Medsurg:

Endocrine II

Prepared by:
Ms. Che Garcia
Glands, Hormones and
Action
Glands, Hormones and
Action
Glands, Hormones and
Action
Glands, Hormones and
Action
Glands, Hormones and
Action
 THYROIDITIS

Inflammation of the thyroid gland

Can be acute, subacute, or
chronic
Each type of thyroiditis is
characterized by inflammation,
fibrosis, or lymphocytic infiltration
of the thyroid gland
 Acute Thyroiditis
Rare disorder caused by an infection
from a bacteria, most commonly
Staphylococcus aureus
S/S: anterior neck pain and swelling,
fever, dysphagia, and dysphonia,
pharyngitis, warmth, erythema
(redness), and tenderness of the
thyroid gland
TREATMENT: Antibiotics
 Chronic Thyroiditis
(HASHIMOTOS DISEASE)

A slow, progressive course, of an

inflammation of the thyroid gland
leading eventually to hypothyroidism
S/S: Asymptomatic; manifestations
of hypothyroidism despite
inflammation of thyroid gland
TREATMENT: Thyroid hormone
replacement
PARATHYROID HORMONE
Parathormone,
the protein
hormone from the
parathyroid
glands, regulates
calcium and
phosphorus
metabolism.
HYPERPARATHYROIDISM
Caused by overproduction of
parathyroid hormone by the
parathyroid glands
Characterized by bone
decalcification and the
development of renal calculi
(kidney stones) containing calcium.
 HYPERPARATHYROIDISM
Commonly Asymptomatic
S/S:
C Cardiac dysrhythmias
A Apathy
L Loss of muscle strength
C Calculi formation (kidneys)
I Increased BP
U Unusual bone decalcification
M Muscle weakness
Treatment: Parathyroidectomy
HYPOPARATHYROIDISM
Inadequate secretion of
parathyroid hormone after
interruption of the blood supply or
surgical removal of parathyroid
gland tissue during thyroidectomy,
parathyroidectomy, or radical neck
dissection
 HYPOPARATHYROIDISM
S/S: elevated blood phosphate (hyperphosphatemia)
and decreased blood calcium (hypocalcemia) levels
Numbness, tingling of fingers, toes; seizures,
carpopedal spasms, hyperactive deep tendon reflexes,
irritability, bronchospasm, anxiety,
CLASSICAL: Positive Trousseaus sign and
Chvosteks sign

Sharp tapping over the Carpopedal spasm is induced

facial nerve just in front of
the parotid gland and
anterior to the ear causes
spasm or twitching of the
mouth, nose, and eye
by occluding the blood flow to
the arm for 3 minutes with a
blood pressure cuff
 Addisons Disease
Decreased adrenocortical hormones
leading to:
Metabolic disturbances (sugar)
F&E imbalances- Na, H2O, K
Deficiency of neuromuscular function
(salt & sex)
 ADRENAL FUNCTION
Adrenal medulla functions as part of the
autonomic nervous system
Causes release of the catecholamine hormones
epinephrine and norepinephrine
Epinephrine regulate metabolic pathways to
promote catabolism of stored fuels to meet
caloric needs from endogenous sources major
Effects of epinephrine release are to prepare to
meet a challenge (fight-or-flight response)
 ADRENAL FUNCTION
A functioning adrenal cortex is necessary for
life
Adrenocortical secretions make it possible for
the body to adapt to stress of all kinds.
The three types of steroid hormones
produced by the adrenal cortex are:
Glucocorticoids, the prototype of which is
hydrocortisone;
Mineralocorticoids, mainly aldosterone;
Sex hormones, mainly androgens (male sex
hormones)
 ADRENAL FUNCTION
Glucocorticoids glucose metabolism
Mineralocorticoids electrolyte
metabolism; cause increased sodium
ion absorption in exchange for
excretion of potassium or hydrogen
ions
Androgens male sex characteristic
development
 Addisons Disease
S/Sx:
Decrease sugar Hypoglycemia
Decreased glucocorticoids - cortisol
T tremors, tachycardia
I - irritability
R - restlessness
E extreme fatigue
D diaphoresis, depression
 Addisons Disease
Decrease plasma cortisol
Decrease tolerance to stress lead to
Addisonians crisis
Decrease salt Hyponatremia
Decreased mineralocorticoids
(aldosterone)
Hypovolemia
Hypotension
Signs of dehydration extreme thirst,
agitation
Wt loss
 Addisons Disease
Hyperkalemia decrease aldosterone
Decrease sexual urge or libido-
Decreased Androgen
Loss of pubic and axillary hair
 Addisons Disease
Treatment
Glucocorticoid and mineralocorticoid
replacement (dose under stress to risk
of Addisonian crisis)
F&E replacement
Nursing
Monitor for S&S of Addisonian crisis
Encourage protein and carbohydrate
diet with added salt
Schedule rest periods
Teach need for lifelong steroid injection
Cushings Syndrome

Etiology and Pathophysiology

Results from excessive levels of

adrenocortical hormones and is manifested

by fat pads on the face (moon face) and over
the upper back (buffalo hump), acne, mood
swings, hirsutism, amenorrhea, and
decreased libido.
Risk women 20-40yr
Cushings Syndrome
Signs and Symptoms
Increase sugar Hyperglycemia
Classic Sx of DM 3 Ps & glycosuria
Increase susceptibility to infection due to
increased corticosteroid
Hypernatremia
HPN
Edema
Wt gain
Cushings Syndrome
Signs and Symptoms
Buffalo hump
Obese trunk
Pendulous abdomen
Thin extremities
Hypokalemia
Weakness & fatigue
Constipation
ECG (+) U wave
Cushings Syndrome

Signs and Symptoms

Hirsutism increase sex hormones
Acne & striae
Increase muscularity of female
Cushings Syndrome

Treatment
Adrenalectomy, removal of pituitary tumor (hypophysectomy)
depending on cause
Treat complications (DM, osteoporosis)
Nursing
Monitor for S&S
Encourage Na and altered K in diet
Protect from infection
Teach use of medical alert band and protection from injury
(fractures secondary to osteoporosis)
Provide emotional support for altered body image and labile mood
PRIMARY
ALDOSTERONISM
Excessive production of aldosterone, which
occurs in some patients with functioning
tumors of the adrenal gland
The principal action of aldosterone is to
conserve body sodium.
Under the influence of this hormone, the
kidneys excrete less sodium and more
potassium and hydrogen
PRIMARY
ALDOSTERONISM
S/S: profound decline in the serum levels of
potassium (hypokalemia) and hydrogen ions
(alkalosis)
Universal sign: Hypertension
Treatment: Adrenalectomy
ADDITIONAL INFO ON
DM
HHNS versus DKA
SOMOGYI EFFECT versus
DAWN PHENOMENON