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UNIVERSITY OF SAN CARLOS

COLLEGE OF NURSING
ENDOCRINE NOTES

Endocrine glands and its hormones:

PITUITARY GLAND – master gland since it controls all the other glands of the endocrine system

1.) Anterior Pituitary Gland ( adenohypophysis) – outgrowth of the pharynx

G H (somatotropine) - stimulation of somatic growth
TSH - stimulates synthesis and release of thyroid hormones
PROLACTIN - regulation of milk production
ACTH - stimulates the adrenal cortex to secrete adrenal hormones
LH - in women stimulate ovarian follicular development and ovulation, LH stimulates testosterone
biosynthesis in men
FSH – female egg cell production or male sperm production
MSH - cause hyperpigmentation of skin

2.) Posterior Pituitary Gland ( neurohypophysis) – extension of the hypothalamus

Oxytocin - stimulates contraction of uterine smooth muscle cells, stimulates milk delivery from the breast
during lactation.

ADH ( Vasopressin) - promotes water conservation by the kidney

ADRENAL GLANDS – a pair of glands located on top of the kidney poles

1.)adrenal cortex – outer part of the adrenal gland

Sugar – glucocorticoids ( cortisone)

Salt – mineralocorticoids ( aldosterone)

Sex – gonadal hormones ( androgen, estrogen)

2.) adrenal medulla – inner part of the adrenal gland

CATECHOLAMINES – fight or flight response of the body

Epinephrine ( adrenalin)

Norepinephrine ( noradrenalin)

THYROID GLAND

T3 ( TRIIDOTHYRONINE) – metabolically active form of T4

T4 (THYROXINE) – contains iodine essential for normal growth and metabolism

THYROCALCITONIN – decreases calcium concentration in the blood

PARATHYROID GLAND

PARATHYROID HORMONE( PARATHORMONE, PTH)

- increases calcium concentration in the blood

PANCREAS

2 FUNCTIONS:

1. EXOCRINE – Produces pancreatic juices which are used in the duodenum as an important part in the
digestive system

2. ENDOCRINE – ISLETS OF LANGERHANS -

ALPHA CELLS (GLUCAGON) – increases blood glucose by glycogenolysis


BETA CELLS (INSULIN) – decreases blood glucose by glycogenesis, transports glucose into cells for
utilization
DELTA CELLS (SOMATOSTATIN) – inhibits the secretion of glucagon and insulin
Disorders of the Pituitary Gland
HYPOPITUITARISM
( dwarfism)
DEFINITION Hyposecretion of GH
S/S Retarded physical growth
Premature aging
Low intellectual devt
Poor devt of secondary sex
characteristics
MANAGEMENT
provide emotional support
encourage expression of
feelings r/t altered body image
prepare to administer human
growth hormone(hGH)
SURGERY
DIABETES INSIPIDUS
(DI)
DEFINITION Hyposecretion of ADH
LAB/DX (+) fluid deprivation test
S/S Polyuria of 4 to 24 L/day
Polydipsia
Dehydration
Inability to concentrate urine
A low urinary specific
gravity:1.006 or less
Postural hypotension
MANAGEMENT monitor electrolyte values and
for signs of dehydration
monitor I&O, weights, specific
gravity of urine
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HYPERPITUITARISM
( gigantism, acromegaly)
Hypersecretion of GH
gigantism – before closure of
epiphyseal plate
acromegaly – after closure of
epiphyseal plate
Coarse facial features
Large hands and feet
Thickening and protrusion of
the jaw
Arthritic changes
Organomegaly
provide emotional support r/t
altered body image
provide frequent skin care
provide pharmacological and
nonpharmacological
interventions for joint pain
prepare the client for radiation
of the pituitary gland as
prescribe
HYPOPHYSECTOMY
COMPLICATION/S
Increase ICP
Bleeding
CSF leakage
Temporary DI
SYNDROME OF
INAPPROPRIATE
SECRETION OF ADH
(SIADH)
Hypersecretion of ADH
Signs of fluid overload
• Weight gain
• Hypertension
Dilutional Hyponatremia
• Changes in LOC and
mental status changes
provide a safe envt, particularly
for the client with changes in
LOC
monitor I&O and obtain daily
weights
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instruct the client to avoid foods

or liquids with a diuretic type monitor fluid and electrolyte
action(e.g caffeinated beverages) balance

administer vasopressin restrict fluid intake as prescribed

tannate( Pitressin Tannate),
desmopressin acetate(DDVAP, administer diuretics and IV fluids
Stimate) or lypressin(Diapid) as as prescribed; monitor IV fluids
prescribed carefully because of the risk for
water intoxication
administer
chlorpropamide(Diabenese) or
clofibrate(Atromid-S) as
prescribed – augments the action
of ADH if partial deficit of ADH
exists

