The endocrine

system

PREPARED BY: MA CONCEPCION S. DAY, LPT, RN,

 The endocrine system
 uses chemical messengers called hormones to
regulate a range of bodily functions through the
release of hormones.

 The endocrine system is a network of glands and

organs located throughout the body.

 It’ssimilar to the nervous system in that it plays

a vital role in controlling and regulating many of
the body’s functions. But unlike the nervous
system, it uses hormones instead of nerve
impulses and neurotransmitters.
PANCREAS
ADRENAL
GONAD
 Diabetes Tests
 A random plasma glucose test measures blood sugar without
regard to when the patient last ate.
 A fasting plasma glucose test looks at blood sugar in a patient
who has not eaten for at least eight hours.
 An oral glucose tolerance test gauges blood sugar after a patient
fasts for at least eight hours, and two hours after he drinks a
sugary solution.
 The oral glucose tolerance test is more sensitive than the fasting
plasma glucose test and is likelier to detect high blood sugar, but
is not as convenient because it requires giving the patient a drink
and waiting two hours before testing.
 In addition looks for other symptoms of diabetes, such as
increased thirst, unexplained weight loss, fatigue, blurred vision
and sores that do not heal.
Thyroid Tests
 TheTSH test, which measures thyroid-stimulating
hormone in the blood, is the primary test to diagnose
thyroid disease.
 administer T4 and T3 tests, which measure the amount of
free, or active, thyroid hormone that is available to body
tissues.
 The thyroid-stimulating immunoglobulin test and the
antithyroid antibody test tell whether a patient has
Graves' disease or another autoimmune disorder
that destroys the thyroid.
 The
radioactive iodine uptake test and a thyroid scan
measure thyroid function and look at the gland for
 Growth Tests
 Blood tests look at levels of insulin-like growth factor and measure
growth hormone during an oral glucose tolerance test to detect
excessive hormones, which cause extreme height, increased head
size, headaches, cardiac dysfunction, high blood pressure, and
prediabetes.
 Too little growth hormone stunts height in children, and adults with
the disorder may have increased body fat, decreased muscle and
bone mass, high cholesterol, and insomnia.
 To check for growth hormone deficiency, an endocrinologist may
administer a growth hormone stimulation blood test, but he is likelier
to use an insulin-intolerance test that checks the body's ability to
lower its blood sugar following an overnight fast.
 magnetic resonance imaging of the pituitary and hypothalamus
glands to see if a tumor is causing growth hormone problems.
Reproduction Tests
 A tests to check hormones released from sex organs. A serum
progesterone test measures the level of the hormone progesterone
and indicates whether ovulation has occurred.
 A follicle-stimulating hormone blood test reveals whether a woman
has enough healthy eggs for fertility.
 The clomiphene citrate challenge test is a more sensitive version of
the follicle-stimulating test, and an endocrinologist may recommend it
in couples with unexplained fertility or for women who are over 35
and looking to conceive.
 The progestin challenge test involves giving progestin for five days to
check whether the pituitary gland or ovaries excrete estrogen. Vaginal
bleeding within 14 days of the test indicates adequate estrogen.
 An endocrinologist may also prescribe the follicle-stimulating
hormone blood test to diagnose menopause in women who have
symptoms including hot flashes, heart palpitations and trouble
sleeping.
Bone Tests
 Patients whose bodies release too much or too little calcium into the blood
have a variety of symptoms, the most common of which are abnormal
vitamin D levels and bone loss.
 An endocrinologist may order a test to check the level of calcium in the
blood, as well as a 24-hour urine test to measure calcium in the urine. In the
24-hour urine test, the patient collects all of her urine over a 24-hour period
in a container and takes it to the lab for analysis.
 A patient may also take a complete blood count to scan for anemia and a
25-hydroxy vitamin D test to look for abnormal vitamin D levels.
 Still other tests measure the levels of bone-forming and bone-destroying
cells in the blood or urine.
 Other diseases related to excess calcium secretion include
hyperparathyroidism, leukemia and metastatic prostate cancer.
The endocrine system and
Pituitary Disorders
Endocrine System
PITUITARY GLAND (HYPOPHYSIS)
Divided into 2 lobes:
Anterior Pituitary (Adenohypophysis)
70% of the gland
Found in the sella turcica, a depression in the
sphenoid bone at the base of the brain
Secretions: GH, PRL, ACTH, TSH, LH, FSH,
MSH
Posterior Pituitary (Neurohypophysis)
Stores & secretes ADH & Oxytocin produced
by the hypothalamus
Endocrine System
 Disorders are generally grouped into:
 HYPER - when the gland secretes

