ENDOCRINE SYSTEM

ANATOMY AND PHYSIOLOGY OVERVIEW

IRIL I. PANES, RN, MAN

OVERVIEW OF ANATOMY AND PHYSIOLOGY

The Endocrine system is composed of an interrelated complex of glands that secrete a variety of hormones directly into the bloodstream Its major function; together with the nervous system; is to regulate body functions and processes.

Endocrine Vs. Nervous

The endocrine system coordinates slower and longer response to stimulus. Regulates growth and homeostatic processes.

The nervous system coordinates response to sudden environmental changes through high-speed electrical signals.

HORMONE REGULATION

HORMONES

Are chemical substances that act as messengers to specific cells and organs (target organs), stimulating and inhibiting various processes. Derived from the Greek term hormon which means to set in motion, arouse, or excite.

 1.

2.

It has two major categories: LOCAL: hormones with specific effect in the area of secretion GENERAL: hormones transported in the blood to distant sites where they exert their effect

CHARACTERISTICS
1.

Hormones are secreted in one of three patterns: a. DIURNAL SECRETION is a pattern that rises and falls within a 24-hour period; e.g. Cortisol a hormone that increases in the morning and drops in the evening.

b. PULSATILE AND CYCLIC PATTERNS of hormonal secretion rise and fall along another time frame, such as monthly; e.g. Estrogen c. Variable type depends on levels of other substrates; e.g. Parathyroid hormone is secreted in response to serum calcium levels

CHARACTERISTICS
2. Hormones operate within a feedback system. Feedback loops can be positive or negative and allow the body to be maintained in an optimum environment 3, Hormones control the rate of cellular activity. They do not initiate biochemical changes 4. Hormones affect only cells that contain appropriate receptors, which initiate a specific function

CHARACTERISTICS
5. Hormones have independent and interdependent functions. The release of hormones from one gland often triggers the release of hormones from the other glands 6. Hormones are constantly deactivated by the liver or other cellular mechanisms and are excreted by the kidneys

REGULATION
ROLE OF THE HYPOTHALAMUS AND PITUITARY GLAND: The two MAJOR ENDOCRINE GLANDS
Endocrine activity is controlled directly or indirectly by the hypothalamus, which links the nervous system to the endocrine system. In response to input from other areas of the brain and from other hormones in the blood, neurons in the hypothalamus secrete several releasing and inhibiting hormones. These hormones act on specific cells in the pituitary gland that regulate the production and secretion of the pituitary hormone

The Pituitary hormones that govern the secretion of hormones from other glands are called TROPIC hormones Glands influenced by the hormones are called TARGET glands

FEEDBACK SYSTEMS

Blood levels of hormones are also controlled by NEGATIVE FEEDBACK. Once a hormone level is sufficient to produce its intended effect, further elevations in the hormone level are prevented by negative feedback. Rising levels of hormone negate the initial change that triggered that hormone release

Negative and Positive Feedback

Negative Feedback: the response from the effector reduces the initial stimulus. Positive Feedback: the response triggers amplification of the stimulus, leading to a greater response

THE ENDOCRINE GLANDS

Hypothalamus

Secretes hormones that make other endocrine glands secrete their hormones. Considered the control center of the endocrine system. Produces two types of hormones:

1)Releasing hormones-switch on hormone production. 2)Inhibiting hormones-switch off hormone production.

Hypothalamus

Pituitary Gland

PITUITARY GLAND STRUCTURE AND FUNCTION

The pituitary gland lies securely cradled within a small recess in the sphenoid bone called sella turcica Master gland of the body About 70% of the gland is the anterior lobe (adenohypophysis) 30% of the gland is the posterior lobe (neurohypophysis)

Pituitary Gland

PITUITARY GLAND( Hypophysis)

HORMONES OF THE ANTERIOR LOBE

a.

