CARE OF CLIENTS WITH ENDOCRINE DISORDERS

THE ENDOCRINE SYSTEM

• The second great controlling system of the body.

• It coordinates and directs the activity of the body’s cells
• It allows communication within the distant sites of the body
• A collection of glands that produce hormones that regulate the body’s growth, metabolism
and sexual development and function.
• Hormones are released into the bloodstream and transported to tissues and organs
throughout the body.

THREE COMPONENTS OF THE ENDOCRINE SYSTEM

1. Endocrine glands
2. The Chemical Messengers called HORMONES
3. Target cells or organs

THE ENDOCRINE GLANDS - are organs that synthesize, store and secrete hormones into the
blood stream.

Functions of endocrine glands:

• maintain & regulate of vital functions

• response to stress & injury

• for growth & development

• energy metabolism

• reproduction

• fluid & electrolyte,acid base balance

PINEAL BODY

• A small cone- shaped gland that hangs from the roof of the third ventricle of the brain.

• Secretes melatonin which is believed to be a “sleep trigger”

HYPOTHALAMUS

• Is a small area of the brain located in the section of the forebrain called the diencephalon.

• It is concerned with HOMEOSTASIS.

HYPOTHALAMUS

• Activates and controls the part of the nervous system that controls involuntary body
functions, the hormonal system & regulates sleep and stimulates appetite
 • Secretes hypothalamic hormones

Pituitary gland

• Approx the size of a pea.

• It hangs by a stalk from the inferior surface of the hypothalamus.

Master gland

It has two functional lobes:

1. Anterior pituitary

2. Posterior pituitary

Pituitary and hypothalamus

Pituitary Gland Hormones

Posterior

Antidiuretic hormone (ADH)

Oxytocin

Anterior

Growth hormone (GH) or somatotropin

Thyroid-stimulating hormone (TSH)

Adrenocorticotropic hormone (ACTH)

Melanocyte-stimulating hormone (MSH)

Luteinizing hormone (LH)

Follicle-stimulating hormone (FSH)

Prolactin

LH, FSH, Prolactin

LH and FSH

Both hormones regulate production of gametes and reproductive hormones

Testosterone in males

Estrogen and progesterone in females

GnRH from hypothalamus stimulates LH and FSH secretion

Prolactin

Stimulates milk production in lactating females

TSH, ACTH, MSH

TSH or thyrotropin

Causes release of thyroid hormones from thyroid gland

ACTH or adrenocorticotropic

Stimulates cortisol secretion from adrenal cortex

Stimulates the release of steroid from the adrenal cortex

MSH or malanocyte stimulating hormone

Increases skin pigmentation

Growth Hormone (GH) SOMATOTROPIN

Stimulates uptake of amino acids and conversion into proteins

Stimulates breakdown of fats and glycogen

Promotes bone and cartilage growth

Increased secretion in response to increase amino acids, low blood glucose, or stress

Regulated by GHRH and GHIH or somatostatin

Oxytocin

Promotes uterine contractions during delivery

Causes milk ejection in lactating women

Antidiuretic Hormone

Also called vasopressin

Promotes water retention by kidneys

Secretion rate changes in response to alterations in blood osmolality and blood

volume

Lack of ADH secretion is a cause of diabetes insipidus

THYROID GLAND

Produces hormones that stimulate body heat production, bone growth, and the body’s
metabolism.

Secretes hormones:

Thyroxine(T4)

Triiodothyronine(T3)

Thyrocalcitonin
Thyroid Gland

One of largest endocrine glands

Highly vascular

Histology

Composed of follicles

Parafollicular cells

Secrete calcitonin which reduces calcium concentration in body fluids when levels
elevated

Thyroid Hormones

Include

Triiodothryronine or T3

Tetraiodothyronine or T4 or thyroxine

Transported in blood

Bind with intracellular receptor molecules and initiate new protein synthesis

TH- is stimulator,hypermetabolism result

Increase rate of glucose, fat, protein metabolism in many tissues thus increasing body
temperature

Normal growth of many tissues & brain development

Parathyroid Glands

4 small glands embedded in thyroid gland

Secrete PTH

regulates calcium & phosphorous metabolism

Stimulates osteoclasts

Promotes calcium reabsorption by kidneys

THYMUS GLAND

Play an important role in development of the immune system

Located in the neck and superior to the heart

Secretes thymosin

adrenal glands

Located on top of each kidney

 Secretes hormones that influence the body’s metabolism, blood chemicals & body
characteristics

Influence the NS involved in the response & defense against stress.

