Endocrine system

 A client with diaphoresis, palpitations, jitters, and tachycardia approximately

1½ hours after taking his regular morning insulin is experiencing symptoms of
hypoglycemia.
 Retinopathy is a chronic complication of diabetes mellitus.
 Exercise decreases insulin resistance.
 Insulin lipodystrophy produces fatty masses at injection sites, causing unpredictable
absorption of insulin injected into these sites.
 Insulin edema is sometimes seen after normal blood glucose levels are established in a
client with prolonged hyperglycemia.
 Insulin resistance occurs mostly in overweight clients and is due to insulin binding
with antibodies, decreasing the amount of absorption.
 Results of a urine glucose test correlate poorly with blood glucose levels.
 Weight gain, lethargy, and slow pulse rate along with decreased T3 and T4 levels
indicate hypothyroidism.
 T3 and T4 are thyroid hormones that affect growth and development as well as
metabolic rate.
 Tetany is related to low calcium levels.
 To palpate the thyroid gland, ask the client to swallow; as he does so, palpate the
gland for enlargement as the tissue rises and falls.
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 Measurement of glycosylated hemoglobin (Hb A1c) is used to assess

hyperglycemia.
 Coarsening of facial features and extremity enlargement are symptoms of acromegaly.
 The medulla of the adrenal gland releases two hormones: epinephrine and
norepinephrine.
 Thyroxine (T4), triiodothyronine (T3), and calcitonin are secreted by the thyroid gland.
 The islet cells of the pancreas secrete insulin, glucagon, and somatostatin.
 The client with diabetes insipidus is at risk for developing hypovolemic shock because
of increased urine output.
 In clients with diabetes insipidus, urine specific gravity should be monitored for low
osmolality (generally less than 1.005) due to the body’s inability to concentrate urine.
 The fluid deprivation test involves withholding water for 4 to 18 hours and checking
urine osmolarity periodically.
 A client with diabetes insipidus will have an increased serum osmolarity (less than 300
mOsm/kg).
 Lethargy and depression are early symptoms of Addison’s disease.
 Daily weight is an objective way to monitor fluid balance in Addison’s disease.
 Rapid variations in weight in Addison’s disease reflect changes in fluid volume and
the need for more glucocorticoids.
 The best indicator for determining if a client with Addison’s disease is receiving the
correct amount of glucocorticoid replacement is by daily weight.
 In addisonian crisis the uncontrolled loss of sodium and impaired
mineralocorticoid function result in loss of extracellular fluid and low blood volume
and possible irreversible shock.
 With hyperthyroidism, the client has high levels of T3 and T4.
 A definitive diagnosis of Addison’s disease must reflect low levels of
adrenocortical hormones.
 Clients with Addison’s disease experience fatigue related to decreased metabolic
energy production and altered body chemistry.
 Clients with Addison’s disease experience fluid volume deficit secondary to decreased
mineralocorticoid secretion.
 Stress can precipitate a hypotensive crisis in clients with Addison’s disease.
 Clients with Addison’s disease must monitor salt intake.
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 Overproduction of adrenocortical hormone results in growth arrest and obesity.

 Thin extremities, an obese truncal area, presence of a “buffalo hump” at the shoulder
area, weakness, and disturbed sleep are symptoms of Cushing’s syndrome.
 Increased mineralocorticoid activity resulting in sodium and water retention in a
client with Cushing’s syndrome commonly contributes to hypertension and heart
failure.
 Hypoglycemia and dehydration are uncommon in a client with Cushing’s syndrome.
 Test results in Cushing’s syndrome include high serum sodium and glucose levels,
low potassium level, reduction of eosinophils, and disappearance of lymphoid
tissue.
 A low-dose dexamethasone suppression test can diagnose Cushing’s syndrome.
 A fluid deprivation test is used to diagnose diabetes insipidus.
 Removing a major source of adrenal hormones may cause a state of temporary
adrenal insufficiency, requiring short-term replacement therapy.
 When both adrenal glands are removed, the client requires lifelong hormone
replacement.
 Clients with Cushing’s syndrome have an increased susceptibility to injury or
infection, secondary to the immunosuppression caused by excessive cortisol.
 Clients with Addison’s disease must increase sodium intake and fluid intake in times
of stress to prevent hypotension.
 Diabetic ketoacidosis is caused by inadequate amounts of insulin or absence of
insulin, and leads to a series of biochemical disorders.
 Diabetes insipidus is caused by a deficiency of vasopressin.
 Hyperaldosteronism is an excess in aldosterone production, causing sodium and
fluid excesses and hypertension.
 Hyperosmolar hyperglycemic nonketotic syndrome is a coma state in which
hyperglycemia and hyperosmolarity dominate.
 A client with chronic pancreatitis may develop diabetes secondary to the pancreatitis.
 A client with syndrome of inappropriate antidiuretic hormone secretion is unable to
excrete dilute urine, causing hyponatremia.
 Amylase, lipase, and trypsin are enzymes produced by the pancreas that aid in digestion.
 The pituitary gland secretes vasopressin and oxytocin.
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 By secretion of thyroid-stimulating hormone, the pituitary gland controls the rate of