Secretes tropic hormones (hormones that stimulate target glands to produce their hormone) 1. Adrenocorticotropic Hormone (ACTH) 2. Thyroid-stimulating Hormone (TSH) 3. Follicle-stimulating Hormone (FSH) 4. Luteinizing hormone (LH)

b. Also secretes hormones that have direct effect on tissues 1. Somatotropic or Growth hormone 2. Prolactin c. Regulated by hypothalamic releasing and inhibiting factors and by negative feedback system

HORMONE FUNCTIONS Pituitary Anterior lobe

Thyroid stimulating Hormone (TSH) : stimulates thyroid gland to release thyroid hormones Adrenocorticotropic Hormone (ACTH): stimulates adrenal cortex to produce and release adrenocorticoids

HORMONE FUNCTIONS Pituitary Anterior lobe

Follicle Stimulating Hormone (FSH), and Luteinizing Hormone (LH): stimulate growth, maturation, and function of primary and secondary sex organs Growth hormone (GH) or somatotropin: stimulates growth of body tissues and bones Prolactin: stimulates development of mammary glands and lactation

HORMONES OF THE POSTERIOR LOBE

Does not produce hormones but stores the hormones produced by the hypothalamus 1. Antidiuretic Hormone (ADH) 2. Oxytocin

HORMONE FUNCTIONS Pituitary Posterior lobe

Antidiuretic hormone (ADH): regulates water metabolism; released during stress or in response to an increase in plasma osmolality to stimulate reabsorption of water and decrease urine output Oxytocin: stimulates uterine contractions during delivery and the release of milk in lactation

HORMONES OF THE INTERMEDIATE LOBE

Secretes Melanocyte stimulating hormone (MSH)

HORMONE FUNCTIONS Pituitary Intermediate lobe

Melanocyte stimulating hormone (MSH): affect skin pigmentation

ADRENAL GLANDS

Two small glands, one above each kidney Consists of two sections
1.

2.

Adrenal cortex (outer portion): produces mineralocorticoids, glucocorticoids, sex hormones (androgens); ESSENTIAL FOR SURVIVAL Adrenal medulla (Inner portion): produces epinephrine, norepinephrine

Adrenal Glands

HORMONE FUNCTIONS ADRENAL CORTEX

Mineralocorticoids (e.g. Aldosterone): regulate fluid and electrolyte balance; stimulate reabsorption of sodium, chloride and water; stimulate potassium excretion Sex hormones (androgens, estrogen, progesterone) : influence development of secondary sex characteristics

HORMONE FUNCTIONS ADRENAL CORTEX

Glucocorticoids (e.g. Cortisol, corticosterone): increase blood glucose levels by increasing rate of glyconeogenesis; increase protein catabolism, increase mobilization of fatty acids; promote sodium and water retention; anti-inflammatory effect; aid body in coping with stress

HORMONE FUNCTIONS ADRENAL MEDULLA

Epinephrine, Norepinephrine: function in acute stress; increase heart rate, blood pressure; dilate bronchioles; convert glycogen to glucose when needed by muscles for energy

THYROID GLAND

Located in anterior portion of the neck Consists of two lobes connected by a narrow isthmus Produces:

1. Thyroxine (T4) 2. Triiodothyronine (T3) 3. Thyrocalcitonin

HORMONE FUNCTIONS

Thyroxine (T4) and Triiodothyronine (T3): regulate metabolic rate; carbohydrate, fat and protein metabolism; aid in regulating physical and mental growth and development Thyrocalcitonin: lowers serum calcium by increasing bone deposition

PARATHYROID GLANDS

Four small glands located in pairs behind the thyroid gland Produce Parathormone (PTH)

FUNCTIONS

Regulate serum calcium and phosphate levels Increase resorption of bone, thereby maintaining normal serum calcium levels; and Maintain an inverse relationship between serum calcium and phosphate levels, thereby fostering normal excitability of nerves and muscles

PANCREAS

Located behind the stomach Has both endocrine and exocrine functions Islets of Langerhans involved in endocrine function

1. BETA CELLS: produce insulin 2. ALPHA CELLS: produce glucagon

Pancreas

FUNCTIONS

BETA CELLS INSULIN: allows glucose to diffuse across cell membrane; converts glucose to glycogen ALPHA CELLS GLUCAGON: increases blood glucose by causing gluconeogenesis and glycogenolysis in the liver; secreted in response to low blood sugar

GONADS
A.

B.

OVARIES : located in the pelvic cavity, produce estrogen and progesterone TESTES : located in scrotum, produce testosterone

FUNCTIONS

OVARIES: Estrogen and Progesterone development of secondary sex characteristics in the female, maturation of sex organs, sexual functioning, maintenance of pregnancy TESTES: Testosterone- development of secondary sex characteristics in the male, maturation of sex organs, sexual functioning

ASSESSMENT

HEALTH HISTORY
A. 1.

2. 3. 4.

