~Problems with Endocrine System
Pituitary Gland:
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Has both a Anterior and Posterior Pituitary Gland.
Master Gland.
Located at the base of the brain
Anterior Pituitary Gland:
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F- FSH (Follicle-stimulating Hormone)
L- LH (Luteinizing Hormones)
A- ACTH (Adrenocorticotropic Hormone)
T- TSH (Thyroid- stimulating Hormone
P- Prolactin
E- Endophines
G- GH (Growth Hormone)- Regulates growth, regulates energy, metabolism, DIRECT
R/S WITH ABILITY TO PROCESS SUGAR... CHANGES TO BS!!
Posterior Pituitary Gland:
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Vasopressin(control excretion of water- antidiuretic hormone) & Oxytocin
Store hormones created in the hypothalamus.
P OV – posterior, Oxytocin, and vasopressin.
Tumors originated in the PPG are usually benign and grow slowly.
Gigantism:
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Abnormally LARGE GROWTH due to an EXCESS OF GROWTH HORMONE
during childhood BEFORE THE GROW PLATE CLOSES!
GROW IN HEIGHT, MUSCLES MASS, AND ORGAN SIZE.
c/o WEAKNESS.
Acromegaly:
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BEGINS IN ADULTHOOD!!
Excess skeletal growth in ONLY THE FEET, HANDS, SUPERCILARY RIDGE
(above eye socket), MOLAR, NOSE, CHIN.
s/s: Headache, vision changes, obstructive sleep apnea.
Pituitary Tumor Assessment/Diagnostics:
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MRI/CT- Detect & locate Tumor.
Growth Hormone Supression Test: For the test, you are given a solution of sugar
(glucose) to drink. This makes your pituitary gland stop making GH. Your blood is drawn
right before you drink the sugar solution and then every 30 minutes for about 2 hours. If
you have a tumor, it will keep on making GH, so the amount of GH in your blood will
stay the same.
Medical Management:
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Radiation
Transsphenoidal Hypophysectomy- Removal of tumor in pituitary gland, accessed
through the nose.
Medication- OCTREOTIDE (SANDOSTATIN): decreases tumor size by inhibiting GH
production. GIVEN 3 TIMES A WEEK, OR ONCE MONTLY
•Transsphenoidal Hypophysectomy: POST-OP
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Keep HOB Elevated
Perform frequent neuro checks.
Assess nasal packing/ mustache dressing: Assess for CSF, LEAVE IN PLACE FOR 3-4
DAYS, DO NOT REMOVE OR MANIPULATE!!
IF THERE IS A CSF LEAK, NOTIFIY PROVIDER.
AVOID STRENOUS PRESSURE & ACTIVITES, DO NOT BEAR DOWN WHILE
USING THE BATHROOM, AVOID COUGING, SNEEZING, BLOWING NOSE,
STOOL SOFTNER, KEEP ICP DOWN.
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DOCUMENT I&Os and DAILY WEIGHT. MONITOR FOR EXCESS OR
DECREASE IN OUTPUT.
Hypopituitarism:
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DECREASE IN HORMONES FROM THE ANTERIOR PITUITARY.
Decrease in glucocorticoids/ mineralocorticoids, decrease in GH & TSH.
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May cause sexual changes!!
Treatment is to provide corticosteroids to restore hormone levels.
POSTERIOR Pituitary disorders: Deficient ADH
SECRETION
 Diabetes insipidus: HIGH & DRY: Increased urination and sodium.
Dry (dehydration).
 Disorder that is caused by damage to the hypothalamus causing deficiency of ADH
(Vasopressin).
 Common in pts with head trauma, brain tumors, radiation.
 Low specific gravity: below 1.001-1.005
 Fluid restriction = hypernatremia= irritability, metal dullness, coma.
 Tx: administer vasopressin.
Diagnostics:
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Pre-procedure: Obtain vitals, baseline weight, urine specific gravity, serum osmolality.
o Weight should go down and sodium should go up, urine output should stay the
same if DI.
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Fluid deprivation/ water restriction test: ONLY DONE IN HOSPITAL SETTING!!
Fluids are withheld for 3-5 hrs. or until pt loses 3% of Body weight.
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Risk for: Hypotension, tachycardia, excessive weight loss.
