Endocrine

Disorders

Submitted by:
Jho Ann Labor

Submitted to:
Mrs. Daphny Hatud
THYROID DISORDERS
GOITER
- Generally results from a lack of iodine, inflammation, or benign or malignant tumors.
Etiology
2 major forms of simple goiter:

Endemic goiter
- caused principally by nutritional iodine deficiency.
- tends to occur in goiter belts, geographical areas characterized by soil and water that
are deficient in iodine

Sporadic goiter
Is not restricted to any geographical area.

Major causes include the ff:

Genetic defects resulting in faulty iodine metabolism
Ingestion of large amounts of nutritional goitrogens (goiter-producing agents that
inhibit thyroxine [T4] production), such as rutabagas, cabbage, soybeans, peanuts,
peaches, peas, strawberries, spinach, and radishes, all of which contain goitrogenic
glycosides.

Clinical Manifestations
a visible swelling at the base of your neck that may be particularly obvious when you
shave or put on makeup
a tight feeling in your throat
Coughing
Hoarseness
Difficulty swallowing

Diagnostic exams
Thyroid scan and reuptake
Ultrasound of the thyroid
Nursing Management
The clients diet should be higher in iodine
Dietary goitrogens should be avoided
Medical Management
Strong iodine solution (Lugols solution) or saturated solution of potassium iodide (SKKI)
drops can be administered.
Endemic goiter can be prevented altogether with the use of iodized salt. Adults require at
least 50 mg of iodine per day; however, 200 to 300 mg/day is considered the minimum
adequate intake needed to prevent goiter
Radioactive iodine to shrink the gland, especially if the thyroid is producing too much
thyroid hormone
Surgical Management
(thyroidectomy) to remove all or part of the gland

HYPOTHYROIDISM
Is deficiency of TH resulting in slowed body metabolism, decreased heat production,
and decreased oxygen consumption by the tissues.
Etiology
congenital defects of the thyroid (cretinism)
defective hormone synthesis
iodine deficiency (prenatal and postnatal)
anti-thyroid drugs
surgery or treatment with radioactive agents for hyperthyroidism
chronic inflammatory (autoimmune) disease
Diagnostic test results:
decreased T3, T4
elevated TSH, cholesterol

Clinical Manifestations
Fatigue
Weakness
Weight gain or increased difficulty losing weight
Coarse, dry hair
Dry, rough pale skin
Hair loss
Cold intolerance (you can't tolerate cold temperatures like those around you)
 Muscle cramps and frequent muscle aches
Constipation
Irritability
Abnormal menstrual cycles
Decreased libido

Nursing Management
provide a warm environment, conducive to rest
avoid all sedatives
assist client in choosing low calorie, low cholesterol diet
increase fluid and fiber to relieve constipation
monitor cardiovascular response to increased hormone levels carefully
increase physical activity and sensory stimulation gradually as condition improves
provide information about prescribed medications and importance of lifelong medical
supervision
Medical Management
thyroid replacement therapy
levothyroxine (Synthyroid), liothyronine

HYPERTHYROIDISM
- Excessive secretion of TH, is a highly preventable endocrine disorder.
- Like most thyroid conditions, it is a disorder that predominantly affects women,
especially women between ages 20 and 40 years.

Etiology
Most common form is Graves disease(toxic, diffuse goiter), which has three principle
hallmarks: hyperthyroidism, thyroid gland enlargement (goiter), and exophthalmos
(abnormal protrusion of the eyes
Adenoma, goiter, viral inflammation, auto-immune glandular stimulation
Diagnostic test results:
elevated T3, T4 values

Thyroid Storm or Crisis

- A medical emergency where patients develop severe manifestation of hyperthyroidism
 - Increases temperature, tachycardia, dysrhythmia
- Worsening tremors, restlessness
- Delirious or psychotic state or coma
- Abdominal pain
- Elevated BP and RR

Precipitated by a major stressor

Infection
Trauma or surgery (thyroidectomy)
Inadequate treatment

Nursing Management
provide calm, restful environment
provide adequate nutrients
provide emotional support
be alert for complications
Medical Management
medications
Propylthiouracil (PTU)
antithyroid drug
blocks thyroid hormone production
can cause agranulocytosis
monitor pt. CBC
methimazole (tapazole)
blocks TH production
Iodine preparations
decrease the size and vascularity of the thyroid gland, inhibit release of thyroid hormones
Lugols solution
Can be given with milk or fruit juices
Should be taken with a straw- may stain the teeth
Complications: brassy taste in the mouth, sore teeth and gums
Saturated solution of potassium iodide (SKKI)
Radioactive iodine
limits the secretion of the hormone by damaging or destroying thyroid tissues
Surgical Management
(performed only when the pt. is in a euthyroid state)
Subtotal thyroidectomy (large goiter)
Total thyroidectomy (if carcinoma is present)

