ENDOCRINE NOTES

Pituitary Gland (Hypophysis)

 Anterior:
o Growth Hormone – Increase size – Muscle and Bones
o Thyroid Stimulating Hormone
o Prolactin – Production of Milk
o Adrenocorticotropic Hormone
o Luteinizing Hormone
o Follicle Stimulating Hormone
o Melanocytes Stimulating Hormone
 Posterior:
o Oxytocin
o Antidiuretic Hormone/Vasopressin
Thyroid Gland
 APG – TSH – (LH and FSH) – TG – T3 (Triiodothyronine = Metabolism/GIT) and T4 (Thyroxine = Heat
Production/Skin) – SNS
o Iodine – TG – TH
 Decrease Iodine – TG Compensates – Increase Cells – Increase production of TH = Goiter
 Hyperthyroidism
o Cause: Grave’s Disease – Autoimmune (Inflammation – Fat Pads – Behind the Eyes = Exophthalmos) –
Hyperactive TG (+ Goiter) – Increase TH
 Increased TG – Increased T3 – Increased Metabolism = Weight Loss and Increased Appetite –
Increased GIT = Diarrhea
 Increased TG – Increased T4 – Increased Heat = Heat Intolerance – Skin = Diaphoresis
 Increased SNS – Hyperactive – Insomnia, Agitated, Restless, Tremors, Increased VS (HR) –
Thyroid Storm/Crisis (Severe)
 Negative Feedback:
 APG Compensates – TSH Decrease – LH and FSH Decrease = Menstrual Changes
o Management:
 Exophthalmos
 Dry – Eye Drops/Artificial Tears
 Sunlight – Sunglass
 Sleep Disturbance – Tape
 Position – Semi-Fowler’s
 DOC: Steroids and Teprotumumab
 Body Weight and Appetite
 Monitor – Daily Weight
 Calorie – High
 Activity – Bed Rest
 Diarrhea
 Fiber (Low) and Fluids (Increase)
 Heat Intolerance
 Environment – Cool (With AC)
 Hyperactive
 Environment – Non-stimulating
 Sedative – Positive
 Stimulants – Avoid
  Vital Signs (High)
 Monitor Heart Rate
 Thyroid Storm
 Priority – ABC
 DOC: Propylthiouracil – IV
o Medication:
 Anti-TH: Thionamide
 Propylthiouracil
 Methimazole
o GI Irritants – Taken with meals
o WOF: Agranulocytosis – Decreased WBC (Fever and Sore Throat) and Platelet
(Bleeding)
o Surgery:
 Thyroidectomy
 Complications:
 Hypoparathyroidism/Hypocalcemia/Tetany
o WOF: Twitching and Spasm
o DOC: Calcium Gluconate
 Thyroid Storm/Crisis
o WOF: Increase Vital Signs
o Management: Report
 Bleeding
o WOF: Anterior/Posterior of the Neck
o Avoid: Flexion/Hyperextension of the Neck
o Position: Semi-Fowler’s
 Laryngospasm
o WOF: Airway Obstruction
o Item: Tracheostomy Set
 Laryngeal Nerve Damage
o WOF: Dysphonia (Severe Hoarseness)
o Avoid: Talking Too Much
o Management: Assess the voice every hour
 Hypothyroidism
o Cause: Hashimoto’s – Autoimmune – Hypoactive TG – Decrease TH
 Decreased TG – Decreased T3 – Decreased Metabolism = Weight Gain and Anorexia – Decreased
GIT = Constipation
 Decreased TG – Decreased T4 – Decreased Heat = Cold Intolerance – Skin = Dry and Hair Loss
 Decreased SNS – Hypoactive – Slow Speech, Movement, and Thought Process, Decreased VS
(HR) – Myxedema Coma (Severe) = (Puffy Face)
o Management:
 Increased Body Weight and Anorexia
 Monitor: Daily Weight
 Calorie – Low
 Activity – Exercise
 Constipation
 Fiber and Fluids – High
 Cold Intolerance
 Environment – Warm
  Hypoactive
 Monitor – LOC
 Sedative – Avoid
 Decreased VS – Monitor
 Myxedema Coma
 Priority – ABC
 DOC: Levothyroxine – IV
o Medication
 Levothyroxine
 Lifetime
 Taken on empty stomach to increase absorption.
 Taken in the morning.
