The Endocrine System

The endocrine system produces chemical messengers

(hormones) that are released into the blood.
It is the secondary control system of the body and is in charge
of body processes that, compared to the speed of the
nervous system, happen slowly.

Hormones play a major role in processes such as:

• Stress Response, Sleep, Body Defences • Reproduction
• Growth and development
• Maintenance of homeostasis
• Regulation of metabolism

Endocrine vs Exocrine Glands

Endocrine glands release more than 20 major hormones directly into the bloodstream where they are
transported to cells in other parts of the body.
Exocrine glands do not release their secretions into the blood, but into a duct, where they act in a local
area
• i.e. the sweat and salivary glands, release secretions onto the skin or inside of the mouth.

Hormones
Hormones are chemicals produced by specialized cells.
Blood transfers hormones to target sites which have cells that have
protein receptors specific to that particular hormone(s)
Hormones affect only certain tissues or organs (target cells/organs)
Although many different hormones circulate throughout the
bloodstream, each one affects only the cells that are genetically
programmed to receive and respond to its message.
Hormone levels can be influenced by factors such as stress, infection,
and changes in the balance of fluid, glucose and minerals in blood.

Effects Caused by Hormone Binding

Changes in plasma membrane permeability or electrical state
Synthesis of proteins, such as enzymes
Activation or inactivation of enzymes
Stimulation of mitosis (cell division)
Promotion of secretory activity

Endocrine Gland Stimulus

There are three ways endocrine glands can be stimulated into
action.
- Hormonal: Most common, glands are stimulated by other
hormones i.e. Hypothalamus->Anterior Pituitary
Pituitary-> Thyroid/Adrenal
- Humoral : changing levels of certain substances in fluids (ie
ions in blood) stimulate hormone release i.e.Parathyroid-
>Calcitonin Pancreas-> Insulin
- Neural: Nerve impulses stimulate hormone release
i.e. Hypothalamus->Posterior Pituitary
Adrenaline->Adrenal Glan
Hypothalalmus
• Located in lower central part of the brain (inferior to the thalamus)
• Secretes hormones which then stimulate or inhibit the release of hormones from the anterior pituitary
gland
• Stimulates the release of hormones from posterior pituitary via neurons

Pituitary Gland
• Size of a pea; often called the “Master Gland” of the endocrine
system
• Hangs by a stalk (infundibulum) from the hypothalamus in the brain
• Produces hormones that control many bodily functions including:
reproduction, growth, fluid balance
• Has two functional lobes
– Anterior Pituitary (hormonal stimulation from hypothalamus)
– Posterior Pituitary (nervous stimulation)

ACTH = Adrenocorticotropic hormone

Anterior Pituitary Hormones

• Growth Hormone: growth of skeletal muscles and long bones, causes amino acids to be built into proteins
& fats to be broken down for a source of energy
• Prolactin: over 300 actions in males & females including lactation, immunity, reproduction, role in
regulation of stress response/anxiety/depression
• Thyroid Stimulating Hormone: Stimulates thyroid gland to manufacture and release hormones that affect
metabolism (T3, T4)
• Adrenocorticotropic Hormone: Regulates endocrine activity of the steroid hormone ‘cortisol’ released
from the adrenal cortex
• Follicle Stimulating Hormone:
– In women FSH stimulates the growth of ovarian follicles (before release of egg from follicle at
ovulation and increases oestradiol production
– In men FSH stimulates sperm production (spermatogenesis)
• Luteinizing Hormone:
– In women LH stimulates ovulation & the release of progesterone after ovulation
– In men LH stimulates testosterone release

Posterior Pituitary Hormones

• The Hypothalamus produces two hormones which are transported to “neurosecretory” cells of the
posterior pituitary for storage
– Oxytocin
• Stimulates contractions of the uterus during labour and
breastfeeding
 • Causes milk ejection in a nursing woman
• Increases social bonding (female & male)
• Increases prosocial behaviours – trust/attachment
– Antidiuretic hormone (ADH or vasopressin)
• Inhibits urine production by promoting water reabsorption
in the kidneys
• Initiates vasoconstriction
• Combination of increased blood volume and vasoconstriction increases blood pressure

Thyroid Gland
• Found at the base of the throat
• Produces three hormones
– Thyroxine (T4)
– Triiodothyronine (T3)
• major metabolic hormones
• iodine-containing hormones which control rate at which
glucose is converted to chemical energy
• ‘T’ = amino acid “Tyrosine” to which 3 or 4 iodine attach
– Calcitonin
• Decreases blood calcium levels by causing calcium to be
deposited on the bones

Parathyroid Glands
• Attached to the thyroid are four tiny glands that function
together called the parathyroid glands.
• Manufacture and Release
Parathyroid Hormone (PTH)
– Raise Blood Calcium Levels
– PTH causes the release of calcium from the bones and
stimulates the kidneys and intestine to absorb more calcium when
blood calcium levels drop parathyroid glands.

