Assessment of the Endocrine System and Care of Patients with Pituitary

and Adrenal Gland Problems

• The following provides a brief overview of the endocrine system:

• http://www.bing.com/videos/watch/?q=you+tube+endocrine+system&vid=8E2187FE28FF3B7A21DD8E2187FE28FF3B7A21DD&FORM=VIRE2

Endocrine System

• Made up of glands in various tissues and organs

• Functions with nervous system to regulate body function to ensure homeostasis by secreting hormones

• Hormones work by negative feedback, they cause opposite action of the initial condition change

• (Figure & Table 64-1, pg. 1413) Gland locations

• Pancreas-behind stomach-main function regulate blood sugar,

digestive enzymes secreted also• Gonads-testes-testosterone,

ovaries-estrogen & progesterone

Pancreas

• Thyroid-located anterior neck two lobes work together-control

metabolism and regulates serum calcium

• Parathyroid-four glands found behind or within the thyroid-

regulates calcium and phosphorus

• Hypothalamus – located beneath the thalamus on both sides of the third ventricle in the brain – secretes hormones that stimulate or inhibit the release of pituitary hormones.

• Pituitary-located at the base of the brain has two lobes (table 64-2, pg

1415)• Anterior-control growth, metabolism,

sexual development, & pigment changes

• Posterior-secretes antidiuretic hormone

• Adrenal-on top of each kidney, outer (cortex) and inner layer (medulla) independent function-Cortex-3 zones –zona glomerulosa-produces mineralocorticoids which function to control sodium and potassium, zona fasciculata and zona reticularis produce glucocorticoids which control fluids and electrolytes, as well as androgens & estrogens

Catecholamine receptors and effects Table 64-4, pg 1416

• Adrenal medulla secretes the catecholamines- epinephrine & norepinephrine-epinephrine increases heart rate, force of heart contractions, facilitates blood flow, relaxes smooth muscles, helps convert glycogen to glucose in the liver, norepinephrine -has strong vasoconstrictive effects, thus increasing blood pressure. (Chart 64-1, pg 1419 Endocrine system changes r/t aging)

Disorders

• Caused by excess or deficiency of a hormone, or defect at receptor site.

• Chapter 65 discusses care of patients with Pituitary and Adrenal Gland Problems

• Hypopituitarism-results in metabolic problems & sexual dysfunction, can be life threatening if deficiencies are of ACTH (adrenocorticotropic hormone) & TSH (thyroid stimulating hormone)

• Cause varies- tumors, malnutrition(anorexia nervosa), head trauma, severe hypotension

resulting in infarction Chart 65-1 pg 1427 key features of deficient

hormones with clinical manifestations• Assessment- history, physical appearance-

manifestations vary depending on hormone affected, labs

• Interventions-replace deficient hormone

• Hyperpituitarism- caused by tumors or hyperplasia, most common are adenomas-benign tumors- result in overproduction of one of three hormones

• Prolactin-results in galactorrhea, amenorrhea, & infertility

• Growth hormone-acromegaly(gigantism)• ACTH(adrenocoricotropic hormone)-

overstimulates adrenal cortex leads to Cushing’s disease

Gigantism

• Chart 65-2 pg 1430 key features of hyperpituitarism• Assessment-history, manifestation

varies depending on hormone overproduced, labs• interventions- drug therapy, surgical

removal of pituitary gland, followed by hormone replacement therapy

Posterior pituitary disorders • Diabetes Insipidus (DI) large volumes of dilute

urine-dehydration is most common manifestation, from-insufficient production of ADH, or inability of kidney to respond to ADH, caused by tumors, trauma, surgery, certain drugs, treatment drug therapy DDAVP

• Syndrome of inappropriate antidiuretic hormone SIADH-retention of water-hyponatremia, from overproduction of ADH, caused by tumors, trauma, respiratory infections, certain drugs. Tx-fluid restriction, diuretics, drug therapy

Disorders of Adrenal Gland

• Adrenal Insufficiency-decreased secretion of ACTH, due to hypothalamic-pituitary control dysfunction, or adrenal gland tissue dysfunction, may occur gradually(Addison’s disease) or quickly as in adrenal crisis(Addisonian crisis) in which there is hypoglycemia, hyperkalemia, hyponatremia, dehydration, & acidosis. Treatment for Crisis Chart 65-7, pg 1436- Fluids-often D5, hydrocortisone sodium, insulin drip to shift potassium, kayexalate.

• Adrenal insufficiency varies in manifestation r/t degrees of hormone deficiency. Muscle weakness, fatigue, anorexia, anemia, hyper-kalemia, hypercalcemia, hypotension, hypo- natremia, hyperpigmentation. Chart 65-8, pg 1437 key features

• Assessment- history, labs(Chart 65-9, pg 1438 lab profiles for hypo&hyperfunction of Adrenal Gland. TX hormone replacement, fluid balance, managing hypoglycemia.

• Adrenal hyperfunction in the adrenal cortex- hypercortisolism-Cushing’s disease causes widespread problems, could arrive from adrenal cortex, anterior pituitary gland, hypothalamus, or even glucocorticoid therapy used for asthma, rheumatoid arthritis, org . Key features Chart 65-12, pg 1441-moon face, buffalo hump, hypertension, osteoporosis, thinning skin, decreased immune function, mood swings. Assessment-history, labs. Tx depends on cause cure possible if pituitary or adrenal then surgical removal , if caused by drug therapy focus on preventing complications, closely monitoring cortisol levels

Cushing’s Disease

• Another adrenal disorder of hyperfunction is hyperaldosteronism- Conn’s syndrome-overproduction from one or both adrenal glands-usually caused benign tumor-results in hypernatremia, hypokalemia, metabolic alkalosis. Pt will be hypertensive, c/o headache, fatigue, muscle weakness. Surgical removal of adrenals is tx followed by glucocorticoid replacement therapy.

• Lastly pheochromocytoma – a catecholamine producing tumor adrenal medulla, usually benign-produce, store, release epinephrine & norepinephrine with wide-ranging adverse effects- intermittent hypertension episodes causing severe HA, palpitations, profuse diaphoresis, flushing, sense of impending doom. DX 24 hr urine, TX surgery, BP monitored closely

Referenceshttp://www.emedicine.medscape.comhttp://www.nlm.nih.gov/medlineplus/endocrinediseases.htmlhttp://www.endocrineweb.com/http://www.merckmanuals.com/professional/sec12/ch152/ch152a.htmlIgnatavicius, D. and Workman, M. (2010). Medical-Surgical Nursing; Patient-centered collaborative care (pp. 1412-1447). St. Louis, MO: SaundersPorth, C. and Marfin, G. (2009). Pathophysiology; Concepts of altered health states (pp.1008 -1046). Philadelphia, PA: Lippincott Williams & Wilkins