Unit 5: Endocrine
Introduction to the Endocrine System
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Endocrinology  the study of hormones
o Hormone  arouse the activity
 Chemical messengers that are made in one part of the body and go to another part of the
body to arouse the activity and give function to another organ
 Sophisticated communicators
 Indirect communication  the “Wi-Fi” of the human body
o Hormone  blood stream  work at a distance
Hormones are small molecules that typically derive from amino acids  300-500 Daltons
o Anything that has a signaling function is considered a hormone
Subcategories of hormones
o Endocrine hormones
 Hormones that get into the bloodstream and work at a far distance
 Go into the bloodstream; if they are picked up by the right receptors, they will have the
correct function
o Paracrine hormones
 More regionally active
 Work within a small distance within the organ that released the hormone
 Have a small effect
 Do get into the bloodstream, but the concentration of the receiving receptor is right close
by
 High concentration of receptors that are very close to the site of synthesis
o Autocrine hormones
 Made directly in a cell and work directly on that same cell or in the cell right next door
 Work at a very, very small distance
 Very high concentration of the receiving receptor end right at the cell, or right next to the
cell of synthesis
Major endocrine orders
o Pituitary gland  master gland
 From the pituitary gland, we produce hormones that work on other organs
 Thyroid stimulating hormone  once it leaves the pituitary, it enters the
bloodstream and acts on the thyroid gland, where there are high receptors of TSH.
Once TSH has reached the thyroid, the thyroid is now stimulated to make thyroid
hormone  thyroxine (T4) and triiodothyronine (T3)
o Regulate metabolism, appetite, thermogenesis muscle function
 Can sense the levels of hormones in the body and will send stimulating hormones/inhibit
hormone production if necessary
 Adrenal corticotropic hormone (ACTH)  acts on the adrenal cortex
 Adrenal glands make adrenal hormones, such as cortisol, which regulate glucose
metabolism and is important to maintaining blood pressure and well-being
 The adrenal glands also make mineralocorticoids such as aldosterone, which is
important for regulating salt and water balance
 Adrenal androgens
 ACTH primarily regulated the cortisol and the adrenal androgens
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Luteinizing hormone (LH) and follicle stimulating hormone (FSH)
 Act on the gonads
o Male  testes; stimulates the development of sperm; testosterone
o Female  ovaries; stimulates oocyte production; estradiol
 Growth hormone
 Critical for optimal growth of long bones
 Prolactin
 Important for lactation
o Thyroid gland
 Thyroid hormone  T3 and T4
o Pancreas
 Inside the pancreas, there are small islands called the islets of Langerhans
 Islets within the pancreas make endocrine hormones such as insulin and glucagon
 Without insulin, you have diabetes and you don’t transport glucose into muscle
and remove glucose from the bloodstream normally
The organs of the endocrine system are referred to as glands
Hormones
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Endocrine glands produce chemical substances called hormones
Hormones are secreted into the blood and eventually affect specific targeted tissues throughout the body
Pituitary Gland
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Very small, about the size of a pea
Located in the Sella Turcica under the hypothalamus
Consists of two parts
o The anterior lobe
o The posterior lobe
Anterior Pituitary Gland
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Hormones are regulated by the hypothalamus
o Thyroid Stimulating Hormone (TSH)
o Adrenocorticotropic Hormone (ACTH)
o Follicle-Stimulating Hormone (FSH)
o Luteinizing Hormone (LH)
o Growth Hormone
o Prolactin Hormone
Disorders of the Anterior Pituitary
o Overproduction of Growth Hormone (GH) 
leads to overgrowth of bone and soft tissues
 Acromegaly  adults; after the closure
of epiphyseal plates
 Gigantism  children; before the closure
of epiphyseal plates
Surgery on the Pituitary Gland  Transsphenoidal Approach
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Nursing management
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o Avoid vigorous coughing, sneezing, or straining at stool to prevent CSF leakage from the point
at which the Sella Turcica was entered
o Elevate head of bed to 30 degrees at all times to avoid pressure on the Sella Turcica
o Monitor neurological status
o Clear nasal drainage should be sent to the laboratory to be tested for glucose
 A glucose greater than 30 mg/dL indicated CSF leakage from an open connection to the
brain. This increases the risk for meningitis
o Provide oral care every 4 hours to keep the surgical area clean and free of debris
o AVOID TOOTH BRUSHING FOR AT LEAST 10 DAYS TO PREVENT DISRUPTING THE
SUTURE LINE AND AVOID DISCOMFORT
o Monitor for signs for Diabetes Insipidus (DI)
 Monitor urine output and serum and urine osmolality closely
o If pituitary is damaged or removed during surgery, the patient will need permanent hormone
replacement therapy  ADH, cortisol, and thyroid hormone
Nursing diagnoses
o Body image disturbance r/t enlargement of hands, feet, jaw, and soft body tissue
o Fluid volume deficit r/t polyuria  may develop diabetes insipidus as a post-operative
complication
