ENDOCRINE SYSTEM
GUIANNE SHY M. RASALAN BSN-4D | TRU Review Center
Endocrine
● Ductless
● Bloodstream directed
● Ex: Enzymes
● Hormones release
Exocrine
● Ducts
○ Sweat glands
○ Sebaceous gland
■ Sebum
○ Digestive system
■ Pancreas
ENDOCRINE
● Pineal gland
○ Melatonin
■ Sleep wake cycle
○ Diurnal Circadian
● Pituitary gland
○ Master gland
○ Hypophysis
■ Hypophysectomy
○ Parts
■ Posterior Pituitary
● Neurohypophysis
○ Oxytocin
■ Uterine contraction
■ Milk ejection
● Let down reflex
■ Feel-good hormone
■ Bonding and attachment
■ Blood phenomenon
○ Antidiuretic hormone
■ ❌ Urine
■ Water retention
● Vasopressin
■ Anterior Pituitary
● Adenohypophysis
○ Prolactin
■ Milk production
○ MSH
■ Melanin production
○ Growth Hormone
■ Somatotropin
■ Carbohydrate metabolism
■ ⬆️ Blood glucose level
● Glycogenesis
○ Liver
○ Formation of glucose
RASALAN, RN | 1
● Glycogenolysis
○ Die glucose
● Gluconeogenesis
○ From amino acids or protein
■ Protein build up
● Anabolism
■ Fats
○ TSH
○ Adrenocorticotropic hormone
○ Gonadotropic hormones
■ FSH
● Females
○ Maturation of Graafian Follicle
○ GEN Hormones
○ Estrogen- Hormone of women
● Males
○ Production of sperm
○ Androgen
■ LH
● Stimulates maturation of corpus luteum
● Hormone of ovulation
● RONE Hormone
● Progesterone- Hormone of pregnancy
● Testosterone
ANTERIOR PITUITARY GLAND DISORDERS
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ACROMEGALY Gigantism Dwarfism
Hormone Growth Hormone
Causes ● During adulthood ● Childhood ● Childhood
● Brain tumor ● Brain tumor ● Brain tumor
● Infection ● Infection ○ Compresse
○ Encephaliti ○ Encephaliti s the
s s pituitary
○ Meningitis ○ Meningitis ● Operation
● Head trauma ● Head trauma ○ Hypophyse
ctomy
Signs and Symptoms ● Perpendicular ● Vertical growth ● Small for gestation
growth ● Risk for fall ● Failure to thrive
○ Malapad during the infancy
● ⬆️ Size of organs period
● Cardiomegaly ● Small limbs
● Extremities are
short and
proportionate to
the torso
● Magkakamukha
Diagnostic Test Suppression Suppression Stimulation
MRI
CT-Scan
Medical Management ● Growth hormone inhibitor or antagonist ● Growth hormone
● Somatostatin ○ Can cause
● B: Bromocriptine (Parlodel malignanci
● O: Octreotide Acetate (Sandotasatin) es
○ Subq ● Somatotropin
● L: Lanreotide (Somatuline) ● Side effects
○ Hyperglyce
mia
○ Bone and
joint pain
Surgical Management ● Hypophysectomy
● Incision site: under the upper lip
○ No use of straw
○ No toothbrush
○ Use mouthwash instead
● Complications:
○ Infection
■ Meningitis
● Fever
● Rashes
● Nuchal rigidity (titigas
ang baga)
○ Brudzinski sign
■ Batok
○ Kernig's Sign
■ Knee
● MOT: Droplet
○ 3ft away
3
● Hand washing: 20
seconds
● Confirmatory Test
○ CSF analysis
○ WBC ⬆️
○ Protein ⬆️
○ Glucose ⬇️
○ CSF Leakage
■ Frequent swallowing
■ Rhinorrhea
■ Otorrhea
■ + Halo sign (secretion will
separate into concentric rings)
■ + Glucose (Dextrastrip Test)
● Green to yellow
○ Increase intracranial pressure
■ Widening
■ Hyper: BP, Temp
■ Brady: Pulse Pressure
■ Brady: RR
● Cushing's triad
