Chapter 40

Assessment
of
Endocrine Function

https://www.nlm.nih.gov/medlineplus/ency/anatomyvideos/000099.htm
 Pituitary Gland

Anterior Pituitary Gland

Posterior Pituitary Gland
 Secrets GH, FSH, LH, prolactin,
• Secrets ADH (aka vasopressin)
ACTH, TSH
• ↑ ADH → SIADH
• ↑ GH in children→ gigantism
• ↓ ADH → DI
• ↑ GH in adults → acromegaly

• ↓ GH: → dwarfism, panhypopituitarism

• ↓ FSH/LH → sterility
INTRODUCTION
 Endocrine system includes glands found in various locations in the body

 These glands secrete hormones that act on specific target tissues

 More or less production of hormones can cause endocrine dysfunction

 Secretion of hormones regulated by :

− Hypothalamus & Pituitary gland, neuroendocrine regulation

− Levels of hormones in the blood and

− Other chemical changes such as glucose, sodium and potassium levels

− Hormonal release is controlled by a negative feedback system

 ENDOCRINE GLANDS INCLUDE THE FOLLOWING:

Additional Hormone-Releasing Organs

 Atria of heart: atrial natriuretic peptide
 Kidneys: renin; erythropoietin
 Skin : Vitamin D
 Function of placenta and its secretion of hormones
 Gastrointestinal structures
 Thymus Gland
 In upper part of the chest above or
near the heart
 Secretes thymosin & thymopoietin
 Large during childhood but usually
shrinks by adulthood
 Production of T lymphocytes
 Decreases with age
 Functional disorders are rare

http://www.phlbi.org/blog/2013/11/2013-research-update/
 Chapter 43

Coordinating Care for

Patients With

Thyroid and
Parathyroid Disorders
 Thyroid problems
Most common thyroid problems, symptoms and treatment

↑ thyroidism → Graves Disease

↓ thyroidism → Hashimoto’s Thyroiditis
Goiter and Thyroid cancer

• https://youtu.be/SVSBo065hmw
Thyroid Gland: Located in the front of the neck. Secretes thyroid hormone.

Purpose: Regulate the body's overall metabolism.

Cont’d…
 Thyroid and parathyroid glands are integral to normal body functions

 Metabolic activity and rate are primarily controlled by 2 thyroid gland hormones

− Triiodothyronine (T3)

− Thyroxine (T4)

 Serum calcium levels are controlled by thyrocalcitonin (Parathyroid glands rise

serum Ca levels)

 Disorders affecting either of these structures can result in hypothyroidism or

hyperthyroidism
 HYPOTHYROIDISM
 Epidemiology

− Caused by disorders affecting the anterior pituitary gland or the hypothalamus

− Most common type is Hashimoto’s thyroiditis

 (Hashimoto's disease is a condition in which your immune system

attacks your thyroid. It’s the most common cause of hypothyroidism.)

 Pathophysiology

− Primary hypothyroidism: as a result of a d/o of the thyroid gland itself.

− Secondary hypothyroidism: by a disorder of the anterior pituitary gland

− Tertiary hypothyroidism: r/t a lack of TRH(thyrotropin releasing hormone) from the

hypothalamus
 HYPOTHYROIDISM (cont’d)

 Clinical manifestations
− Decreased energy, increased
sleep, fatigue, weight gain,
decreased appetite, and
susceptibility to cold
− Myxedema, deposition of
glycosaminoglycan
(polysaccharide) in cell & tissues
 Management
− Diagnosis confirmed through
laboratory data, including T3, T4,
and TSH
− Replacement of thyroid hormone
is the primary treatment
 Myxedema
(HYPOTHYROIDISM)

Deposition of glycosaminoglycan
 HYPERTHYROIDISM (Grave’s Disorder)
 Epidemiology