Adrenal Glands

Functions as part of sympathetic nervous system

Composed of medulla and cortex (3 layers)

Hormones

Medulla secretes epinephrine and norepinephrine(catecholamines)

Cortex secretes –(steroid hormones)- mineralocorticoids, glucocorticoids, androgens

PANCREAS

Secretes a hormone (insulin) & glucagon that controls the use of glucose by the body.

Pancreas

Located along small intestine and stomach

Influence CHO,CHON, FAT metabolism

Exocrine gland

Produces pancreatic digestive juices

Endocrine gland

Consists of pancreatic islets

Composed of

Alpha cells secrete glucagon

Beta cells secrete insulin

Delta cells secrete somatostatin

Insulin and Glucagon

Insulin

Target tissues: liver, adipose tissue, muscle, and satiety center of hypothalamus

Increases uptake of glucose and amino acids by cells

Glucagon

Target tissue is liver

Causes breakdown of glycogen and fats for energy

 ovaries and
testicles

Secretes hormones that influence female and male characteristics

Hormones of the Reproductive System

Male: Testes

Testosterone

Regulates production of sperm cells and development and maintenance of male

reproductive organs and secondary sex characteristics

Inhibin

Inhibits FSH secretion

Female: Ovaries

Estrogen and Progesterone

Uterine and mammary gland development and function, external genitalia structure,
secondary sex characteristics, menstrual cycle

Inhibin

Inhibits FSH secretion

Relaxin

Increases flexibility of symphysis pubis

The Endocrine System

FUNCTIONS

1. Maintainance and regulation of vital functions

2. Response to stress and injury

3. Growth and development

4. Energy metabolism

5. Reproduction

6. Fluid, electrolyte and acid-base balance

ENDOCRINE GLANDS

1. Pituitary

2. Adrenal

3. Thyroid
 4. Parathyroid

5. Pancreas

6. Ovaries

7. Testes

Sources of Hormones

Sources of Hormones

Sources of Hormones

Sources of Hormones

Sources of Hormones

Sources of Hormones

Sources of Hormones

PITUITARY GLAND

1. Anterior Pituitary (Adenohypophysis)

• Growth hormone (Somatotropin) effects of GH on cartilage growth require

Insulin like growth factors(IGFS) also called SOMATOMEDINS w/c produce
by the liver

• Hypersecretion :

• CAUSE by- pituitary tumor

Children - Gigantism

Adult – Acromegaly

Assessment:

large hands & feet,ht > 7 feet tall

thickening & protrusion of jaw, arthritic change

deepening of voice, dysphagia, oily rough skin

hypertension, visual disturbances

diaphoresis

Intervention:

Pharmaco therapy- for joint pains

Surgery: HYPOPHYSECTOMY removal of pituitary tumor via craniotomy or

via transphenoidal approach (endoscopic transnasal)
Complication of craniotomy:

Bleeding

Increase intracranial pressure

Meningitis

Hypopituitarism

Complication of transphenoidal surgery:

Cerebrospinal fluid leak

Hypopituitarism

Post op care

Monitor VS, neuro status,bleeding,inc ICP,POST NASAL DRIP (Indication of

cerebrospinal fluid in the transphenoidal surgery)

Avoid sneezing, coughing or blowing of the nose

Monitor I/O ,electrolytes for temporary ADH disturbances

ATB, ANALGESICS, ANTIPYRETICS

Glucocorticosteroids & other hormones replacement

HYPOPITUITARISM

Hyposecretion of one or more of the pituitary hormones caused by tumors, truma,

enchaphalitis,autoimmunity, stroke

Hormones most affected- GH,LH (gonadotropic), FSH

Assessment:

Obesity,low BP, infertility, sexual dysfunction,visual defect

Headache,reduced CO

Intervention:

Hormone replacement

HYPOSECRETION OF GH- DWARFISM

SOMATREN( PROTROPIN) stimulate linear growth

 • Intervention SIADH:

• Hypertonic IVF to correct hyponatrimia

• fluid restriction ,monitor for H2O intoxication

• Diuretics to control plasma osmolality

Monitor I/O, wt gain, electrolyte loss

• Administer Declomysin(demecloycline)drug to inhibit ADH & induced

H2O reabsorption & diuresis

Hyposecretion of ADH- Diabetes Insipidus

Causes- trauma, stroke, brain tumor,brain infections

kidney tubules fail to reabsorb H2O & respond to ADH

Assessment:

Polydipsia(2-20 L/ day)

Polyuria(diluted urine)-4-24L/day

Retarded growth

Dehydration ,postural hypotension, tachycardia,fatigue,headache

Constipation

• Dilute urine, ↓ sp. gr. ↓urine osmolality,↑se. osmolality

SAMPLE QUESTION

After several diagnostic tests, a client is diagnosed with diabetes insipidus. A nurse
performs an assessment on the client, knowing that which symptom is indicative of
this disorder?

