Fluids and Electrolytes, Metabolism and Endocrine (NCM103) Patients With Endocrine Alterations I
Endocrine System Anatomy and Physiology
Endocrine System - Is composed of ductless glands that synthesize and release hormones directly into the blood o Hormones: Are generally thought of as chemical messengers triggering intracellular responses Characteristics: 1. With specific rate and rhythm 2. Operates within a feed-back system o NEGATIVE FEEDBACK SYSTEM In the endocrine system, sensors detect a change in the hormone level and adjust hormone secretion so that the body levels are maintained within an appropriate range 3. Affects only target cells within specific receptors for the hormone 4. Excreted by kidneys, deactivated by the liver or cellular mechanism o Structural Classifications of Hormones Steroids ` Derived from CHOLESTEROL and are consequently poorly soluble in water Peptides ` Protein and polypeptide synthesis in the endoplasmic reticulum of the endocrine tissue ` Generally have rapid response times Amino Acid Derive ` Derivative of Tyrosine (T 3 and T 4 , Dopamine, Epinephrine, Norepinephrine)
MAJOR ENDOCRINE GLANDS o Hypothalamus and Pituitary Gland o Thyroid Gland o Parathyroid Gland o Endocrine Pancreas o Adrenal Gland o Gonads (Ovaries and Testes)
HYPOTHALAMUS O Part of the diencephalon, located below the thalamus O Collecting center for information covering the internal well-being of the body O Contains neurosecretory cells O Controls most of the endocrinal activity of the pituitary gland O Secretes releasing hormones for the pituitary gland Thyroid Releasing Hormone Thyroid Stimulating Hormone Corticotrophin Releasing Hormone Adrenocorticotropic Hormone Growth Hormone Releasing Hormone Growth Hormone Somatostatin X Growth Hormone Gonadotrophin Releasing Hormone Luteinizing Hormone & Follicle Stimulating Hormone Prolactin Releasing Hormone Prolactin Topics Discussed Here Are: 1. Anatomy and Physiology of the Endocrine System 2. Hypopituitarism Dwarfism 3. Hyperpituitarism Acromegaly 4. Transsphenoidal Hypophysectomy LOOKY HERE
jcmendiola_Achievers2013 Colloid Follicular Cells 1. Uptake of IODINE 2. Synthesis of thyroglobulin PITUITARY GLAND (HYPOPHYSIS) O Is a small gland that lies in the Sella Turcica connected to the hypothalamus by the hypophyseal stalk O Master Gland Controls production of the activities of the other endocrine glands O 3 Histollogically distinct sections two of which secrete hormones in humans 1. Anterior Pituitary (Adenohypophysis) Glandular tissue that contains a variety of secretory cell types 2. Posterior Pituitary (Neurohypophysis) Neural tissue that contains glial cells and terminal axons from cells of the hypothalamus 3. Pars Intermedia Small avascular zone remnant in human beings with no physiological function
THYROID GLAND O Is in the neck, H-Shaped, located immediately below the larynx on each side of anterior to the trachea O Thyroid Hormones A composite of: 3 T 3 /T 4
4 Obtunded tyrosine residues T 3 /T 4
T 3 has more rapid effect (Usually 3 days) T 4 less, rapid effect (usually 11 days) The Parafollicular cells secretes calcitonin
PARATHYROID GLAND O 4 Small glands rear, attached to or embedded in the thyroid gland O Regulates serum Ca and P balance by means of PTH PTH: Influences bone Reabsorption, Ca absorption from renal tubules Its activation Serum Ca : Serum Phosphate o Ca PTH Bone resorption Ca absorption in intestines Ca reabsorption of kidneys
ADRENAL GLAND O Are paired endocrine organs situated on the top of the kidneys Pituitary Gland Anterior Pituitary Gland Posterior Pituitary Gland FSH LH ACTH TSH Prolactin GH ADH Oxytocin
jcmendiola_Achievers2013 O The adrenal cortex is divided into an outer cortex and an inner medulla Adrenal Cortex (3 Zones) Zona Glomerulosa Aldosterone (Mineralocorticoids) Zona Fasiculata Zona Reticularis Medulla Catecholamines
Functions of Adrenal Cortex Aldosterone Primary mineralocorticoid secreted by the adrenal glands
Functions of the Adrenal Medulla Acts on the post-ganglionic sympathetic nerve Secretes catecholamines ` Epinephrine ` Norepinephrine About 80% of basal catecholamine in epinephrine
Functions of Catecholamine Actions mimic those of SNS, but have lower durations Strong B-adrenergic effect Potent stimulator of the HR and constriction Has strong metabolic effects and increase metabolic rate by 100%
Testes GnRH LH release from anterior PG LH acts on Leydig Cells Testosterone synthesis and release Acts as steroids (Athletes) Protein Synthesis Musculoskeletal Growth in puberty Ovaries LH from APG LH acts on ovarian Thecal cells Ovarian granulosa converts the androgens into estrogen / estradiol Menstruation MS Growth in Puberty
ENDOCRINE PANCREAS O The pancreas, located in the upper abdoemen, has endocrine as well as exocrine functions O Exocrine Function Secretion of pancreatic enzymes into the GIT through the pancreatic duct O Endocrine Function Secretion of insulin, glucagon and somastostatin directly into the blood stream O The pancreas contains Islets of Langerhans which has 3 types of hormones that regulate blood glucose level Glucocorticoids: Cortisol and Androgens
Hypo and Hyper Function - Disturbances of endocrine function can be usually divided into 2 categories O Hypo Function Decreased functional ability of the associated organ When the gland does not have enough hormones O Hyper Function Increased functional ability of the associated organ When the gland secretes excessive hormones