■ Do not stimulate the anus
■ No enama
■ Blood test
■ Lumbar puncture ❌
○ Hypopituitarism
■ Diabetes insipidus
POSTERIOR PITUITARY GLAND DISORDERS
DIABETES INSIPIDUS SIADH
Hormone ⬇️ ADH ⬆️ ADH
Causes ● Head trauma ● Brain tumor
● Diuretics ● Medications
● Surgical removal ○ Lithium
● Hypophysectomy ○ AntiPsychotics
●
Signs and Symptoms ADH LEVEL ADH LEVEL
⬆️ ⬇️
● ●
URINE OUTPUT: URINE OUTPUT:
⬇️ ⬆️
● ●
● URINE OSMOLALITY: ● URINE OSMOLALITY:
Diluted Concentrated
● SERUM OSMOLALITY: ⬆️ ● SERUM OSMOLALITY: ⬇️
Concentrated Diluted
● ELECTROLYTE ● ELECTROLYTE
IMBALANCES: IMBALANCES: Dilutional
Hypernatremia Hyponatremia
● FLUID VOLUME: Fluid Volume ● FLUID VOLUME: Fluid Volume
Deficit Excess
Diagnostic Test ● Stimulation ● Suppression
● CT-Scan ● CT-Scan
● MRI ● MRI
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● Urinalysis ● Urinalysis
● Kidney Function test ● Kidney Function test
○ BUN ○ BUN
○ CREA ○ CREA
MEDICAL MANAGEMENT ● Desmopressin Acetate ● Demeclocycline (Declomycin)
(DDAVP)
○ NOCTIVA- via nasal
spray
SURGICAL MANAGEMENT ● HYPOPHYSECTOMY
NURSING MANAGEMENT ● Fluids ● Fluids⬇️
○ Increase fluid Hypertonic Solutions
⬆️
●
● Isotonic solution (0.9%) ○ Urine
○ PNSS ● 3% NaCl
○ PLR ● Diet
● Diet: ○ Normal Sodium
○ Low sodium Intake less than 2.5
● Monitor grams per day
○ Closely monitor urine ○
output
■ ⬇️ Urine
output
○ Urine specific gravity
(1.000-1.025)
○ Daily weights
○ Complication
■ Cerebral
edema
● LOC
Cha
nges
● Seiz
ure
○ Seizure precaution
■ Prioritize
safety
■ Protect the
head
■ Support the
extremities
■ Removed all
metal, glass,
and sharp
objects
■ Prioritize
after
seizure:
airway
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THYROID GLAND DISORDERS
ANATOMY AND PHYSIOLOGY
● Thyroid gland Hormones
○ T3 (Triiodothyronine)
■ Metabolism
○ T4 (thyroxine
■ Heat
○ Thyrocalcitonin = ⬇️ serum calcium
■ Calcium from blood to bone
■ Bone reabsorption
○ Parathyroid hormone
■ ⬆️ Serum calcium
Hypothyroidism (Myxedema) Hyperthyroidism (Grave’s Disease)
Hormones ● T3, T4, T. Calcitonin
Causes ● Autoimmune disease ● Iodine excess
● Iodine Deficiency ● De Quervain's thyroiditis
● Hashimoto thyroiditis ○ Subacute
● Radioactive Iodine- granulomatous
destruction of thyroid gland thyroiditis
● Anti-thyroid glands ● Tumor
● Surgical removal ○ Toxin goiter
○ Thyroidectomy ● Thyroid Hormones
Signs and Symptoms ● V/S: ⬇️ ● V/S: ⬆️
● Metabolism: Constipation ● Metabolism: Diarrhea
● Body Heat: Cold intolerance ● Body Heat: Heat
● Weight: Weight Gain Intolerance
● Menses: Excessive Menses ● Weight: Papayat
(Menorrhagia) ● Menses:
● Eyes: Periorbital Metronorrhea-Spotting
between period
○ Amenorrhea:
Stooping
● Eyes: Exophthalmos
Diagnostic Test T3 ⬇️ T3 ⬆️
⬇️ ⬆️
● ●
T4 T4
⬆️ ⬇️
● ●
● TSH ● TSH
● Stimulation ● Suppression
Management ● Drug of Choice: Thyroid
Hormone Replacement
Therapy
● T3: Liothyronine Sodium
○ Cytomel
● T4: Levothyroxine Sodium
○ Synlevothyroid
● T3 and t4: thyroid usp/
desiccated thyroid hormone
●
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