The endocrine system consists of glands that regulate metabolic processes through hormone secretion. Disorders can result from overactivity or underactivity of hormones. Common endocrine disorders include pituitary disorders like hyperpituitarism and hypopituitarism, thyroid disorders like hypothyroidism and hyperthyroidism, and parathyroid disorders like hypoparathyroidism. Symptoms depend on the hormone affected and include fatigue, weight changes, mood issues, and metabolic abnormalities. Treatment involves hormone replacement, medications, surgery, or lifestyle modifications. Nursing care focuses on monitoring for complications, providing support and education, and maintaining fluid and electrolyte balance.

1. ENDOCRINE SYSTEM AND MAJOR DISORDERS By: MISS SHENELL A. DELFIN, RN

2. FUNCTION: Endocrine system consist of a series of glands “ductless” that function individually or conjointly to integrate and control innumerable metabolic activities in the body. These glands automatically regulate various body processes by releasing chemical messengers called hormones. OVERACTIVITY OR UNDERACTIVITY of any one of them affects the whole system.

4. Growth and development

5. Reproduction

6. Fluids and electrolytes

7. Acid base-balance

9. ENDOCRINE GLANDS

11. ENDOCRINE GLANDS

12. ENDOCRINE GLANDS

15. ENDOCRINE GLANDS

17. ENDOCRINE GLANDS

19. ENDOCRINE GLANDS

20. HORMONE REGULATION NEGATIVE FEEDBACK MECHANISM CHANGING OF BLOOD LEVELS OF CERTAIN SUBSTANCES (e..g CALCIUM & GLUCOSE) RHYTHMIC PATTERNS OF SECRETION (e.g. CORTISOL, FEMALE REPRODUCTIVE HORMONES) AUTONOMIC & C.N.S. CONTROL (PITUITARY-HYPOTHALAMIC AXIS, ADRENAL MEDULLA HORMONES)

21. NEGATIVE FEEDBACK MECHANISM DECREASED HORMONE CONCENTRATION IN THE BLOOD (e.g. Thyroxine) PITUITARY GLAND RELEASE OF STIMULATING HORMONE (e.g. TSH) STIMULATION OF TARGET ORGANS TO PRODUCE & RELEASE HORMONE (e.g. Thyroid gland release of Thyroxine) RETURN OF THE NORMAL CONCENTRATION OF HORMONE

22. NEGATIVE FEEDBACK MECHANISM INCREASED HORMONE CONCENTRATION IN THE BLOOD(e.g. Thyroxine) PITUITARY GLAND IS INHIBITED TO RELEASE STIMULATING HORMONE (e.g. TSH) DECREASED PRODUCTION & SECRETION OF TARGET ORGANOF THEHORMONE (e.g. Thyroid gland release of Thyroxine) RETURN OF THE NORMAL CONCENTRATION OF HORMONE

23. Endocrine Disorders If you can remember what each hormone does in the body, it will be easier to remember what results from imbalances of that hormone. Most symptoms of hormone HYPERACTIVITY are the opposite of symptoms of that hormones HYPOACTIVITY.

24. ANTERIOR PITUITARY DISTURBANCES HYPOPITUITARISM HYPERPITUITARISM

25. PITUITARY ANTERIOR LOBE

26. Hyperpituitarism May be due to overactivity of gland or the result of an adenoma Characterized by: Excessive serum concentration of pituitary hormones (GH, ACTH, PRL) Morphologic and functional changes in the anterior pituitary

27. Growth Hormone Hypersecretion GIGANTISM

28. Manifestations of acromegaly. Progressive alterations in facial appearance include enlargement of the cheekbones and jaw along with thickening of soft-tissue structures such as the nose, lips, cheeks, and the flesh above the brows. (Courtesy of Clinical Pathological Conference, American Journal of Medicine.)

29. Hyperpituitarism:Clinical Manifestations Arthritis Chest: barrel-shaped Rough facial features Odd sensations: hands and feet Muscle weakness & fatigue Enlargement of organs Growth of coarse hair Amenorrhea; breast milk production Loss of vision; headaches Impotence; increased perspiration Snoring

30. Hyperpituitarism:Clinical Manifestations

31. Hypopituitarism Deficiency of one or more anterior pituitary hormones Causes Infections / Inflammatory disorders Autoimmune diseases Congenital absence Tumor Surgery / Radiation therapy

32. Hypopituitarism:Clinical Manifestations Hypo-thermia, -glycemia, -tension Loss of vision, strength, libido, & secondary sexual characteristics

