Endocrine Disorders Part 2: Endocrine assessment Part 1

Hypothalamus, Pituitary (anterior and posterior), Thyroid, Parathyroids (4 little beans on the back of the thyroid), Adrenals, Pancreas, Ovaries, Testes

Hemostatsis maintained through: -Negative feedback control mechanisms, Hormone secretion is based on the body’s need, Excesses or deficiencies can lead to conditions that affect many systems, There are simple negative feedback hormone responses, There are complex negative feedback hormone responses

For low blood levels of cortisol the hypothalamus secretes CRH, CRH triggers the anterior pituitary gland to secrete adrenocorticotropic hormone (ACTH), The ACTH triggers the adrenal cortex to secrete cortisol, which increase serum cortisol levels, The final result being increased secretion of cortisol, For high levels of cortisol the hypothalamus stops secreting CRH, Lack of CRH prevents secretion of ACTH by the anterior pituitary, Lack of ACTH prevents secretions of cortisol by the adrenal cortex, The final result being decreased secretion of cortisol

Parts of the hypothalamus are glandular tissues, Produces regulatory hormones, Control functions for the rest of the endocrine system, Sends releasing hormones to the anterior pituitary, Is directly connected to the posterior pituitary glands (make and stores vasopressin ADH and oxytocin

The hypothalamus secretes (Thyrotropin releasing hormone) ⬇️, TRH stimulates ⬇️, Anterior pituitary to release ⬇️, TSH (thyroid stimulating hormone) which tells the ⬇️, Thyroid to make T3 & T4 !

Corticotropin-releasing hormone (CRH), Thyrotropin-releasing hormone (TRH), Gonadotropin-releasing hormone (GnRH), Growth hormone-releasing hormone (GHRH), Growth hormone-inhibiting hormone (somatostatin, GHIH), Prolactin-inhibiting hormone (PIH), Melanocyte-inhibiting hormone (MIH)

Located at the base of the brain, Anterior lobe (adenohypophysis), Secretes many hormones that target other tissues and endocrine glands

Located at the base of the brain, Posterior lobe (neurohypophysis), Hormones: vasopressin or ADH (are the same thing!), and oxytocin are made in the hypothalamus but stored in the posterior pituitary, Is connected by nerve fibers to the hypophyseal stalk

Ok great thanks!

TSH, Thyroid gland, Stimulates synthesis/release of thyroid hormone

ACTH, Adrenal cortex, Stimulates the synthesis and release of corticosteroids and adrenocortical growth

LH, Ovary/testes, Stimulates ovulations, progesterone and testosterone secretion

FSH, Ovary/testes, Stimulates estrogen secretion, follicle maturation, and spermatogenesis

PRL, Mammory glands, Stimulates breast milk production

GH, Bone/soft tissue, Promotoes growth through lipolysis, protien anabolism, and insulin antagonism

MSH, Melanocytes, Promotes pigmentation

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ADH, Kidneys, Promotes water reabsorption

No abbreviation given, Uterus and mammory glands, Stimulates uterine contractions and ejections of breast milk

Are the male and female reproductive endocrine glands, Are dormant until puberty, Stimulation from gonadotropic hormones (from the anterior pituitary) causes maturation, Males: Testes produce testosterone, Females: Ovaries produce estrogen

Are vascular and tent shaped, Ontop of each kidney, Adrenal hormones have an affect on the entire body, Have an outer cortex and inner medulla

90% of the glands, Mineralocorticoids: control fluid & electrolyte balance, Mineralocorticoid: Aldosterone: Promotes sodium & water reabsorption, Mineralocorticoid: Cortisol affects: Body’s response to stress Carbohydrate, protien, fat metabolism Emotional stability Immun function Sodium and water balance

10% of the gland, Catecholaminds: Epinephrine (85%) and norepinephrine NE (15%)

Controls metabolism by secreting Thyroxine (T4)- 80% Triiodothyronine (T3)-20%, Regulates calcium and phosphorus balance by secreting thyrocalcitonin (TCT or calcitonin), Feedback loop between hypothalamus, anterior pituitary, and thyroid gland

Ok great thanks!

