which of these tissues are

a part of the endocrine system?

Thymus, Pituitary, Kidnys

adrenals, thyroid/parathyroid

Spleen, pancreas, ova/testes 

Pituitary, adrenals, thyroid/parathyroid, 

pancreas, ova/testes 

What hormones are produced by the

Hypothalamus?

Thyroid-stimulating hormone (TSH)

Adrenocorticotropic hormone (ACTH, corticotropin) 

Luteinizing hormone (LH)

Follicle-stimulating hormone (FSH)

Prolactin (PRL)

Growth hormone (GH)

Melanocyte-stimulating hormone (MSH)

Vasopressin (antidiuretic hormone [ADH])

Oxytocin

Triiodothyronine (T3)

Thyroxine (T4)

Calcitonin

Glucocorticoids (Cortisol) 

Mineralocorticoids (aldosterone)

Estrogen

Progesterone

Insulin

Glucagon

Somatostatin

Thyroid

Stimulates synthesis and release of thyroid hormone

ACTH (adrenocorticotropic hormone, corticotropin)

stimulayes _____ tissue and has what action on the body?

Adrenal cortex

Stimulates synthesis and release of corticosteroids and adrenocortical growth

Ovary/Testis

Stimulates ovulation and progesterone secretion

Stimulates testosterone secretion

FSH (follicle-stimulating hormone)

stimulayes _____ tissue and has what action on the body?

Ovary/Testis

Stimulates estrogen secretion and follicle maturation

Stimulates spermatogenesis

Mammary glands

Stimulates breast milk production

GH (growth hormone)

stimulayes _____ tissue and has what action on the body?

Bone and soft tissue

Promotes growth through lipolysis, protein anabolism, and insulin antagonism

MSH (melanocyte-stimulating hormone)

stimulayes _____ tissue and has what action on the body?

Melanocytes

Promotes pigmentation

Vasopressin (antidiuretic hormone [ADH])

stimulayes _____ tissue and has what action on the body?

Kidney

Promotes water reabsorption

Oxytocin stimulayes _____ tissue and

has what action on the body?

Uterus and mammary glands

Stimulates uterine contractions and ejection of breast milk

• Maintain blood glucose level 

• Increase lipolysis, 

• Increase protein catabolism

• Degrade collagen and connective tissue

• Increase the number leukocytes released 

• Exert anti-inflammatory effects  

• Maintain behavior and cognitive functions

How do Glucocorticoid Hormones 

Increase lipolysis?

How do Glucocorticoid Hormones 

Exert anti-inflammatory effects?

• Fetal development,

• Control metabolic rate of all cells

• Promote other pituitary secretion 

• Regulate protein, carbohydrate, and fat metabolism

• Exert chronotropic and inotropic cardiac effects

• Increase red blood cell production

• Affect respiratory rate and drive

• Increase bone formation and decrease bone resorption of calcium 

• Act as insulin antagonists

calcium and phosphorus metabolism

by acting on bone, kidney, and the intestinal tract

Promotes glycogen synthesis and storage

• Inhibits glycogenolysis, gluconeogenesis, and ketogenesis

• Increases triglyceride synthesis

• Promotes protein synthesis

• Increases amino acid transport

• Promotes glycogenesis

• Increases fatty acid synthesis

• Promotes triglyceride storage

• Decreases lipolysis

the hormone causes the opposite action of the initial condition change.

ex: When blood glucose levels start to rise above normal, the hormone insulin is secreted. Insulin increases glucose uptake by the cells, causing a decrease in blood glucose levels.

Thus the action of insulin (decreasing blood glucose levels) is the opposite of or negative to the condition that stimulated insulin secretion (elevated blood glucose levels).

hormones that stimulate other endocrine glands

ex: TSH, FSH

luteinizing hormone [LH] 

follicle-stimulatinghormone [FSH]

renin-angiotensin system, serum potassium ion concentration, and adrenocorticotropic hormone (ACTH).

The adrenal cortex secretes aldosterone when the serum potassium level increases above normal by as little as 0.1 mEq/L.

