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Hypothalamus
Releasing and inhibiting hormones
Corticotropin-releasing hormone
Thyrotropin-releasing hormone
Growth hormone-releasing hormone
Gonadotropin-releasing hormone
Somatostatin-=-inhibits GH and TSH
Anterior Pituitary
Growth Hormone-Adrenocorticotropic hormone
Thyroid stimulating hormone
Follicle stimulating hormoneovary in female, sperm
in males
Luteinizing hormonecorpus luteum in females,
secretion of testosterone in males
Prolactinprepares female breasts for lactation
Posterior Pituitary
Antidiuretic Hormone
Oxytocincontraction of uterus, milk ejection from
breasts
Adrenal Cortex
Mineralocorticoidaldosterone. Affects sodium
regulates blood sugar levels, affects growth, antiinflammatory action, decreases effects of stress
Adrenal androgensdehydroepiandrosterone and
Adrenal Medulla
Epinephrine and norepinephrine
Thyroid
Follicular cellsexcretion of triiodothyronine (T3)
Parathyroid
Parathyroid hormoneregulates serum calcium
glyconeogenesis
Somatostatindecreases intestinal absorption of
glucose
Kidney
1, 25 dihydroxyvitamin Dstimulates calcium
Ovaries
Estrogen
Progesteroneinportant in menstrual cycle,*maintains
pregnancy,
Testes
Androgens, testosteronesecondary sexual
Thymus
Releases thymosin and thymopoietin
Affects maturation of T lymphocetes
Pineal
Melatonin
Affects sleep, fertility and aging
Prostaglandins
Work locally
Released by plasma cells
Affect fertility, blood clotting, body temperature
Assessment
Health historyenergy level, hand and foot size
Diagnostic Evaluation
Serum levels of hormones
Detection of antibodies against certain hormones
Urinary tests to measure by-products (norepinephrine,
metanephrines, dopamine)
Stimulation testsdetermine how an endocrine gland
responds to stimulating hormone. If the hormone
responds, then the problem lies w/hypothalmus or
pituitary
Suppression teststests negative feedback systems
that control secretion of hormones from the
hypothalamus or pituitary.
primary dwarfism.
Diabetes Insipidus
Deficiency of ADH
Excessive thirst, large volumes of dilute urine
Can occur secondary to brain tumors, head
Manifestations
Excessive thirst
Urinary sp. gr. of 1.001.1.005
cause lipodystrophy.
Can also use Diabenese and thiazide diuretics in mild
disease as they potentiate the action of ADH
If renal in originthiazide diuretics, NSAIDs
(prostaglandin inhibition) and salt depletion may help
Educate patient about actions of medications, how to
administer meds, wear medic alert bracelet
SIADH
Excessive ADH secretion
Retain fluids and develop a dilutional hyponatremia
Often non-endocrine in originsuch as bronchogenic
carcinoma
Causes: Disorders of the CNS like head injury, brain
surgery, tumors, infections or medications like
vincristine, phenothiazines, TCAs or thiazide diuretics
Meds can either affect the pituitary or increase
sensitivity to renal tubules to ADH
Management: eliminate cause, give diuretics (Lasix),
fluid restriction, I&O, daily wt., lab chemistries
SIADH
Restoration of electrolytes must be gradual
May use 3% NaCl in conjunction with Lasix
Thyroid
T3 and T4
Need iodine for synthesis of hormonesexcess will
Thyroid
Inspect gland
Observe for goiter
Check TSH, serum T3 and T4
T3 resin uptake test useful in evaluating thyroid
Thyroid
Antibodies seen in Hashimotos, Graves and other
auto-immune problems.
Radioactive iodine uptake test measures rate of iodine
uptake. Patients with hyperthyroidism exhibit a high
uptake, hypothyroidism will have low uptake
Thyroid scanhelps determine the location, size,
shape and size of gland. Hot areas (increased
function) and cold areas (decreased function) can
assist in diagnosis.
Nursing Implications
Be aware of meds patient is taking (see list in text) that
Hypothyroidism
Most common cause is Hashimotos thyroiditis
Common in those previously treated for hyperthyroidism
Atrophy of gland with aging
Medications like lithium, iodine compounds, antithyroid
Manifestations
From mild symptoms to myxedema
Myxedema accumulation of mucopolysaccharides in
Pharmacologic Management of
hypothyroidism
Levothyroxine is preferred agent
Dosage is based on TSH
Desiccated thyroid used infrequently due to
inconsistent dosing
Angina can occur when thyroid replacement is
initiated as it enhances effects of cardiovascular
catecholamines (in pt. w/pre-existent CAD). Start at
low dose.
Hypnotics and sedatives may have profound effects on
sensorium
Management in Myxedema
Cautious fluid replacement
Glucose to restore to normal glycemic levels
Avoid rapid overheating due to increased oxygen
Hyperthyroidism
Extreme form is Graves disease
Caused by thyroiditis, excessive amount thyroid
Manifestations of hyperthyroidism
Thyrotoxicosisnervousness, irritable, apprehensive,
Management
Reduce thyroid hyperactivityusually use radioactive
Pharmacologic Therapy
Irradiation with administration of radioisotope iodine
Antithyroid Medications
PTUpropylthiouracilblocks synthesis of
hormones
Tapazole (methimazole)blocks synthesis of
hormones. More toxic than PTU.