− Commonly diagnosed in women 20-40 yrs of age

− 10x more prevalent in women

− Graves’s disease

 Pathophysiology

− Accelerated metabolism is characteristic of hyperthyroidism and affects

most body systems
 Hyperthyroidism (Grave’s Disorder)…cont’d
Patho: No specific cause. May be autoimmune or inherited.
Possible causes may be due to hypersecretion of thyroid hormones-
tumors (pituitary/thyroid), hypothalamic malignancies, stress or infection.
The thyroid makes too much thyroid hormone. Increasing in T3 and T4
levels and T3 inhibits the release of TSH, i.e., TSH level decreases
Metabolic rate increases/increase appetite This disorder is more common
in women.
HYPERTHYROIDISM CLINICAL MANIFESTIONS
 Elevated heart rate
 Cardiac dysrhythmias
 Palpitations/tachycardia
 Thyroid bruit
 Heat intolerance
 Increased gastric activity
 Exophthalmos
 Tremors
 Goiter
 Excessive sweating
 Increased appetite
 Weight loss
 Fatigue
 Nervousness/anxiety
 Insomnia
 Light to absent menses
 Fine hair and hair loss
 Oligomenorrhea
 Muscle weakness
Medical and surgical management for HYPERTHYROIDISM

• antithyroid drugs,

• radiation,

• thyroidectomy
 THYROID CANCER
 According to the American Cancer Society, approximately 62,980 new cases of
thyroid cancer were diagnosed in 2014 (47,790 in women and 15,190 in men), and
there were approximately 1,890 deaths.

 Thyroid cancer patients usually present with a nodule on the thyroid gland

 Other than anaplastic, thyroidectomy is the treatment of choice

 4 types of thyroid cancer (based on how the cancer cells look under a microscope)

− Papillary, follicular, medullary, and anaplastic

 In patients with anaplastic carcinoma, because of the aggressive nature of this fast-
growing tumor, radiation therapy is the treatment of choice.
Parathyroid glands

 There are 4 parathyroid glands located behind the thyroid

 Secretes parathyroid hormone.

− Control calcium, phosphorus & Vit D levels in the body.

− increases serum calcium through the following actions:

 Increases bone resorption through osteoclastic activity

 Stimulates renal reabsorption of calcium

 Stimulates activation of vitamin D, which increases intestinal reabsorption of

calcium
https://youtu.be/sD9st1ZPFrQ
HYPOPARATHYROIDISM
 Epidemiology
− Idiopathic
− Acquired (2nd to removal of parathyroid glands for cancer of head or neck)
− Reversible
 Pathophysiology
− Hypocalcemia is the primary disorder
 HYPOPARATHYROIDISM (cont’d)

 Clinical manifestations
− Decreased serum calcium levels
− Numbness/tingling around mouth or hands and feet
− Muscle cramps, spasms of hands and feet, and tetany

 An increased risk of tetany that can result in laryngospasm

and airway compromise due to hypocalcemia.

 Management
− Treatment based upon whether the presentation is acute or
insidious
− Focuses primarily on raising serum calcium levels
HYPERPARATHYROIDISM

 Epidemiology
− 85% of the cases of primary hyperparathyroidism

− 15% of cases are secondary disorders

 Secondary disorders are most often observed in patients with chronic renal failure or chronic
malabsorption of calcium.

 Pathophysiology
− Causes hypercalcemia secondary to its actions on bone, kidneys, and the
bowel

− The action of PTH on bone leads to osteoclastic (breakdown of bone) activity

and bone demineralization, which causes pathologic fractures and bone
lesions.
HYPERPARATHYROIDISM (cont’d)

 Clinical manifestations

− May be asymptomatic

− Polyuria, anorexia, and constipation

 Management

− Direct measurement of intact PTH

− Treatment focuses primarily on lowering serum

levels
 Gonads

− Sexual development and function are controlled by hormones

secreted from the ovaries and testes

 Pancreas

− Located in upper left quadrant of the abdominal cavity

− Both exocrine and endocrine functions

− Insulin

− Glucagon
ASSESSMENT
 History
− Complete a comprehensive history
− Evaluating family history for endocrine disorders
 Physical assessment
− Change in physical appearance may be apparent
− Cardiovascular functions
− Changes

 testes and thyroid glands

(size, symmetry, shape and nodules/changes)

 homeostasis and metabolic activity

 nutritional status, weight, sleep pattern, energy

AGE-RELATED CHANGES
 Changes in endocrine function are associated with aging

 Decreased metabolism

− decreased appetite, susceptibility to cold intolerance, changes in the quality

of sleep, and decreased resting pulse rate and blood pressure.

 Changes in release of reproductive hormones

− sexual functioning; including erectile dysfunction and decreased libido

− decreased glucose tolerance may present with elevated blood glucose

levels and weight gain.