Four small glands, On the back of the thyroid gland, They secret parathyroid hormone PTH, that regulates calcium and phosphorus metabolism This acts on bones, kidneys, and the GI tract

Activates vitamin d, Increases kidney reabsrobtion of calcium and magnesium, Increases phosphorus, bicarb, and sodium excretion

Increases net release of calcium and phosphorus from bone into ECF, Decreases bone formation, Increases bone breakdown

Enhances absorption of calcium and phosphorus from gut via activated vitamin D

Usually results in reduced glandular function and/or reduces hormone secretion such as with ADH, Gonads decrease estrogen production, Thyroid gland decreases metabolism, Pancrease has decrease glucose tolerance

Age and gender, Thyroid disorders more common in women, Do a good med review: cortisone, levothyroxine, oral contraceptives, and antihypertensives, Androgen & thyroid hormone misuse, Family hx of: obesity, growth disorders, developmental delays, DM, infertility, thyroid disorders

Nutrition & GI changes can arise from endocrine disorders, N/V abdominal pain?, Increase or decrease in food or fluid intake?, Excessive thirst: Diabetes insipidus, Hunger & thirst associate with DM (polyuria, polydipsia, polyphagia, Rapid changes in weight without dieting, Deficiencies (protein, iodine) can cause endocrine disorders

Onset of symptoms: gradual or sudden?, Recurrent?, Affecting ADLs?, Energy levels?, Elimnation, Sexual & reproductive functions, Any physical appearance changes?

Prominent forehead/jaw, Round puffy face (Cushing’s), Dull or flat expression, Exopthalamos (pictured “eyes bugging out”), Thyroid enlargement (goyter, don’t palpate!), Jugular vein distention

Hypo or hyper pigmentation, Vitiligo, Fungal infections, Bruising petechiae, Foot ulcers, slow wound healing, Hair: hirsutism (abnormal hair growth or loss), hair loss, change in texture, Nails: thickness, malformation, brittleness

Chest size/ symmetry, Truncal obesity & buffalo hump, Breasts for symmetry, size, pigmentation, discharge, Striae, Size of scrotum, penis, labia, clitoris, Hair distribution (in genital area)

Thyroid gland & testes, Is usually performed by PCP, ***NURSING SAFETY PRIORITY*** DO NOT palpate or put pressure on the thyroid when suspecting hyperthyroidism. This can stimulate a sudden release of thyroid hormones causing a thyroid storm!!

Chest, Cardiac rate & rhythm, Bruits of thyroid gland enlargement

Assess behaviors, personality, responses, Assess coping skills, support systems, Body features can change prompting depression or anxiety, Sexua functioning/fertility concerns, Financial concerns from prolonged illness

The client reports now needing to shave only once weekly instead of daily

Blood, Urine, Saliva, Always use proper techniques for collection and handling of specimens

**Place catecholamines on ice**, Explain procedure/restrictions/drugs used, Do not use double/triple lumens (contamination, Take drugs perscribed on time (set alarm)

Empty bladder at start of urine collection-discard, Empty bladder at end time and include in collection, May need additives or to keep on ice, Is usually a 24 hr urine collection

Karen said don’t memorize!, Measures level of specific hormone in blood or body fluid, Antibody based: Immunological Chromatographic, Very sensitive; can detect minute quantities

Tests UNDER active endocrine gland by stimulating it, Measurments taken after and compared to normals

Hormone levels are high or upper normal, Drugs that suppress hormone production given, Failure of suppression of the hormone production indicates hyperfunction

Genetic used whe hormone levels are too low to be measured, DNA/ RNA analysis, Blood glucose levels, Glucose tolerance test, Gylosalated hormone (A1C)

Skull x-rays: Assess for erosion of sella turcica (houses the pituitary), MRI with contrast (or CT), Ultrasound: Thyroid, parathyroid glands, ovaries, testes, CT: Adrenal glands, ovaries, pancreas

Ambulatory procedure, Quick and easy, Used to indicate the compisition of thyroid nodules

Requires systematic approach; variety of s/s, Physical, psychosocial, & lab findings needed for accurate endocrine assessment, Teach: abusing/misusing hormones/steroids can have adverse endocrine system effects, Discuss psychosocial concerns regarding appearance, sexual function, fertility, Include family for insight on personality changes, Endocrine problems can be slow/insidious or abrupt/life-threatening