ENDOCRINE DRUGS: PITUITARY,

THYROID, PARATHYROID, AND ADRENAL

DISORDERS
ENDOCRINE SYSTEM

• Endocrine System
• Glands
• Hormones

Hypothalamus
• Master Gland
• Diencephalon of the brain
• Activates, control, endocrine processes, somatic functions (Body temp, sleep,
appetite)
• Coordinating center (nervous and endocrine responses)
• Secretes releasing hormones (stimulate pituitary gland-stimulate specific glands
)

Pituitary gland
• Hypophysis
• Located on the bony sella
turcica under dura matter

Pituitary gland: Anterior

 FSH
 LH
 Prolactin
 ACTH
 TSH
 GH/Somatotropin

 hormones- enter circulation- target organ

Pituitary gland: Posterior

 Vasopresssin (ADH)
 Oxytocin
 hormones
( hypothalamus- posterior pituitary gland for storage)

GNRH- Hypothalamus

FSH/LH- APG

testis/ovary

Testosterone production (spermatogenesis)

Estrogen, ovulation

oversecretion or undersecretion of hormones

Oversecretion (hypersecretion) ACTH or growth hormone and results in
Cushing’s syndrome or acromegaly (excess of growth hormone in adults)

bone and soft tissue deformities

enlargement of the viscera without an increase in height
insufficient secretion of growth hormone

dwarfism

Pituitary Gland
• Anterior pituitary gland
• Growth hormone (GH)
• Stimulates growth in tissue and bone
• Thyroid-stimulating hormone (TSH)
• Acts on thyroid gland
• Adrenocorticotropic hormone (ACTH)
• Stimulates adrenal gland
• Gonadotropins (FSH), (LH)
• Affects ovaries

Pituitary Gland (cont’d)

• Anterior pituitary gland
• Growth hormone
• Drugs for growth hormone deficiency: somatrem
(Protropin), somatropin (Humatrope)
• Drugs for growth hormone excess: bromocriptine (Parlodel),
octreotide (Sandostatin) 
Pituitary Gland
• Anterior pituitary gland
• Growth hormone (GH)
• Stimulates growth in tissue and bone
• Thyroid-stimulating hormone (TSH)
• Acts on thyroid gland
• Adrenocorticotropic hormone (ACTH)
• Stimulates adrenal gland
• Gonadotropins (FSH), (LH)
• Affects ovaries
Thyroid gland
• Anterior part of the neck
• Controls rate of body metabolism and
growth
• T4- , T3- , thyrocalcitonin

Thyroid Hormones
 unique property of containing iodine
molecules
 These hormones are synthesized and stored bound to proteins in the cells of
the thyroid gland until needed for release into the bloodstream.

The thyroid hormones

 cell replication
 brain development
 normal growth
 cellular metabolism
 influence every major organ system

Hypothyroidism
• Decrease in thyroid hormone secretion
• Etiology
• Primary: thyroid gland disorder, more common
• Due to thyroid gland inflammation, radioiodine
therapy, excess intake of antithyroid drugs, surgery
• Myxedema (adult), cretinism (child)
• Secondary: lack of TSH secretion

Thyroid Gland (cont’d)

• Levothyroxine (T4, Synthroid)
• Action
• Increase metabolism, body growth
• Use
• Treat hypothyroidism, myxedema, cretinism
• Contraindications
• Thyrotoxicosis, MI, severe renal disease
Thyroid Gland (cont’d)
• Levothyroxine (T4, Synthroid)
• Interactions
• Increased cardiac insufficiency with epinephrine
• Increased effects of anticoagulants, TCAs, vasopressors,
decongestants
• Decreased effects of antidiabetics, digitalis
• Decreased absorption with cholestyramine, colestipol
Thyroid Gland (cont’d)
• Levothyroxine (T4, Synthroid)
• Side effects/adverse reactions
• Nervousness, insomnia, weight loss
• Tremors, headache
• Nausea, vomiting, diarrhea, cramps
• Tachycardia, palpitations, hypertension
 • Dysrhythmias, angina
• Thyroid crisis *

Thyroid Gland (cont’d)

Hyperthyroidism
• Increase in T4 and T3
• Etiology
• Hyperfunction of
thyroid gland
• Excess release of
thyroid hormones
• Symptoms
• Tachycardia,
palpitations, excess
sweating, heat
intolerance,
nervousness,
irritability,
exophthalmos, weight loss

Thyroid Gland (cont’d)

• Hyperthyroidism
• Propylthioruacil (PTU),
methimazole (Tapazole)
• Action
• Reduce excess
secretion of T4, T3
by inhibiting thyroid
secretion
• Use
 • Treat thyrotoxic crisis, preparation for subtotal
thyroidectomy

Thyroid Gland (cont’d)