Sodium Iodide-suppresses release of thyroid hormone
SSKI (saturated solution of potassium chloride)
suppresses release of hormones and decreases
vascularity of thyroid. Can stain teeth
Dexamethazonesuppresses release of thyroid
hormones
Surgical Management
Reserved for special circumstances, e.g. large goiters,
Nursing Management
Reassurance r/t the emotional reactions experienced
May need eye care if has exophthalmos
Maintain normal body temperature
Adequate caloric intake
Managing potential complications such as
Parathyroid Glands
Parathormone maintains sufficient serum calcium
levels
Excess calcium can bind with phosphate and
precipitate in various organs, can cause pancreatitis
Hyperparathyroidism will cause bone decalcification
and development of renal calculi
More common in women
Secondary hyperparathyroidism occurs in those with
chronic renal failure and renal rickets secondary to
excess phosphorus retention (and increased
parathormone secretion)
Manifestations of
Hyperparathyroidism
May be asymptomatic
Apathy, fatigue, muscle weakness, nausea, vomiting,
Management
Recommended treatment for hyperparathyroidism is
surgical removal
Hydration therapy necessary to prevent renal calculi
Avoid thiazide diuretics as they decrease renal excretion of
calcium
Increase mobility to promote bone retention of calcium
Avoid restricted or excess calcium in the diet
Fluids, prune juice and stool softeners to prevent
constipation
Watch for s/s of tetany postsurgically (numbness, tingling,
carpopedal spasms) as well as cardiac dysrhythmias and
hypotension
Hypercalcemic crisis
Seen with levels greater than 15mg/dL
Can result in life-threatening neurologic,
Hypoparathyroidism
Seen most often following removal of thyroid gland,
Clinical Manifestations of
Hypoparathyroidism
Irritability of neuromuscular system
Tetanyhypertonic muscle contractions , numbnes,
Management of Hypoparathyroidism
Restore calcium level to 9-10 mg/dL
May need to give IV calcium gluconate for immediate
treatment
Use of parathormone IV reserved for extreme
situations due to the probability of allergic reactions
Monitor calcium levels
May need bronchodilators and even ventilator
assistance
Diet high in calcium and low in phosphorus; thus,
avoid milk products, egg yolk and spinach.
Management of Hypoparathyroidism
Keep calcium gluconate at bedside
Ensure has IV access
Cardiac monitoring
Care of postoperative patients who have undergone
Adrenals--Pheochromocytoma
Usually benign tumor
Originates from the chromaffin cells of the adrenal
medulla
Any age but usu. Between 40-50 years old
Can be familial
10% are malignant
May be associated with thyroid carcinoma or
parathyroid hyperplasia or tumor
Clinical Manifestations
Headache, diaphoresis, palpitations, hypertension
May have hyperglycemia related to excess epinephrine
secretion
Tremors, flushing and anxiety as well
Blurring of vision
Feeling of impending doom
BPs exceeding 250/150 have occurred
Management
Bedrest
Elevated HOB
ICU
Nipride
Calcium channel blockers and Beta blockers
Surgical management (manipulation of the tumor can
Addisons Disease
Adrenocortical insufficiency
Autoimmune or idiopathic atrophy
Can be caused by inadequate ACTH from pituitary
Therapeutic use of steroids
Manifestations
Muscle weakness
Anorexia
Dark pigmentation
Hypotension
Hypoglycemia
Low sodium levels
High potassium levels
Can result in Addisonian crisis
Addisonian crisis
Circulatory shock
Pallor, apprehension, weak&rapid pulse, rapid
Management
Restore circulatory statusfluids, steroids
May need antibiotics if infection precipitated crisis
May need lifelong steroid therapy and
mineralocorticoid therapy
May need additional salt intake
Check orthostatics
Daily weights
Aware that stressors can precipitate crises
Medic alert bracelet or similar identification of history
Cushings Syndrome
Results from excessive adrenocortical activity
May be related to excessive use of corticosteroid
Manifestations of Cushings
syndrome
Cataracts, glaucoma
Hypertension, heart failure
Truncal obesity, moon face, buffalo hump, sodium
Medical Management
If pituitary source, may warrant transphenoidal
hypophysectomy
Radiation of pituitary also appropriate
Adrenalectomy may be needed in case of adrenal
hypertrophy
Temporary replacement therapy with hydrocortisone or
Florinef
Adrenal enzyme reducers may be indicated if source if
ectopic and inoperable. Examples include: ketoconazole,
mitotane and metyrapone.
If cause is r/t excessive steroid therapy, tapering slowly to a
minimum dosage may be appropriate.
Management
Surgical removal of tumor
Correct hypokalemia
Usual postoperative care with abdominal surgery
Administer steroids
Fluids
Monitoring of blood sugar
Control of hypertension with spironolactone
Corticosteroid Therapy
Hydrocortisone--Cortisol
Cortisone--Cortate
Prednisone--Deltasone
Prednisolone-Prelone
Triamcinolone--Kenalog
Betamethasone--Celestone
Fludrocortisone (contains both mineralocorticoid and
glucocorticoid) Florinef
Indications
RA
Asthma
MS
COPD exacerbations
Lupus
Other autoimmune disorders
Dermatologic disorders
Dosing
Lowest dose
Limited duration
Best time to give dose is in early morning between 7-8
am
Need to taper off med to allow normal return of renal
function
atherosclerosis
Increased risk of infection
Glaucoma and corneal lesions
Muscle wasting, poor wound healing, osteoporosis,
pathologic fractures
Hyperglycemia, steroid withdrawal syndrome
Moon face, weight gain, acne
Case Study 1
35 year old male presents with BP of 188/112 at a
Case Study 2
50 year old woman presents with enlargement of left
Case study 3
48 year old woman with a past history of mental
Case Study 4
40 year old deeply tanned woman presents with a 6
Case Study #5
27 year old woman presents with depression, insomnia,