Module13

EndocrineSystem

OverviewoftheEndocrineSystem
Homeostasis o Selfbalancingofbodysinternalenvironment o Achievedandmaintainedbyendocrinesystemandnervoussystems Endocrinesystemandnervoussystemsworkaloneandtogether o Toperformsimilarfunctionsinbody Communication Integration Control Communicationprovidesmeansofcontrolandintegrationofdifferentfunctionperformedbyorgans,tissueand cells Endocrinesystemssendsmessagesbychemicalsmessengerscalledhormones Minuteamountsofhormonessecretesfromendocrineglandscellsintobloodanddistributedbycirculatory system Endocrineglandssecretehormonesdirectlyintoblood o Becauseductlesssystem(NODUCTS) o Oftencalledductlessglands Cellsaffectedbyhormonesreferredtoastargetorgancells

1.1

Glandsoftheendocrinesystems
Hormoneproducingglands o Hypothalamusgland o Pituitarygland o Thyroidgland o Parathyroidglands o Adrenalglands o Pancreas o Gonads(testes/orchiesandovaries)

1.1.1

Hypothalamusgland
Situatedinthebrain Synthesizeschemicalssecretedtopituitaryglandstostimulatereleaseofhormones Andhelpsregulatebodytemperature

1.1.2

Pituitarygland
Situatedatthebaseofbrain Peasizedgland Oftencalledmasterglandofbody o Influencesmanyotherendocrinesglands Eventhoughitlookslikeoneglandconsistsoftwoseparateglands o Anteriorpituitarygland o Posteriorpituitarygland

1.1.2.1 AnteriorPituitarygland
Playsmoreimportantroleininfluencingbodyfunction Hormonesproducedbyanteriorpituitaryglandbroad&significantrangeofeffects Secretesfollowinghormones: o Samatotropinhormone o Thyrotropinhormone o Gonadotropinhormone o Adrenocorticotropinhormone(ACTH)

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Module13 1.1.2.1.1

EndocrineSystem

Samatotropinhormone

Growthhormone: o Influencesbodygrowthanddevelopment

1.1.2.1.2

Thyrotropinhormone

AKA:thyroidstimulatinghormone(TSH) o Influencesgrowth,development,secretingactivitiesofthyroidgland

1.1.2.1.3

Gonadotropinhormone

Influencesgonads o Essentialfornormaldevelopmentandfunctionofreproductivesystem o Maleandfemale

1.1.2.1.4

Adrenocorticotropinhormone(ACTH)

Actsprimarilyonadrenalcortex o Outerportionofadrenalglands Stimulatesgrowthandownsecretionofcorticosteroids

1.1.2.2 PosteriorPituitarygland
Producestwohormones o Antidiuretichormone(ADH) o Oxytocin

1.1.2.2.1

Antidiuretichormone(ADH)

Promotesconservationofwaterbykidney WhenADHnotproduced(ornotenoughproduced) o Dailyurinevolumeincreases1015Lperdayinsteadof1.5Lperday Conditionknownasdiabetesinsipidus

1.1.2.2.2

Oxytocin

Stimulatescontractionofmuscleofuterus o Particularlyduringpregnancy Playsroleinproductionofmilkinmammaryglandsofnursingmothers

1.1.3

Thyroidgland
Butterflyshaped Anteriorpartoftheneckbelowlarynx Consistsoftwolobes o Oneeachsideofuppertrachea o Connectedbystriptissuecalledisthmus Thyroidsecretesiodine o Containshormonecalledthyroxin o Controlsrateofcellmetabolism Excessivesecretionofthyroxinraisesmetabolicrate o Causeshyperthyroidism Hyperthyroidismcharacterizedby: Fastpulserate Dizziness Increasedbasalmetabolism Profusesweating Tremors Nervousness Tremendousappetite Coupledwithweightloss

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Module13

EndocrineSystem

Hypothyroidism Insufficientsecretionofthyroxin Hypothyroidismcharacterizedby: Decreasedbasalmetabolism Sweatingalmostabsent Maygainweight Maybeconstantlyfatigued