33. DWARFISM

34. MANAGEMENT HYPOPITUITARISM SURGICAL REMOVAL / IRRADIATION REPLACEMENT THERAPY THYROID HORMONES STEROIDS SEX & GROWTH HORMONES GONADOTROPINS (restore fertility) HYPERPITUITARISM SURGICAL REMOVAL / IRRADIATION MONITOR FOR HYPERGLYCEMIA & CARDIOVASCULAR PROBLEMS

35. Trans-sphenoidal hypophysectomy

36. POSTERIOR PITUITARY DISTURBANCES DIABETES INSIPIDUS SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE

37. FUNCTION: WHEN THERE IS A OF SERUM OSMOLALITY, THE NORMAL BODY RESPONSE IS TO THE SECRETION OF ADH. WHEN THE NORMAL FEEDBACK MECHANISM FOR ADH IS SUSTAINED, THERE IS EXCESSIVE WATER RETENTION IN THE BODY WHEN THERE IS OR INADEQUATE AMOUNT OF ADH, THE BODY IS UNABLE TO CONCENTRATE URINE, & EXCESSIVE H2O LOSS OCCURS

40. DIABETES INSIPIDUS CHARACTERIZED BY A DEFICIENCY OF ADH. WHEN IT OCCURS, IT IS MOST OFTEN ASSOCIATED WITH : NEUROLOGICAL CONDITIONS, SURGERY, TUMORS, HEAD INJURY, OR INFLAMMATORY PROBLEMS

41. DIABETES INSIPIDUS ABSOLUTE / PARTIAL DEFICIENCY OF VASOPRESSIN S/SX: POLYURIA 15-29L/ DAY POLYDIPSIA SG OF URINE IS <1.010 S/SX OF DHN SHOCK

42. DIABETES INSIPIDUS ABSOLUTE / PARTIAL DEFICIENCY OF VASOPRESSIN MANAGEMENT HORMONAL REPLACEMENT – FOR LIFE VASOPRESSIN (PITRESSIN TANNATE IN OIL) – IM OR NASAL SPRAY NON-HORMONAL THERAPY CHLORPROPRAMIDE – INCREASE RESPONSE OF THE BODY TO DECREASEDVASOPRESSIN INCREASE FLUIDS MONITOR I&O + WEIGHT (MIOW) MAINTAIN FLUID & ELECTROLYTE BALANCE

43. SYNDROME OF INAPPROPRIATE ADH(SIADH) ELEVATED ADH S/SX: DECREASED SERUM SODIUM CX IN LOC TO UNCONSCIOUSNESS SEIZURES WATER INTOXICATION N/V MENTAL CONFUSION Persistent excretion of concentrated urine Signs of fluid overload Hyponatremia

44. SYNDROME OF INAPPROPRIATE ADH MANAGEMENT: WATER INTAKE RESTRICTION ADMINISTER AS ORDERED: NaCl Diuretics Demeclocycline (declamycin) – a tetracycline analogue that interferes with the action of ADH on the collecting tubules

45. THYROID DISORDERS

47. Hypothyroidism underactive state of the thyroid gland hyposecretion of thyroid hormone most common in women, middle-age primary function is to control the level of cellular metabolism by secreting thyroxin (T4) and triiodothyronine (T3) DX: decreased T3, T4 Elevated TSH, cholesterol

48. Hypothyroidism A state of low serum TH levels or cellular resistance to TH Iodine deficiency Oncologic Autoimmune Drugs Developmental Iatrogenic Dietary Non-thyroidal Endocrine

50.  metabolic rate

51.  oxidation of nutrients for energy

54. MYXEDEMA COMA- a condition resulting from persistent low thyroid production.

55. Med. Mgt. – thyroid replacement therapy Levothyroxine(Synthyroid) ,liothyronine Expected effects: diuresis, puffiness, improved reflexes and muscle tone, PR

57. avoid use of all sedatives

58. assist client in choosing calorie,  cholesterol diet

59.  fluid and fiber to relieve constipation

60.  physical activity and sensory stimulation gradually as condition improves

61. monitor cardiovascular response to increased hormone levels carefully

63. Hyperthyroidism over-secretion of the thyroid gland also called thyrotoxicosis or graves disease, tissues are stimulated by excessive thyroid hormone a recurrent syndrome, may appear after emotional stress or infection occurs mostly in women 20-50 yrs old Causes : adenoma, goiter, viral inflammation, auto-immune glandular stimulation, grave’s disease - most common cause

