ANATOMY AND PHYSIOLOGY the production of hormones can treat

many hormonal disorders in the body.

What is the endocrine system?
The pituitary gland has 2 lobes…
The endocrine system is made up of glands and the
hormones they secrete. These are the pituitary (the
master gland), pineal, thyroid, parathyroid,
thymus, islets of Langerhans, adrenals, ovaries in
the female and testes in the male The function of
the endocrine system is the production and
regulation of chemical substances called
hormones.

Some other organs also secretes hormone ex.

Digestive system. Secretin, gastrin, cholecystokinin

Functions of the Endocrine System

1. Water equilibrium. 

2. Growth, metabolism, and tissue

maturation.  The endocrine system and nervous system work
together to help maintain homeostasis… balance.
3. Heart rate and blood pressure The hypothalamus is a collection of specialized
management.  cells located in the brain, and is the primary link
between the two systems. It produces chemicals
4. Immune system control.  that either stimulate or suppress hormone
secretions of the pituitary gland.
5. Reproductive function controls. 

6. Uterine contractions and milk release. 

Control of Hormone Release
7. Ion management. 
• Negative feedback mechanisms. Negative
8. Blood glucose regulator.  feedback mechanisms are the chief means
of regulating blood levels of nearly all
9. Direct gene activation.  hormones.

10. Second messenger system.  • Endocrine gland stimuli. The stimuli that

activate the endocrine organs fall into three
major categories- hormonal, humoral, and
neural.
Hormones…
• Hormonal stimuli. The most common
A hormone is a chemical transmitter. It is released
stimulus is a hormonal stimulus, in which
in small amounts from glands, and is transported
the endocrine organs are prodded into
in the bloodstream to target organs or other cells.
action by other hormones; for example,
Hormones are chemical messengers, transferring
hypothalamic hormones stimulate the
information and instructions from one set of cells
anterior pituitary gland to secrete its
to another.
hormones, and many anterior pituitary
Hormones regulate growth, development, mood, hormones stimulate other endocrine organs
tissue function, metabolism, and sexual function. to release their hormones into the blood.

Hyposecretion or hypersecretion of any hormone • Humoral stimuli. Changing blood levels of