A. Diarrhea

B. Polydipsia

C. Weight gain

D. Fatigue

Diabetic Insipidus

Collaborative management: objective to replace ADH,

ensure adequate fluid replacement, correct underlying cause

1.IVF
2.ADH replacement –DEMOSPRESSIN(DDAVP) by iv,sc,intranasally

adverse reaction of DDAVP –H2O intoxication

3.monitor vs, nuero & cardiovascular status, electrolyte.

4.monitor signs of dehydration, I/O,wt., sp.gravity of urine

Surgical tx-Hypophysectomy removal of post pituitary tumor

Nursing management:

Monitor VS,I/O, wt, neuro status,sp.gravity of urine

Monitor excessive thirst &urination avoid food or liquid that produce diuresis

Disorders of adrenal glands

Adrenal medulla-center of the gland

Adrenal cortex-outer

Regulated by hypothalamus-pituitary adrenal axis

hypothalamus

CRH(corticotropin releasing hormone)

ACTH

Glucocorticoid & minaralocorticoid hormones

Hypofunction of adrenal cortex(adrenOcortical insufficiency)

ADDISON’S Diseases (rare disorder)

HYPOSECRETION OF GLUCOCORTICOIDS

Causes:

Autoimmune or idiopathic atrophy of the adrenal

TB or histoplasmosis

Infection of the adrenal gland

Inadequate secretion of ACTH from pituitary gland

Adrenalectomy

Therapeutic use of corticosteriods (suppress function of Adrenal Cortex

Assessment-addison’s dis

Muscle weakness,fatigue,emaciation,anorexia,wt loss

Postural hypotension

Hypoglycemia,hyperkalemia,hyponatrimia

Emotional disturbances,inablity to cope up w/stress

Bronze pigmentation of the skin

Menstrual changes in woman, impotence in men

Addisson’s crisis-(life threatening crisis)-cyanosis,shock

pallor,confusion,restless,dehydration,rapid-weak pluse & RR, decrease BP

cause:hyponatremia,hypoglycemia,hyperkalemia & shock

Diagnostic test- lab test—dec BG,NA,ADRENOCORTICAL &cortisol levels,inc k,wbc

CT scan,MRI of the adrenal, kidney & pituitary

Collaborative management- Addison’s

Correct fluid & electrolyte imbalance

Steroid hormone replacement therapy

Hydrocortisone,Dexamethasone(decadron),Cortison Observe for signs of
Addison's crisis

Monitor wt, I/O,VS,K & BG levels

Avoid exposure to infection

Client education:

avoid infection

diet- hi in CHON,CHO, mod NA intake, restrict/low K intake

life long steroid replacement, gradual w/drawal of drug

Which of the following findings would be typical of Addison’s disease?

a. hypokalemia

b. hypernatremia

c. hypoglycemia
 d. decreased blood urea nitrogen level

Which of the following is the priority for a client in Addisonian crisis?

a. controlling hypertension

b. preventing irreversible shock

c. preventing infection

d. relieving anxiety

Hyperfunction of adrenal cortex

CUSHING SYNDROME (HYPERCORTISOLISM)

Overactivity of the adrenal gland with hypersecretion of glucocorticoid

Causes: Adrenal tumor

Adrenal hyperplasia

Over production of ACTH

Pituitary tumor that produces ACTH

Therapeutic use of hi dose of glucocorticoids

Manifestations:

“Moon face” oiliness of the skin,acne,dorsocervical fat on the neck”buffalo hump”,

NA & H2O retention, K depletion, cataract,

Hyperglycemia(steroid diabetes),wt gain, poor wound healing, hypertension

Inc production of androgens cause viralism(musculin changes)-hersutism

Mental changes memory loss, poor concentration

Medical management: CS

Adrenal tumor-Adrenalectomy removal of gland w/tumor

Pituitary tumor-resection of pit tumor via transphenoidal hypophysectomy

Hormone replacement ,,radiation therapy

Nursing management:

Diet-low NA&CHO,hi CHON & K

Dec risk for injury, infection

Improve body image,promote skin integrity

Observe adverse effect of steroids

Monitor potential complication:ADDISONIAN CRISIS

MONITOR BG & electrolyte status

Teach pt self care

A nurse instructor asks a student to describe the pathophysiology that occurs in

Cushing’s disease. Which statement by the student indicates an accurate
understanding of this disorder?