The main glucocorticoid produced by

the adrenal cortex is:

• Carbohydrate, protein, and fat metabolism

• The body's response to stress

• Emotional stability • Immune function

androgens and estrogens

****Adrenal secretion of these hormones is usually not significant because the gonads (ovaries and testes) secrete much larger amounts of estrogens and androgens.

In women the adrenal gland is

the major source of _____

The adrenal medulla has secretory cells

that stimulate What?

Cold temperatures increase the conversion of T4 to T3.

True of Fales?

T3 and T4.

The two hormones differ in structure, but their functions are the same.

What is the secretion of

T3 and T4 is controlled by?

the pituitary-thyroid gland axis feedback mechanism.

If thyroid hormone levels are high, TSH release is inhibited. If thyroid hormone levels are low, TSH release is increased.

Elevated serum calcium levels increase

the secretion of _______.

increases serum calcium by three methods:

bone release of calcium.

activates vitamin D, which then increases the absorption of calcium and phosphorus from the intestines.

In the kidney tubules, PTH allows calcium to be reabsorbed

Serum calcium level

Secretion decreases when serum calcium levels are high, and it increases when serum calcium levels are low.

liver, it causes glycogenolysis

(the conversion of glycogen to glucose).

anabolic 

(one that stimulates growth)

As you age there is a decreas in  antidiuretic hormone (ADH) production. which means Urine is more dilute and may not concentrate when fluid intake is low.

What are the Nursing Actions/Adaptations for this pt?

The patient is at greater risk for dehydration as a result of urine loss. 

Assess the older patient more frequently for dehydration. If fluids are not restricted because of another health problem, teach CNAs to offer fluids at least every 2 hours while awake.

As you age there is a decreas in  ovarian production of estrogen. This means Bone density decreases.

What are the Nursing Actions/Adaptations for this pt?

Teach the patient to engage in regular exercise and weightbearing activity to maintain bone density. 

Handle the patient carefully to avoid injury from pathologic fractures.

As you age there is a decreas in  ovarian production of estrogen. This means the Skin is thinner, drier, and at greater risk for injury.

What are the Nursing Actions/Adaptations for this pt?

Avoid pulling or dragging the patient. 

Use minimal tape on the skin. 

Assist patients confined to bed or chairs to change positions at least every 2 hours. 

Teach patients to use moisturizers on the skin and to avoid agents that promote skin dryness.

As you age there is a decreas in  ovarian production of estrogen. This means Perineal and vaginal tissues become drier, and the risk for cystitis increases.

What are the Nursing Actions/Adaptations for this pt?

Perform or assist the patient to perform perineal care at least twice daily. 

Unless another health problem requires fluid restriction, encourage all women to drink at least 3 liters of fluids daily. 

Teach sexually active patients to urinate immediately after sexual intercourse.

As you age there is a decreas in glucose tolerance. This means Weight becomes greater than ideal along with: • Elevated fasting blood glucose level • Elevated random blood glucose level • Slow wound healing • Frequent yeast infections • Polydipsia • Polyuria

What are the Nursing Actions/Adaptations for this pt?

Encourage the patient to engage in regular exercise and to keep body weight within 10 lbs of ideal. 

Teach patients the clinical manifestations of diabetes, and in¬ struct them to report any of these manifestations to the health care provider. 

Suggest diabetes testing for any patient with: Persistent vaginal candidiasis, Failure of a foot or leg skin wound to heal in 2 weeks or less, Increased hunger and thirst, Noticeable decrease in energy level

As you age there is a decreas in general metabolism. 

This means there is: Less tolerant of cold. Decreased appetite. Decreased heart rate & blood pressure (BP).

 What are the Nursing Actions/Adaptations for this pt?

rule out hypothyroidism. Can be difficult to distinguish betwine the two.

Teach patient to dress warmly.

eat small but frequent meals

What two hormone deficienciesare the most life threatening?

testicular failure:

decreased testosterone production

decreased or absent spermatogenesis.

Decreased testosterone levels in men cause sterility.

Growth hormone (GH) deficiency changes tissue growth patterns directly.