THYROIDITIS
Inflammation of the thyroid gland
3 basic forms:
Acute suppurative
Uncommon inflammatory disease usually caused by bacterial invasion in the form of
an abscess of the thyroid gland.
Subacute thyroiditis
Self-limiting inflammatory condition. No etiologic agent has been identified, although
the condition may be viral in origin and commonly follows respiratory infection.
Chronic thyroiditis
(Hashimotos disease)is the most common form of thyroiditis
more prevalent in women than in men and usually occurs between 20 and 50 years old
commonly caused by an autoimmune destruction of the thyroid gland
Clinical Manifestations
fatigue
neck pain
painless asymmetrical enlargement of the gland
weight gain
constipation
dry skin
depression and poor exercise tolerance

Medical Management
salicylates
NSAIDs
Oral glucocorticoid such as prednisone
Thyrotoxicosis
Beta blockers to decrease palpitations and reduce shakes and tremors may be helpful.
As symptoms improve, the medication is tapered off since the thyrotoxic phase is
temporary.
thyroid hormone replacement
Nursing Management
Supportive care and palliative care

THYROID CANCER
A disease when abnormal cells begin to grow in the thyroid gland.
Etiology
genetic predisposition
prolonged exposure to radiation and chemicals
Clinical Manifestations
appearance of a hard, irregular, and painless nodule in an enlarged thyroid gland
the node itself is typically solitary, rapidly enlarging, and cold in contrast to benign
adenomas, which may take up radioactive iodine

Diagnostic exam
thyroid scan
CXR

Nursing Management
provide support and teaching that a client with cancer requires
If the client has undergone a total thyroidectomy, replacement of thyroid hormones is
necessary. Discharge teaching focuses on ensuring that the client understand the
medication and how to take it.

Medical Management
Chemotherapy
External radiation or TSH suppressive therapy
Surgical Management
Total thyroidectomy
Neck resection (maybe done for metastases to the neck)
PARATHYROID DISORDERS

HYPERPARATHYROIDISM
A disorder caused by over activity of one or more of the parathyroid glands.

Clinical Manifestation
backache
tubular calcium deposits-
kidney stones, renal colic, polyuria, and polydipsia
muscle weakness
personality changes, depression
cardiac arrhythmias and hypertension

Diagnostic exams
X-Ray : bone demineralization
Laboratory findings: serum calcium levels are elevated, serum phosphate levels are
depressed, and both urine calcium and phosphorus levels are high
Nursing Management
prevent fractures
assist with activities
encourage fluids
stool softeners or laxative for frequent constipation
assess for complications of disease
renal function should be carefully assessed preoperatively

Medical Management
lower elevated calcium levels (hydration and calciuria)
Normal saline, furosemide
Antiresorption agents (plicamycin, gallium nitrate, phosphates, and calcitonin)

Surgical Management
Parathyroidectomy
(Surgical removal of the gland or glands causing hypersecretion of PTH).
HYPOPARATHYROIDISM
- produced by hypo secretion of the parathyroid glands.
- Serum calcium levels are abnormally low, serum phosphate levels are abnormally high,
and pronounced neuromuscular irritability (tetany) may develop.
Etiology
Iatrogenic (treatment-induced)
Idiopathic (without a specific cause)
Diagnostic findings:
Low calcium, low PTH, high phosphorus, decreased urine calcium
Radiographic studies of the skull or computed tomography of the head showing areas of
calcification
Ophthalmic examination revealing calcification of the ocular lens, which may lead to
cataract formation

Clinical Manifestations
Acute (accidental damage to parathyroid tissues during thyroidectomy
Increased muscular irritability
Grimacing
Tingling of fingers
Laryngospasm
Dysrhythmias
Chronic (idiopathic, resulting in lethargy; thin, patchy hair; thin, patchy hair; brittle nails;
dry, scaly skin; and personality changes
presence of Chvosteks sign
(spasms of facial muscles after a tap over the facial nerve signifying facial
hyperirritability)
presence of Trousseaus sign
(spasms of the wrist and hand after compression of the upper arm, as by a blood pressure
cuff)
hyperactive deep tendon reflexes
circumoral paresthesia
numbness and tingling of fingers

Nursing Management
carefully assess the client for development of hypocalcemia
check for Chvosteks and Trousseaus signs
assess for any manifestation of respiratory distress secondary to laryngospasm
Medical Management
elevate serum calcium
Calcium gluconate
Oral calcium replacements
Vitamin D
Parathyroid hormone
High-calcium, low-phosphate diet
Address seizures and laryngeal spasm