Adrenal Glands
• Sit on top of each kidney
• Made up of two zones which have differing endocrine
functions:
• adrenal medulla (inner)
• adrenal cortex (outer)
Adrenal Cortex: (outer layer)
Produces 3 major hormones (the corticosteroids)
These are mainly:
- Aldosterone
- Glucocorticoids
- Sex hormones

Adrenal Cortex: (outer layer)

Aldosterone
• Regulates water and electrolyte balance
• Targets receptors on the kidney tubules. An increase in aldosterone causes more water to be reabsorbed
back into blood stream by the kidney (raises blood volume & BP)
• Production of aldosterone is stimulated by:
• 1. Renin in the “Renin-Angiotensin-Aldosterone Pathway” (Renin is produced by kidneys when blood
pressure drops)
• 2. High levels of circulating Potassium
• Aldosterone is the most important regulator of sodium secretion

Glucocorticoids
• Includes cortisone and cortisol
• Help resist long-term stressors by increasing blood glucose levels
• Anti-inflammatory (reduce oedema) and inhibit pain causing molecules (prostaglandins)
• Released in response to increase blood levels of ACTH (from anterior pituitary)
• Prescribed as drugs to people with inflammatory conditions eg. Rheumatoid arthritis

Sex hormones
• Produced in the inner layer of the adrenal cortex
• Small amounts are made throughout life
• Mostly androgens (DHEA, testosterone) are made but some estrogens (female sex hormones) are also
formed

Adrenal Medulla (inner layer)

Secretes two hormones adrenaline (epinephrine) and noradrenaline (norepinephrine)
Stimulated by the nervous system
These hormones prepare the body to deal with short-term stress (“fight or flight”) by:
• Increasing heart rate, blood pressure, blood glucose levels
• Dilating small passageways of lungs

Pancreas
• The pancreas is a mixed gland
– Produces pancreatic juice (exocrine)
– Produces hormones(endocrine)
• The pancreatic islets or Islets of Langerhans produce hormones:
• Insulin – Lowers Blood Glucose Levels
– released from beta cells of the islets
– Attaches to receptor sites on muscle and fat cells to
allow glucose into cells (sends glucose transporters
(GLUT4) to cell surface to allow glucose in)
– Influences Liver to convert glucose to glycogen
• Glucagon – Raises Blood Glucose Levels
– Released from the alpha cells of the islets
 – causes the liver to convert stored glycogen into glucose, which is released into the bloodstream
– Influences conversion of fat and protein to glucose

Pineal Gland
• Found in the brain
• Secretes Melatonin which influences:
– The body’s wake and sleep cycles – circadian rhythm (high at night and low at noon)
– Immunity
– Reproduction
– Antioxidant (detoxification)
– Body mass regulation
– Bone formation & cardiovascular regulation

Thymus Gland
• Active in infants and children (atrophies in adults)
• Produces thymosin
– Matures some types of white blood cells
– Important in developing the immune system 25

Other Hormone-Producing Tissues and Organs

• Small intestine
• Stomach
• Kidneys
• Heart
• Many other areas have scattered endocrine cells

Endocrine System Disorders

Pituitary Gland
• Anterior pituitary produces growth hormone
• Disorders
– Gigantism
– Acromegaly
– Pituitary dwarfism

Gigantism
• Overproduction of growth hormone (hypersecretion) in childhood most commonly due to a benign
tumour of the pituitary gland
• Occurs before closure of epiphysis resulting in overgrowth of long bones
• 2.4 – 2.8 metres height common
Other signs
- Delayed puberty, prominent forehead and jaw, headaches
- Treated by removal of tumour

