The Endocrine System

Endocrine System
Endocrine vs. Exocrine Organs are not physically connected Alters activities of target organs/cells Purpose: Growth/Development Reproduction Regulation Stress Reactions

Hormones are Activated By

Hormonal Humoral

Neural

Gland/Hormone Functions
Some glands produce >1 hormone
Some hormones produced by >1 gland Some organs have >1 function Some hormones have >1 function

Functions of Endocrine Glands

Endocrine Functions only Production Secretion Contained within other organs which have other functions

Categories of Glands
Central: Pituitary Hypothalamus
Thyroid Adrenals Parathyroids Thymus Pineal Gonads Pancreas Others

Peripheral:

Hypothalamus
Found on floor of diencephalon Neural and endocrine functions Biofeedback mechanism for: Osmotic pressures Temperature regulations Metabolic functions

Pituitary
Extends from Hypothalamus-behind sphenoid bone Master Gland of body Anterior- Portal network Posterior- Neural-contains axons of Hypothalamus neurons

Anterior Pituitary
GH- Growth Hormone Prolactin TSH- Thyroid Stimulating Hormone ACTH- Adrenocorticotropic FSH- Follicle Stimulating Hormone LH- Luteinizing Hormone

Posterior Pituitary
ADH- Anti-Diuretic Hormone Oxytocin

Pituitary Disorders
Acromegaly- Hypersecretion of GH
Dwarfism- Hyposecretion of GH

Thyroid
Inferior to larynx 2 Lobes T3- Triiodothyronine T4- Thyroxine Calcitonin

Thyroid Disorders
Hypothyroidism- Hyposecretion
Hyperthyroidism- Hypersecretion

Graves Disease

Goiters- iron deficiencies

Parathyroids
4 small glands posterior surface of thyroid Parathyroid hormone Responsible for osteoclast of bone Decreases blood phosphate levels (By way of kidneys) Enhances activation of Vitamin D

Parathyroid Disorders
Hyperparathyroidism
Moan and groan, stones and bones

Pineal Gland
Forms part of diencephalon Melatonin Inhibits hypothalamus release of gonadotropins Melatonin-decreases in light/increase in dark (circadian rhythm)

Thymus Gland
Posterior to sternum, around great vessels Thymosin Both lymphatic and endocrine Lymphatic- produces T-lymphocytes Endocrine- programs T-cells

The Adrenals
Located on superior end of each kidney
Medulla- inner gland Cortex- outer gland

Adrenal Medulla
Sympathetic preganglionic fibers synapse on cells in medulla
Release of epinephrine/norepinephrine into general circulation

Adrenal Cortex
Produce over 30 steroid hormones
Three main cortical hormones Mineralocorticoids Glucocorticoids Sex hormones

Mineralocorticoids
Regulate levels of electrolytes and water in extracellular fluid
95% are aldosterone
Sodium reabsorption Potassium excretion

Glucocorticoids
Influence carbohydrate metabolism Important in bodys response to stress 95% cortisol (hydrocortisone) stimulates gluconeogenesis secretion is regulated by ACTH

Sex Hormones
Androgens (testosterone)
Estrogens Both are secreted in greater numbers by gonads

Adrenal Disorders
Cushings diseasecortisol over-production secondary to increased ACTH
Addisons Diseasecortisol/aldosterone deficiencies

Gonads
Testes- males Testosterone Ovaries- females Estrogens Progesterone Both produce hormones/gametes

Pancreas
Retroperitoneal-posterior to stomach Exocrine & Endocrine Endocrine- islets of Langerhans Alpha Beta Delta

Alpha cells
20% of islets
Hormone glucagon Stimulates breakdown of glycogen in liver- raises glucose levels in blood (glycogenolysis & glyconeogenesis)

Beta Cells
75% of islets
Hormone- insulin Decreases glucose levels

Glucose Metabolism
Organic components of food: Carbohydrates (instant-energy) Glucose Fats Fatty acids/glycerols Proteins Amino acids

Carbohydrate Metabolism
Insulin is released by humoral, hormonal, neural means
Increased glucose Parasympathetic stimulation Gastrointestinal hormones

Carbohydrate Metabolism
60% of carbohydrates are stored as glycogen in liver
If muscles are not exercised after eating-stored as muscle glycogen

Glycolysis
Glucose is broken down into pyruvate and lactate- releasing 2ATPs
(Anaerobic metabolism)

Krebs Cycle

Fat Metabolism
A third of any glucose passing through liver is converted to fatty acids
Fatty acids are converted to triglycerides and stored in adipose tissue

Fat Metabolism
Without insulin, fat is broken back down into triglycerides/cholesterol CAD
Fatty acids are also broken down into ketone bodies

Protein Metabolism
In absence of insulin- protein storage stops and breakdown begins (muscle)
Amino acid breakdown for energy leads to increased urea in urine organ dysfunction

Pancreas Disorders
DiabetesType 1- Juvenile onset Type 2- Mature onset Gestational diabetes

Type 1 Diabetes
Insulin dependant
S/S: polyuria polydipsia polyphagia blurred vision weight loss

Type 2 Diabetes
Generally non-insulin dependant
Has ability to make small amounts of insulin

Can develop into insulin dependant

Gestational Diabetes
Develops during pregnancy
Deficiencies in insulin leads to inability to metabolize carbohydrates

Generally disappears after delivery

Insulin Agents
Early- porcine, bovine Recent- genetic engineered human insulin Protein Rapid, intermediate and long-term Combination of long-term, rapid each day

Insulin Types
Regular- Fast acting 0.5-1 hour onset 6-8 hour duration
NPH- Intermediate 1-1.5 hour onset 24 hour duration

Insulin Types
Ultralente- Long acting 4-6 hour onset 36 hour duration Oral agents:
Diabinese (chlorpropamide) Orinase (tolbutamide) Micronase (glyburide) Glucotrol

Diabetic Emergencies
Hypoglycemia Hyperglycemia Diabetic Ketoacidosis (DKA) Hyperosmolar Hyperglycemic Nonketotic Coma (HHNK)

Hypoglycemia
Rapid on-set < 60 mg/dl Causes: too much insulin decreased intake salicylates excessive activity beta blockers emotional stress hypothermia chronic alcoholism sepsis

S/S of Hypoglycemia
Altered LOCs- irritability, nervousness, confusion, combative Cool, clammy Weak, rapid pulse Snoring, salivation Normal BP

Diabetic Ketoacidosis
Fat metabolism leads to ketoacids Acidosis leads to K+ in circulation & hyperkaluria K+ deficiency Osmotic diuresis dehydration, electrolyte imbalances

S/S of DKA
Warm, dry skin Dry mucous membranes Tachycardia, thready pulse Postural hypotension Weight loss Polys

S/S of DKA
Abdominal pain Anorexia, nausea/vomiting Acetone breath Kussmauls Decreased LOC

Hyperosmolar Hyperglycemic Nonketotic Coma

Generally Type II diabetic Osmotic diuresis secondary to sugars Not acidotic as in DKA Factors: Geriatric Preexisting diseases Increased insulin requirements Medication use- thiazide, diuretics Parenteral/enteral feedings

S/S of HHNK
Weakness Thirst Polyuria Weight Loss Extreme dehydration

Treatment of Diabetic Emergencies

Hypoglycemia- ABCs
IV- NS Monitor ECG Oral, IV Dextrose Poss. Glucagon IM Poss. Thiamine Monitor glucose!

Treatment of Diabetic Emergencies

Hyperglycemia (DKA, HHNK)ABCs O2 IV- NS Monitor ECG for abnormalities