ADRENOCORTICAL DISORDERS

ADRENAL INSUFFICIENCY
PRIMARY ADRENAL INSUFFICIENCY/ ADDISONS DISEASE
Primary adrenal insufficiency results from idiopathic atrophy or destruction of the
adrenal glands by an autoimmune process or other disease
Risk Factors
A history of other endocrine disorders
Taking glucocorticoids for more than 3 weeks with sudden cessation
Taking glucocorticoids more than once every other day
Adrenalectomy
Tuberculosis

Clinical Manifestations
Mild fatigue
Languor
Irritability
Weight loss
Nausea/vomiting
Postural hypotension
Addisonian Crisis (Acute adrenal insufficiency)
May occur when the client has been under stress without appropriate hormone
replacement.
Stressors include pregnancy, surgery, infection, states of dehydration or anorexia,
fever, and emotional upheaval
Manifestations are related to the degree of hormone deficiency and electrolyte
imbalance and include sudden penetrating pain in the back, abdomen, or legs;
 depressed or changed mentation; volume depletion; hypotension; loss of consciousness
and shock

Nursing Management
monitor the clients vital signs closely while the disease is being diagnosed
check the pulse carefully, at least every 4 hours
monitor for exposure to cold and infections
correct fluid, electrolyte, steroid imbalances
prevent future crises

SECONDARY ADRENAL INSUFFICIENCY

Results from dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis.
Causes
Hypopituitarism
Pituitary tumor or infarction
Radiation
Diagnostic results
Low cortisol production
Low plasma ACTH

Medical Management
glucocorticoids
Nursing Management
instruct client to wear an emergency identification bracelet and to carry an emergency kit
for hydrocortisone injection in case of an adrenal crisis

ADRENOCORTICAL HYPERFUNCTION
HYPERCORTISOLISM/ CUSHINGS SYNDROME
results from over activity of the adrenal gland, with consequent hyper secretion of
glucocorticoids
Etiology
pituitary hyper secretion
ectopic secretion of ACTH
Clinical Manifestations
thinning of scalp hair
mood swings
moon face
ruddy cheeks (ecchymosis)
hypertension
striae and truncal obesity
osteoporosis
protein tissue wasting, muscle weakness, thin limbs

Nursing Management
encourage to have regular exercise
advise eat well-balanced diet
avoid fatty foods
Medical Management
corticosteroid medications
consequently, most patients are effectively treated by carefully tapering off (and
eventually stopping) the medication that causes the symptoms

HYPERALDOSTERONISM
Excessive secretion of aldosterone, which causes increases in sodium reabsorption and
loss of potassium and hydrogen ions.
Clinical Manifestations
hypertension
hypernatremia
hypokalemia

Nursing Management
Provide client education about a low-sodium diet, medications, and manifestations of
hypokalemia if the client is to be medically treated.
assess the clients ability to manage the complex therapeutic regimen
Medical Management
Spironolactone (aldactone) to increase sodium excretion and to treat hypertension and
hypokalemia
Amiloride is the drug of choice for clients who cannot tolerate spironolactone
ADRENOMEDULLARY DISORDER

PHEOCHROMOCYTOMA
- A catecholamine- secreting tumor of the chromaffin cells of the sympathetic nervous
system; usually found in the adrenal medulla.
Etiology
unknown
Clinical Manifestations
diabetes mellitus
hypertension
hyperthyroidism
rapid pulse
psychoneurosis (emotional instability)

Nursing Management
assess and control the clients BP preoperatively
closely monitor the client for the development of stressful episodes before treatment has
begun
evaluate the clients neurologic status
give IV fluids as prescribed
carefully measure urine output hourly
assess the clients manifestations of hemorrhage

ANTERIOR PITUITARY DISORDERS

HYPERPITUITARISM
- Over secretion of one or more of the hormones secreted by the pituitary gland.
- caused primarily by a hormone-secreting pituitary tumor, typically a benign adenoma.
Clinical Manifestations
excessive or abnormal growth patterns relate to overproduction of growth hormone
abnormal milk secretion(galactorrhea)
excessive release of thyroid, sex, and adrenocortical hormones
visual field abnormalities
 headache

Nursing Management
emotional support
Physical Assessment:
neurologic assessment
Surgical Management
tumor resection

HYPOPITUITARISM
- deficiency of one or more hormones produced by the pituitary gland
Clinical Manifestations
loss of growth hormone
deficiency of FSH and LH
Medical Management
removal of causative factor such as tumor
permanent replacement of the hormones secreted by the target organs
injections of human growth hormone to treat growth deficiency
corticosteroids to treat adrenocortical insufficiency
thyroid hormone replacement