can be harmful to the body. Controlling certain ions and nutrients may also
stimulate hormone release, and this is
 referred to as humoral stimuli; for example,
the release of parathyroid hormone (PTH) by
cells of the parathyroid glands is prompted
by decreasing blood calcium levels.
• Neural stimuli. In isolated cases, nerve
fibers stimulate hormone release, and the
target cells are said to respond to neural
stimuli; a classic example is sympathetic
nervous system stimulation of the adrenal
medulla to release norepinephrine and
epinephrine during periods of stress.
Hypothalamus also secretes
Somastostatin - which inhibits GH and TSH
Dopamine - Inhibits prolactin release from the
pituitary , inhibits FSH and LH
 The gonadotropin-inhibitory hormone increases
prolactin release by inhibiting dopamine neurons
in the hypothalamus.
SECRETIONS FROM THE ANTERIOR PITUITARY
GLAND…
Growth Hormone (GH): essential for the growth
and development of bones, muscles, and other
organs. It also enhances protein synthesis,
decreases the use of glucose, and promotes fat
destruction.
Adrenocorticotropin (TRŌ pun) (ACTH):
essential for the growth of the adrenal cortex.
Thyroid-Stimulating Hormone (TSH): essential
for the growth and development of the thyroid
gland.
Follicle-Stimulating Hormone (FSH): is a
gonadotropic hormone. It stimulates the growth
ovarian follicles in the female and the production of
sperm in the male.
Luteinizing Hormone (LH): is a gonadotropic
hormone stimulating the development of corpus
luteum in the female ovarian follicles and the
production of testosterone in the male. The yellow
corpus luteum remains after ovulation; it produces
estrogen and progesterone.
Prolactin (PRL): stimulates the development and
growth of the mammary glands and milk
production during pregnancy. The sucking motion
of the baby stimulates prolactin secretion.
Melanocyte-stimulating hormone (MSH):
regulates skin pigmentation and promotes the
deposit of melanine in the skin after exposure to
sunlight
SECRETIONS FROM THE POSTERIOR LOBE OF
THE PITUITARY GLAND…
Antidiuretic Hormone (ADH): stimulates the
reabsorption of water by the renal tubules.
Hyposecretion of this hormone can result in
diabetes insipidus.
Oxytocin: stimulates the uterus to contract
during labor, delivery, and parturition. A synthetic
version of this hormone, used to induce labor, is
called Pitocin. It also stimulates the mammary
glands to release milk.
SECRETIONS FROM THE PINEAL GLAND…
The pineal gland is pine-cone-shaped and only
about 1 cm in diameter.
Melatonin: communicates information about
environmental lighting to various parts of the body.
Has some effect on sleep/awake cycles and other
biological events connected to them, such as a
lower production of gastric secretions at night.
Serotonin: a neurotransmitter that regulates
intestinal movements and affects appetite, mood,
sleep, anger, and metabolism.
SECRETIONS OF THE THYROID GLAND…
The thyroid gland plays a vital role in metabolism
and regulates the body’s metabolic processes.
Calcitonin: influences bone and calcium
metabolism; maintains a homeostasis of calcium in
the blood plasma
Thyroxine (T4) and triodothyronine (T3):
essential to BMR – basal metabolic rate (the rate at
which a person’s body burns calories while at rest);
influences physical/mental development and
growth
Hyposecretion of T3 and T4 = cretinism,
myxedema, Hashimoto’s disease
Hypersecretion of T3 and T4 = Grave’s disease,
goiter,
SECRETIONS OF THE PARATHYROID GLAND…
The two pairs of parathyroid glands are located on
the dorsal or back side of the thyroid gland. They
secrete parathyroid (PTH) which plays a role in the
metabolism of phosphorus. Too little results in
cramping; too much results in osteoporosis or
kidney stones.
THE ISLETS OF LANGERHANS…
The islets of Langerhans are small clusters of cells
located in the pancreas.
Secretions from the islets of Langerhans…
Alpha cells facilitate the breakdown of glycogen to
glucose. This elevates the blood sugar.
Beta cells secrete the hormone insulin, which is
essential for the maintenance of normal blood
sugar levels. Inadequate levels result in diabetes
mellitus.
Delta cells suppress the release of glucagon and
insulin.
THE ADRENAL GLANDS…
The triangular-shaped adrenal glands are located
on the top of each kidney. The inside is called the
medulla and the outside layer is called the cortex.
SECRETIONS FROM THE ADRENAL CORTEX…
Cortisol: regulates carbohydrate, protein, and fat
metabolism; has an anti-inflammatory effect; helps
the body cope during times of stress
Hyposecretion results in Addison’s disease;
hypersecretion results in Cushing’s disease
Corticosterone: like cortisol, it is a steroid;
influences potassium and sodium metabolism
Aldosterone: essential in regulating electrolyte
and water balance by promoting sodium and
chloride retention and potassium excretion.
Androgens: several hormones including
testosterone; they promote the development of
secondary sex characteristics in the male.
SECRETIONS FROM THE ADRENAL MEDULLA…
Dopamine is used to treat shock. It dilates the
arteries, elevates systolic blood pressure, increases
cardiac output, and increases urinary output.
Epinephrine is also called adrenalin. It elevates
systolic blood pressure, increases heart rate and
cardiac output, speeds up the release of glucose
from the liver… giving a spurt of energy, dilates the
bronchial tubes and relaxes airways, and dilates
the pupils to see more clearly. It is often used to
counteract an allergic reaction.
Norepinephrine, like epinephrine, is released
when the body is under stress. It creates the
underlying influence in the fight or flight response.
As a drug, however, it actually triggers a drop in
heart rate.
SECRETIONS OF THE OVARIES…
The ovaries produce several estrogen hormones
and progesterone. These hormones prepare the
uterus for pregnancy, promote the development of
mammary glands, play a role in sex drive, and
develop secondary sex characteristics in the
female.
Estrogen is essential for the growth, development,
and maintenance of female sex organs.
SECRETIONS OF THE TESTES…
The testes produce the male sex hormone called
testosterone. It is essential for normal growth and
development of the male sex organs. Testosterone
is responsible for the erection of the penis.
SECRETIONS OF THE PLACENTA…
During pregnancy, the placenta serves as an
endocrine gland.
It produces chorionic gonadotropin hormone,
estrogen, and progesterone.