Disorders of the Adrenal Gland

ADDISON’S DISEASE CUSHING’S SYNDROME

DEFINITION Hyposecretion of adrenal Hypersecretion of adrenal
hormones hormones

S/S
Hypoglycemia Elevated blood glucose
Hyperkalemia Hypokalemia
Hyponatremia Hypernatremia
Postural hypotension Hypertension
Emotional disturbances Truncal obesity with thin
Lethargy, fatigue, and muscle extremities
weakness Moonface
Dark pigmentation Buffalo hump
Supraclavicular fat pads
Fragile skin that easily bruises
Hirsutism

MANAGEMENT
monitor v/s, particularly BP, monitor v/s particularly BP
weight, and I&O monitor I&O
monitor lab values provide good
monitor blood glucose and skin care
potassium levels allow the client to discuss
feelings r/t body appearance
administer glucocorticoids or
mineralocorticoid meds as administer
prescribed aminoglutethimide(Elipten,
Cytadren)- an adrenal enzyme
low potassium, high sodium inhibitor as prescribed
diet
low sodium, high potassium diet
Patient Education:

avoid individuals with infection

avoid stress

avoid strenuous exercise

SURGERY Hypophysectomy – if the

condition results from increase
ACTH secretion by the pituitary
gland

Adrenalectomy – if the condition

results from adrenal adenoma
COMPLICATION ADDISONIAN CRISIS
acute adrenal insufficiency
precipitated by stress, illness
and infection

S/S:
hyponatremia, hyperkalemia
hypoglycemia
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shock

Mgt:
administer IV glucocorticoids as
prescribed - hydrocortisone
sodium succinate(Solu- cortef)

PHEOCHROMOCYTOMA

DEFINITION Catecholamine- producing tumor in the adrenal

medulla
S/S HPN
Severe headaches
Palpitations
Pain in the chest or abdomen with n & v

MANAGEMENT monitor v/s (BP)

avoid stimuli (increased abdominal pressure,

micturition, and vigorous abdominal palpation)

instruct the client not to smoke, drink caffeinated

beverages

promote rest and a nonstressful envt

provide a diet high in calories, vitamins and

minerals

avoid tyramine- rich foods ( e. g. aged cheese, ripe

banana, wine, gravies)

COMPLICATION HYPERTENSIVE CRISIS

DOC : phentolamine(Regitine)
SURGERY ADRENALECTOMY
• lifelong glucocorticoid replacement is
necessary with a bilateral adrenalectomy

• temporary glucocorticoid replacement, up

to 2 years is necessary for a unilateral
adrenalectomy

POST OP:
monitor for signs of shock and hemorrhage,
particularly during first 24 to 48 hours

DISORDERS OF THE THYROID GLAND

HYPOTHYROIDISM HYPERTHYROIDISM
(GRAVE’S DSE)
DEFINITION hyposecretion of thyroid hormone hypersecretion of thyroid
Normal lab values: hormone
T3 = 80 to 230 ng/dL decreased rate of body
T4 = 5 to 12 ug/dL metabolism increased rate of body
metabolism
S/S Intolerance to cold Enlarged thyroid gland (goiter)
Weight gain Protruding eyeballs
Bradycardia (exophthalmos)
Constipation Heat intolerance
Generalized puffiness and edema Diaphoresis
around the eyes and face Weight loss
Forgetfulness and loss of memory Diarrhea
Dry skin and hair Smooth, soft skin and hair
Personality changes
tachycardia and palpitations
MANAGEMENT monitor vital signs provide adequate rest