True or Fales?

Fales.

Growth hormone (GH) deficiency changes tissue growth patterns indirectly.

GH itself has little effect on tissues and cells. Rather, the presence of GH stimulates the liver to produce substances known as somatomedins. These somatomedins then enhance growth activities in cells and tissues.

↑ rate of bone destructive activity, leading to thinner, more fragile bones (osteoporosis)

and an increased risk for fractures

tumors, malnutrition, Shock or severe hypotension, infarction,

head trauma, infection, radiation or surgery, AIDS

Postpartum hemorrhage

This is known as Sheehan's syndrome.

What are the S/S of 

Gonadotropin (LH and FSH) deficiency?

loss of or change in secondary sex characteristics

men- facial and body hair loss.

episodes of impotence and decreased libido

Women- amenorrhea, dyspareunia (painful inter¬ course), infertility  and decreased libido. dry skin, breast atrophy, and a decreased amount or absence of axillary and pubic hair.

vision

Assess the patient's visual acuity, especially peripheral vision, for changes or loss.

Deficient Hormone

Growth hormone (GH)

What are the Clinical Manifestations?

Decreased bone density,  

Pathologic fractures,  Decreased muscle strength, 

Increased serum cholesterol levels

Women: Amenorrhea Anovulation Low estrogen levels Breast atrophy Loss of bone density Decreased axillary and pubic hair Decreased libido 

Men: Decreased facial hair Decreased ejaculate volume Reduced muscle mass Loss of bone density Decreased body hair Decreased libido Impotence

Decreased thyroid hormone levels 

Weight gain

Intolerance to cold

Scalp alopecia

Hirsutism

Menstrual abnormalities

Decreased libido

Slowed cognition

Lethargy

Decreased serum Cortisol levels

Pale, sallow complexion,  Malaise and lethargy

Anorexia,  Postural hypotension, Headache,

Hypoglycemia, Hyponatremia,

Decreased axillary/pubic hair (women)

Diabetes insipidus: 

• Greatly increased urine output

• Low urine specific gravity (< 1.005)

• Hypovolemia: Hypotension Dehydration 

• Increased plasma osmolarity • Increased thirst

• Output does not decrease when fluid intake decreases

Addison's

(chronic adrenal insufficiency, hypocortisolism, and hypocorticism)

What part of the brain helps regulates negative feed back

(temp, breath, blood osmolarity) 

For the patient who might have an underactive endocrine gland.

 to determine whether the gland is capable of normal hormone production.

hormones are given to stimulate the target gland to maximum production. Hormone levels are then measured and compared with expected normal values.

replacement of deficient hormones.

Older patients or those with a chronic disease often require a lower amount of hormone replacement.

Anterior Pituitary Hyperfunction

S/S of hyper:

 PROLACTIN (PRL)

Hypogonadism (loss of secondary sexual characteristics)

• Decreased gonadotropin levels • Galactorrhea

• Increased body fat • Increased serum prolactin levels

Anterior Pituitary Hyperfunction

S/S of hyper:

GROWTH HORMONE (GH) ACROMEGALY

Anterior Pituitary Hyperfunction

S/S of hyper:

ADRENOCORTICOTROPIC HORMONE (ACTH)

CUSHING'S DISEASE (PITUITARY)

• Elevated plasma Cortisol levels

• Weight gain

• Truncal obesity • "Moon face" • Extremity muscle wasting • Loss of bone density

• Hypertension

• Hyperglycemia • Purple striae • Acne

• Thin, easily damaged skin

• Hyperpigmentation

Anterior Pituitary Hyperfunction

S/S of hyper:

THYROTROPIN

(THYROID-STIMULATING HORMONE [TSH])

• Elevated plasma TSH levels

• Elevated plasma thyroid hormone levels

• Weight loss • Tachycardia and dysrhythmias

• Heat intolerance • Increased Gl motility • Fine tremors

Anterior Pituitary Hyperfunction

S/S of hyper:

GONADOTROPINS (LUTEINIZING HORMONE [LH], FOLLICLE-STIMULATING HORMONE [FSH])

