 ENDOCRINE SYSTEM
 Revised March, 2008
 From Saunders Intro to Med/Surg Nursing, 3rd Edition

FUNCTIONS
 Growth and development
 Energy Metabolism
 Reproduction
 Fluid and electrolyte imbalance
 Homeostasis
 2 TYPES OF GLANDS
 ENDOCRINE
 EXOCRINE
 Thyroid Gland
located in lower portion of neck
Major role in metabolism and G & D
Thyroid hormone ( thyroxine or T4)
Triiodothyronine ( T3)
Both ^ the bodies rate of metabolism
Calcitonin regulates serum calcium levels
 Health hx and PE for pts w/ thyroid disorders
 Assess for changes in:
•
Weight
•
Energy level
•
Sleep patterns
•
Personality & emotional state
•
Tolerance to heat or cold
 Thyroid Function Tests
1. Thyroid Scan
-radioactive iodine given IV or PO
-X-ray taken to detect pattern of uptake
-”Hyperactive Thyroid” absorbs lg. Amts of iodine
-”Hypoactive Thyroid”or “Thyroid Malignancy” if small amts absorbed
 2. Radioactive Iodine Uptake (RAIU)
 Radioactive iodine is given PO
 Test measures thyroid gland activity

A normal thyroid gland will remove 15-45% of iodine w/i 24 hrs.

Test is painless
 * Important to wash hands w/ soap & H20 for 24 hrs after voiding*
 3. Thyroid Ultrasound
 Det. Size, shape & position
 Abnormal findings indicate cyst/solid nodulecancerous
 Non-invasive, short duration test.
 4.
Laboratory Studies
 Very sophisticated and specialized
T3
T4 (free and total)
TSH*
TRH stimulation test
 THYROID DISORDERS
 1. HYPERTHYROIDISM

“GRAVES DISEASE” or “toxic diffuse goiter”
 Increased synthesis & production of thyroid hormones ( T3 & T4)
 Autoimmune disorder
 Nrsg. Assessment
 Rapid pulse with arrythmias
 Elev. Systolic BP
 Wm. Skin, elev. Temp
 Diaphoresis & heat intolerance
 Hand tremors
 weight loss & fatique
 Amenorrhea
 Exophthalmos
 Intense nervousness
 Thyroid storm/crisis*
 Nsg Dx: Disturbed sleep pattern r/t metabolic disturbance*
 MEDICAL TREATMENT
 Goal is to decrease excessive thyroid hormone production
 Inderal
 Tapozole*
 Lugol’s solution
 Radio Active Iodine
 SURGICAL TREATMENT
 Thyroidectomy or subtotal thyroidectomy
Preop Teaching is important !
1. Drsg on front of neck
2. Avoid straining neck, support head
3. Turn/deep breath, limit coughing
 Nursing Post Op Care….
 Assess respiratory status
 Elevate HOB
 Level of consciousness
 Wound drng
 Voice quality
 Neuromuscular irritability (tetany)*
 Chvostec’s Sign*
 Trousseau’s Sign
 Hypothyroidism
1. Cau. By T4 deficiency
2. Metabolism is slowed
3. Congenital FormCretinism*
4. Adult Form Myxedema
 Signs & Symptoms
 Slowing of physical & mental activity
 Forgetfulness, Headache, lethargy
 Weight gain, constipation
 Dry skin, generalized &/or facial edema*

 Signs and Symptoms may be more subtle in elderly or be masked by other diseases.
 Thyroid function test should be routine in elderly
 Encourage the elderly to report changes or new sx. This is necessary to provide the best care
 Nursing Diagnosis for Hypothyroidism*
 Risk for impaired skin integrity related to dry skin.
 Constipation related to decreased peristalsis
 Not: Imbalanced nutrition: decreased body requirements related to intake less than metabolic
needs*
 Patients may look depressed, weary, and always complain of being cold*
 Trmt. For Hypothyroidism
1. Synthroid
2. Cytomel
3. Pts. Require lifelong hormone replacement therapy & should be monitored to evaluate the
response to therapy*
 May lead normal life with treatment*
 Must be taught s/s of hyperthyroidism*
 Lab test are frequently done to monitor status
 Nrsg. Considerations
 Myxedema Coma
 Respiratory Depression
 Monitor Cardiac function
 Review Nrsg Interventions pg. 891
 GOITER