 WOF: Under medication – Hypothyroidism
o Over medication/Side Effect/Adverse Effect – Hyperthyroidism
Parathyroid Gland
 PTH – Blood – Increase Calcium
o Bones – Decrease Calcium
 Calcitonin – Decrease Blood
o Thyroid – Increase Bone
Calcium – Phosphorus (Inverse: Increase Calcium = Decrease Phosphorus)
o Muscle Activity (Inverse – Increase Calcium=Hypoactive/Decrease Calcium = Hyperactive)
o Heart – Abnormal Calcium = Arrythmia or Dysrhythmia
 BP (Direct – Increase Calcium = High BP/Decrease Calcium = Decrease BP)
o Kidneys – Attracts Water (Osmotic Diuresis) – Increase Calcium = Supersaturated (Solid/Stone)
 Hyperparathyroidism
o Cause: Tumor (Lung/Pancreas) – Ectopic Production of PTH – Blood = Increase Calcium – Bone =
Decrease Calcium
 Hypercalcemia – Hypophosphatemia
 Hypoactive Muscle – GIT – Constipation
 Weak Bones – Bone Disorder – Bone and Joint Pain
 Pathologic Fracture
 Heart – Arrhythmia – Increased BP
 Kidney – Polyuria – Fluid Volume Deficit
 Renal Calculi
o Management:
 Treatment – Removal of Tumor
 High Calcium:
 Diet – Low Calcium
 DOC: Calcitonin
 Decreased Phosphate:
 Diet – Increased Protein
 DOC – IV Phosphorus
 Constipation
 Fiber and Fluids – Increase
 Weak Bones
 Avoid – Injury/Fracture
 Activity – Moderate Exercise
 DOC: Alendronate (Fosamax)
  Heart – Arrythmia – High BP
 Monitor Vital Sign – HR and BP
 Kidneys – Polyuria – FVD – Renal Calculi
 Fluid Intake – Increase
 Hypoparathyroidism
o Cause: Thyroidectomy – Accidental Removal of PTG – Decreased PTH – Blood = Decreased Calcium –
Bone = Increased Calcium
 Hypocalcemia – Hyperphosphatemia
 Hyperactive Muscle – Twitching and Spasm
o Tetany
o Trousseau’s – Carpopedal Spasm (Arm)
o Chvostek’s – Facial Twitching (Cheeks)
o Spasm – Laryngospasm and Bronchospasm
o Seizure
 Heart – Arrhythmia – Low BP
o Management:
 Low Calcium
 Diet – Increase Calcium and Vitamin D
 DOC: Calcium Gluconate
 High Phosphate
 Diet – Low Protein
 DOC: Aluminum Hydroxide
 Laryngospasm
 Item – Tracheostomy Set
 Bronchospasm
 DOC: Bronchodilator
 Seizure – Precaution
 Heart – Arrhythmia – Decrease BP
 Monitor Vital Sign – HR and BP
Adrenal Glands
 Parts:
o Medulla – Catecholamines
 Epinephrine
 Norepinephrine
o Cortex – Steroid Hormones
 Controlled by APG – Adrenocorticotropic Hormone (Adrenal Cortex – GMA or SSS)
together with Melanocyte Stimulating Hormone (Skin – Melanin)
 Glucocorticoids “Sugar” – Cortisol – SSS PC
 Natural Release – Morning
 Sugar – Increases
 Stress – Increase Cortisol – Resistance to Stress
 Suppress – Immunity (Anti-inflammatory)
 Proteins – Breakdown
 Calcium – Decrease
 Mineralocorticoids “Salt” – Aldosterone – SOREPOEX
 Sodium and Water – Retention/Reabsorption
 Potassium – Excretion/Removal
 Androgen “Sex”
 Cushing’s Syndrome
o Cause: Adrenal Adenoma and Steroid Therapy – Increase GMA
 Increased Glucocorticoids
 Natural Release – Morning
 Sugar – Hyperglycemia – Increase Insulin – Increase Adipocytes (Central) – “Full Moon
Face, Buffalo Hump, Central/Truncal Obesity”
 Suppress – Decrease Immunity – Increase Infection
 Proteins – Increase Break Down – Skin and Extremities (Thin – Easy Bruising and Striae)
 Calcium – Hypocalcemia
o Weak Bones
 Increased Mineralocorticoids – Increase Aldosterone
 Sodium and Water – Increase retention – Hyponatremia and Fluid Volume Excess
 Potassium – Increase Excretion – Hypokalemia
 Increased Androgen – Female – Virilization – Hirsutism and Menstrual Changes
o Management:
 High Cortisol
 Avoid – Stress
 High Glucose
 Monitor – Blood Glucose
 Decreased Immunity
 Avoid – Crowded and Patient Visit
 Protein – Breakdown
 Diet – High Protein
 Decrease Calcium
 Diet – Increase Calcium and Vitamin D
 Na and H2O – Increased
 Diet – Decrease Na
 Fluid Intake – Restrict
 Low Potassium
 Diet – Increase Potassium
 High Androgen – Disturbed Body Image
 Master Therapeutic Communication
 Surgery – Adrenalectomy
 WOF: Addison’s
o Medication: “Mood Disturbance” – Ate Charo – “MMK’
 Mitotane
 Metyrapone
 Ketoconazole
 These Decreases Production of Steroids
 Addison’s Disease
o Cause: Adrenalectomy – Autoimmune – Decreased GMA
 Controlled by APG – Increased Adrenocorticotropic Hormone (Adrenal Cortex –
Decreased GMA or SSS) together with Increased Melanocyte Stimulating Hormone (Skin
– Increased Melanin = Hyperpigmentation “Bronze Skin”)
 Decreased Glucocorticoids “Sugar” – Decreased Cortisol – SSS PC
 Sugar – Hyperglycemia
 Stress – Decreased Resistance to Stress
 Calcium – Hypercalcemia
  Decreased Mineralocorticoids “Salt” – Aldosterone – SOREPOEX
 Sodium and Water – Decreased Retention – Hyponatremia and Fluid Volume Deficit
 Potassium – Decreased Excretion – Hyperkalemia
 Decreased Androgen “Sex” – Female – Hair Loss and Menstrual Changes
o Management:
 Decreased Cortisol – Decreased Resistance to Stress
 Avoid – Stress
 Low Glucose
 Monitor Blood Glucose
 High Calcium
 Diet – Low Calcium
 Low Sodium and Water – “Salt Cravings”
 Diet – Increased Sodium
 Fluid Intake – High
 High Potassium
 Diet – Decrease Calcium
 Low Androgen – Disturbed Body Image
 Therapeutic Comm.