a. It is characterized by an oversecretion of glucocorticoid

hormones

b. It is characterized by an undersecretion of glucocorticoid

hormones

c. It is characterized by an oversecretion of insulin

d. It is characterized by an undersecretion of corticotropic

hormones

ALDOSTERON-MINERALCOSTEROID

HYPERALDOSTERONISM- Hypersecretion of aldosterone- cause by adrenal tumor w/c

produces :

CONN’s SYNDROME- Characteristics:

2ndary HTN hypokalemia, hypernatremia

CL Manifestations:

Hypokalemia,hypernatremia,alkalosis

Muscle weakness, cramping, paralysis, fatigue,

Metabolic alkalosis

Trousseau’s & chvostek’s signs

Glucose intolerance

Polydipsia,polyuria

Kidney inability to acidify & concentrate urine

Conn’s syndrome

Collaborative management:

Adrenalectomy-unilateral or bilateral
 Diet- low NA

monitor BP,monitor food supplement

Medications for HTN ,hypokalemia,aldactone

Commonly used corticosteriod prep:

Generic Brand

Hydrocortisone cortisol,cortef,solucortef,hydrocone

Dexametasone decadrone,dexon,delalone,dexameth

Prenisolone delta cortef,prelone

Bethamethasone celestone,bethameth

Methylprenisolone solu-medrol

Disorder of adrenal medulla

PHEOCHROMOCYTOMA-

CAUSE –Release of excessive amount of Catecholamine(epinephrine & norepinephrine

Manifestations:

HTN –major symptom (hallmark )

Headache, palpitation,diaphoresis,tremor,flushing,anxiety

Hyperglycemia

Complications-hypertensive retinopathy, nephropathy, CVA, myocarditis

Management

Adrenalectomy-monitor BP

Diet –hi vitamin,minerals,calories

Observe for HYPERTENSIVE CRISIS(LIFE TREATENING)

BP 250/150,dilated pupils,palpitation, tachycardia,blurring

vision,dysnea,headache,polyuria,N/V, ABM, abdo pain

med.for HTN crisis- REGITINE-PHENTOLAMINE MESYLATE

DISORDERS OF THYROID GLAND

EUTHYROID-normal thyroid function

GOITER-enlargement of the thyroid gland, result from lack of iodine, inflammation,

tumor
1.endemic goiter also known as simple goiter colloidal goiter nutritional iodine
deficiency(commom type) also caused by of large intake of goiterogenic subs.

intervention: supplementary iodine such as SSKI, or lugol’s sol.

2.Nodular goiter-overgrowth-hyperplesia of TG

pt.asymptomatic

Hallmark of Hyperthyroidism/Grave’s disease

Exopthalmos

Heart disease

Goiter

Thyroid storm(thyrotoxic crisis)-life treatening,precipitated by

stress,infection,trauma,diabetic ketoacidosis,thyroidectomy

Cl manifestations-hi fever,extreme tachycardia,N/V,hi BP,cong heart failure,altered

mental state,tremors,anxiety

Which of the following is a symtom of hyperthyroidism?

a. cold intolerance

b. weight loss

c. hypotension

d. buffalo hump

Sample Question

A nurse is performing an assessment on a client following a thyroidectomy. The nurse

notes that the client has developed hoarseness and a weak voice. Which nursing
action is most appropriate?

A. Notify the physician immediately

B. Reassure the client that this is usually a temporary condition

C. Check for signs of bleeding

D. Administer calcium gluconate

SAMPLE QUESTION

A nurse develops a plan of care for a client with Grave’s disease and includes which of
the following in the plan?

A. Provide small meals

B. Provide extra blankets

C. Provide a high-fiber diet

D. Provide a restful environment

Complication of hypothyrodism:

MYXEDEMA COMA CRISIS- mortality rate of nearly 100%

Characteristics:

Drastic decrease in metabolic rate

Hypoventilationleading to resp acidosis

Hypothermia

Hypotension

Hyponatrimia,hypercalcemia,hypoglycemia

H2O intoxication

Intervention:

Patent airway

IVF, glucose IV

THYROID HORMONE

MonitorBP ,electrolyte,changes in mental status

Sample Question

Mr. Tonkin is admitted to an emergency room, and a diagnosis of myxedema coma is

made. Which action would the nurse prepare to carry out initially?