1.1.4

Parathyroidglands
Foursmallroundbodies Posteriortothyroidgland SecretesParahormones o Regulatescalciumandphosphoruscontentofbloodandbones Hyperparathyroidism o Excessofparathyroidhormoneinblood o Causescalciumlevelsinbloodtoincreasebywithdrawofcalciuminbones o Causesskeletondemineralisedandsubjecttospontaneousfractures Excessivecalciummaybedepositedasstonesinkidneys

1.1.5

Adrenalglands
Locatedsuperiorsurfaceofeachkidney o Fittinglikeacap Twolayerstosection o Adrenalcortex o Adrenalmedulla

1.1.5.1 Adrenalcortex
Outerlayerofadrenalcortexproducethreetypesofsteroidhormonesthatareofvitalimportance o Mineralocorticoidsaldosterone(controlwaterlevelsandelectrolytes) o Glucocorticoidscortisol(controlsfat,carbohydratesandproteinmetabolism o Androgens(males)andOestrogens(females)

1.1.5.2 Adrenalmedulla
Secretesepinephrine(adrenalin) o Inpresenceofemotionalcries,hypoglycaemiaorlowbloodpressure Epinephrinecausespowerfulcontractionofmanyarterioles o Especiallyinskin,mucousmembranesandkidney Butdilatesotherarterioles o Suchas,coronarysystem,skeletonmusclesandlungs

1.1.6

Pancreas
Twotypesofsecretorytissue o Firstsecretesdigestivejuicethroughducttosmallintestine Knownasexocrinefunction o Secondreleaseshormonesintoblood(bodyfluids) Knownasendocrinefunction

Endocrineportionofpancreasconsistofcellsarrangedingroups CalledIsletsofLangerhans IsletsofLangerhanscontainthreetypesofendocrinecells o Alphacells o Betacells o Deltacells

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Module13 1.1.6.1 Alphacells

Alphacellssecrethormoneglucagon Glucagoncausestemporaryriseinbloodsugar

EndocrineSystem

1.1.6.2 Betacells
Betacellssecreteinsulin Insulinessentialforcarbohydratemetabolism o Insulinlowersbloodsugarlevelsbyincreasingtissueutilizationofglucose o Andstimulatesformationandstorageofglycogeninliver Glucagonandinsulinacttoregulatesugarmetabolisminbody(workaslockandkey)

1.1.6.3 Deltacells
Deltacellsproducesomatostatinhormone Somatostatinhelpregulatecarbohydratesbyinhibiting(decreasing)secretionofglucagon o Alsoinhibitinggrowthhormonesecretion

(Alfacells)Glucagondeliversglycogentolivertoconverttoglucose Releasedinthebloodstream Betacellsreleaseinsulinforcellstoabsorbbloodglucose WhenisletsofLangerhanscellsdestroyed/stopfunctioning o Sugarabsorbedfromintestineremainsinbloodandexcesssugarexcretedbykidneysintourine o Conditioncalleddiabetesmellitus/sugardiabetes InsulinasSynthetichormone o Giventopatientshavingthisdiseaseaspartofongoingtreatment

1.1.7

Gonads(testes/orchiesandovaries)
Gonadsrefertooprimarysexorgansofreproductivesystem(maleandfemale)

1.1.7.1 Testes(Orchies)
Testesproduceandsecretemalehormone:testosterone Testosteroneinfluences o Developmentandmaintenanceofmaleaccessorysexorgans o Andsecondarysexcharacteristicsofmale Maleaccessorysexorgansincludetwogroupsoforgans o Internalsexorgans o Externalsexorgans Secondarymalesexcharacteristicsinfluencedbyhormonetestosteroneare: o Increasedgrowthofhair(particularlyface,chest,axillaandpubicregion) o Enlargementoflarynx(Adamsapple) Thickeningofvocalcordsproducelowerpitchedvoice o Thickeningofskin o Increasedmusclegrowth o Broadeningofshouldersandnarrowingofwaist o Thickeningandstrengtheningofbones