MEN

• Elevated LH and FSH levels

• Hypogonadism or hypergonadism

Anterior Pituitary Hyperfunction

S/S of hyper:

GONADOTROPINS (LUTEINIZING HORMONE [LH], FOLLICLE-STIMULATING HORMONE [FSH])

Women

• Normal LH and FSH levels

(The most common clinical manifestations in men and women are related to the physical presence of a tumor rather than to excessive hormone secretion.)

 dopamine agonists, including bromocriptine mesylate (Parlodel), cabergoline (Dostinex), and pergolide (Permax)

These drugs stimulate dopamine receptors in the brain and inhibit the release of many pituitary hormones, most specifically GH and PRL.

Surgical removal of the pituitary gland and tumor

it is the most common treatment for hyperpituitarism.

decreases hormone levels, relieves headaches, and may reverse changes in sexual functioning.

Body changes, organ enlargement, and visual changes are not usually reversible.

Affter a hypophysectomy _____ packing is present for 2 to 3 days after surgery.

it will be necessary to breathe through the ______.

nasal 

mouth

What should a pt not do after a hypophysectomy, untill heald?

Why?

brush teeth, cough, sneeze, blow the nose, or bend forward after surgery.

These activities can open the muscle graft, increase intracranial pressure, and delay healing of the incision.

about 2 weeks after surgery until the incision has healed.

the patients neurologic response: changes in vision, mental status, al¬ tered level of consciousness, or decreased strength of the extremities.

This is an inication of ↑ ICP

postnasal drip:

Assess nasal drainage for quantity, quality, and the presence of glucose (which indicates that the fluid is CSF).

light yellow color at the edge of the clear drainage on the dressing is called the "halo sign" = CSF.

Patients that have had a hypophysectomy may have mouth dryness from mouth breathing.

Wha kind of oral care can they do?

After a hypophysectomy what kind of infection are pts at risk of?

How would you assess it?

meningitis

assess for headache, fever, and nuchal (neck) rigidity.

After the pituitary gland has been removed, hormone replacment is optional.

True or false?

False

If the entire pituitary gland has been removed, thyroid hormones and glucocorticoid replacement is lifelong.

ADH deficiency

(either a decrease in ADH synthesis or an inability of the kidneys to respond to ADH).

results in the excretion of large volumes of dilute urine

Nephrogenic diabetes insipidus is an ________ disorder,

Inwhich the renal ______  do not respond to the actions of ADH.

inherited 

tubules 

Drugs: 

Desmopressin (DDAVP, Rhinal Tube, Minirin, Stimate)

Vasopressin (Pitressin)

The syndrome of inappropriate antidiuretic hormone (SIADH)

is a problem in which vasopressin (antidiuretic hormoney [ADH]) is secreted even when plasma osmolarity is low or normal.

A decrease in plasma osmolarity normally inhibits ADH production and secretion.

SIADH occurs with specific drugs.

What type of drug?

hyponatremia  

expansion of the extracellular fluid volume

(fluid vol. overload)

• Recent head trauma • Cerebrovascular disease

• Tuberculosis or other pulmonary disease • Cancer

• past and current drug use

Fluid restriction

Measure intake, output, and daily weights

Drug therapy: diuretics

Hypertonic saline

inadequate secretion of adrenocorticotropic hormone (ACTH), dysfunction or direct dysfunction of adrenal gland tissue.

Manifestations occur quickly with stress.

decreased gluconeogenesis, along with depletion of liver and muscle glycogen.

leading to hypoglycemia

The glomerular filtration rate and gastric acid production decrease

leading to reduced urea nitrogen excretion, causing anorexia and weight loss.

Emergency Care of the Patient with Acute Adrenal Insufficiency 

HORMONE REPLACEMENT

Start rapid infusion of normal saline or dextrose 5% in normal saline. 

• Initial dose of hydrocortisone sodium succinate (SoluCortef) is 100 to 300 mg or dexamethasone 4 to 12 mg as an IV bolus. 