A. Warm the client

B. Administer fluid replacement

C. Maintain an airway

D. Administer thyroid hormone

Assessment:

Hypo –causes:thyroidectomy,parathyroidectomy,radical neck

dissection,Grave’s,Hashimoto’s dis

Manifestations:

Low Ca & high P

- Trousseau or Chvostek sign, hyperactive DTR’s

- hypotension,tetany,anxiety,depression

Intervention: IV parathormone,IV calcim gluconate

 diet-hi cal.low phosphorus,Vit D po

Hyper – high Ca(hallmark) & low P

- cardiac dysrhythmias

- hypertension

Assessment of Hyperparathyroid

:muscoloskeletal symp-joint pain,bone deformities,pathologic fracture, muscle

weakness,

Renal envolment-polyuria,polydepsia,sand/stone in the urine

N/V, costipation ,peptic ulcer,

Hypercalcemia,hypophosphatemia

Complication:-HYPERCALCEMIC CRISIS- Extreme elevation of CALCIUM level

Collaborative management:

Hydration therapy

Drug to lower ca level-

Calcitonin salmon(calcimar)

Plicamycin,glucocorticoids,Gallium nitrate,Furosimide

Surgery-Parathyroidectomy

post op observe signs of CHVOSTEK’S,TROUSSEAUS’S ,LARYNGEAL STRIDOR

HYPOGLYCEMIA &
HYPERGLYCEMIA

A nurse is assisting a client with diabetes mellitus who is recovering from diabetic
ketoacidosis (DKA) to develop a plan to prevent a recurrence. Which of the following
is most important to include in the plan of care?

a. eat six small meals per day

b. receive appropriate follow-up health care

c. monitor blood glucose levels frequently

d. test urine for ketone levels

COMPLICATIONS OF DM

HYPOGLYCEMIA

Mild- BG level <50-60mg/dl

Moderate- BG level <40mg/dl

Severe – BG level <20mg/dl

Mild Moderate Severe

Hunger confusion disorientation

Nervousness double vision seizures

Palpitation drowsiness loss of consciousness

Sweating headache difficulty arousing memory lapses

from sleep

Tremor lightheadedness

Tachycardia slurred speech, numbness of lips & tongue

A nurse is caring for a client with type 1 diabetes mellitus. Which client complaint
would alert the nurse to the presence of a possible hypoglycemic reaction?

a. hot, dry skin c. anorexia

b. Muscle cramps d. tremors

A nurse is monitoring a client diagnosed with diabetes mellitus for signs of

complications. Which of the following, if exhibited in the client, would indicate
hyperglycemia & warrant physician notification?

a. hypertension c. polyuria

b. diaphoresis d. increased pulse rate

DIABETIC KETOACIDOSIS(DKA)

COMPLICATION OF TYPE 1 DM

Severe insulin deficiency (DKA)

3 MAIN clinical feature

Elevated blood glucose >250mg/dl

Dehydration/ electrolyte loss

Acidosis ,low plasma bicarbonate (PH<7.35, bicarb<15meq)

S/S

Acetone breath (fruity odor) due to inc ketone level

Kaussmaul resp-hyperventillation,v deep but not labored

Polyuria
Alert,or lethargic or comatose

Pathophysiology of DKA

Hyperglycemic hyperosmolar nonketotic syndrome-(hhns)

HHNS-severe hyperglycemia w/o acidosis & ketosis

Type 2 DM

Causes osmotic diuresis INTERVENTION:

Loss of water & electrolyes, Goal –hydrate

Glycosuria similar to DKA , insulin not needed Hypernatremia

Elevated BUN level & plasma osmolality

Manifestations:

Hypotension Tachycardia

Profound dehydration

Neurologic signs-seizure, alteration of sensorium,hemaparesis

Blood glucose level >600-1200mg/dl

Bella Flores is taking NPH daily every morning. The nurse instructs that the most
likely time for a hypoglycemic reaction to occur is:

1. 2-4 hrs after administration.

2. 6-14 hrs after administration.

3. 16-18 hrs after administration.

4. 18-24 hrs after administration.

A client with DM asks the nurse to recommend something to remove corns from his
toes. The nurse should advice him to

a. apply a high quality corn plaster to the

area

b. consult his physician or podiatrist about removing corns

c. apply iodine to the corns before peeling them off

d. soak his feet in borax solution to peel off the corns

“Don’t aim for success if you want it; just do what you love and believe in, and it will
come naturally.”

- DAVID FROST
“ Destiny is not a matter of chance, it is a matter of choice; it is not a thing to be
waited for, it is a thing to be achieved.”

- WILLIAM JENNINGS BRYAN