ENDOCRINE DISORDERS

Tricia Mae Carmona, RN

TOPRANK | Nursing
 PITUITARY GLAND
Also known as:
•
• controlled by:
• Location:
• Housed in:

2 LOBES:

•
•

TOPRANK | Nursing
 ANTERIOR PITUITARY GLAND
HORMONES FUNCTION

G
T
P
A
L
F
M
TOPRANK | Nursing
 POSTERIOR PITUITARY GLAND
HORMONES FUNCTION
O

TOPRANK | Nursing
 THYROID GLAND
•
• Shape:
• Highly vascular
• Location:

3 HORMONES PRODUCED:
•
•
•

TOPRANK | Nursing
 NORMAL PHYSIOLOGY

TOPRANK | Nursing
 NEGATIVE FEEDBACK MECHANISM

TOPRANK | Nursing
 FINDINGS HYPERTHYROIDISM HYPOTHYROIDISM

Cause

Appearance

TOPRANK | Nursing
TOPRANK | Nursing
TOPRANK | Nursing
 DIAGNOSTIC EVALUATION:
SERUM TESTS
• T3
• T4
• TSH
• Increased:
• Dysfunction of the thyroid gland –
• Failure of pituitary gland, hypothalamus, or both –
• Pituitary disorder –
• Inadequate secretion of TSH –
• Thyroid deficiency at birth –
• Decreased:
TOPRANK | Nursing
 DIAGNOSTIC EVALUATION:
PHYSICAL ASSESSMENT:
• Abnormal assessment:
• Soft –
• Firmness –
• Tenderness -

RADIOACTIVE IODINE UPTAKE

• Measures:
• Normal:
• Elevated:
• Decreased:

TOPRANK | Nursing
 Findings Hyperthyroidism Hypothyroidism

T3 & T4
TSH
Menstruation
Metabolism
Body Weight
Appetite
GIT
Heat Production
Skin
SNS
Vital Sign
Severe form
TOPRANK | Nursing
 Hyperthyroidism Hypothyroidism
Summary

TOPRANK | Nursing
 Findings Hyperthyroidism Hypothyroidism
Hashimoto’s
Exophthalmos
High T3 & T4
High TSH
High Menstruation
High Body Weight
Low Appetite
Diarrhea
Heat Intolerance
Dry
Lethargy
Tachycardia
Myxedema coma
TOPRANK | Nursing
 Interventions Hyperthyroidism Hypothyroidism

Calorie

Fiber

Fluids

Activity

Environment

Sedatives

Stimulants

Avoid
TOPRANK | Nursing
 MEDICAL INTERVENTION:
HYPOTHYROIDISM

PHARMACOLOGIC THERAPY: Levothyroxine

• Increases action of:
• Decreases action of:
Intervention:
• Take medication: without
•
WOF:
•
•
TOPRANK | Nursing
 MEDICAL INTERVENTION:
HYPERTHYROIDISM
Pharmacologic Therapy :
• Anti-thyroid Medications: THIOAMIDES
Example:
WOF:
Teachings:
• Lugol’s solution
WOF:
Limited use for:
• Radioactive Iodine
Contraindicated to:
Avoid:
TOPRANK | Nursing
 THYROIDECTOMY
Done when thyroid function has returned to normal:

Preoperative Medications:
1. Anti-thyroid Medications
2. Beta-blockers

Important considerations:
• Aspirin:
• Patient receiving iodine:
• Symptoms of iodine toxicity → warrants withdrawal
•
•
•
•
TOPRANK | Nursing
 COMPLICATIONS OF THYROIDECTOMY
1. Hypoparathyroidism / Hypocalcemia / Tetany
Due to:
WOF:
DOC:
2. Thyroid storm / thyrotoxic crisis
Due to:
WOF:
DOC:
•
•