Acromegaly
•Over production of growth hormone during adulthood
•Usually occurs in 30s or 40s
•Irreversible
•Bones increase in size causing enlargement of jaw, forehead, hands, feet and lips
•Barrel chest
Hypopituitary dwarfism
• Condition of growth retardation characterized by patients who are very short in stature but have normal
body proportions.
• Underproduction (hyposecretion) of growth hormone in childhood.
• Different to a Achondroplasia (not endocrine) which is caused by a genetic mutation affecting the growth
of long bones which results in normal size torso but shorter limbs and larger head

Hyperthyroidism
Hyperthyroidism: Overactive Thyroid due to:
• Excess Iodine intake
• Thyroiditis
• Thyroid nodules
• Graves disease: Autoimmune disorder in which
autoantibodies produced by immune system stimulate
thyroid to produce too much thyroxine (T4)

S/S of Hyperthyroidism
• High metabolic rate, exopthalamus, weight loss, increased
pulse, temp and BP, insomnia, anxiety, dysphagia, tremor,
diaphoresis, skin thinning
• Enlargement of thyroid (goitre)
• Treated by thionamide drugs, subtotal or total
thyroidectomy, or radioactive iodine ablation

Hypothyroidism
Hypothyroidism: Underactive Thyroid due to:
• Inadequate Iodine intake
• Over-response to thyroid treatment or surgery
• Medications
• Hashimoto’s disease: Autoimmune disorder in which autoantibodies produced by immune system attack
and damage the thyroid gland

S/S of Hypothyroidism
• Low metabolic rate, fatigue, weight gain, increased sensitivity to cold, dry skin, bradycardia, muscle
weakness, aches, depression, impaired memory,
• Enlargement of thyroid (goitre)
• Treated by synthetic thyroid hormones (levothyroxine)

Parathyroid glands
• Release parathyroid hormone (PTH) which causes release of Ca from
bones
• Hyperparathyroidism
– mainly due to benign tumour
– Causes bone demineralisation, skeletal pain and fractures
– https://www.youtube.com/watch?v=sD9st1ZPFrQ
• Hypoparathyroidism (rare)
– Often due to removal when treating hyperthyroidism or hyperparathyroidism

Cushing’s Syndrome
• Excess release of Glucocorticoids from adrenal gland
• Can be caused by:
– Hyperplasia of adrenal tissue by excess ACTH (adrenocorticotropic
hormone) released by anterior pituitary –> increased cortisol production
– Tumour
– Excess administration of corticosteroids

S&S
– Rounded face
– Fatty hump between shoulders
– Pink/purple stretch marks on skin
– High BP and BGL, bone loss
– Depression of immune system

Addison’s disease
Hyposecretion of adrenal cortex hormones
causing low levels of aldosterone and glucocorticoids
(cortisol)
• Causes
– autoimmune response causes destruction of
adrenal cortex
– Pituitary hypofunction
– Infections
S&S
Bronze skin, Na and H2O loss, weakness, muscle/joint pain,
salt craving, low BGL, acopia, increased risk of infection,
fatigue, irritability, depression, GIT symptoms, weight loss

Pancreas and Diabetes

• Pancreatic islets (Islets of Langerhans)
• Alpha cells produce glucagon which causes the liver to release
stored glucose in to the blood stream
• Beta cells produce insulin which allow for the uptake of glucose into
cells
• Diabetes Mellitus refers to a group of diseases that affect how the
body uses blood glucose
• Chronic diabetes includes three types:
• Diabetes Mellitus Type 1
• Diabetes Mellitus Type 2
• Gestational Diabetes
Diabetes Mellitus
Common Signs and Symptoms (Type 1 and Type 2)
• Frequent urination – Polyuria – due to osmotic diuresis (kidney releases excess glucose into urine and
water follows – This affects thirst levels too)
• Increased thirst – Polydipsia
• Extreme hunger - Polyphagia
• Unexplained weight loss
• Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that
happens when there's not enough available insulin)
• Fatigue
• Irritability
• Blurred vision
• Slow-healing sores
• Frequent infections, such as gums or skin infections and vaginal infections

Diabetes Mellitus Type 1

Progressive destruction of beta cells of the pancreas by WBC’s
Results in limited/no insulin production
• Glucose cannot move into cells
• Blood glucose levels rise to abnormally high levels
• Body has to use fat and muscle to make ATP (energy)
Autoimmune, genetic predisposition, (past viral infection may
trigger)
80-90% of beta cells are destroyed before symptoms appear
Usually before age of 25

Diabetes Mellitus Type 1

Diagnosis
Blood tests
• Fasting blood test result is at or above 7.0mmol/L or a random blood test result is at or above
11.1mmol/L
• HbA1c blood test (done over 3 months) result is ≥ 6.5%. Measures amount of glucose incorporated in to a
RBC as a percentage of Hb
• Urinalysis
• Glucose challenge: OGTT (oral glucose tolerance test)

Management
• Insulin (SC)
• Education (diet, exercise)
• Monitor BGL
• Regular HBA1c

• What is the pathophysiology of type 1 diabetes and what causes it?

