The Endocrine System
production of the sex steroids, estrogen and
Endocrine system
• A system of glands, each of which secretes a type of
hormone into the bloodstream to regulate the body.
• The endocrine system is an information signal
system like the nervous system.
• Hormones regulate many functions of an organism,
including mood, growth and development, tissue
function, and metabolism.
• The endocrine system is made up of a series of
ductless glands that produce chemicals called
hormones.
Major endocrine gland
1. Hypothalamus
• is located in the lower central part of the brain.
• This part of the brain is important in regulation of
satiety, metabolism, and body temperature. In
addition, it secretes hormones that stimulate or
suppress the release of hormones in the pituitary
gland.
• Many of these hormones are releasing hormones,
which are secreted into an artery (the hypophyseal
portal system) that carries them directly to the
pituitary gland.
2. Pineal body
• The pineal body, or pineal gland, is located in the
middle of the brain.
• It secretes a hormone called melatonin, which may
help regulate the wake-sleep cycle of the body.
3. Pituitary gland
• located at the base of the brain beneath the
hypothalamus and is no larger than a pea.
• It is often considered the most important part of the
endocrine system because it produces hormones
that control many functions of other endocrine
glands.
• When the pituitary gland does not produce one or
more of its hormones or not enough of them, it is
called hypopituitarism.
• The pituitary gland is divided into two parts: the
anterior lobe and the posterior lobe.
The anterior lobe produces the following hormones, which are
regulated by the hypothalamus:
A. Growth hormone
• Stimulates growth of bone and tissue (growth
hormone deficiency in children results in growth
failure. Growth hormone deficiency in adults results
in problems in maintaining proper amounts of body
fat and muscle and bone mass.
B. Thyroid-stimulating hormone (TSH)
• Stimulates the thyroid gland to produce thyroid
hormones
C. Adrenocorticotropin hormone (ACTH)
• Stimulates the adrenal gland to produce several
related steroid hormones
D. and E. Luteinizing hormone (LH) and follicle-stimulating
hormone (FSH)
• Hormones that control sexual function and
progesterone in females or testosterone in males
F. Prolactin
• Hormone that stimulates milk production in females
The posterior lobe produces the following hormones, which
are not regulated by the hypothalamus:
A. Antidiuretic hormone (vasopressin) - Controls water loss by
the kidneys
B. Oxytocin - Contracts the uterus during childbirth and
stimulates milk production
• The hormones secreted by the posterior pituitary are
actually produced in the brain and carried to the
pituitary gland through nerves. They are stored in
the pituitary gland.
4. Thyroid gland
• Secretes the following hormones:
• Triiodothyronine
• Thyroxine (tetraiodothyronine)
• Calcitonin
5. Parathyroid gland
Secretes the hormone:
• Parathyroid hormone
6. Adrenal gland
• The adrenal glands are triangular-shaped glands
located on top of each kidney.
• The adrenal glands are made up of two parts.
• The outer part is called the adrenal cortex, and the
inner part is called the adrenal medulla.
• The outer part produces hormones called
corticosteroids, which regulate the body's
metabolism, the balance of salt and water in the
body, the immune system, and sexual function.
7. Thymus
• A specialized organ in the immune system.
• Thymus is responsible for the production of T-
lymphocytes (T cells), which are critical cells of the
adaptive immune system.
8. Reproductive gland
The reproductive glands are the main source of sex
hormones.
• In males, the testes, located in the scrotum, secrete
hormones called androgens; the most important of
which is testosterone.
• In females, the ovaries, located on both sides of the
uterus, produce estrogen and progesterone as well
as eggs.
9. Pancreas
• The pancreas is an elongated organ located toward
the back of the abdomen behind the stomach.
• The pancreas has digestive and hormonal functions.
One part of the pancreas, the exocrine pancreas,
secretes digestive enzymes.
 • The other part of the pancreas, the endocrine • Thyroid gland
pancreas, secretes hormones called insulin and
glucagon. • Parathyroid gland

• Pancreas
• These hormones regulate the level of glucose (sugar)
in the blood. Endocrine Changes Associated with Aging
Assessment of the Endocrine System • Increased antidiuretic hormone
Anatomy and Physiology Review • Decreased ovarian function
• Hypothalamus • Decreased glucose tolerance
• Pituitary glands • Decreased peripheral metabolism
• Gonads Assessment Techniques
• Adrenal glands