thyroid hormone released.
 The parathyroid gland secretes parathyroid hormones, depending on the levels of calcium
and phosphorus in the blood.
 The thyroid gland secretes thyroid hormone, but doesn’t control how much is
released.
 Irradiation, involving administration of iodine 131 (131I), destroys the thyroid gland
and thereby treats hyperthyroidism.
 The pancreas is an accessory gland of digestion.
 In its exocrine function, the pancreas secretes digestive enzymes (amylase,
lipase, and trypsin).
 Amylase breaks down starches into smaller carbohydrate molecules.
 Lipase breaks down fats into fatty acids and glycerol.
 Trypsin breaks down proteins.
 The pancreas secretes enzymes into the duodenum through the pancreatic duct.
 In its endocrine function, the pancreas secretes hormones from the islets of Langerhans
(insulin, glucagon, and somatostatin).
 Insulin regulates fat, protein, and carbohydrate metabolism and lowers blood glucose
levels by promoting glucose transport into cells.
 Glucagon increases blood glucose levels by promoting hepatic
glyconeogenesis.
 Somatostatin inhibits the release of insulin, glucagon, and somatotropin.
 Endocrine glands discharge secretions into the blood or lymph.
 The Whipple procedure is a surgical treatment for pancreatic cancer.
 Most elderly clients with hyperthyroidism present with depression, apathy, and
weight loss.
 Cold intolerance, weight gain, and thinning hair are some of the signs of
hypothyroidism.
 Numbness, tingling, and cramping of extremities are symptoms of hypocalcemia,
which may be a symptom of hypoparathyroidism.
 Thyroid storm is a form of severe hyperthyroidism that can be precipitated
by stress, injury, or infection.
 Myxedema coma is a rare disorder characterized by hypoventilation, hypotension,
hypoglycemia, and hypothyroidism.
 Hyperosmolar hyperglycemic nonketotic syndrome occurs in clients with type 2
diabetes mellitus who are dehydrated and have severe hyperglycemia.
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 Hyperthyroidism is known as Graves’ disease.

 Hyperparathyroidism is overproduction of parathyroid hormone and is characterized by
bone calcification or renal calculi.
 Signs and symptoms of hyperthyroidism include nervousness, palpitations,
irritability, bulging eyes, heat intolerance, weight loss, and weakness.
 Hyperparathyroidism is characterized by weakness and anorexia.
 Signs and symptoms of hypothyroidism include fatigue, cool skin, and sensitivity to
cold.
 The adrenal glands are composed of the adrenal cortex and the adrenal medulla.
 The adrenal cortex secretes three major types of hormones:
glucocorticoids, mineralocorticoids, and sex hormones.
 Glucocorticoids (cortisol, cortisone, and corticosterone) mediate the stress response,
promote sodium and water retention and potassium secretion, and suppress corticotropin
secretion.
 Mineralocorticoids (aldosterone and deoxycorticosterone) promote sodium and
water retention and potassium secretion.
 Sex hormones (androgens, estrogens, and progesterone) develop and maintain
secondary sex characteristics and libido.
 The parathyroid gland secretes parathyroid hormone (parathormone), which regulates
calcium and phosphorus levels and promotes the resorption of calcium from bones.
 The pituitary gland is composed of anterior and posterior lobes; together these lobes
produce various hormones that affect the body.
 The anterior lobe of the pituitary secretes follicle-stimulating hormone, leuteinizing
hormone, corticotropin, thyroid-stimulating hormone, and growth hormone.
 Follicle-stimulating hormone stimulates graafian follicle growth and estrogen
secretion in women and sperm maturation in men.
 Luteinizing hormone induces ovulation and the development of the corpus luteum in
women and stimulates testosterone secretion in men.
 Corticotropin stimulates secretion of hormones from the adrenal cortex.
 Thyroid-stimulating hormone regulates the secretory activity of the thyroid gland.
 Growth hormone is an insulin antagonist that stimulates the growth of cells, bones,
muscle, and soft tissue.
 The posterior lobe of the pituitary secretes vasopressin and oxytocin.
 Vasopressin (antidiuretic hormone, also called ADH), helps the body retain water.
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 Oxytocin stimulates uterine contractions during labor and milk secretion in

