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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=8E2187FE28FF3B7A21DD8E 2187FE28FF3B7A21DD&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 thyroidregulates 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 catecholaminesepinephrine & 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 appearancemanifestations 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. Txfluid 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- Fluidsoften 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, hyperkalemia, hypercalcemia, hypotension, hyponatremia, 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 cortexhypercortisolism-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 syndromeoverproduction 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 effectsintermittent 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.com http://www.nlm.nih.gov/medlineplus/endocrinediseases.html http://www.endocrineweb.com/ http://www.merckmanuals.com/professional/sec12/ch152/ch152a.html Ignatavicius, D. and Workman, M. (2010). Medical-Surgical Nursing; Patientcentered collaborative care (pp. 1412-1447). St. Louis, MO: Saunders Porth, C. and Marfin, G. (2009). Pathophysiology; Concepts of altered health states (pp.1008 -1046). Philadelphia, PA: Lippincott Williams & Wilkins