Medical Management:
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Replace ADH with DDAVP (Desmopressin).
Admin HYPOtonic solution: ½ NS.
Identify & Tx underlying cause.
SYNDROME OF INAPROPRIATE ANTIDIURETIC HORMONE
(SIADH): EXCESSIVE ADH SECRETION. DOWN CAME THE THE WATER
& WASHED THE SODIUM OUT !!
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RESTRICT FLUIDS!!
INCREASED SPECIFIC URINE GRAVITY: ↑ 1.30.
S/S: thirsty, bounding pulse, n/v, muscle cramping, low urine output, tachycardia,
tachypnea, rales/ crackles, weight gain, coma, seizures.
Labs: increased Bun and decreased sodium.
Medical management:
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Fluid restriction: less than 1000mL/day
HYPERtonic solution: 3-5% ns. Give slowly.
Declomycin/ demeclocycline= increases excretion of H20 from the kidney.
CLOSELY MONITOR I&Os, daily weight, urine and blood labs, and neuro
assessment.
Adrenal Disorders:
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Each adrenal gland has 2 endocrine glands with separate, independent functions.
Adrenal medulla-Center of the glands SECRETES CATECHOLAMINES.
o Epinephrine, Norepinephrine, and Dopamine.
Adrenal Cortex- Secrets steroid hormones (sugar, salt, sex).
Addison’s Disease: (NOT ENOUGH Sugar, salt,
sex)
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Hypofunction of the adrenocortical glands
Causes: TB, AIDS, cancer, antibiotics, anticoagulants,
anticonvulsants.
Symptoms: Fatigue, malaise, weakness, anorexia, dizziness,
syncope, decreased libido, amenorrhea
GI symptoms: N/V, abd. pain, diarrhea, constipation.
Signs: WEIGHT LOSS , hyperpigmentation (Bronze),
HYPOTENSION, vitiligo.
Labs: Low BS, low sodium, HIGH POTASSIUM (peaked T
waves).
Addisonian or Hypotensive crisis= overexcretion,
infection, decreased intake of sodium. Can be fatal.
Management: Administer fluids/ electrolytes, REPLINSH
ESSENTAIL STEROIDS!! Trendelenburg to increase BP,
GLUCOSE, D5NS
Cushing’s syndrome (Hypercortisolism):
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EXCESSIVE ADRENOCORTICAL ACTIVITY (TOO MUCH SUGAR, SALT, SEX)
Causes: Tumor on the pituitary gland, excess use of corticosteroids (prednisone).
Symptoms: Menstrual irregularities, masculine traits/
recession of female traits.
EXCESSIVE GROWTH OF FACIAL HAIR, Breast
atrophy, voice deepens.
C: Cushing’s
U: unusual hair growth (facial hair)
S: stretch marks, bruising of the skin
H: Hump (Buffalo hump)
I- increases sugar, salt, sex. ( high BS & sodium)
N- Normalize hormones. Remove tumor or
adrenal- enzyme inhibitors.
G- Gain ( Weight Gain in stomach)
S- Smalls arms/ legs. Slow wound healing..
Surgery:
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If pts have complete removal of pituitary gland. PRE- OP MANGEMENT OF
GLUCOSE AND BP IS REQUIRED.
Temporary therapy with hydrocortisone may be required to prevent adrenal insufficiency
post-surgery.
Conn’s syndrome: Primary Aldosteronism
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Excessive aldosterone levels= sex hormone. Increased sodium and decreased potassium.
HALLMARK SIGN: RESISTANT HYPERTENSION WITH LOW POTASSIUM.
TX: Low sodium diet, potassium sparing diuretics OR oral potassium supplements,
NEVER BOTH!!
Adrenomedullary tumors:
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Pheochromocytoma: 5 Hs (HTN, HA, hyperhidrosis (excessive sweating),
hypermetabolism, hyperglycemia.
Manipulation of tumor during surgery can cause extreme ↑BP and arrhythmias.
Removal of tumor may cause hypotension and hypoglycemia.
Post op: assess q 15 minutes for adrenal insufficiency, hypotension, hemorrhage,
and shock!!
Monitor Bowel sounds and abd for distention and tenderness.