• Infuse additional 100 mg of hydrocortisone sodium succinate by continuous IV drip over the next 8 hours. 

• Give hydrocortisone 50 mg IM concomitantly every 12 hours. 

• Initiate an H2 histamine blocker (e.g., ranitidine) IV for ulcer prevention.

Emergency Care of the Patient with Acute Adrenal Insufficiency 

HYPERKALEMIA MANAGEMENT

Administer insulin (20 to 50 units) with dextrose (20 to 

50 mg) in normal saline to shift potassium into cells. 

• Administer potassium binding and excreting resin (e.g., Kayexalate). 

• Give loop or thiazide diuretics. 

• Avoid potassium-sparing diuretics. 

• Initiate potassium restriction. 

• Monitor intake and output. 

• Monitor heart rate, rhythm, and ECG for manifestations of hyperkalemia (slow heart rate; block; tall, peaked T waves; fibrillation; asystole).

Emergency Care of the Patient with Acute Adrenal Insufficiency 

HYPOGLYCEMIA MANAGEMENT

Administer IV glucose. 

• Administer glucagon, as needed. 

• Maintain IV access. 

• Monitor blood glucose level hourly.

What are the S/S of Addison's disease

NEUROMUSCULAR MANIFESTATIONS

What are the S/S of Addison's disease

Anorexia • Nausea, vomiting • Abdominal pain

• Bowel changes (constipation/diarrhea) • Weight loss

• Salt craving

What are the S/S of Addison's disease

What are the S/S of Addison's disease

CARDIOVASCULAR MANIFESTATIONS

• Anemia • Hypotension • Hyponatremia

• Hyperkalemia • Hypercalcemia

What laboratory findings would you

expect with  Addison's disease?

low serum Cortisol, low fasting blood glucose, low sodium, elevated potassium, and increased blood urea nitrogen (BUN) levels.

In primary disease, the eosinophil count and ACTH level are elevated.

Nursing interventions of Addison's aim to promote what?

How?

fluid balance:

monitor for fluid deficit

prevent hypoglycemia  

Weigh the patient daily, record intake and output

Assess vital signs every 1 to 4 hours,

assess for dysrhythmias or postural hypotension. 

mineralocorticoid hormone,

such as fludrocortisone (Florinef),

Hyperstimulation of the adrenal medulla caused by a tumor 

results in excessive secretion of catecholamines, of which 80% is epinephrine and the remainder is norepinephrine.

The presence of excess glucocorticoids, regardless of the cause, affects metabolism and all body systems to some degree.

True or Fales?

Conditions Causing Increased Cortisol Secretion 

ENDOGENOUS SECRETION (CUSHING'S DISEASE)

Bilateral adrenal hyperplasia*

• Pituitary adenoma increasing the production of ACTH (pitu¬ itary Cushing's disease) 

• Malignancies: carcinomas of the lung, Gl tract, pancreas • Adrenal adenomas or carcinomas

Conditions Causing Increased Cortisol Secretion 

EXOGENOUS ADMINISTRATION (CUSHING'S SYNDROME)

Therapeutic use of ACTH or glucocorticoids—most commonly for treatment of: 

Asthma Autoimmune disorders Organ transplantation Cancer chemotherapy Allergic responses Chronic fibrosis

What are S/S of Hypercortisolism

(Cushing's Disease/Syndrome)

GENERAL APPEARANCE

• Fat redistribution: 

• Moon face • Buffalo hump • Truncal obesity 

• Weight gain

What are S/S of Hypercortisolism

(Cushing's Disease/Syndrome)

CARDIOVASCULAR MANIFESTATIONS

Hypertension • Increased risk for thromboembolic events • Frequent dependent edema • Capillary fragility: 

• Bruising • Petechiae

What are S/S of Hypercortisolism

(Cushing's Disease/Syndrome)

MUSCULOSKELETAL MANIFESTATIONS

Muscle atrophy (most apparent in extremities)

• Osteoporosis (bone density loss) 

