Chapter 56
Assessment of the Endocrine
System
Thyroid Gland
The image above identifies the anatomic location
of the thyroid gland.
Concepts
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The priority concepts for this chapter are
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Nutrition
Elimination
The interrelated concept for this chapter is
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Fluid and electrolyte balance
3
Endocrine System
The image above identifies the locations of
various glands within the endocrine system.
Anatomy and Physiology Review
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Hypothalamus (a neuroendocrine gland)
Pituitary glands
Adrenal glands
Thyroid gland
Islet cells of the pancreas
Parathyroid gland
Gonads
Negative feedback mechanism
Excesses or deficiencies of hormone
secretion can lead to pathologic conditions.
Hypothalamus
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Function—produce regulatory hormones
Hypothalamus and Pituitary Glands
The image above shows the hypothalamus, hypophysial
stalk, anterior pituitary gland, and posterior pituitary gland.
Gonads
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Testes (male)
Ovaries (female)
Function is dormant until puberty
Gonadotropic hormones secreted by the anterior
pituitary trigger development of secondary
sexual characteristic
Adrenal Glands
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Adrenal cortex
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Mineralocorticoids (aldosterone)
Glucocorticoids (cortisol)
Adrenal medulla
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Adrenal medullary hormones (catecholamines
epinephrine and norepinephrine)
• Stress response
Thyroid Gland
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Composed of follicular and parafollicular cells
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Follicular—T4 and T3
Parafollicular—TCT or calcitonin
Control of metabolism takes place through T3
and T4.
Calcium and phosphorus balance takes place
partly through the actions of calcitonin.
Parathyroid Glands
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Secretion of parathyroid hormone (PTH)
Regulates calcium and phosphorus metabolism
by acting on bones, kidneys, GI tract
PTH increases bone resorption.
Serum calcium levels determine PTH secretion.
Pancreas
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Exocrine and endocrine functions
Islet cells
Glucagon—hormone that increases blood
glucose levels
Insulin—promotes movement and storage of
carbohydrate, protein, and fat
Somatostatin—inhibits release of glucagon and
insulin from pancreas
Endocrine Changes
Associated with Aging
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Reduced glandular function
Decreased hormone secretion
Encourage regular screening examinations
Assessment: Recognize Cues (1 of 4)
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Patient history
Nutrition history
Family history and genetic risk
Current health problems
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Changes in energy levels
Changes in elimination patterns
Sexual and reproductive functions
Changes in physical features
Assessment: Recognize Cues (2 of 4)
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Physical assessment
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General appearance
Scale and body hair growth patterns
Prominent forehead or jaw
Round or puffy face
Dull or flat expression
Exophthalmos
Skin and nails
Trunk abnormalities in size, symmetry
Hair distribution
Genitalia
Assessment: Recognize Cues (3 of 4)
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Psychosocial assessment
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Behaviors, personality, psychological responses may
be changed
 Coping skills
 Support systems
 Health-related beliefs
 Self-perception
 Readiness to learn and self-manage
Assessment: Recognize Cues (4 of 4)
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Diagnostic assessment
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Laboratory tests
• Assays
• Provocative/Suppression tests
• Urine tests
• Genetic testing
• Tests for glucose
Imaging assessment
Other diagnostic assessment
Chapter 56
Audience Response System Questions
Question 1
Which is the priority nursing assessment for a
client with primary adrenal cortex dysfunction?
A. Vital signs
B. Daily weights.
C. Fluid intake and output.
D. Physiologic response to stress.
Answer to Question 1
ANS: D
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The adrenal cortex makes up about 90% of the
adrenal gland. Hormones secreted from the adrenal
cortex are responsible for fluid and electrolyte
balance, stress response, metabolism of nutrients,
and emotional and sex hormone responses. Priority
nursing interventions with adrenal cortex dysfunction
focus on the negative feedback mechanisms of
aldosterone and cortisol. Assessing the physiologic
responses to stress is appropriate, as cortisol affects
the body’s stress response. All other assessments
can then be completed.
Question 2
Which client assessment finding alerts the
nurse to perform a detailed endocrine system
assessment? Select all that apply.
A. Fatigue
B. Weight gain
C. Reports being cold all the time
D. Decrease in peripheral pulses
E. Changes in hair texture and distribution
Answer to Question 2
ANS: A, B, C, E
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Changes in physical appearance can reflect an
endocrine problem. Obvious changes identified
during the physical assessment include hair texture
and distribution, facial contours and eye protrusion,
voice quality, body proportions, and secondary
sexual characteristics. Changes in weight and
fatigue may also be associated with endocrine
disorders as well as other conditions. Poor
peripheral pulses are more likely associated with
cardiovascular diseases.
Question 3
Which assessment finding in an older adult
client does the nurse identify that may indicate
an age-related decrease in antidiuretic hormone
(ADH)?
A. Diluted urine and dehydration
B. Yeast infection and polydipsia
C. Higher than normal body weight
D. Constipation, lethargy, and dry skin
Answer to Question 3
ANS: A
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These are symptoms that result from an agerelated decrease in antidiuretic hormone. The
other symptoms listed are not related to age.