jcmendiola_Achievers2013 Disorders
Dwarfism
Etiologic Factors:
Signs and Symptoms 1. Decreased growth velocity 2. Delayed structural maturation 3. Delayed teeth eruption 4. Delayed / lack of sexual development
Nursing Diagnosis - Delayed growth and development related to lack of growth hormone - Social isolation related to short stature and peer acceptance - Chronic low self-esteem related to ectopic discordant expectation by peers and adults
Disorders of the Pituitary Gland Pituitary Function Tests A. Serum Growth Hormone Can be affected by drugs (Has to be repeated many times; fasting) B. Serum Prolactin C. Adrenocorticotropic Hormone D. Water Deprivation Test E. Glucose Tolerance Test F. Insulin Tolerance Test
Hypopituitarism A. Definition e Is the decreased (HYPO) secretions of or more of the 8 hormones normally produced by the pituitary gland e Decreased secretions of most pituitary hormones; the term PANHYPOPITUITARISM is used e Most often affected hormones are GROWTH HORMONE and GONADOTROPINS B. Etiology and Related Factors + Congenital
jcmendiola_Achievers2013 + Gland Destruction Infection Tumor Postpartal Necrosis C. Clinical Manifestations 1 The Signs and Symptoms depend on 1. Which hormones are undersecreted 2. Underlying cause of the abnormality
Anterior Pituitary Gland Hormone Effect (Decreased) Luteinizing Hormone (LH) & Follicle Stimulating Hormone (FSH) Oligomenorrhea, Amenorrhea, Infertility Decreased libido; Poor development of sexual characteristics Growth Hormone (GH) Dwarfism Adrenocorticotropic Hormone (ACTH) Adrenal insufficiency or disorder Thyroid Stimulating Hormone (TSH) Hypothyroidism
D. Diagnostic Tests - Blood test - Radioscan of the Pituitary Gland - Decreased Serum Growth Hormone E. Nursing Diagnosis Depends on the disease condition
Dwarfism - Is a short stature that results from an undersecretion of the Growth Hormone - Defined as an *** of 4 feet 10 inches or less. The most typical range height among people with dwarfism is 2 feet 8 inches 4 feet 8 inches
Classification: Disproportionate Dwarfism o Some parts of the body are small and others are of average size / above average size Proportional Dwarfism o A body is proportionately small o All parts of the body are small to the same degree and appear to be proportionately like a body of an average person
Nursing Management: Nursing Intervention o Provide Education and Evaluation Teach regarding synthesizing of growth hormone Document growth every 3 6 months o Encourage Social Interactions Encourage child to verbalizing feelings regarding short stature Suggest involvement in activities that do not used height as an advantage such as music, art and gymnastics Ask the child to identify behavior that may deter socialization and find ways to change behavior
jcmendiola_Achievers2013 o Strengthen Self-esteem Help child and parents to identify age-appropriate behavior and develop a plan for maintaining consistent behavior in the home and socially Make sure client has realistic expectations Encourage use of positive feedback rather than punishment
Hyperpituitarism - Defined as over secretion of one or more of the hormones secreted by the pituitary gland - Primarily caused by a hormone-secreting pituitary tumor, typically a benign adenoma - Growth Hormone and Prolactin are hormones mostly affected
Acromegaly A. Definition c The hypersecretion of growth hormone from the pituitary gland B. Etiologic Factors c Pituitary Tumor c Congenital Disorder C. Pathophysiology (Acromegaly)
Signs and Symptoms: c Wedding ring is too tight / shoes / cap c Hypertrophy of sweat and sebaceous glands c Galactorrhea (Prolactin) c Cardiomegaly Hypertension c Sexual Dysfunction c Peripheral Neuropathy c Visual Field Defects c Arthrosis c Spade-shaped hands and feet c Abnormal glucose tolerance test; Glucosuria; POLYURIA
D. Medical Management - Surgery: Transsphenoidal Hypophysectomy
E. Nursing Intervention 1. Provide emotional support to client and family 2. Provide frequent skin care 3. Prepare client for surgery Removal of Pituitary Gland
ACROMEGALY AFTER closure of the epiphyseal plates GIGANTISM BEFORE closure of the epiphyseal plates Hypothalamic Tumor Pituitary Adenoma Pituitary Hyperplasia Imaging Studies: MRI CT Scan Overproduction of Growth Hormone Serum Growth Hormone Signs and Symptoms
Etiology: Primary Disease o Originate within the target gland responsible for producing the hormone Secondary Disease o The target gland is essentially normal but its function is altered by defective levels of stimulating hormones / releasing factors from the hypothalamus-pituitary system
jcmendiola_Achievers2013 Transsphenoidal Hypophysectomy - Transsphenoidal approach to the pituitary gland, removal is carried out through the nasal cavity, sphenoidal sinus and into the Sella Turcica
Advantages: No need to shave the head No visible scar Low blood loss, less need for transfusion Decreased infection rate Well tolerated by frail and older patients Good visualization of tumor field Disadvantages: Restriction field of surgery Potential cerebrospinal fluid (CSF) leak
Post-Operational Management: ` Vital signs, visual acuity and Neurologic status are monitored ` Urine output and specific gravity and serum electrolytes and osmolality are monitored for development of diabetes Insipidus and SIADH ` Drainage from nose is monitored for signs of infection or CSF leak (clear fluid)