Term used to describe enlargement of the thyroid gland*
 Usually caused by a dietary deficiency of iodine
 Tx depends on thyroid hormone production and degree of enlargement
 TREATMENT
•
Iodine 2-3 wks, repeated 3-4/x year
•
Does not cure goiter
•
Iodized table salt easiest way to inc. iodine in diet*
•
Surgery needed w/ inc. pressure on airway
 CA OF THYROID
1. May present as painless lump
2. Bx done to diagnose
3. Treatments include: Total Thyroidectomy,* radioactive iodine trmts, and thyroid replacement
therapy*
 PARATHYROID GLAND DISORDERS
 DIAGNOSTIC TESTS
 Blood and urine studies
 Radiographs
 EKG
 HYPERPARATHYROIDISM
1. High levels of PTH  elevated bld calcium levels ( hypercalcemia)*
2. Pathologic (spontaneous) fractures*(from Ca shifting into blood)
3. Renal calculi and obstruction
4. Dysrhythmias and hypertension
5. Nsg Dx: Impaired urinary elimination r/t urinary calculi*
 SIGNS & SYMPTOMS
 Elevated serum calcium levels
 weakness, lethargy, depression, anorexia and constipation
 Poor muscle tone, bone pain, HTN, fractures*
 Cardiac dysrhythmias, wt. Loss and urinary calculi
 TREATMENT
•
Surgery if tumor is cause
•
Inc. fluids dilutes urine
•
Phosphates to reduce calcium level
•
Limit dietary calcium
•
Calcitonin*
 HYPOPARATHYROIDISM
 Deficiency of PTH
 Low serum calcium (hypocalcemia)
 Common cause – accidental removal
 Classic signs +Chvostek’s and Trousseau’s signs*
 SIGNS & SYMPTOMS
1. Painful muscle spasms (hands, feet)
2. Fatigue and weakness
3. Tingling/twitching of face
4. Mental/emotional changes
5. Dysrhythmias
6. Nsg Dx: Decreased Cardiac Output r/t hypocalcemia
 TREATMENT
Oral calcium salts
Vitamin D
Aluminum hydroxide
 ANTERIOR PITUITARY GLAND DISORDERS
 Diagnostic Tests
 Refer to page 856 Table 42-2
 HYPERPITUITARISM
 Over production of GH & prolactin
 Most often caused by an adenoma
 Gigantism
 Acromegaly
 A. Gigantism
1. Affects infants/children
2. Cau. Proportional over-growth of “all” body tissues
3. May be over 8ft. By adulthood
 B. Acromegaly
1. Sx occur in 4th or 5th decades
2. Enlargement of hands and feet
3. Thickened ears, nose, jaw, forehead, bulbous nose
4. Heart, liver & spleen enlarge
 DIAGNOSIS
 Confirmed by cranial x-rays
 CTS
 Elevated GH levels
 GTT most reliable test for acromegly*
 MED/SURGICAL TRMT.
 Radiation therapy
 Parlodel and Sandostatin drug therapy
 Hypophysectomy*
 HYPOPITUITARISM
•
Inadequate secretion of GH
MANIFESTS AS:
1. Dwarfism
or
2. Panhypopituitarism

Dwarfism
 Occurs early in life
 Ht is 40% below normal
 Proportional physical characteristics
 Delayed or absent sexual maturation
 Higher frequency of mental retardation
 Shorter life span

Panhypopituitarism
•
Very rare disease
•
Tumor, infections, post-partum emboli, damage or removal of pituitary gland
•
Simmonds cachexia develops as result
 Posterior Pituitary Disorders
 Characterized by deficient or excess amounts of ADH (anti diuretic hormone) or “vasopressin”
 ADH helps to maintain fluid balance
 ^ ADH levels = low u/o or fluid retention
 Low ADH levels= more H2O passes through kidneys than normal
 Diabetes Insipidus
 Results from underproduction of ADH*
 Char by large volumes of dilute urine (polyuria) *
 Urine will be very dilute*
 SIGNS & SYMPTOMS
 Copious amounts of very dilute urine, may exceed 30 liters/day
 Dehydration
 Thirst
 hypotension, tachycardia, dizziness weakness, fainting*
 Medical Treatment
 VASOPRESSIN (PITRESSIN)
SQ, IM or nasal spray
Refer to pg. 859 Table 42-3
 Nursing Interventions
 I&O
 IV Fluid Replacement
 Encourage oral intake
 Weigh daily
 Fall Precautions
 VS

SIADH (Syndrome Inappropiate Anti-Diuretic Hormone)
•
Opposite of DI
•
Excessive secretion of ADH*
•
Results in an inability to excrete dilute urine
•
Fluid retention & water intoxication occur* (?cardiac patients)
•
Na deficiency
 SIADH
 Causative Factors