SECRETIONS OF THE GASTROINTESTINAL
MUCOSA…
The mucosa of the pyloric area of the stomach
secretes the hormone gastrin, which stimulates the
production of gastric acid for digestion.
The mucosa of the duodenum and jejunum
secretes the hormone secretin, which stimulates
pancreatic juice, bile, and intestinal secretion.
Secretions of the thymus…
The thymus gland has two lobes, and is part of the
lymphatic system. It is a ductless gland, and
secretes thymosin. This is necessary for the
Thymus’ normal production of T cells for the
immune system.
DI and SIADH
Brain Regulation
 Disorder of sodium and water balance is a
common complication following
neurosurgery
 Neuroscience patients must be continually
assessed and monitored for their response
to therapy
 Early detection is critical to the protection
and integrity of the brain
Normal Brain Regulation
 TBW accounts for 60% of body weight
 20% ECF
 40% ICF
 Fluid shifts can occur depending on
concentrations of solutes in ICF and ECF
 Na and K are principle determinants in
fluid shifts
 Osmolarity: amount of solute in fluid
(urine, blood)
 The unit of osmotic concentration is
the osmole. the number of moles of solute
that contribute to the osmotic pressure of a
solution. A milliosmole (mOsm) is 1/1,000
of an osmole. A microosmole (μOsm) (also
spelled micro-osmole) is 1/1,000,000 of an
osmole.
Normal Serum Osmolarity: 280-295 mOsm/L
 Serum Osmo above 295 mOsm/L = water
deficit
 Concentration is too great
 Water concentration is too little
When serum osmolality increases, your body
releases ADH. This keeps water from leaving in the
urine, and it increases the amount of water in the
blood. The ADH helps restore serum osmolality to
normal levels. If you drink too much water, the
concentration of chemicals in your blood
decreases.
 Serum Osmo below 280 mOsm/L
= water excess
 Amount of particles or solute is too
small in proportion to the amount of
water
 Too much water for the amount of
solute
To maintain plasma or serum osmo within range,
free water intake and excretion must balance
 When serum osmolality decreases, your
body stops releasing ADH. This increases
the amount of water in your urine. It keeps
too much water from building up in your
body (overhydration).
 Antidiuretic Hormone (ADH): balances Na
and water in body and controls water
conservation
 Changes in pressure of ECF triggers release
of ADH from pituitary gland
 Release is coordinated with activity of the
thirst center- regulates intake
 ADH binds with receptor sites of the
collecting duct in kidney resulting in
increased free-water resorption
  ADH causes vasoconstriction

Presence of ADH- renal tubule permeability to

water is increased and water is reabsorbed

Absence of ADH- renal tubule permeability to

water is decreased – renal excretion to fluids

 Plasma osmolality = Primary regulatory

mechanism for the release of ADH

 Receptors in the brain are sensitive to

changes in osmolality

 Receptors that trigger thirst mechanism are

close

to those that control ADH release

 Serum osmo greater than 290 mOsm/L

triggers thirst

Vasopressin is a peptide hormone produced in the

hypothalamus and released from the posterior
pituitary. Secretion of vasopressin is followed by
activation of its receptors V1a, V1b, and V2
throughout the body.