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Module13 1.1.7.2 Ovaries

EndocrineSystem

Femalegonadsovariesproducehormone: o Oestrogen o Progesterone Oestrogeninfluences o Developmentandmaintenanceoffemaleaccessorysexorgans o Andsecondarysexcharacteristics o Promoteschangeinmucousliningofuterus(endometrium)duringmenstrualcycle Progesterone o Preparesuterusforreceptionanddevelopmentoffertilizedovum o Andmaintainsliningduringpregnancy

NaturallyderivedProgesteroneandoestrogenhormonesincorporatedintooralcontraceptive/birthcontrol CombinationofhormonesreleasedthroughmonthlyseriesofpillsfoolthebodyintoNOTpreparingfor implantationofanembryo Becauseuterusnotpreparedforimplantation,pregnancycannotoccur Secondaryfemalesexcharacteristicsinfluencedbyhormoneoestrogenare: o Developmentofbreastsandductilesystemofmammaryglandsinbreasts o Increasequantitiesoffatty/adiposetissueinsubcutaneouslayer Especiallyinbreasts,thighsandbuttocks o Increasevascularizationinskin

1.1.8

Othersourcesofhormones
Hormonescanbeextractedfrom: o Glandsofanimals o Producedsynthetically Medicalofficersmayprescribetheseforpt.withdeficiencyinthem/benefitfromthem o E.g.oxytocin(hormonestimulatesuterinecontractionsduringpregnancy) Synthesizedforuseduringdeliveryprocessforwomendeficientinthishormone

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Module13

EndocrineSystem

Clinicalconditions
Diabetesmellitus Hyperglycaemia Hypoglycaemia Acutepancreatitis

2.1

Diabetesmellitus
Pathophysiology o Diabetesmellitusisdiseaseresultingfrominsufficientproductionofinsulin o Insulinishormoneproducedbybetacellsinpancreas o Enablesbloodglucosetoenterbodyscells CellsrequireglucoseforproductionofATP(AdenosineTriphosphate)i.e.energy

2.1.1

Type1Diabetesmellitus
Insulindependentdiabetes(IDDM) Pt.DOESNOTproduceANYinsulin Insulininjecteddaily Onsetusuallyinchildhood

2.1.2

Type2Diabetesmellitus
Noninsulindependentdiabetes Pt.produceslowlevels(inadequateamounts)ofinsulin Diseasemaybecontrolledbydiet/oralhypoglycaemic

2.1.3

Rolesofglucoseandinsulin
Glucoseismajorsourceofenergyforbody Constantsupplyofglucoseneededforthebrain Insulinactsaskeyforglucosetoentercells

2.2

Hyperglycaemia(hotanddryinsulinIcry)
Extremelyhighbloodsugarlevel Duetolackofinsulin Kidneysexcreteglucose Requireslargeamountsofwater Withoutglucosebodyusesfatforfuel Ketonesareformed Ketonescanproducediabeticketoacidosis

2.2.1

Hyperglycaemiasignsandsymptoms

Onsetisaslowprocess(cantakehours/daystodevelop) Presencemaybesuspectedbyone/moreof: o Kausmaulsbreathingdeeprapidbreathing o KetonesFruitysmellonbreath o Rapidweakpulse o Decreasedbloodpressure o Ifpt.restless,lethargic/unresponsive o DecreasedLOCfromconfusiontocoma o Polyuria o Polydipsiaincreasedthirst o Warm,dryskinandsunkeneyes Dehydrationduetofluidlossinurine o Nausea,vomitingandabdominalpain o HighHGTreading18.9mmol

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Module13 2.2.2

EndocrineSystem

Hyperglycaemiacauses
Pt.maybeunawarethattheydiabetic/haveneglectedtoundergotreatment Ifpt.isdiabeticontreatmentwithdrugs(insulininjection/tablets) o Pt.mayhaveforgottenorneglectedtotakethemedication Infection/someformsofstressmayaffectnormalfunctioningofinsulin