POSTERIOR PITUITARY (NEUROHYPOPHYSEAL) DISORDERS

DIABETES INSIPIDUS
- Deficiency of antidiuretic hormone (ADH, vasopressin) results in inability to
conserve water.
Risk Factors
head injury
neurosurgery
hypothalamic tumors
pituitary tumors
Clinical Manifestations
polyuria
polydipsia
dry skin and mucous membranes

Nursing Management
know which clients are at risk
monitor intake and output
monitor excessive thirst or urination
assess serum and urine values: decreased specific gravity, decreased urine osmolality,
increased serum osmolality are early indicators of DI
observe effects of DI on concurrent medical and surgical disorders
client and family teaching
Surgical Management
hypophysectomy to remove posterior pituitary tumor

SYNDROME OF INAPPROPRIATE SECRETION OF ANTIDIURETIC HORMONE

(SIADH)
- Excessive amounts of ADH secreted from posterior pituitary and other ectopic
sources.
Risk Factors
vasopressin overuse (from DI)
increased intracranial pressure secondary to infectious processes or brain trauma
lymphoma of the duodenum, brain, bladder;
prostatic cancer

Clinical Manifestations
related to degree of hyponatremia: confusion, lethargy, and irritability
decreased motility with anorexia, nausea, vomiting; abrupt weight gain
Nursing Management
know which clients are at risk
monitor appropriate urine and serum laboratory tests
assess for manifestations of hyponatremia by evaluating neurologic status
monitor daily weights and intake and output
observe for changes in concurrent disorders
 administer demeclocycline as ordered to interfere with ADH action; monitor for possible
nephrotoxicity
monitor for hypernatremia with fluid over-correction
client and family teaching

OVARIAN DISORDERS

OVARIAN TORSION (ADNEXAL TORSION)

- is an infrequent but significant cause of acute lower abdominal pain in women.
- This condition is usually associated with reduced venous return from the ovary as a
result of internal hemorrhage, hyper stimulation, or a mass
Clinical Manifestations
abdominal tenderness
low grade fever
edema
ischemia
Management
surgery to untwist the ovary
analgesics

POLYCYSTIC OVARY SYNDROME (PCOS)

- is a common endocrine system disorder among women of reproductive age
- women with PCOS may have enlarged ovaries that contain small collections of fluid
called follicles located in each ovary as seen during an ultrasound exam.
Clinical Manifestations
Irregular periods (Infrequent or heavy)
hirsutism
acne
obesity
Management
keep weight in check (prevent obesity)
dietary changes
be active through exercises
TESTICULAR DISORDERS

TESTICULAR CANCER
- Most common and serious solid tumor cancer in men between 15 and 35 years of
age.
Clinical Manifestations
painless enlargement noted as heaviness
some men describe it as a dragging sensation
Nursing Management
Ice bags are applied to the scrotum
Scrotal support is worn when the client is ambulating
teach the client self-care strategies and how to monitor for the development of
complications
Medical Management
Radiation therapy
Chemotherapy

TESTICULAR TORSION
- Occurs when a testicle is mobile and the spermatic cord twists cutting off the blood
supply.
Clinical Manifestations
- Acute scrotal swelling
- Severe pain as blood supply to the testicles is interrupted
Surgical Management
Orchiopexy (spermatic cord is untwisted and the testicle is immobilized by
suturing it to the scrotum)
ORCHITIS
- Rare, acute testicular inflammation, usually caused by a viral infection.
Clinical Manifestations
edematous
extremely tender testicles
reddened scrotal skin
fever
Management
bed rest
scrotal support
local heat to the scrotum
medications for pain reduction, fever, and infection

PANCREATIC DISORDER

DIABETES MELLITUS
- Is a chronic systemic disease characterized by either a deficiency of insulin or a
decreased ability of the body to use insulin.
Diagnostic tests
fasting blood glucose (client has not ingested any nutrients other than water for at least 8
hours)
casual blood glucose (a blood sample drawn without fasting for 8 hours)
post load blood glucose (blood glucose samples are drawn 2 hours after a standard meal
and reflect the efficiency of insulin-mediated glucose uptake by peripheral tissues)

TYPES:
Type 1 DM
- is absolute insulin deficiency in other words, the body cannot produce insulin. This is
from a defect in the pancreas, the insulin-producing organ of the body.
- is often understood to be an auto-immune disorder, in which the body destroys its own
tissue (in this case, the cells of the pancreas).
Type 2 DM
- arises because of insulin resistance. In this case, the body may be producing insulin but
cannot use it properly.
 - These individuals usually carry excess body fat; 80% of clients with Type 2 DM are obese
at onset.

Medical Management
promote proper nutrition
promote regular physical activity
administer medications (oral antidiabetes agents, insulin therapy, and combination
therapy)
Nursing Management
explain the pathophysiology of diabetes
plan an exercise program
prevent complications from exercise
plan nutrition therapy to achieve target blood glucose