Assessment of the Endocrine

System

Endocrine system

Endocrine system (ES) the nervous

system and the interconnected network of
glands
A key feature of all endocrine glands (EG) is
the secretion of hormones
Hormones are biochemicals that exert their
effect on target tissues
Target tissues (TT) usually located some
distance from the endocrine gland, with no
direct physical connection between EG and
TT

Endocrine system

For this reason EG are called ductless

glands and must use circulatory system to
transport secreted hormones to the TT
EG include the following:

Pituitary gland
Adrenal glands
Thyroid gland
Islet cells of the pancreas
Parathyroid glands
Gonads

Endocrine system

The endocrine system works with the

nervous system to regulate overall
physiologic function
neuroendocrine regulation
The ES keeps the constant normal
balance (homeostasis) of the organs
and systems in response to
environmental changes

Endocrine system

Hormones:

steroid - hydrocortisone
peptide (protein) - insulin
amine epinephrine

Negative feedback control mechanisms

In the healthy physiologic state, hormone

concentration in the bloodstream is maintained
at a relatively constant level
When the hormone concentration rises, further
production of that hormone is inhibited
When the hormone concentration falls, the rate
of production of that hormone increases

Assessment. History

Demographic data

age and gender (some disorders are age

related: hyperosmolar states, loss of
ovarian function, decreased thyroid and
parathyroid function; and gender related
sexual effects of hyperpituitarism and
hypopituitarism)

Assessment. History

Personal and family history

family history of obesity, grows or development

difficulties, diabetes mellitus, infertility, or
thyroid disorders
assess the client of the following: endocrine
dysfunction; signs or symptoms that could
indicate an endocrine disorder; hospitalisations
past and current medications (hydrocortisone,
levothyroxine, oral contraceptives,
antihypertensive drugs)

Assessment. History

Diet history

Nutritional changes and GI tract

disturbances may reflect a variety of
endocrine problems (nausea, vomiting,
abdominal pain)
Changes in food and fluid intake
(diabetes insipidus, diabetes mellitus)
Rapid changes in weight without
accompanying changes in diet (diabetes
mellitus, thyroid disfunction)

Assessment. History

Socioeconomic status

are the clients resources adequate to maintain

the healthy diet, purchase needed medications

Current health problems

did the clients symptoms occur gradually, or

was the onset sudden?
has the client been treated for this problem in
the past?
How have the current symptoms interfered with
activities of daily living?

Assessment. History

energy levels (changes in energy levels are

associated with a number of endocrine
problems: thyroid, adrenal glands)
elimination

urine amount and frequency. Does he or she

urinate frequently in large amounts? Does the
client wake during the night to urinate
(nocturia), or does he or she experience pain on
urinaton (dysuria)?

information about the frequency of bowel

movements and their consistency and color

Assessment. History

sex and reproduction. Women are asked

about any changes in the menstrual
cycle (increased flow, duration,
frequency of menses; pain or excessive
cramping; or a recent change in the
regularity of menses). Men are asked
whether they have experienced
impotence. Both have to be asked about
changes in libido or any fertility problems

Assessment. History

Physical appearance. The client is asked

about changes in the following:

hair texture and distribution

facial contours
voice quality
body proportions
secondary sexual characteristics

Physical Assessment

Inspection

use a head-to-toe approach

observe a general clients appearance,
height, weight, fat distribution, muscle
mass in relation to age
head: prominent forehead, jaw; round or
puffy face; dull or flat face expression;
exophtalmos (protrunding eyeballs and
retracting upper lids)

Physical Assessment

Inspection

lower half of the neck visible enlargement of

the thyroid gland (N isthmus can be observed
during the swallowing)
jugular vein dilation can indicate fluid overload
skin color, areas of hypo- or
hyperpigmentation; fungal skin infections, slow
wound healing, petechiae (adrenocortical
hyperfunction); skin infections, foot ulcers, slow
wound healing (diabetes mellitus)

Physical Assessment

Vitiligo (patchy areas of depigmentation

with increased pigmentation at the edges)
primary hypofunction of the adrenal
glands. Most often occur on the face, neck
and extremities. Mucous membranes can
exhibit a large areas of pigmentation
Necessary to document the location,
distribution, color, size of all skin
discolorations and lesion

fingernails malformation, thickness, or

brittleness (thyroid gland difficulties)

Physical Assessment

the extremities and the base of the spine

are assessed for edema (disturbance in
fluid and electrolyte balance)
trunk

abnormalities in chest size and simmetry

truncal obesity, supraclavicular fat pads and
a buffalo hump adrenocortical excess
secondary sexual characteristics breasts
of both men and women for size,
symmetry, pigmentation and discharge

Physical Assessment

Striae (usually reddish purple stretch

marks) on the breasts or abdomen are
often seen with adrenocortical excess

hair distribution hirsutism (abnormal

grows of body hair, especially on the
face, chest, and the linea alba of the
abdomen of women), excessive hair loss,
or change in hair texture
genitalia (hypogonadism)

Physical Assessment

Palpation

Thyroid gland (size, symmetry, general

shape, presence of nodules or other
irregularities)

the nurse palpates the thyroid gland

standing either behind (may be easier) or
in front of the client
offering the client sips of water to promote
swallowing during the examination helps
palpate the thyroid gland

Physical Assessment

the client is asked to sit and to lower the

chin
using the posterior approach, the thumbs
of both hands are placed on the back of the
clients neck, with the fingers curved around
to the front of the neck on either side of
the trachea
the client is asked to swallow, and the
nurse locates the isthmus of the thyroid
and feels it rising. The anterior surface of
the thyroid lobe is also identified

Physical Assessment

to examine the right lobe, the nurse:

turns the clients head to the right

displaces the thyroid cartilage to the right with
the fingers of the left hand
palpates the right lobe with the right hand

this procedure is reversed for examination

of the left lobe

Physical Assessment

Auscultation

the nurse auscultates the clients chest to

establish baseline vital signs and to
determine irregularities in cardiac rate
and rhythm
the nurse documents any difference in
clients blood pressure and pulse in the
lying, standing, or sitting positions
(orthostatic vital signs) many
endocrine disorders can cause
dehydration and volume depletion

Physical Assessment

Auscultation

if an enlarged thyroid gland is palpated,

the area of enlargement is auscultaded
for bruits (hypertrophy causes an
increase in vascular flow)

Diagnostic Assessment

Laboratory tests

Best practice for endocrine testing

explain the procedure to the client

emphasize the importance of taking a medication
prescribed for the test on time. Tell the client to
set an alarm if the medication is to be taken
during the night
instruct the client to begin the urine collection
(whether for 2, 4, 8, 12 or 24 hours) by emptying
his or her bladder. Tell the client NOT to save the
urine specimen that begins the collection. The
timing for the urine collection begins after this
specimen. To end the collection, the client empties
his or her bladder at the end of the timed period
and adds that urine to the collection

Diagnostic Assessment

make sure that the preservative has

been added to the collection
container at the beginning of the
collection, if necessary. Tell the
client of its presence in the
container

Diagnostic Assessment

check your laboratorys method of

handling hormone test samples. Blood
samples drawn for certain hormones
(e.g., catecholamines) must be placed
on ice and taken to the laboratory
immediately
if you are drawing blood samples from
a line, clear the IV line thoroughly. Do
not use a double- or triple-lumen line
to obtain samples; contamination or
dilution from another port is possible

Diagnostic Assessment

Stimulation/suppression tests
Radioimmunoassay
Urine tests
Tests for glucose

Radiographic examinations
Other diagnostic tests (needle
biopsy)