69. Thyroid Storm or Crisis a medical emergency pts. develop severe manifestation of hyperthyroidism  temp., tachycardia, dysrhythmias worsening tremors, restlessness delirious or psychotic state or coma abdominal pain  BP and RR Precipitated by a major stressor: infection trauma or surgery (thyroidectomy) inadequate treatment

70. Do you take this woman as your wife…. In sickness and in health… TAKE ME! TAKE ME!!

73. Flushed, smooth skin

74. Heat intolerance

75. Mood swings

76. Diaphoresis

77. Tachycardia

78. Palpitations

79. Dyspnea

80. Delirium, coma

84. Nsg. Interventions: Provide emotional support Provide eye care eye drops, dark glasses, patch eyes if necessary elevate head of bed for sleep restrict dietary sodium assess adequacy of lid closure Be alert for complications

86. Monitor for signs of bleeding and excessive edema

89. Chvostek’s sign and Trousseau’s sign

91. WOF: irregular breathing, swelling, choking---possible hemorrhage and tracheal compression

95. PARATHYROID GLAND DISORDERS

99. CHVOSTEKS/ TROUSSEAU’S

100. FATIGUE, WEAKNESS

101. CARDIAC ARRHYTHMIAS

102. SEIZURE

104. Necessary component for blood coagulation mechanismsPromotes absorption of calcium in the GI tract ( by stimulating kidneys to convert vit.D to its active form). HYPOCALCEMIA

105. TESTS USED TO ELICIT SIGNS OF CALCIUM DEFICIENCY TROUSSEAU'SSIGN CHVOSTEK'SSIGN

106. PARATHYROID DISORDERS DIAGNOSTIC TESTS: HEMATOLOGICAL SERUM CALCIUM SERUM PHOSPHORUS SERUM ALKALINE PHOSPHATASE URINARY STUDIES URINARY CALCIUM URINARY PHOSPHATE - TUBULAR REABSORPTION OF PHOSPHATE

107. HYPOPARATHYROIDISM XRAY: INCREASED BONE DENSITY MANAGEMENT: Ca SUPPLEMENT VIT D SUPPLEMENT – LIQ FORM: WITH WATER, JUICE OR MILK, pc SEIZURE prec LISTEN FOR STRIDOR OR HOARSENESS TRACHEOSTOMY SET @ BEDSIDE CaGLUCONATE @ BEDSIDE

108. T ETANY AKE RACHEOSTOMY C ALCIUM GLUCONATE ARE ALCIUM 8.6 – 10.6 mg / dL

110. Necessary component for blood coagulation mechanismsMUSCLE WEAKNESS PERSONALITY CHANGES CARDIAC ARRHYTHMIAS Promotes absorption of calcium in the GI tract ( by stimulating kidneys to convert vit.D to its active form). ANOREXIA N/V CONSTIPATION PEPTIC ULCER DSE

111. HYPERPARATHYROIDISM INCREASED PTH PRODUCTION HYPERCALCEMIA HYPOPHOSPHATEMIA PRIMARY – TUMOR OR HYPERPLASIA OF THE PARATHYROID GLAND SECONDARY – COMPENSATORY OVERSECRETION OF PTH IN RESPONSE TO HYPOCALCEMIA FROM: CHRONIC RENAL DSE MALABSORPTION SYNDROME OSTEOMALACIA

112. HYPERPARATHYROIDISM MANAGEMENT: TX OF CHOICE : SURGICAL REMOVAL OF HYPERPLASTIC TISSUE IV PNSS 5L/ DAY WITH DIURETICS CRANBERRY JUICE (ACID-ASH) LOW Ca STRAIN URINE FOR STONES CARE FOR PARATHYROIDECTOMY

113. DISORDERS OF THE PANCREAS

114. DIABETES MELLITUS (TYPE I, TYPE II)

116. TWO TYPES OF DIABETES

118. genetic / hereditary predisposition

119. viruses

120. pancreatitis

121. pancreatic tumor

122. autoimmune disorder

123. obesity (overweight people require more insulin to metabolize the food they eat or the number of insulin receptor sites in cells is decreased)

126. disturbance in insulin reception in the cells

127.  number of insulin receptors

129. common in overweight or obese

130. w/ some circulating insulin present, often do not require insulin

133. P olyuria olydipsia olyphagia ruritus aresthesia oor healing oor eyesight

136. Normal value= 80-120 mg/dl

138. N value = < 120mg/dl

140. obtain FBS, administer 100 gm. Glucose by mouth diluted in juice; obtain blood and urine specimen after 1, 2 and 3 hrs.