provide a warm environment for provide a cool and quiet

the client environment

instruct the client in low calorie,
low cholesterol, low saturated fat
diet
assess the client for constipation;
provide roughage and fluids to
prevent constipation
administer thyroid replacement;
levothyroxine sodium
(Synthroid) is most commonly
prescribed
S/E: tachycardia, restlessness,
nervousness and insomnia
NSG RESPONSIBILITY:
Administer in the morning to
prevent insomnia
Instruct the client about thyroid
replacement therapy for a lifetime
COMPLICATION Myxedema Coma
- results from persistently low
thyroid production
- can be precipitated by acute
illness, rapid withdrawal of
thyroid medications, anesthesia
and surgery, hypothermia or the
use of sedatives and narcotics
S/S: Hypotension
Bradycardia
Hypothermia
Hyponatremia
Hypoglycemia
Respiratory failure
MGT:
maintain a patent airway
administer levothyroxine
sodium(Synthroid) IV as
prescribed
keep client warm
SURGERY
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provide a high calorie diet
avoid the administration of
stimulants
administer antithyroid
medications that block thyroid
synthesis as prescribed
e.g. propylthiouracil(PTU)
methimazole( Tapazole)
A/R: agranulocytosis
administer iodine preparations
that inhibit the release of thyroid
hormone as prescribed
e.g.
SSKI (Lugol’s Solution)
- given preop to decrease
vascularity of thyroid gland
prepare the client for radioactive
iodine therapy as prescribed, to
destroy thyroid cells
administer propanolol (Inderal)
for tachycardia
Thyroid Storm
- occurs in a client with
uncontrollable hyperthyroidism
- occurs from manipulation of the
thyroid gland during surgery and
the release of thyroid hormone
into the bloodstream
S/S: Fever
Tachycardia
Systolic hypertension
Agitation, tremors and
anxiety
Delirium and coma
MGT:
maintain a patent airway and
adequate ventilation
administer antithyroid
medications, sodium iodide
solution, propanolol (Inderal) and
glucocorticoids as prescribed
monitor continually for cardiac
dysrhythmias
use a cooling blanket to decrease
temperature
THYROIDECTOMY
PRE- OP:
instruct the client in how to
perform coughing and deep
breathing exercises by supporting
the neck
POST OP:
monitor for respiratory distress
have a tracheostomy set, oxygen,
and suction at the bedside
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monitor surgical site for edema

and for signs of
bleeding(anteriorly and
posteriorly)

monitor for laryngeal nerve

damage:
(dysphonia, high pitched voice,
stridor, dysphagia, and
restlessness)

monitor for signs of

hypocalcemia and tetany:
(Positive chvostek’s sign,
Positive trousseau’s sign)

DISORDERS OF THE PARATHYROID GLAND

HYPOPARATHYROIDISM HYPERPARATHYROIDISM
(HYPOCALCEMIA, (HYPERCALCEMIA)
HYPERPHOSPHATEMIA)
DEFINITION hyposecretion of parathyroid hormone hypersecretion of parathyroid hormone

S/S (+) trousseaus’s sign – carpal spasm induced by
arterial occlusion of the arm with a BP cuff
(+) chvostek’s sign – facial nerve irritability
elicited by tapping the nerve
Fatigue and muscle weakness
Skeletal pain and tenderness
Bone deformities that result in pathological fractures

bronchospasm Renal stones

laryngospasm
carpopedal spasm
dysphagia
photophobia
cardiac dysrhythmias
seizures

MGT prepare to administer IV calcium gluconate or monitor for cardiac dysrhythmias

calcium chloride for hypocalcemia
cmonitor for I&O and for signs of renal stones

place a tracheostomy set, oxygen, and suctioning monitor for skeletal pain; move client slowly and
at the bedside carefully

provide a high calcium and low phosphorus
diet(milk and dairy products)
instruct client in the administration of calcium
supplements as prescribed
instruct client in the administration of vitamin D
supplements as prescribed
instruct the client in the administration of
phosphate binders – promotes excretion of
phospate
SURGERY
encourage fluids
administer furosemide (Lasix) as prescribed to lower
calcium levels
administer phosphates as prescribed, which interfere
with calcium absorption
administer calcitonin ( Calcimar) as prescribed, to
decrease skeletal calcium release and increase renal
clearance of calcium
administer calcium chelators(calcium EDTA)
as prescribed to lower calcium levels
HYPERPARATHYROIDECTOMY
PRE – OP:
ensure that calcium levels are decreased to near normal

inform the client that talking may be painful for the first
day or two after surgery

POST OP:
place a tracheostomy set, oxygen, and suctioning at the
bedside
assess neck dressing for bleeding
monitor for hypocalcemic crisis as evidenced by
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tingling and twitching in the extremities and face

monitor for laryngeal nerve damage

DISORDERS OF THE PANCREAS

DIABETES MELLITUS

DEFINITION Impaired carbohydrate, protein, and lipid

metabolism

TYPES TYPE 1 – INSULIN DEPENDENT DM

( IDDM)
• also referred to as juvenile diabetes
• characterized by no insulin production
by the islets of langerhands caused by
autoimmune disease