• Why is hypoglycaemia a complication of type 1 diabetes?
• https://www.youtube.com/watch?v=jxbbBmbvu7I

Type 2 Diabetes Mellitus

• Environmental factors (diet and exercise and possibly a genetic predisposition or concurrent disease)
contribute to the onset of Type 2 DM
• Chronically high levels of circulating glucose lead to:
– Insulin resistant muscle and fat cells (impaired receptor sites for insulin to dock, therefore, a lack
of cellular ability to take up glucose from the blood)
– Insulin resistant hepatic cells (causing inability to suppress hepatic glucose production)
 – Eventually pancreatic Beta Cell dysfunction (pancreas produces more and more insulin to reduce
high levels of glucose [due to insulin resistance + high intake] and eventually unable to produce
enough insulin)
• Mostly in adults, but especially recently, diagnosed in children and adolescents as well

Primary Causes of DMT2

• Chronic, high sugar/processed carbohydrate diet
• Not getting enough exercise
Risk Factors:
• Obesity
• Some ethnic groups – genetic predisposition (particularly Indigenous Australians, African Americans,
Native Americans, Asians, Pacific Islanders, and Hispanic Americans)
• Gestational diabetes a baby weighing more than 4 KGS
• High blood pressure
• High triglycerides or cholesterols
• Waist measurement > 100cm Males, > 80cm women
• Polycystic Ovary Syndrome
• Cushing’s Disease

Management
• Oral hypoglycaemics
• increase sensitivity of tissue to insulin
• stimulate beta cells
• Diet
• Exercise
• Weight Loss
• Insulin (only when other measures fail)

Acute complications of diabetes

Hypoglycaemia (mostly only for Type 1)
• Decreased blood sugar level that occurs when blood glucose is too low, (< 4mmol/L)
• Due to administration of too much insulin or oral hypoglycaemics, inadequate oral intake, unexpected
physical activity
Signs and Symptoms
• Pallor - Tremor
• Anxiety - Tachycardia
• Palpitations - Diaphoresis
• Headache - Dizziness
• Irritability - Fatigue
• Poor judgment - Confusion
• Visual disturbances - Hunger
• Seizures - Coma

Hypoglycaemia Treatment
• If conscious (Oral glucose eg 3⁄4 cup orange juice or soft drink, 2 tsp sugar, 6 jelly beans ) and then
complex carbohydrate (bread, biscuits, chocolate)
• Glucagon ( SC or IM)
• IV glucose
• Monitor BGLs

Chronic Complications of Diabetes

• Heart disease and atherosclerosis, peripheral arterial insufficiency
• Nerve damage – neuropathy:
– Tingling, burning, numbness loss of sensation
– Damage to nerves that control digestion = N&V, diarrhoea, constipation
– Erectile dysfunction in men
• Kidney damage - nephropathy
• Eye damage: retinopathy, glaucoma, cataracts, blindness
• Slow healing:
– Cuts and blisters can become infected easily and heal poorly
– Severe damage may require amputation
• Skin conditions:
– more susceptible to skin problems including fungal and bacterial infections
• Hearing impairment
• Sleep apnoea
• Alzheimer’s disease – T2DM seems to increase the risk of AD

Long term complications of diabetes

Poor Healing: elevated glucose levels in RBCs reduce release of oxygen to the tissues
Neuropathy: high BGLs cause inflammation and decreased nerve sensation
Increased Rick of Infections: High BGLs increase survival of some pathogens
Increases atherosclerosis: reduces and can block blood flow which causes poor wound healing, diabetic
retinopathy, diabetic gangrene, kidney failure, stroke, MI

Nursing considerations-potential problems

• Diabetes: Poor wound healing due to reduced O2 to tissues, damaged vessels.
• Interventions
• Strict aseptic care of wounds
• Prevent pressure sore development
• Encourage mobilization
• Encourage good nutrition and fluid intake
• Encourage, educate on hygiene