• Hyperthyroidism
• Propylthioruacil (PTU), methimazole (Tapazole)
• Interactions
• Increase effect of anticoagulants
• Decrease effect of antidiabetics
• Digoxin and lithium increase action of thyroid drugs
• Phenytoin increases T3 level

Thyroid Gland (cont’d)

• Nursing interventions
• Monitor vital signs, weight
• Administer thyroid replacement drug before breakfast
• Check labels prior to using OTCs
• Advise reporting of symptoms of hyperthyroidism
• Encourage medic-alert tag
• Warn of foods that inhibit thyroid secretion

Thyroid Gland (cont’d)

• Nursing interventions
• Administer antithyroid drugs with meals
• Warn of iodine effects and presence in iodized salt, shellfish, OTC cough
medications
• Do not abruptly stop antithyroid drugs
• Advise reporting of symptoms of hypothyroidism

Pituitary Gland (cont’d)

• Posterior pituitary gland
• Antidiuretic hormone
• Vasopressin (Pitressin)
• Desmopressin acetate (DDAVP)

DIABETES INSIPIDUS
 disorder of the posterior lobe
 deficiency of antidiuretic hormone(ADH), or vasopressin
 Great thirst (polydipsia) and large volumes of dilute urine
 may be secondary to head trauma, brain tumor, or surgical ablation or
irradiation of the pituitary gland.

Clinical Manifestations
 Without the action of ADH on the distal nephron of the kidney

daily output of very dilute, water-like urine

specific gravity of 1.001 to 1.005 occurs
urine contains no abnormal substances such as glucose and albumin
Thirst(tends to drink 2 to 20 liters of fluid
daily and craves cold water)

PHARMACOLOGIC THERAPY
Desmopressin (DDAVP)
 synthetic vasopressin without the vascular effects of natural ADH
 longer duration of action and fewer adverse effects
 administered intranasally
 One or two administrations daily or every 12 to 24 hours
PHARMACOLOGIC THERAPY
 IM administration of ADH or vasopressin tannate in oil
 administered every 24 to 96 hours.
 the vial of medication should be warmed or shaken vigorously before
administration
 administered in the evening so that maximum results are obtained during sleep
 SE: Abdominal cramps
 Rotation of injection sites is necessary to prevent lipodystrophy

PHARMACOLOGIC THERAPY
 Clofibrate- antidiuretic effect
 Chlorpropamide (Diabinese) and thiazide diuretics -used in mild forms of the
disease - potentiate the action of vasopressin.
The patient receiving chlorpropamide should be warned of the possibility of
hypoglycemic reactions

PARATHYROID FUNCTION
• Parathormone -
regulates calcium and
phosphorus metabolism.
• Increased secretion of
parathormone results in
increased calcium
absorption from the
kidney, intestine, and
 bones, thereby raising the blood calcium level. Some actions of this hormone
are increased by the presence of vit d.
• Parathormone also tends to lower the blood phosphorus level.

• Excess parathormone -elevated levels of serum calcium, a potentially life-

threatening situation.
• When the product of serum calcium and serum phosphorus (calcium ×
phosphorus) rises, calcium phosphate may precipitate in various organs of the
body and cause tissue calcification.

Parathyroid Disorders
• Inadvertent surgical removal is
the most common cause of
hypoparathyroidism
Clinical Manifestations
• Hypocalcemia -irritability of the neuromuscular system
• Tetany is a general muscle hypertonia with tremor and spasmodic or
uncoordinated contractions occurring with or without efforts to make voluntary
movements
 Numbness
 Tingling
 cramps in the extremities
 stiffness in the hands and feet

Parathyroid Glands
• Parathyroid hormone
• Action
• Corrects blood calcium deficit
• Use
• Treat hypoparathyroidism, hypocalcemia in chronic renal
failure
Parathyroid Glands (cont’d)
• Calcitriol (Rocaltrol)
• Action
• Promotes calcium absorption from GI tract and renal
tubules
• Use
• Treat hypoparathyroidism, hypocalcemia
• Contraindications
• Hypercalcemia, hyperphosphatemia, excess vitamin D,
malabsorption syndrome

Parathyroid Glands (cont’d)

• Calcitriol (Rocaltrol)
• Interactions
• Increased dysrhythmias with digoxin, verapamil
• Decreased calcitriol absorption with cholestyramine
• Side effects/adverse reactions
 • Drowsiness, headache, dizziness, lethargy, photophobia, GI
distress, hypercalciuria, hyperphosphatemia, hematuria

Parathyroid Glands (cont’d)

• Calcitriol (Rocaltrol)
• Nursing interventions
• Monitor calcium levels
• Advise reporting of symptoms of hypocalcemia
• Tetany, twitching of mouth, tingling, numbness of
fingers, carpopedal spasm, spasmodic contractions,
laryngeal spasms
• Warn about checking OTC drugs for calcium content