o Sleep pattern disturbance r/t soft tissue swelling  following surgery
o Sensory-perceptual alteration r/t enlarged pituitary gland tumor
Adrenocorticotropic Hormone  ACTH
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Produced by the anterior pituitary gland
Tells the adrenal glands to secrete catecholamines (epinephrine and norepinephrine) and steroids
(cortisol)
Epinephrine  adrenaline; fight or flight response
Norepinephrine  noradrenaline
Steroids  glucocorticoids, mineralocorticoids, androgens
Addison’s Syndrome
o Increased function of the adrenal glands causing LOW levels of cortisol
o Decreased function of the adrenal glands  cortisol levels are LOW
o Common among both genders and is due to an autoimmune disease
o Assessment
 Progressive weakness
 Fatigue
 Weight loss
 Anorexia
 Hypotension
 Hyponatremia
 Hyperkalemia
 GI upset  nausea, vomiting, diarrhea
 Hyperpigmentation
o Signs and symptoms
 Bronze pigmentation of the skin
 Changes in distribution of body hair
 GI disturbances
 Weakness
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 Hypoglycemia
 Postural hypotension
 Weight loss
o Complications  Adrenal Crisis
 Life-threatening complication of Addison’s disease or abrupt withdrawal from
corticosteroids use
 Profound fatigue
 Dehydration
 Vascular collapse  decrease in blood pressure
 Renal shut down
 Decreased serum Na
 Increased serum K
Cushing’s Syndrome
o Increase in cortisol is caused most commonly by stress and long-term steroid use
 Adrenal tumors, ectopic ACTH production can also cause increase in cortisol levels
o Assessment
 high blood cortisol
 Na+ and water retention
 Buffalo hump & back pain
 Osteoporosis/kyphosis/fractures
 Cardiac hypertrophy, hypertension
 Diabetes/polydipsia
 Catabolism
 Moon face (tomato face)
 Muscle wasting and fat accumulation
 Pendulous abdomen and breasts
 Red striae
 Thin arms and legs
 Bruising with ecchymoses
 Thin skin with ulcers
 Poor wound healing
 Oedema
o Nursing Diagnoses
 Risk for infection
 Risk for injury
 Altered nutrition  more than the body requires
 Self-esteem disturbance
 Impaired skin integrity
o Nursing interventions
 Watch for s/s of infections
 Monitor blood glucose levels in diabetic patients
 Daily weights
 Vital signs Q4H
 Do not stop medications abruptly  tapper dosages
Thyroid Stimulating Hormone (TSH)
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Produced in the anterior pituitary gland
Hyperthyroidism
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o Grave’s disease  autoimmune disorder with an unknown cause
o Goiters  nodules on the thyroid secrete T3 &T4 independent of TSH levels
o Assessment
 Hair loss
 Irritability
 Fatigue
 Fast heartbeat
 Weight loss
 Insomnia
 Intolerance to heat
 Increased perspiration
 Muscle aches
 Weakness in upper arms and thighs
 Increased bowel movements
 Decreased menstrual flow
o Nursing Management
 Provide calm, quiet room due to increased metabolism, which causes sleep disturbances
 Provide adequate rest
 Relieve eye discomfort with artificial tears/lubricant due to exophthalmos (bug eyes) to
soothe and moisten conjunctiva membranes
 Provide adequate calories
 Elevate head of bed to promote fluid drainage from orbital area around the eye
o Lab tests
 Low or undetectable TSH levels
 Free T4 increased
o Complications
 Thyroid storm
 Medical emergency
 Thyroidectomy
 Post-op care
o Assess for bleeding every 2 hours for 24 hours
o Assess for irregular breathing, neck swelling, frequent swallowing, assess
dressing
o Place in semi-fowlers position and support head with pillows
o AVOID FLEXION OF THE NECK
o Monitor VS
o Check & complications post-op pain by giving meds
Hypocalcemia
o Tetany  numbness, tingling of face, fingers, limbs
o Increased muscle stiffness
 Trousseau’s sign  carpopedal spasms of the hands and feet, wrists and ankles
 Chvostek’s sign  facial muscle spasms when the face is tapped below the temple
 Compromised respiratory function dur to accessory muscle involvement  laryngeal
stridor
o Treatment
 Goal  maintain normal calcium levels
 Emergency  IV calcium gluconate over 10-20 minutes
 Calcium salts can cause hypotension and cardiac arrest  SLOW PUSH
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Give high calcium foods
 Dark green vegetables, soybeans, tofu
 Instruct on foods that reduce calcium absorption
 Spinach, rhubarb, bran, and whole grains
Hypothyroidism
o Most commonly in females
o Primary hypothyroidism  increase in TSH production
o Secondary hypothyroidism  caused by pituitary disease
o Primary cause in USA is atrophy of the thyroid gland (Primary Hypothyroidism)  Hashimoto’s
thyroiditis
o Worldwide, #1 cause is iodine deficiency
o Assessment
 Thinning hair, hair loss
 Puffy face
 Dry and coarse skin
 Constipation
 Cool extremities and swelling of limbs
 Loss of eyebrow hair
 Enlarged thyroid
 Slow heartbeat
 Poor appetite
 Infertility, heavy menstruation
 Carpal tunnel syndrome
 Weight gain
 Poor memory
 Intolerance to cold
 Feeling of tiredness
o Complications
 Myxedema Coma
 Severe hypothyroidism  medical emergency
 Required IV thyroid replacement
o Lab tests  Hashimoto’s
 TSH levels HIGH
 T3 LOW
 Free T4 LOW
o Treatment
 Levothyroxine (Synthroid)
 Synthetic
 Peaks 1-2 weeks
 Litotrix
 Synthetic
 Peaks 2-3 days
 Used in acutely ill patients with hypothyroidism
 Armour
 Natural
 Dose not standardized
 TREATMENT IS LIFE LONG
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What is important to teach patients on when to take their thyroid medications?