2.2.3

Hyperglycaemiamanagement
NOprehospitaltreatmentavailabletoBAAtoreducehighbloodsugarlevels Pt.mustbetreatedaccordingtobasiclifesupportprocedures Numberofimportantquestiontoask: o Tobeaskedofpt.ifpt.isrational/relativesifpt.unabletospeak Areyouadiabetic? Haveyoutakenyoumedication? Whendidyoutakeyourmedication? Haveyoueatenyournormalmealstodays? Whenlastdidyoueat? Haveyoubeenfeelingillrecently? Ifpt.hasbeenfeelingill,findoutthesymptomsoftheillness. Askifpt.hasvarioussymptomsmentionedabove o LookforMedicAlertbracelet o Performinitialassessment o ObtainbaselinevitalsignsandSAMPLEhistory** o Checkforemergencymedicalidentificationsymbol o AlwaysdoFULL,carefulassessment o Askpt./familyaboutlastmeal/insulindose o DONOTadministeranythingtounconsciouspt.

2.2.3.1 Complicationwithdiabetesmellitus
Complicationduetohighbloodsugarleveldevelopwhendiabetesmellitusnotcontrolled Thisincludes o Heartdiseasese.g.MI o Peripheralvasculardisease(poorcirculationcanleadtolossoftoes/evenlimbs) Poorcirculationcancausegangrene o Eyesightprobleme.g.progressiveblindness o Diabeticcoma

2.3

Hypoglycaemia(coldandwetsugarIget)
Braindependentonconstantsupplyofoxygenandsugar Anyinterruptioninsupplywillleadtounconsciousness/braindamageandordeath Althoughhypoglycaemiamostassociatedwithdiabetesalsooccursinotherconditions o Afterexcessivealcoholintake o starvation

2.3.1

Hypoglycaemiacauses
Insulinoverdoseaccidental/deliberate Hypoglycaemiatabletoverdoseaccidental/deliberate Extremecasesofgrandmalepilepsyconvulsion

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Module13 2.3.2

EndocrineSystem

Hypoglycaemiasignsandsymptoms
Normal/rapidrespirations Pale,moistskin Sweating Dizziness/headache Rapidpulse Normal/lowbloodpressure AMS(alteredmentalstatus) Aggressive/confusedbehaviour Hunger Faint/seizure/coma Weaknessononesideofbody

2.4

Acutepancreatitis
Pancreatitis/inflammationofpancreasoccurswhenpancreatic/bileductblocked Digestiveenzymesunabletopassintoduodenum o Thenbegintoleakintopancreatictissue o Wheretrypsinbeginstodigestthepancreas Acutepancreatitisoneofcausesforacuteabdomen Pt.presentswithguardingbyabdominalmuscles Pt.mayliecurledupononeside

2.4.1

Acutepancreatitissignsandsymptoms
Epigastricpain(Mildform)mayonlyfeature Inseverform,pt.willbeinshockandhaveupperabdominalpain&tenderness

2.4.2

Acutepancreatitismanagement
Treatsameaspt.withshock/acuteabdomen

2.5

Clinicalworddefinitions
Diabetesmellitus o Metabolicdisordercannotmetabolizeglucose o Usuallyduetolackofinsulin Glucose o Oneofbasicsugarsinthebody o Alongwithoxygen Primaryfuelforcellularmetabolism Insulin o Hormoneproducedbypancreas o Enablesglucosetoentercells o Withoutinsulincellsstarve Hormone o Chemicalsubstanceproducedbyglands o Specialregulatoryeffectsonotherbodyorgansandtissues

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Module13
HYPERglycaemia SignsandSymptoms Kausmaulsbreathing Rapidweakpulse Decreasedbloodpressure DecreasedLOCfromconfusiontocoma Restless,lethargic/unresponsivept.

EndocrineSystem
HYPOglycaemia

SignsandSymptoms
Normal/rapidrespirations Rapidpulse Normal/lowbloodpressure AMS(alteredmentalstatus) (likea drunkperson) Aggressive/confusedbehaviour Faint/seizure/coma Dizziness/headache Weaknessononesideofbody Sweating Pale, moistskin Hunger HGT<3.5mmol/L

Polydipsiaincreasedthirst Warm,dryskinandsunkeneyesDehydrationduetofluidlossinurine Nausea,vomitingandabdominalpain HighHGT>18.9mmol/L KetonesFruitysmellonbreath Polyuria

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