Brain trauma

Brain tumors

Infections
 SIADH
 Kidneys retain excessive water. Plasma volume expands.
 Leads to:

^BP

Hyponatremia

Na remains in intracellular causing H20 intoxication to develop
 SIGNS & SYMPTOMS
•
Weakness, muscle cramps, twitching (r/t low Na)
•
Anorexia
•
Nausea, diarrhea, irritability, HA (r/t H2O retention)
•
Weight gain without edema
 H2O Intox and CNS
 Change in LOC
 Seizures
 Coma
 Medical Treatment
 Intended to correct the cause
 Promote elimination of excess water
 Lithium Carbonate or demeclocycline (Blocks effect of ADH)
 Strict fluid restrictions, especially for cardiac patients*
 Hypertonic NS (3%) pulls Na out of intracellular space and int extracellular fluids to raise serum
NA
 High Na diet
 ADRENAL GLAND DISORDERS
 ADRENAL GLANDS******
 CONTAIN 2 PARTS:
 Cortex secretes steroid hormones (mineralocorticoids and glucocorticoids), androgens, and
estrogens
 Medulla  secretes epinephrine & norepinephrine
 Aldosterone*
 Most important mineralocorticoid*
 Regulates Na and K*
 Keeps blood volume balanced*
 Cortisol
 Most important glucocorticoid
 Anti-inflammatory
 Immune response
 Controls emotional state
 ACTH*
 ADRENAL CORTICOIDTROPIC HORMONE
 Sent to adrenals by pituitary
 Stimulates production of hormones
 Serum ACTH levels are checked to see if Pituitary gland is sending messages to adrenals
 DISORDERS OF ADRENAL GLANDS
 Addisons Disease
 &
 Cushings Syndrome

Addison’s Disease
 Decreased functioning of the adrenal cortex hormones (cortisol & aldosterone)
 Occurs in 1 per 100,000 people

Decrease of ACTH

TB

Fungal infections
 Known as an autoimmune disease (tissue destroyed by own antibodies)
 SIGNS & SYMPTOMS
 Weakness, lethargy and malaise
 Skin hyperpigmentation (looks sun tanned)
 Light headedness upon rising*

Due to hypovolemia (orthostatic

Have patient move slowly, help getting out of bed
hypotension) *
 Decrease tolerance to minor stress
 Variety of GI complaints
 Salt cravings
 Acute adrenal crisis also known as Addisonian crisis…*
-may occur after adrenal surgery, pituitary destruction or abrupt withdrawal of steroids*
-life threatening because of fluid and electrolyte imbalances
Caused by abruptly stopping steroids or stress, Ex: infections or illness*
 Medical diagnosis of Addison’s disease
 Clinical signs and symptoms
 Variety of lab findings

Low cortisol,low glucose,low Na,high K
 ACTH stimulation test

High = Adrenals at falt

Low= Pituitary at fault
 EKG

Peaked T waves, high K
 X-rays
 Medical Treatment
 Mainstay of treatment is lifelong replacement therapy with glucocorticoids (Cortisol) and
mineralocorticoids (Aldosterone)
 See pg 872 Table 42-8

CUSHINGS SYNDROME
(Combination of variety of symptoms)
 Results from overproduction of adrenal cortex hormones
 Endogenous cause tumor
 Exogenous cause prolonged use of high doses of corticosteroids*

RA, Lupus, Asthma, Polymyalgia Rheumatica*
 SIGNS & SYMPTOMS
 Moon face*
 Abdomen is heavy & pendulous (trunchal obesity)*
 Arms/legs are thin*
 Bones soften (osteoporosis)
 Delayed wound healing
 Irritability or Mood swings
 Medical Diagnosis
 Physical s/s
 Lab Studies
 Dexamethasone Test

Should show drop of cortisol and steroid levels, compared to baseline. If not, Cushing’s is a
possibility
 X-rays if tumor is suspected
 Medical treatment
 Varies as to the cause

Prescribed steroids

Benign adrenal tumors removed

ACTH causing pituitary tumors removed (surgery or radiation)

Drug therapy (Lysidren, Nizoral,Cytadren) could cause Addisonian crisis
 If bilateral surgical removal of adrenal glands  patient is treated for Addison’s Disease….
 Lab Stuff
 Addison’s Disease

Hypoglycemia, Hypo Natremia, Hyperkalemia
 Cushing’s Syndrome

Hyper glycemia, Hypernatremia, Hypokalemia
 NRSG. INTERVENTIONS
 Protect from injury
 Reduce risk for infection*
 Assess skin integrity
 Prom. Good hygiene
 Mon. wt. Dly, VS, chk. Lytes & sugar