ENDOCRINE #2: THYRIOD SYSTEM
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THYROID System: Secretes the hormones thyroxine (T4), triiodothyronine (T3), and
calcitonin, which control body metabolism and regulate calcium balance.
The secretion of T3 and T4 by the thyroid is controlled by an endocrine feedback system
involving the pituitary gland and the hypothalamus (structures in the brain). Lowered
levels of these thyroid hormones result in increased levels of pituitary and
hypothalamic hormones.
Levels of the thyroid hormones rise; pituitary and hypothalamic hormones decrease. This
helps keep levels appropriately balanced.
Hypothyroidism: inadequate circulation of thyroid hormones causes a DECREASE
METABOLIC RATE.
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S/S: Hypotension, muscle weakness, cold intolerance, cold hands/feet, hair loss,
bradycardia, nervousness, depression, constipation, WEIGHT GAIN, POOR
MEMORY
Management: Replenish thyroid hormone with Levothyroxine with lifelong therapy.
Myxedema Coma: Most severe complication of hypothyroidism.
o HALLMARK SIGN: HYPOTHERMIA & UNCONCIOUNES.
o DECREASES RESP DRIVE, LOW TEMP, LOW HR & BP.
o Management: Maintain pt airway, admin 02 & fluids and thyroid
hiormone (IV) & gradually warm pt, vasopressors &
corticosteroids may also be admin.!!
Hyperthyroidism: Excessive secretions of thyroid hormone. GRAVES DISEASE IS THE
MOST COMMON CAUSE!!
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Causes: thyroiditis, excessive iodine intake, cancer, nodules/ tumor.
S/S: anxious, restless, irritability, tachycardia, increases appetite & weight loss, low
cholesterol.
Nursing Intervention: Frequent small meals, HIGH CALORIE/ HIGH PROTEIN
INTAKE.
Medical Management: antithyroid agents, surgery, radioactive iodine (CANNOT
BE PREGNANT, AND MUST AVOID PREGNANCY FOR UP TO 6
MONTHS AFTER THEAPY AND MUST BE 6 WKS FROM LAST
LACTATION TO RECEIVE THERAPY.).
PROPER EYE CARE: WEAR DARK GLASSES IN THE SUN, SLEEP IN EYE
MASK, SLEEP WITH HOB ELEVATED, RESTRICT SALT!!!
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Thyroid Storm: HIGH FEVER, TACHYCARDIA, ALTERED LOC,
EXOPTHALMOS.
Management: Hypothermic blankets, ice packs, oxygen, Dextrose IVF.
Medication: PTU(Propylthiouracil) MMI
( Methimazole) Prevent production of thyroid hormone.
o MONITOR CBC FOR WBC INCREASE. THIS MAY SIGNAL
INFECTION/ STOP TAKING MEDICATION!!
 Thyroidectomy: must have suction & trach kit at beside!!
Endocrine #3
Hyperparathyroidism: Overproduction of parathormone.
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Complications: Bone decalcification
& renal calculi (kidney stones).
MOST PEOPLE ARE
ASYPTOMATIC.
High calcium= low reflex response.
High calcium and LOW
PHOSPORUS!!
Treatment:
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Hydration therapy
Encourage mobility.
Monitor tentany (hyperactivity r/t
hypocalcemia).
Admin Bisphosphonates: alendronate (Fosamax)
Hypercalcemia tx:
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IVF, calcitonin, monitor edema/ consider diuretics, and Bisphosphonates.
Hypoparathyroidism: Inadequate secretion of parathormone.
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Most common cause is removal of thyroid gland.
INCREASED Phosphate and DECREASED calcium.
Complications: Tetany (Involuntary muscle cramp or spasm).
o Mild Tetany: numbness, tingling, cramps, stiffness.
o Severe Tetany: Bronchospasm, laryngeal spasms, dysphagia, seizures, Chvostek
& trousseau signs.
Treatment: Increase calcium levels.
o Meds: Calcium, ergocalciferol (vitamin d), mag oxide, parathyroid hormone.
o Post Op thyroid removal admin calcium gluconate & sedatives to
prevent hypoparathyroidism, tetany, and seizures.
o Do not give milk, eggs, yogurt, cheese. Give fruit, fruit juice, tofu.