• History • Personal history

• Demographic data • Diet history

• Family history and genetic risk • Socioeconomic status

• Current health problems including any changes in

the following:

• Energy levels • Sexual and reproductive functions

• Elimination • Physical appearance

Physical Assessment • Examine for the following:

• Prominent forehead or jaw • Vitiligo

• Round or puffy face • Striae

• Dull or flat expression • Hirsutism

• Exophthalmos

Palpation – Androgen therapy for virilization;

gynecomastia can occur
• Thyroid glands and testes can be examined by
palpation. – Estrogens and progesterone

• Auscultation is used to establish baseline vital signs – Growth hormone

and to assess cardiac rate and rhythm.
Hyperpituitarism
• Assess client’s coping skills for endocrine
dysfunction; referral to social service agency may be • Hormone oversecretion occurs with pituitary tumors
required. or hyperplasia

Laboratory Tests • Neurologic symptoms may occur.

• Stimulation/suppression tests • Galactorrhea, amenorrhea, and infertility can result.

• Assays
• Gigantism is the onset of growth hormone
hypersecretion before puberty.
• Urine tests

• Tests for glucose • Acromegaly is the onset of growth hormone

hypersecretion after puberty.
• Radiographic examinations
• Disturbed Body Image
• Other diagnostic tests
• Interventions include:
Interventions for Clients with Pituitary and Adrenal
Gland Problems – Nonsurgical management:

Hypopituitarism • Drug therapy

• Deficiency of one or more anterior pituitary hormone • Radiation therapy

results in metabolic problems and sexual
dysfunction. – Surgical management:

• Growth hormone stimulates the liver to produce • Preoperative care

substances known as somatomedins that enhance
growth activity. • Operative procedure

• Collaborative Management • Postoperative Care

• Assessment • Monitor neurologic response.

• Interventions include: • Observe for complications.

– Replacement of deficient hormones • Assess for postnasal drip.

• Teach client to avoid coughing early after the – Blood volume depletion
surgery.
– Hyperkalemia, which can cause cardiac
• Assess for meningitis. arrest

• Replace hormones and glucocorticoids as needed. Interventions

• Sexual Dysfunction • Promote fluid balance and monitor for fluid deficit.

• Interventions for hyperpituitarism: • Record weight daily.

– Identification of specific client problems with • Ensure fluid balance.

sexual expression.
• Assess vital signs every 1 to 4 hours, assess for
– Drug therapy to supplement hormones as dysrhythmias or postural hypotension.
needed.
• Monitor laboratory values to identify
Diabetes Insipidus hemoconcentration.

• Water metabolism problem caused by an antidiuretic • Give cortisol and aldosterone replacement therapy.
hormone deficiency
Adrenal Gland Hyperfunction
• Diabetes insipidus is classified as:
• Cushing’s syndrome
– Nephrogenic
• Pheochromocytoma
– Primary
Clinical manifestations:
– Secondary
• buffalo hump, enlarged trunk, acne, muscle wasting,
– Drug-related weakness

• Assessment • Hirsutism, clitoral hypertrophy, and male pattern

balding in women
• Diabetes insipidus related to dehydration
Nonsurgical Management
• Increase in frequency of urination and excessive
thirst • Drug therapy gives temporary relief: mitotane,
aminoglutethimide, metyrapone
• Dehydration and hypertonic saline tests used for
diagnosis of the disorder • Radiation therapy

• Urine diluted with a low specific gravity (<1.005) Surgical Management

• Interventions • Total hypophysectomy

• Oral chlorpropamide • Preoperative care

• Desmopressin acetate intranasally • Operative procedure

• Early detection of dehydration and maintenance of • Postoperative care

adequate hydration
– Preventing skin breakdown
• Lifelong vasopressin therapy for clients with
permanent condition of diabetes insipidus – Pathologic fractures

• Syndrome of Inappropriate Antidiuretic Hormone – Gastrointestinal bleeding

Secretion
Hyperaldosteronism
• Vasopressin is secreted even when plasma
osmolarity is low or normal. • Conn's syndrome

• Feedback mechanisms do not function properly. • Interventions include:

• Water is retained, resulting in hyponatremia – Surgery when potassium levels are normal
(decreased serum sodium level).
– Drugs to increase potassium levels
Interventions
– Glucocorticoid replacement to prevent
• Fluid restriction adrenal crisis