141. N value = blood glucose rise to 140 mg/dl in the 1st hour and returns to normal by 2nd and 3rd hrs.

145. Management of Hypoglycemia Give simple sugar orally if pt. is conscious and can swallow – orange juice, candy, glucose tablets, lump of sugar Give Glucagon (SQ or IM) if pt. is unconscious or cannot take sugar by mouth As soon as pt. regains consciousness, he should be given carbohydrate by mouth If pt. does not respond to the above measures, he is given 50 ml of 50% glucose I.V. or 1000 ml of 5%-10% glucose in water I.V.

147. Oral Antidiabetic Agents

148. Oral Antidiabetic Agents

149. DIABETES MILLETUS INSULIN THERAPY DISPENSED IN “U”/ml : eg 100, 80 REFRIGERATE GIVEN @ ROOM TEMP GENTLY ROTATED, NOT SHAKEN ROUTE : SQ ; IM OR IV SYRINGE: 5/8 INCH ; SAME BRAND

151. DIABETES MILLETUS INSULIN THERAPY: SITE OF INJECTION: ABDOMEN ANTERIOR THIGH ARM UPPER BACK BUTTOCKS

155. Lipodystrophy – localized disturbance of fat metabolism

156. Ex. Lipohypertrophy – thickening of subcutaneous tissue at injection site, feel lumpy or hard, spongy result to  absorption of insulin making it difficult to control the pt.’s blood glucose

158. carry a rapid-acting source of glucose during exercise

159. excessive or unplanned exercise may trigger hypoglycemia

161. ACUTE COMPLICATIONS OF DIABETES MILLETUS DIABETIC KETO-ACIDOSIS (DKA) INSULIN SHOCK HYPERGLYCEMIC, HYPEROSMOLAR, NONKETOTIC (HHONK) COMA

163. Diabetic Ketoacidosis (DKA) Coma S/Sx: polyuria, thirst nausea, vomiting, abdominal pain –-- due to acidosis weakness, headache, fatigue --- due to acidosis and F/E imbalance dim vision dehydration, hypovolemic shock (PR, BP, dry skin, wt. loss) hyperpnea (Kussmaul’s breathing) acetone breath (fruity odor) lethargy  COMA Blood glucose level > 250-350 mg/100 ml.

168. lethargy

169. temp, PR, BP, signs of severe fluid deficit

170. Confusion, seizure, coma

172. Interventions for DKA and Hyperosmolar Coma Regular insulin IV push or IV drip 0.9% NaCl IV – 1 L during the 1st hr, 2-8 L over 24 hrs. administer sodium bicarbonate IV to correct acidosis Monitor electrolyte levels, esp. serum K+ levels administer K+, monitor UO hourly (30ml/hr)

173. Long-term Complications of DM Vascular Changes ) Macroangiopathy – hardening and damage of the walls of large arteries Coronary Artery Disease CVA (Stroke) Peripheral vascular disease – foot ulcers and gangrene b. ) Microangiopathy – destruction of small blood vessels Retinopathy – damage to retinal capillaries; hemorrhage, blindness Nephropathy – damage microcirculation of kidneys; CRF 2. Neuropathy Damage to the neurons caused by vascular insufficiency and  blood glucose Sensory and motor impairment Numbness, tingling, pain in extremities Painless neuropathy Impotence!!

177. DISORDERS OF THE ADRENAL GLANDS

178. ADRENAL GLAND STIMULATED BY ACTH ADRENAL MEDULLA- SECRETES CATECOLAMINE, (EPINEPHRINE, & NOREPINEPHRINE). ADRENAL CORTEX- MAIN BODY; RESP FOR SECRETION OF GLUCO,MINERALO, SEX HORMONES (ANDRO & ESTRO) FUNCTION IS TO CONTROL THE (-) FEEDBACK MECHANISMS REGULATING HORMONE RELEASE

180. ADRENAL CORTEX DISORERS ADRENAL INSUFFICIENCY ( ADDISON’S DSE) CUSHING’S SYNDROME

181. ADRENAL INSUFFICIENCYADDISON’S DISEASE INCAPABILITY OF THE ADRENAL CORTEX TO PRODUCE GLUCOCORTICOIDS IN RESPONSE TO STRESS

183. Addison's Disease Replacement of hormones Hydrocortisone; Fludrocortisone PNSS (0.9 NaCl) Dextrose Diet: High-CHO & CHON Low potassium, high sodium

184. Addison’s disease

185. Addison's Disease MVS [4x / day] Infection, Addisonian crisis, dehydration MIOW / MBP / MBG Give steroids with milk or an antacid Avoid: Contacts & Stress