TOPRANK | Nursing
TOPRANK | Nursing
 COMPLICATIONS OF THYROIDECTOMY
3. Bleeding
WOF:
Position:
Avoid:
4. Laryngospasm
Due to:
WOF:
Item:
5. Laryngeal nerve damage
WOF:
Assess for:
Avoid:
TOPRANK | Nursing
 RECAP: COMPLICATIONS OF THYROIDECTOMY
1. Signs of airway obstruction A. Hypoparathyroidism /
2. Due to accidental removal of Hypocalcemia / Tetany
the parathyroid gland B. Thyroid storm
3. WOF: dysphonia
C. Bleeding
4. Due to: Leakage of thyroid
hormone in the circulation D. Laryngospasm
5. Avoid: flexion and E. Laryngeal nerve damage
hyperextension of the neck
6. DOC: Calcium Gluconate

TOPRANK | Nursing
 ADRENAL GLANDS
PARTS:
1. MEDULLA
•
•
2. CORTEX
•
•
•

TOPRANK | Nursing
 ADRENAL CORTEX
1. Glucocorticoids
• Natural release:
• Sugar:
• Stress:
• Suppress:
• Breakdown:
• Blocks:
• Regulation:
TOPRANK | Nursing
 ADRENAL CORTEX
2. Mineralocorticoids
• Na and H2O
•K

3. Androgen

TOPRANK | Nursing
 Findings CUSHING’S ADDISON’S

Cause
Appearance

Glucocorticoids • Sugar • Sugar

• Stress resistance • Stress resistance
• Suppression of immunity • Suppression of immunity

• Protein Break-down • Protein Break-down

• Skin & Extremities • Skin & Extremities

TOPRANK | Nursing • Blocks Calcium • Blocks Calcium

 BOTH CUSHING’S AND ADDISON’S HAVE:
• MOOD DISTURBANCE

• HIGH RISK FOR INFECTION

TOPRANK | Nursing
TOPRANK | Nursing
 Findings CUSHING’S ADDISON’S

Mineralocorticoids • Na & H2O retention • Na & H2O retention

• K excretion • K excretion

Androgen

TOPRANK | Nursing
 DIAGNOSTIC EVALUATION:
CUSHING’S
Confirmatory:
• SERUM CORTISOL
Normal:
Morning:
Evening:

• URINARY CORTISOL
-
Abnormal:

TOPRANK | Nursing
 DIAGNOSTIC EVALUATION:
CUSHING’S
• LOW DOSE DEXA SUPPRESSION TEST
Dose given:
Time:
Plasma cortisol level obtained at:
Normal:
Abnormal:

TOPRANK | Nursing
 DIAGNOSTIC EVALUATION:
ADDISON’S
• SERUM CORTISOL & PLASMA ACTH
•
• PRIMARY ADRENAL INSUFFICIENCY

• Other laboratory findings:

•
•
•
•
TOPRANK | Nursing
 CUSHING’S ADDISON’S

Summary

TOPRANK | Nursing
 Findings Cushing’s Addison’s
Moon face
Buffalo hump
Bronze skin
Truncal obesity
Hypoglycemia
Poor resistance to stress
Thin skin
Hypercalcemia
Hyponatremia
FVE
Hyperkalemia
Hirsutism
TOPRANK | Nursing
 Interventions CUSHING’S ADDISON’S

Avoid
Carbohydrates
Protein
Calcium diet

Na & H2O intake

K Diet

Disturbed Body image

TOPRANK | Nursing
 MEDICAL INTERVENTION:
CUSHING’S

Pharmacologic Therapy: Adrenal Enzyme Inhibitors

•
•
•

TOPRANK | Nursing
 MEDICAL INTERVENTION:
ADDISON’S
Pharmacologic Therapy:
•
•
Health Education:
• Stress management
• Infection prevention
• Medical Alert Bracelet
• Emergency steroid Kit
• Increase steroid dose during:

TOPRANK | Nursing
 PHEOCHROMOCYTOMA
Origin: • Clonidine Suppression
Peak: Normal:
Abnormal:
Diagnostics:
• Urine Catecholamines • Imaging Studies
•
Abnormal:
• Total Plasma Catecholamines NEVER:
• Supine and at rest for:
• Abnormal:
Epi:
Norepi:

TOPRANK | Nursing
 PHEOCHROMOCYTOMA
MANIFESTATIONS: 6H

•
•
•
•
•
•

TOPRANK | Nursing
 PHEOCHROMOCYTOMA
PHARMACOLOGIC THERAPY:
•
•
•

SURGERY:
•
TOPRANK | Nursing
 HYPOPITUITARISM
Causes:
•
•
•
Manifestations: DEFICIENCY IN:
• GH:
• TSH:
• PROLACTIN:
• ACTH:
• LH/FSH:

TOPRANK | Nursing
 HYPOPITUITARISM
DIAGNOSTICS:
1. Baseline serum hormone levels

2. Insulin Tolerance Test

• Normal:
• Abnormal:

3. Imaging Test
4. Visual Field Testing
• Compression of optic chiasm:

TOPRANK | Nursing
 HYPOPITUITARISM
MANAGEMENT:
1. Hormone replacement therapy
ACTH:
TSH:
LH/FSH:
GH:

2. Treat the underlying cause

Ex:

3. Lifelong monitoring and adjustment of hormone dosages

TOPRANK | Nursing
 HYPERPITUITARISM
Caused by:

Manifestations: INCREASE IN:

• Prolactin
• GH
• ACTH
• TSH

Surgical Management:
•

TOPRANK | Nursing
 HYPERPITUITARISM
DIAGNOSTICS:

1. SERUM HORMONE LEVELS

2. Glucose Suppression Test (OGTT)
• Normal:
• Abnormal:

3. MRI
4. Visual Field Testing
• Compression of optic chiasm:

TOPRANK | Nursing
 HYPERPITUITARISM
PHARMACOLOGIC THERAPY:

1. Dopamine Agonist
• Examples:
• Used for:
• Binds to dopamine receptors
•
2. Somatostatin Analogs
• Examples:
• Used for:
• Mimics somatostatin
TOPRANK | Nursing
 HYPERPITUITARISM
PHARMACOLOGIC THERAPY:

3. Growth Hormone Receptor Antagonists

• Example:
• Used for:
• Blocks GH receptors

TOPRANK | Nursing
 HYPERPITUITARISM
SURGICAL MANAGEMENT:
TRANSPHENOIDAL HYPOPHYSECTOMY

Accessed via:
Indications:
Performed under:
Small opening on:

TOPRANK | Nursing
 HYPERPITUITARISM
PREOPERATIVE CARE:
TRANSPHENOIDAL HYPOPHYSECTOMY

• Baseline hormone levels

• Imaging studies
• Visual Field Testing:
• Patient education:
•
•

TOPRANK | Nursing
 HYPERPITUITARISM
POSTOPERATIVE CARE:
TRANSPHENOIDAL HYPOPHYSECTOMY

• Elevate HOB

• Avoid increased in ICP

• Monitor UO

• Provide oral hygiene

TOPRANK | Nursing
 ADH/Vasopressin

TOPRANK | Nursing
 Findings SIADH DI

Cause

ADH

Fluid Imbalance

Serum Sodium &

Osmolality

Urine Output

Urine Specific
Gravity
Concentration of
TOPRANK | urine
Nursing
 DIAGNOSTIC EVALUATION:
DIABETES INSIPIDUS
• FLUID DEPRIVATION TEST
• Done as:
• Obtain labs:
• Withhold fluids for:
• Urine collection every:
• Stopped if:
• Weigh every:
• Confirmatory:
• Inability to:
TOPRANK | Nursing
 DIAGNOSTIC EVALUATION:
DIABETES INSIPIDUS
• DESMOPRESSIN / VASOPRESSIN ADMINISTRATION
• Done after:
• CENTRAL DI
• Urine osmolality increases
• NEPHROGENIC DI
• No response to desmopressin administration

TOPRANK | Nursing
 Summary:
SIADH DI

TOPRANK | Nursing
 1. Hypertension
2. Weight gain
3. Flat neck veins
4. Crackles
5. Altered LOC
6. Edema
7. Tachycardia
8. Poor skin turgor
9. Dry skin
10. Distended neck vein
11. Sunken eyeball
12. Hypotension
TOPRANK | Nursing
 Findings SIADH DI

High ADH

FVD

Hypernatremia

Oliguria

High USG

Dilute urine

Polydipsia

Cerebral Edema
TOPRANK | Nursing
Intervention SIADH DI
•D •A

Medications
• D

Fluid intake
•D
Monitor • I
• E
TOPRANK | Nursing