ADH Feedback Loop Syndrome of Inappropriate Antidiuretic Hormone

 SIADH: Persistent abnormally high

(inappropriate) levels of ADH in the absence
of stimuli with normal renal function

 No longer regulated by plasma osmo

and volume

 Imbalance of fluid and electrolytes

 Feedback system is impaired and posterior

pituitary continues to release ADH

 Renal tubules continue to reabsorb free

water regardless of the serum osmolality

 Excessive activity of the neurohypophyseal

system r/t brain disease

At Risk Patients for SIADH

 Post-Operative with pituitary surgery

 Acute head injury

 Pulmonary infections (Pneumonia)

  Psychoses
Serum Osmolality Less than 275
mOsm/L
 Drugs
BUN/Creat WNL
 Nervous system infections (meningitis)
Urine Specific Greater than
Investigate the following conditions for SIADH Gravity 1.005normal in the
ranges of 1.005 to
 Thirst and fluid status with accurate I&O 1.030

 Confusion Adrenal/threshold WNL

 Dyspnea Serum Potassium Less than 3.5

mEq/L
 Headache

 Fatigue Treatment of SIADH

 Correct underlying cause
 Weakness  Fluid restriction 500-1000 ml/day
 Severe hyponatremia:
 Increased weight w/o edema  3% NS may be given
With SIADH, the urine is very concentrated. Not
 Change in LOC
enough water is excreted and there is too much
 Lethargy water in the blood. This dilutes many substances
in the blood such as sodium. A low blood sodium
 Vomiting level is the most common cause of symptoms of too
much ADH.
 Muscle weakness and cramping  Lasix may be given (watch K level)
Nursing Management of SIADH
 Muscle twitching
 Frequent Neuro assessment
 Seizures
 Mental status and LOC
Labs to Diagnose SIADH  Pulmonary assessment
 s/s fluid overload
Serum Na  Cardiac assessment
Urine Na  Dysrhythmias and BP abnormalities
 Monitor for seizure activity
Urine Osmolality  Seizure precautions
 Accurate I&O
Serum Osmolality
 Daily Weights
BUN/Creatinine  Same time each day, same scale,
same clothes
Urine Specific Gravity  Oral hygiene
 Reduce stress, pain, discomfort
Serum Potassium
 A low potassium level can make muscles feel
Lab Results for SIADH weak, cramp, twitch, or even become
paralyzed, and abnormal heart rhythms may
develop.
Serum Sodium Less than 135
mEq/L   hyponatremia can include altered
personality, lethargy and confusion.
Urine Sodium Greater than 20 Severe hyponatremia can cause seizures,
mEq/L coma and even death.
Urine Osmolality Higher than serum
 Correlation of Decreasing Sodium Levels and
Symptoms
Diabetes Insipidus
Disordered regulation of water balance due to
impaired urinary concentrating ability secondary to
inadequate secretion of ADH or resistance to ADH.
Four Types of DI:
Central/Neurogenic (CDI)
=rare disorder of water homeostasis secondary to
deficient synthesis or secretion of arginine
vasopressin peptide (AVP) from the hypothalamo–
neurohypophyseal system (HNS) in response to
osmotic stimulation.
Nephrogenic (NDI)-
=is an inability to concentrate urine due to
impaired renal tubule response to vasopressin
(ADH), which leads to excretion of large
amounts of dilute urine
Dipsogenic
= damage in thirst regulating center
Gestational
=It occurs only during pregnancy when an
enzyme made by the placenta destroys ADH in
the mother. Primary polydipsia. Also known as
dipsogenic diabetes insipidus, this condition can
cause production of large amounts of diluted urine
from drinking excessive amounts of fluids
Pathophysiology of DI
Causes of DI
 Head Trauma
 Post-operative (hypophysectomy, pituitary
tumor)
 Brain Tumors
 CNS Infection (meningitis, abcess)
 Increased ICP
 Idiopathic - denoting any disease or
condition which arises spontaneously or for
which the cause is unknown.
 ICH- intracerebral brain hemorrhage
 Stroke
 Hypoxia
 Medications (Dilantin, clonidine, alcohol)
 Damage to hypothalamus or posterior
pituitary
Diabetes Insipidus (DI) Clinical Signs!
 Dehydration! Excessive loss of water from
body tissue and imbalance of essential
electrolytes (Na, K, Cl)
 Polydipsia (excessive thirst)
 Polyuria (excessive amount of urine)
 Low specific gravity (1.001 to 1.005)
 Serum hyperosmolality and hypernatremia
Investigate the following for DI
 Unquenchable thirst
 Polydipsia
 Polyuria (hourly urine output > 200 mls)
 Unexplained weight loss
 Urinary frequency
 Nocturia
 Dry skin/poor skin turgor
  Tachycardia and hypotension
 Inability to respond to the increased thirst Water Deprivation Test
stimulus and compensate for the excessive • After baseline measurement of: weight,
polyuria ADH, plasma sodium, and urine/plasma
 Hypernatremia that becomes severe and is osmolality, the patient is deprived of fluids
manifested by- confusion, irritability, under strict medical supervision
stupor, coma and neuromuscular • Frequent (q2h) monitoring of plasma and
hyperactivity progressing to seizures. urine osmolality follows. 
 Elderly • The test is generally terminated when
 Unconscious/intubated plasma osmolality is >295 mOsm/kg or the
patient loses ≥3.5% of initial body weight. 
Labs and Diagnostics for DI • DI is confirmed if the plasma osmolality is
Serum calcium >295 mOsm/kg and the urine osmolality is
Glucose <500 mOsm/kg. 
Creatinine
Potassium Nephrogenic DI vs Neurogenic DI
Urea level  DDAVP Challenge
 Check urine osmolality 1-2hrs after
 The following may also be indicated: 1mcg SQ DDAVP
 If little or no change: likely
 24hr urine collection to quantitative NDI or dipsogenic DI
polyuria  If significant increase in
 CT/MRI urine osmolality, likely CDI
 rule out pituitary causes,  Abbreviation for “1-desamino-8-d-arginine
metastases, hemorrhage, vasopressin.” DDAVP is a synthetic version
neuronal damage, cerebral of antidiuretic hormone (ADH) originally
tumors. developed to treat diabetes insipidus. .
 Radioimmunoassy: to measure Desmopressin
 5 units vasopressin IV
circulating ADH concentrations
 Measure osmolality
 A significant increase (>50%) in
urine osmolality after administration
of ADH is indicative of CDI