excessive hormones
 HYPO - when the gland does not

secrete enough hormones

 Hyper and Hypo can be classified as:
 PRIMARY - when the Gland itself is the

problem
 SECONDARY - when the problem is the

pituitary or the hypothalamus

Endocrine System
Growth hormone (Somatotropin)
Growth of body tissues and
bone
 Hyper-secretion:
GIGANTISM (children)
ACROMEGALY (adults)
 Hypo-secretion of GH:
Dwarfism
Endocrine System
 Endocrine System
ACTH (Adrenocorticotropic
Hormone)
 Stimulates adrenal cortex to
secrete the adrenal hormones
cortisol and aldosterone
 Hyper-secretion:
Cushing’s Syndrome
 Hypo-secretion:
Addison’s Disease
 Endocrine System
TSH (Thyroid Stimulating
Hormone)
Stimulates the thyroid gland
to secrete T3 and T4
 Hyper-secretion:
Hyperthyroidism
 Hypo-secretion:
Hypothyroidism
Endocrine System
Gonadotropin (FSH/ LH)
 Affect growth, maturity and functioning of primary and
secondary sex characteristics
 They influence the gonads (ovaries and testes) to secrete
gonadal hormones- estrogen, progesterone, testosterone
 Hyper-secretion:
 precocious puberty
 Hypo-secretion
 Males: impotence,  production of spermatozoa
 Females: no ovulation, no menstruation, infertility
Endocrine System
MSH (Melanocyte Stimulating
Hormone)
 Stimulates
the skin
melanocytes to produce the
pigment melanin
 Hypersecretion:
Bronze appearance of the
skin (hyperpigmentation)
 Hyposecretion:
Albinism
(hypopigmentation)
 Endocrine System

ADH (Antidiuretic Hormone / Vasopressin)

 causes the renal retention of water (not
affecting sodium) in the renal tubules
 It can also cause vasoconstriction;
“vasopressin”
 Hyper-secretion:
o SIADH - excessive retention of water
by the renal tubules:
 Hypo-secretion:
o DI - inability of the renal tubules to
retain water
o Diagnostic Test: Water deprivation
 Endocrine System
Oxytocin
 releasedduring childbirth to
cause uterine contraction
 responsible for the “let-down”
reflex of milk ejection
Pituitary Gland Disorder

Hyperpituitaris
m
Pituitary Gland Disorder
 Hyperpituitarism
 Etiologic factors:
Tumor and hyperplasia (Benign
pituitary adenoma, hyperplasia of
pituitary tissue)
Prolactinomas (prolactin-secreting
tumors) account for 60 to 80% of all
pituitary tumors
GH-producing adenomas
Pituitary Gland
Disorder
Hyperpituitarism
Assessment findings:
 Acromegaly
 gradual, marked
enlargement of the
bones of the face, jaw,
hands and feet.
 Gigantism
 proportional overgrowth
of all body tissues with
remarkable height
 Pituitary Gland Disorder
Hyperpituitarism
Assessment findings:
 Neurologic manifestations
 Headache
 Somnolence, Behavioral changes, seizures
 Signs and symptoms of increased ICP
 Disturbance in appetite, sleep, temperature
regulation and emotional balance due to
hypothalamic involvement
 Visual disturbances due to the compression of
the optic chiasm above the pituitary gland:
Hemianopsia or scotomas or blindness
Pituitary Gland Disorder
 Pituitary Gland Disorder
Hyperpituitarism
Assessment findings:
Pituitary Gland Disorder
Hyperpituitarism
Assessment findings:
 Diagnostic tests:
skull x-ray, CT scan, MRI
(tumor or pituitary
enlargement)
Plasma GH levels
determination: increased
 Pituitary Gland Disorder
Hyperpituitarism
Medical Management:
 Surgery
 Removal of pituitary gland
 Transphenoidal
hypophysectomy
 Radiation
 Pituitary Gland Disorder
Hyperpituitarism
Medical Management:
 Pharmacotherapy
 Bromocriptine (Parlodel)