Presenting problem: symptoms may include Change in appearance, hair, nails, skin (change in texture and pigmentation); change in size, shape or symmetry of head, neck, face, eyes or tongue Change in energy level Temperature intolerance Development of abnormal secondary sexual characteristics; change in sexual function

HEALTH HISTORY
5. Change in emotional state, thought pattern, or intellectual functioning 6. Signs of increased activity of sympathetic nervous system (e.g. nervousness, palpitations, tremors, sweating) 7. Change in bowel habits, appetite or weight; excessive hunger or thirst 8. Change in urinary pattern

B. Lifestyle: any increased stress C. Past medical history: growth and development (any delayed or excessive growth); diabetes, thyroid disease, hypertension, obesity, infertility D. Family history: endocrine diseases, growth problems, obesity, mental illness

PHYSICAL EXAMINATION
A.

B.

C. D.

E.

Check height, weight, body stature and body proportions Observe distribution of muscle mass, fat distribution, any muscle wasting Inspect for hair growth and distribution Check condition and pigmentation of skin; presence of striae Inspect eyes for any bulging

F. Observe for enlargement in neck area and quality of voice G. Observe development of secondary sex characteristics H. Palpate thyroid gland (normally cannot be palpated): note size, shape, symmetry, any tenderness, presence of any lumps and nodules

LABORATORY/ DIAGNOSTIC TEST

A variety of test may be performed to measure the amount of hormones present in the serum or urine in assessing pituitary, adrenal, and parathyroid functions; these tests will be referred to when appropriate under specific disorders of the endocrine system

THYROID FUNCTION
A.

1.

2.

3.

SERUM STUDIES: nonfasting blood studies (no special preparation is necessary) Serum T4 level: measures total serum level of thyroxine Serum T3 level: measures serum triiodothyronine level TSH: measurement differentiates primary from secondary hypothyroidism

B. RADIOACTIVE IODINE UPTAKE (RAIU) 1. Iodine administration orally; measurement by a counter of the amount of radioactive iodine taken up by the gland after 24 hours 2. Performed to determine thyroid function; increased uptake indicates hyperactivity; minimal uptake may indicate hypothyroidism

Nursing Care:

Take thorough history; thyroid medication must be discontinued 7-10 days prior to test; medications containing iodine, cough preparations, excess intake of iodine-rich foods, and tests using iodine (IVP) can invalidate this test. Assure client that no radiation precautions are necessary

 1.

2.

THYROID SCAN Administration of radioactive isotope (orally or IV) and visualization by a scanner of the distribution of radioactivity in the gland Performed to determine location, size, shape and anatomic function of thyroid gland; identifies areas of increased or decreased uptake; valuable in evaluating thyroid nodules

PANCREATIC FUNCTION
A.

B.

FASTING BLOOD SUGAR: measures serum glucose levels; client fasts from midnight before the test TWO-HOUR POSTPRANDIAL BLOOD SUGAR: measurement of blood glucose 2 hours after a meal is ingested

Fast from midnight before the test Client eats a meal consisting of at least 75g carbohydrate or ingests 100g glucose Blood drawn 2 hours after the meal

C. ORAL GLUCOSE TOLERANCE TEST: most specific and sensitive test for diabetes mellitus

Fast from midnight before the test Client ingests 100g glucose; blood sugars are drawn 30-60 minutes and then hourly for 3-5 hours; urine specimens may also be collected Diet for 3 days prior to test should include 200g carbohydrate and at least 1500kcal/day During test, assess the client for reactions such as dizziness, sweating and weakness

D. GLYCOSYLATED HEMOGLOBIN (HEMOGLOBIN A) reflects the average of blood sugar level for the previous 100-120 days. Glucose attaches to a minor hemoglobin (A). This attachment is irreversible

Fasting is not necessary Excellent method to evaluate long term control of blood sugar

ANALYSIS

ALTERED NUTRITION: MORE/LESS THAN BODY REQUIREMENT HIGH RISK FOR INFECTION ALTERED URINARY ELIMINATION FLUID VOLUME EXCESS OR DEFICIT HIGH RISK FOR IMPAIRED SKIN INTEGRITY SEXUAL DYSFUNCTION KNOWLEDGE DEFICIT INEFFECTIVE INDIVIDUAL COPING SLEEP PATTERN DISTURBANCE BODY IMAGE DISTURBANCE