TYPE 2 – NON – INSULIN DEPENDENT

DIABETES MELLITUS
• common among obese
• characterized by insulin resistance or
impaired insulin receptors
S/S Polyuria
Polydipsia
Polyphagia
Weight loss
Blurred vision
Slow wound healing
Vaginal infections
Weakness and paresthesias
Signs of inadequate circulation to the feet

LAB/DX FINDINGS:

NORMAL FINDINGS:
Blood glucose level = 60 – 120 mg/dl
FBS = 70 – 110 mg/dl
Postprandial glucose = 70 – 110 mg/dl
OGT – glucose returns to normal in 2 – 3 hours and
urine is negative for glucose
HbA1c:
RANDOM BLOOD SUGAR
> 200 mg/dl
FASTING BLOOD SUGAR(FBS)
> 110 mg/dl but < 126 mg/dl
POSTPRANDIAL GLUCOSE
> 140 mg/dl but < 200 mg/dl
ORAL GLUCOSE TOLERANCE(OGT)
- blood glucose level returns to normal slowly
and urine is positive for glucose

diabetic with good control: 7.5% or less GLYCOSYLATED HEMOGLOBIN

diabetic with fair control:7.6% to 8.9% (HbA1c)
diabetic with poor control: 9% or greater - used to assess the effectiveness of treatment
regimen and client’s compliance for 3 months
> 7.0 %

MANAGEMENT D - iet 50 - 60 % CHO, 20 - 30 % FATS, 10 - 20%

CHON
I - nsulin
A - ntidiabetic agents
B - blood sugar monitoring
E - xercise
T - transplant of the pancreas
E - nsure adequate food intake
S - crupulous foot care
COMPLICATIONS A. CX OF INSULIN THERAPY
1. INSULIN LIPODYSTROPHY
- caused by repeated use of an injection site
2. DAWN PHENOMENON
• Results in the nocturnal release of growth
hormone, which may cause the blood
glucose to begin to rise at about 3 AM
• TX :evening dose of intermediate acting
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insulin at 10 PM
3. SOMOGYI’S PHENOMENON
• normal or elevated blood glucose levels are
present at bedtime, a decrease occurs at
about 2 AM to 3 AM to hypoglycemic
levels and a subsequent increase occurs as
a result of the production of
counterregulatory hormones
• Tx: decrease intermediate insulin at
suppertime, moving the intermediate
insulin dose to bedtime or increasing
bedtime snack

B. ACUTE COMPLICATION OF DM
1. Hypoglycemia
- occurs when the blood glucose level falls to less
than 50 to 60 mg/Dl
fast acting simple carbohydrate:
• three or four commercially prepared
glucose tablets
• 4 to 6 ounces of fruit juice or regular soda
• 6 to 10 life savers or hard candy
• 2 to 3 teaspoons of sugar or honey.
2. Diabetic Ketoacidosis
• Common in type 2 DM
• S/S include hyperglycemia, dehydration
and electrolyte loss, and acidosis
• Tx : fluids, insulin ( IV Regular ), and
electrolyte replacement ( K)
3. Hyperglycemic hyperosmolar nonketotic
syndrome (HHNS)
• Common in type 2 DM
• extreme hyperglycemia without ketosis and
acidosis
• Tx: same with DKA

C. CHRONIC COMPLICATIONS OF DM

1. Diabetic Retinopathy
• permanent vision changes and blindness
can occur
• Mgt : maintain safety

2. Diabetic nephropathy
• a progressive decrease in kidney function
Mgt:
• monitor I & O
• monitor BUN and creatinine levels and for
albuminuria

3. Diabetic neuropathy
• general deterioration of the nervous system
• development of ulcers
Mgt:
• cut toenails straight across
• apply moisturizing lotion to the feet but not
between the toes

INSULIN PREPARATIONS

ONSET(HR) PEAK ( HR) DURATION(HR)

Short Acting 30 min – 1 hr 2-4 6 -12
e. g. regular insulin
(Humulin R, Novolin R)
Intermediate Acting 2-4 6 - 12 18 - 24
e. g. isophane insulin
( NPH, Humulin N, Novolin N)
Long Acting 6 - 12 18 - 24 48 - 72
e. g. zinc suspension (Ultralente,
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Humulin U)

MYRAY 04/07/08 Lean 03