lactating women. Norepinephrine regulates generalized vasoconstriction.
 Epinephrine regulates instantaneous stress reaction and increases metabolism,
blood glucose levels, and cardiac output.
 Amenorrhea is a sign of decreased levels of follicle-stimulating hormone, which is one of
the anterior pituitary hormones.
 Weight gain is associated with Cushing’s syndrome, which is associated with the
adrenal cortex.
 Urine output is related to posterior pituitary function.
 Two leading causes of diabetes insipidus are hypothalamic or pituitary tumors and
closed-head injuries.
 Normal sodium levels are 135 to 145 mEq/dL.
 Clients with Kussmaul’s respirations, abdominal discomfort, lethargy, and serum
glucose levels above 300 mg/dL could be diagnosed with diabetic ketoacidosis.
 Serum ketones would aid in confirming the diagnosis of diabetic ketoacidosis.
 Insulin forces potassium out of the plasma, back into the cells, causing hypokalemia.
 Diabetic clients are especially prone to infections.
 Normal calcium levels are 8.5 to 10.5 mg/dL.
 Symptoms of hypoparathyroidism include hyperphosphatemia and hypocalcemia.
 Excessive thyroid hormone levels indicate Graves’ disease (hyperthyroidism).
 Low thyroid hormone levels indicate hypothyroidism.
 Clients with hyperthyroidism are typically anxious, diaphoretic, nervous, and fatigued and
need a calm, restful environment in which to relax and get adequate rest.
 A client with hypoparathyroidism has a decreased calcium level.
 Graves’ disease causes bulging of the eyes, weight loss, and heat intolerance.
 Pheochromocytoma is a tumor of the adrenal gland that causes hypertension.
 Tumors that affect the pituitary gland would lead to acromegaly, Cushing’s
syndrome, and hypopituitarism.
 Tumors of the adrenal gland would cause symptoms such as hypertension.
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 The hypothalamus secretes corticotropin-releasing factor, which stimulates the

anterior pituitary to secrete corticotropin.
 Chvostek’s sign is positive when a sharp tapping over the facial nerve, in front of the
parotid gland and anterior to the ear, causes the mouth, nose, and eye to twitch.
 Immediate treatment for a client who develops hypocalcemia and tetany after
thyroidectomy is calcium gluconate.
 Hypophysectomy is the surgical removal of the pituitary gland.
 Pheochromocytoma is a tumor of the adrenal gland and doesn’t cause abdominal or
back symptoms.
 Spicy foods, caffeine, and alcohol should be avoided in pancreatitis.
 A high-calorie, high-protein diet is appropriate for clients with
hyperthyroidism.
 During periods of infection or illness, insulin-dependent clients may need even more
insulin to compensate for increased blood glucose levels.
 Based on the American Diabetes Association guidelines, fasting blood glucose of 126
mg/dl or more on at least two occasions is indicative of diabetes mellitus.
 Tests that help determine a definitive diagnosis of diabetes mellitus include random
blood glucose levels, glucose tolerance tests, and measurement of glycosylated
hemoglobin (Hb A1c).
 A pheochromocytoma is usually a benign tumor of the adrenal medulla.
 A pheochromocytoma secretes epinephrine and norepinephrine, resulting in hypertension
and paroxysmal tachycardia.
 An endemic goiter is an iodine-deficient enlargement of the thyroid gland.
 Tumors of the adrenal medulla usually produce hypertension because they release
excessive amounts of epinephrine and norepinephrine.
 The endocrine system consists of chemical transmitters called hormones and specialized
cell clusters called glands.
 The hypothalamus controls temperature, respiration, blood pressure, thirst, hunger,
and water balance.
 The functions of the hypothalamus affect the client’s emotional states.
 The hypothalamus also produces hypothalamic-stimulating hormones, which affect the
inhibition and release of pituitary hormones.
 Carpopedal spasm occurs as a result of hypocalcemia.
 Hyperglycemia is a result of low insulin levels.
 Clients with Cushing’s syndrome usually have a “moonface.”
 A major adverse effect of corticosteroid therapy is a slowing of metabolism.
 Endocrine system 85

 Thyroidectomy may lead to hypoparathyroidism if the parathyroid is also removed during surgery.
 Hyperparathyroidism may cause serum calcium levels to rise.
 Steroid use induces calcium to leave bone, suppressing parathyroid hormone.
 A client with Addison’s disease needs more steroids than the body produces.
 A client being treated for adrenal crisis (addisonian crisis) should have serum sodium and potassium values monitored.
 Elevated serum glucose levels contribute to long-term effects of diabetes mellitus, such as coronary artery disease, hypertension, and
peripheral vascular disease.
 Failure to maintain levothyroxine therapy can lead to a low body temperature.
 Balancing diet, exercise, and medication is essential to diabetes control in type 1, type 2, or gestational diabetes mellitus.
 Hypothyroidism slows the metabolic rate and mental responses, causing edema, decreased body temperature, and slower respiratory
and heart rates.
 The predominant feature of syndrome of inappropriate antidiuretic hormone secretion is water retention with oliguria, edema, and weight
gain.