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Care of Clients with Problems In Oxygenation,


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

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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

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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

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Alpha Cells Glucagon
Beta Cells Insulin
Delta Cells Somatostatin

General Aspects of Altered Endocrine Function

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




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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

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+ 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

Posterior Pituitary Gland
Hormone Effect (Decreased)
Antidiuretic Hormone (ADH) Diabetes Insipidus
Oxytocin Child birth problems / Pregnancy problems

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

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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


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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)