Adrenal Gland
• One gland on top of each
kidney
• Regulates Na and
electrolyte balance
• Affects CHO, fat and CHON met
• Sexual characteristics
• Fight or flight response

Adrenal cortex
- Outer shelf
- Glucocorticoids and
minerocorticoids
- Small amount of sex
hormones (androgens,
estrogens)
- adapt to stress of all kinds.
- steroid hormones produced
glucocorticoids-
hydrocortisone
mineralocorticoids-
aldosterone

GLUCOCORTICOIDS
• important influence on glucose metabolism
• increased hydrocortisone secretion results in elevated blood glucose levels.

MINERALOCORTICOIDS
• Mineralocorticoids exert their major effects on electrolyte metabolism.
Adrenal medulla
- Inner core
- Sympathetic nervous system, Epi,
Norepi

Adrenal Glands
• Adrenal glands
• Adrenal medulla
• Adrenal cortex
• Produces glucocorticoids (cortisol)
• Promote sodium retention, K excretion
• Adrenal hyposecretion (Addison’s disease)
• Levels controlled by negative feedback
• Mineralocorticoids (aldosterone)
• Secretes aldosterone
• Promotes sodium and water retention
• Controlled by RAAS
• CUSHING’S SYNDROME
 Generalized muscle
weakness and wasting
 Moon face, buffalo hump
 Truncal obesity, thin
extremities, supraclavicular
fat pads, weight gain
 Hirsutism (masculine
characteristics in female)
 Hyperglycemia,
hypernatremia
 Hypokalemia, hypocalcemia
 Hypertension
 Fragile skin that easily
bruises
 Reddish purple striae on abdomen and upper thighs

Adrenal Glands (cont’d)

• Glucocorticoids
• Prednisone (Deltasone)
• Action
• Suppresses inflammation, immunosuppression
• Use
• Decrease inflammation
• Interactions
• Increased effect with barbiturates, phenytoin, rifampin,
ephedrine, theophylline
• Decreased effects of aspirin, anticonvulsants, INH, antidiabetics

Adrenal Glands (cont’d)

• Glucocorticoids
• Prednisone (Deltasone)
• Side effects/adverse reactions
• Increased appetite, sweating, headache, flushing
• Mood changes, depression, psychosis
• Tachycardia, hypertension
• Hyperglycemia, abnormal fat deposits, muscle wasting, edema
• Glaucoma, peptic ulcers

Practice Question #1
1. A client has adrenocortical insufficiency and was
2. taking hydrocortisone (Solu-Cortef) 240 mg every 12
3. hours IV. Before discharge the drug was switched to
4. prednisone (Deltasone). Which is appropriate
5. teaching for discharging a client with oral cortisone?
6. Stop the drug when feeling better.
7. Prednisone is always given by injection.
8. The dose needs to be tapered off over 5 to 10 days.
9. Weight loss and hypoglycemia are common.

Practice Question #1 (cont’d)

Answer: C. Rationale: Glucocorticoids must be tapered off gradually to avoid
adrenal crisis. Never stop the drug abruptly. Prednisone is an oral preparation.
Weight gain and hyperglycemia are side effects of cortisone.
• Individual Studies: (To be included in the Prelim-Exam: Oral
Revalida)
Make a Drug study on the following:
Hypothalamic Hormones Agonist
 goserelin
 histrelin
 leuprolide
 nafarelin
 tesamorelin
Antagonist
 degarelix
 ganirelix

Drugs affecting anterior pituitary hormones

Growth Hormones Agonist

- Somatropin
- Somatropin rDNA origin

Growth Hormones Agonist

- bromocriptine mesylate
- lanreotide
- octreotide acetate
- pegvisomant
• Drugs affecting other pituitary hormones:
• Chorionic gonadotropin

Posterior Pituitary Hormones

- conivaptan
- desmopressin
- tolvaptan

Adrenocortical Agents
Glucocorticoids
- Beclomethasone
- Bethamethasone
- Budesonide
- Cortisone
- Dexamethasone
- Flunisolide
- Hydrocotisone
- Methylprednisolone
- Prednisolone
- Prednisone
- Triamcinolone

Mineralocorticoids
- cortisone
- fludrocortisone
- hydrocortisone

Thyroid and Parathyroid

Thyroid Agents/Hormone
- levothyroxine
- iothyronine
- iotrix
- thyroid dessicated

Antithyroid agents
- methimazole
- PTU, propylthiouracil

Iodine solutions
- Sodium iodide
- Strong iodine solution
- Potassium iodide

Parathyroid agents
- calcitriol
- parathyroid hormone
- teriparatide