• Drug therapy: diuretics, hypertonic saline, Pheochromocytoma

demeclocycline
• Catecholamine-producing tumors that arise in
• Safe environment chromaffin cells

• Neurologic assessment every 4 hours • Intermittent episodes of hypertension or attacks

varying in length from a few minutes to several hours
Adrenal Gland Hypofunction
• Main treatment: surgery
Addisonian crisis
• Treatment of hypertension to reduce stressors
• Clinical manifestations include:

– Decreased pigmentation • Diet rich in calories, vitamins, and minerals

– Decreased body hair Interventions for Clients with Problems of the Thyroid
and Parathyroid Glands
– Hypoglycemia
Hyperthyroidism
 Thyrotoxicosis Ineffective Breathing Pattern

 Graves’ disease, the most frequent causes: goiter,  Interventions:

exophthalmos, pretibialedema
◦ Observe and record rate and depth of
Laboratory assessment respirations.

 Thyroid scan ◦ Auscultate the lungs.

◦ Assess for respiratory distress.

 Ultrasonography
◦ Assess the client receiving sedation for
 Electrocardiography
respiratory adequacy.
Drug Therapy
Disturbed Thought Processes
 Radioactive iodine therapy; not used in pregnant
 Interventions:
women
◦ Assess lethargy, drowsiness, memory
◦ Additional drug therapy may be needed.
deficit, poor attention span, and difficulty
communicating.
◦ Implement radiation precautions.
◦ These problems should decrease with
◦ Monitor regularly for changes in thyroid thyroid hormone treatment.
function.
◦ Provide a safe environment.
Surgical Management
◦ Provide family teaching.
 Surgery possible in absence of good response to drug
therapy.
Myxedema Coma
 Postoperative care for:
 Coma, respiratory failure, hypotension,
hyponatremia, hypothermia, hypoglycemia
◦ Hemorrhage
 Emergency care
◦ Respiratory distress
Thyroiditis
◦ Hypocalcemia and tetany
 Inflammation of the thyroid gland
◦ Laryngeal nerve damage
 Three types of thyroiditis: acute, subacute
◦ Thyroid storm or thyroid crisis (granulomatous), and chronic (Hashimoto’s disease)
—the most common type
Infiltrative Opthalmopathy
 Dysphagia and painless enlargement of the gland
 Provide symptomatic treatment.
 Nonsurgical management, drug therapy
 Treatment of hyperthyroidism does not correct eye
and vision problems of Graves’ disease.
 Surgical management
 Elevate the head of bed at night. Thyroid Cancer

 Instill artificial tears.  Papillary, follicular, medullary, and anaplastic

 Treat photophobia with dark glasses.  Collaborative management

 Give steroid therapy.  Surgery treatment of choice: thyroidectomy

 Provide diuretics.  Suppressive doses of thyroid hormone for 3 months

after surgery
Hypothyroidism
 Study performed after drugs are withdrawn
 Decreased metabolism from low levels of thyroid
hormones Hyperparathyroidism

 Myxedema coma a rare, serious complication  Parathyroid glands: calcium and phosphate balance

 Mostly a result of thyroid surgery and radioactive  Hypercalcemia and hypophosphatemia

iodine treatment of hyperthyroidism
 Nonsurgical management:
 Clinical manifestations
◦ Diuretic and fluid therapy
 Decreased Cardiac Output
◦ Drug therapy: phosphates, calcitonin,
 Interventions: calcium chelators

◦ Monitor circulatory status.  Surgical Management

◦ Monitor for signs of inadequate tissue  Parathyroidectomy preoperative care:

oxygenation.
◦ Client stabilized; calcium levels normalized
◦ Monitor for changes in mental status.
◦ Studies: bleeding and clotting times, CBC
◦ Monitor fluid status and heart rate.
◦ Teaching: coughing, deep-breathing
◦ Administer oxygen or mechanical exercises, neck support
ventilation, as appropriate.
  Operative procedures

(Continued)

 Postoperative care includes:

◦ Observe for respiratory distress.

◦ Keep emergency equipment at bedside.

◦ Hypocalcemic crisis can occur.

◦ Recurrent laryngeal nerve damage can

occur.

Hypoparathyroidism

 Decreased function of the parathyroid gland

 Iatrogenic hypoparathyroidism

 Idiopathic hypoparathyroidism

 Hypomagnesemia

 Interventions: correcting hypocalcemia, vitamin D

deficiency, and hypomagnesemia