186. CUSHING’S SYNDROME CAUSE: SUSTAINED OVER-PRODUCTION OF GLUCOCORTICOIDS BY ADRENAL GLAND FROM ACTH BY PITUITARY TUMOR EXCESSIVE GLUCORTICOID ADMINISTRATION

187. CUSHING’S SYNDROME S/SX: TRUNCAL OBESITY BUFFALO HUMP MOON-FACE WT GAIN SODIUM RETENTION THINNING OF EXTREMITIES – FROM LOSS OF MUSCLE TISSUE DUE TO PROTEIN CATABOLISM

188. CUSHING’S SYNDROME PURPLE STRIAE – FROM THINNING OF SKIN ECHYMOSIS FROM SLIGHT TRAUMA ANDROGENIC EFFECTS: OLIGOMENORRHEA HIRSUTISM GYNECOMASTIA HYPERTENSION FROM S. Na

190. CUSHING’S SYNDROME TREATMENT & NURSING CARE: PSYCHOLOGICAL SUPPORT PREVENT INFECTION – INFLAM & IMMUNE RESPONSE ARE SUPPRESSED PROMOTE SAFETY SURGERY – SUB/TOTAL ADRENALECTOMY Treat HPN

191. ALDOSTERONISM HYPERSECRETION OF ALDOSTERONE CONN’S SYNDROME

192. CONN’S SYNDROME PRIMARY ALDOSTERONISM CAUSE: ADRENAL ADENOMA S/SX: HYPOKALEMIA FATIGUE HYPERNATREMIA, HPN MANAGEMENT: SURGERY ALDACTONE – ALDOSTERONE ANTAGONIST

194. ADRENAL MEDULLA HORMONES : EPINEPHRINE NOREPINEPHRINE EFFECTS

195. PHEOCHROMOCYTOMA TUMOR OF ADRENAL MEDULLA SECRETES INCREASED AMOUNT OF CATECHOLAMINES A small tumor in the adrenal gland that secretes large amounts of epinephrine and norepinephrine. S/SX: HPN HYPERGLYCEMIA CARDIAC ARRHYTHMIA & CHF DIAGNOSTIC TEST : VMA IN 24H URINE- VANILLYMANDALIC ACID

196. VMA IN 24H URINE END PRODUCT OF CATECHOLAMINE METABOLISM DRUGS & FOOD TO BE WITHHELD 24H B4 THE TEST: COFFEE & TEA BANANA VANILLA CHOCOLATES

197. PHEOCHROMOCYTOMA MANAGEMENT: SURGERY MEDICAL : ADRENERGIC BLOCKING AGENTS: PHENTOLAMINE NURSING CARE: MONITOR BP IN SUPINE & STANDING MONITOR URINE FOR GLUCOSE & ACETONE

200. ACROMEGALLY,

202. SIADHLOCATION: BASE OF THE BRAIN

204. CUSHING SYNDROME

207. HYPERPARATHYROIDISMLOCATION: NEAR THYROID

209. CRETINISM

210. MYXEDEMA

211. HYPERTHYROIDISM (GRAVE’S DSE)LOCATION: ANTERIOR PART OF NECK

212. QUESTION NO. 1 A CLIENT IS FOUND TO BE COMATOSE & HYPOGLYCEMIC W/ A BLOOD SUGAR OF 50 MG/DL. WHAT NURSING ACTION IS IMPLEMENTED FIRST? INFUSE 1L OF D5W OVER A 12 HR PERIOD. ADMIN. 50% GLUCOSE IV CHECK THE CLIENT’S URINE FOR THE PRESENCE OF SUGAR AND ACETONE ENCOURAGE THE CLIENT TO DRINK ORANGE JUICE W/ ADDED SUGAR

213. QUESTION NO.2 WHAT IS THE PRIMARY ACTION OF INSULIN IN THE BODY? ENHANCES THE TRANSPORT OF GLUCOSE ACROSS THE CELL WALLS AIDS IN THE PROCESS OF GLUCONEOGENESIS STIMULATES THE PANCREATIC BETA CELLS DECREASE THE INTESTINAL ABSORPTION OF GLUCOSE

214. QUESTION NO.3 POSTOPERATIVE THYROIDECTOMY NURSING CARE INCLUDES WHICH MEASURES? HAVE CLIENT SPEAK EVERY 5-10 MINUTES IF HOARSENESS IS PRESENT PROVIDE LOW-CALCIUM DIET TO PREVENT HYPERCALCEMIA CHECK THE DRESSING AT THE BACK OF THE NECK FOR BLEEDING APPLY SOFT CERVICAL COLLAR TO RESTRICT MOVEMENT

215. Any Questions???