• Pathologic fractures

• Decreased height with vertebral collapse

• Aseptic necrosis of the femur head

• Slow or poor healing of bone fractures

What are S/S of Hypercortisolism

(Cushing's Disease/Syndrome)

• Thinning skin ("paper-like" appearance, especially on the back of the hands) 

• Striae

• Increased pigmentation (with ectopic or pituitary production of ACTH)

What are S/S of Hypercortisolism

(Cushing's Disease/Syndrome)

• Increased risk for infection

Decreased immune function: 

• Decreased circulating lymphocytes • Decreased production of immunoglobulins (antibodies) 

• Decreased inflammatory responses: • Decreased eosinophil count • Slight increase in neutrophil count but activity is reduced 

• Decreased production of proinflammatory cytokines, histamine, and prostaglandins 

• Manifestations of infection/inflammation may be masked

drug therapy, nutrition therapy,

and monitoring fluid volume excess.

Notify the health care provider of any change that indicates the fluid overload

Pt risk for skin breakdown. Use a pressure-reducing or pressurerelieving overlay on the mattress.

Assess skin pressure areas

change positions every 2 hours, 

Aminoglutethimide (Elipten, Cytadren)- to decrease Cortisol production.

metyrapone (Metopirone)-to decrease Cortisol production.

cyproheptadine (Periactin)-interferes with ACTH production.

Mitotane (Lysodren)- used for inoperable adrenal tumors

weight loss and increased urine output.

Observe for manifestations of electrolyte imbalance, especially changes in electrocardiogram (ECG) patterns.

sodium and potassium values, every 8 hours

Immediately after adrenalectomy  surgery, assess the patient every 15 minutes for ______. 

Why?

shock (e.g., hypotension; a rapid, weak pulse; and a decreasing urine output)

due to possible insufficient glucocorticoid replacement.

glucocorticoid 

mineralcorticoid 

PATIENT AND FAMILY EDUCATION GUIDE 

Cortisol Replacement Therapy

Take your medication in divided doses

Take your medication with meals or snacks. 

Weigh yourself daily.

↑dose with or illness

 Never skip a dose of medication. 

Always wear your medical alert bracelet or necklace.

Make regular visits for health care follow-up. 

Learn how to give yourself an intramuscular injection of hydrocortisone.

call your physician.

If you cannot reach your physician, go to the nearest emergency department.

You may need an injection to take the place of your usual oral medication. 

intermittent episodes of hypertension

During these episodes, the patient has severe headaches, palpitations, profuse diaphoresis, flushing, apprehension, or a sense of impending doom.

hThe patient may also report heat intolerance, weight loss, and tremors.

A nurse who supects a pt to have pheochromocytoma should palpate the abdomen to confirm adrenal swelling.

True of fales?

Fales

Increased abdominal pressure, defecation, and vigorous abdominal palpation can provoke a hypertensive crisis.

Pts with pheochromocytoma should avoid what types of foods and drugs?

Why?

Drugs: tricyclic antidepressants, droperidol, glucagon, metoclopramide, phenothiazines, and naloxone

 Foods or beverages:  high in tyramine (e.g., aged cheese, red wine) 

can induce a hypertensive crisis

Before a pt has a thyroidectomy what interventions should a nurse do?

give (euthyroid)- decrease the secretion of thyroid hormones.

Hypertension, dysrhythmias, and tachycardia must be controlled before surgery.

Monitoring the patient for complications:

bleeding!!!!!

trickle in throught 

dificulty breathing

swelling 

vital signs every 15 minutes until the patient is stable

Thyroid surgery can cause parathyroid gland injury.

What are the S/S?

hypocalcemia -low serum calcium levels

 tetany [hyperexcitability of nerves and muscles])

a life-threatening event that occurs in patients with uncontrolled hyperthyroidism and occurs most often with Graves' disease

Manifestations of crisis develop quickly.

because patients receive antithyroid drugs, beta blockers, and iodides before thyroid surgery.

it can still occur.

include fever, tachycardia, and systolic hypertension.

As the crisis progresses: confused, or psychotic  seizures, leading to coma.

Even with treatment, thyroid storm may lead to death.