
4. Prepare CALCIUM gluconate
5. Provide a HIGH-calcium and LOW phosphate diet
6. Advise client to eat Vitamin D rich foods
7. Administer Phosphate binding drugs

Hyperfunctioning: HYPERPARATHYROIDISM
Hypersecretion of the gland
CAUSE: Tumor
PATHOPHYSIOLOGY: Increase PTH- increased CALCIUM levels in the body
ASSESSMENT Findings for Hyperparathyroidism
1. Fatigue and muscle weakness/pain
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2. Skeletal pain and tenderness
3. Fractures
4. Anorexia/N/V epigastric pain
5. Constipation
6. Hypertension
7. Cardiac Dysrhythmias
8. Renal Stones

NURSING INTERVENTIONS
1. Monitor VS, Cardiac rhythm, I and
O
2. Monitor for signs of renal stones,
skeletal fractures. Strain all
urine.
3. Provide adequate fluids- force
fluids
4. Administer prescribed Furosemide
to lower calcium levels
5. Administer NORMAL saline
6. Administer calcium chelators
7. Administer CALCITONIN
8. Prepare the patient for surgery

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