Treatment of DI
Lab Results for diagnosis of DI Correct the underlying cause and maintain
adequate fluid replacement.
 DI Therapy varies with the degree and type
of DI present or suspected.
 IVF may be necessary to correct
hypernatremia; avoid rapid replacement
 Free water restriction
 After assessing fluid status and serum
sodium level, treat both dehydration and
hypernatremia
 For chronic neurogenic DI- require
hormonal replacement therapy: DDAVP
(nasal vasopressin)
 Consultation with an endocrinologist is
Diagnosis of DI should be considered in any strongly recommended
person producing large volumes of dilute urine
 Treatment for Nephrogenic DI  Central Pontine Myelinolysis: brain cell
Removal of the underlying cause/offending drug dysfunction caused by destruction of the
 DDAVP usually ineffective myelin sheath covering nerve cells in
 Thiazide diuretic (HCTZ) is first line brainstem
treatment  Na levels rise too fast or corrected too
 Adequate hydration quickly
 Low-sodium diet + thiazide diuretics to  s/s: (not necessarily immediate)
induce mild sodium depletion.  Acute paralysis
 Indomethacin may also be useful to reduce  Dyschagia
urine volume.  Dysarthria

Nursing Management of DI Most Important Nursing Intervention for DI and

 Hourly Neuro Checks SIADH
 Frequent Vital Signs  Frequent Labs
 Evaluate for s/s of hypovolemic shock  We have severe electrolyte
 Strict I&O abnormalities
 Rehydrate for symptoms of extreme thirst  Careful not to correct too quickly!!
 Measure and record weight using the same  Na should not rise more than
scales at the same time and with the 0.5mEq/L/hr and 10 mmol/L/24
patient wearing the same clothing hrs
 Assess mucous membranes and skin turgor  Frequent neuro assessment
and monitor for symptoms of dehydration  The nurse can pick up abnormal
 Provide rest behavior and signs and symptoms
 Safety measures to prevent injury first
secondary to dizziness and fatigue  Note any changes from baseline
 Alert the health care team of problems of
urinary frequency and extreme thirst that
interferes with sleep and activities.

SIADH vs DI Lab Values

Complications to treatments of DI and SIADH

 Cerebral Edema!