inhibit
the synthesis of GH
(acromegaly) & prolactin
 Pituitary Gland Disorder
Hyperpituitarism
Nursing Management: Surgery
 Pre-operatively: Health Teaching
 explain to the patient that this surgery will
remove the tumor from the pituitary gland
 A nasal catheter and nasal packing are
expected in the nasal cavity for a day
 Indwelling catheter will be inserted (to
monitor UO) – Diabetes Insipidus can be
a complication of the surgery
 Review all patient’s medication regimen
and provide routine pre-op care
Pituitary Gland Disorder
Hyperpituitarism
Nursing Management: Surgery
 Post-operatively:
Strictlykeep the patient
on BED rest for 24° and
encourage ambulation on
day 2
position the patient
fowler’s to avoid tension
on the suture line and to
avoid increased
intracranial pressure
 Pituitary Gland Disorder
Hyperpituitarism
Nursing Management: Surgery
 Post-operatively:
Remind the patient NOT to sneeze,
forcefully cough, bend over and blow
the nose for several days to avoid
disturbing the suture lines
Mild analgesic can be given for
headache
Pituitary Gland Disorder

Hyperpituitarism
Nursing Management: Surgery
 Post-operatively:
 Anticipate the patient to manifest signs and symptoms of DI after surgery

Be alert for  thirst and  UO w/

low SG
Replace fluids and administer IV vasopressin
as ordered. DI should resolve in 72°
Report outputs above 900 ml / 2 hours or
specific gravity below 1.004 (D. Insipidus)
Hyperpituitarism
Nursing Management: Surgery
Post-operatively:
Be alert for potential leakage of
CSF from the operative site
If rhinorrhea is present, test the
discharge for glucose and if
positive, report to the physician
of the CSF leakage
Pituitary Gland Disorder
Hyperpituitarism
Nursing Management:

Provide safety measures because

pituitary tumor can cause visual
disturbances. Approach the
patient to the unaffected side
if he has hemianopsia.
Pituitary Gland Disorder
Hypopituitarism
 Hypo-functionof pituitary gland causing
deficiencies in both the pituitary hormones
and the hormones of the target glands
 Clinical manifestation:
Observed when 75% of the pituitary gland
is dysfunctional
Metabolic dysfunction
Sexual immaturity
Growth retardation
Pituitary Gland Disorder
Hypopituitarism
Absence of all pituitary secretions
Panhypopituitarism (Simmond’s
disease)
Postpartum pituitary necrosis
severebleeding, hypovolemia and
hypotension at the time of delivery
Sheehan’s syndrome
Pituitary Gland Disorder

Hypopituitarism

Causes:
Trauma
Tumor
Surgery / radiation of pituitary gland
Congenital
Pituitary Gland Disorder
Hypopituitarism
Assessment:
 Hemianopsia/headache (if due to tumor)
 Weight loss, emaciation
 Varying signs of hormonal disturbances
depending on which hormones are being
under-secreted
o menstrual dysfunction
o hypometabolism
o adrenal insufficiency
o growth retardation
 Pituitary Gland Disorder
Hypopituitarism
Diagnostic tests
 Skull x-ray, CT scan, MRI (reveal pituitary tumor)
 Blood examination:

 plasma hormone levels

(depending on specific hormones
under-secreted)
Pituitary Gland Disorder
Hypopituitarism
Collaborative Management:
 specific treatment depends on the cause
 Tumor: surgical removal or irradiation of the
gland
 Regardless of the cause, treatment will include
replacement of deficient hormones (HRT):
 Corticosteroids
 Thyroid hormone
 Sex hormones, gonadotropins
End