 Severe Form – Addisonian Crisis
 WOF:
o Increase Aldosterone – Low Sodium “Shock” High Potassium
o Pain – Severe (Head to Toe)
 DOC: Hydrocortisone – IV
o Medication:
 Corticosteroids “Sone”
 Lifetime
 Taken in the Morning with Meals
 DO NOT STOP ABRUPTLY – Addisonian Crisis
 Other Consideration – Refer to Management to Cushing’s
 WOF: Cushing’s
ADH/Vasopressin
 Decrease Fluids – Posterior Pituitary Gland – ADH – Kidneys – Fluid Retention – Decreased Urine Output
o Increase Water = Decrease Sodium/Decrease Water = Sodium Increase
o Urine Output and Urine Specific Gravity – Inversely Proportional
 Decreased UO = Increased USG/Increased UO = Decreased USG
 USG and Urine Concentration – Directly Proportional
 Increased USG = Concentrated = Dark
 Decreased USG = Diluted = Clear
 USG: 1.010 – 1.030 Normal Value
o SIADH
 Cause: Tumor (Lung Cancer)
 ADH: High – Increased Fluid Retention
 Fluid Status: Fluid Volume Excess “Water Intoxication”
 Serum Sodium: Dilutional Hyponatremia – Cerebral Edema
 Urine Output: Oliguria
 Urine Specific Gravity: High
 Concentration of Urine: High – Concentrated – Dark
 Vital Sign: Hyper-Tachy-Tachy
  Management:
 Demeclocycline – ADH Antagonist
 Diuretics
o Loop Diuretics – Do Not Give if Sodium is < 125mEq/L
 Fluid Intake: Restrict – 800 – 1000ml/day
 Monitor:
o Daily Weight (1kg – 1L)
o I and O or Urine Output
o Electrolyte (Na)
 Complication:
o Cerebral Edema – LOC, ICP, Seizure
o Diabetes Insipidus
 Cause: Head Injury or Surgery
 ADH: Low – Decreased Fluid Retention
 Fluid Status: Fluid Volume Deficit “Polydipsia
 Serum Sodium: Increased Sodium – Cerebral Shrinkage
 Urine Output: Polyuria
 Urine Specific Gravity: Low
 Concentration of Urine: Low – Diluted – Clear
 Vital Sign: Hypo-Tachy-Tachy
 Management:
 ADH/Vasopressin (Desmopressin)
o Route: Oral, Intranasal, SC, IV
o Action: Decreases urine output
o WOF: “Water Intoxication” Retention
o Patient should decrease fluid intake.
 Fluid Intake: Replacement
 Monitor:
o Daily Weight
o I and O or Urine Output
o Electrolyte
 Complication:
o Cerebral Shrinkage – LOC and Seizure
 Diabetes Mellitus 1
o Early Onset/Juvenile
o Thin
o Autoimmune – Destruction – Pancreas
o Decreased Insulin/Insulin (No Metabolism of Carbohydrates)
o Diabetic Ketoacidosis
 Sugar Level: 250mg/dl
o Management:
 Diet – 50% - 60% - Carbohydrates (Complex Carbs) – High Fiber
 30% - 40% - Fats
 10% - 20% - Protein = 50% Sugar
 Insulin: DOC
 Exercise – Moderate 3 – 5 times/week
 Avoid Stress – Increase Cortisol – Increase Sugar
 Action – Increases usage of glucose.
 WOF: Hypoglycemia
  When: In the morning/same time of the day/after meal (Complex Carbs)
 > 250mg/dl or Ketonuria – Avoid Exercise
 Diabetes Mellitus 2
o Late Onset/Adult
o Obese
o Metabolic Syndrome/Syndrome X
 Hypertension, Hyperglycemia, Increased LDL, Increased Triglyceride
o Insulin Resistance/Low Insulin
o Hyperosmolar, Hyperglycemic, Non-Ketotic Syndrome (HHNS)
 600mg/dl
o Management:
 Diet – 50% - 60% - Carbohydrates (Complex Carbs) – High Fiber
 30% - 40% - Fats
 10% - 20% - Protein = 50% Sugar
 Insulin: Last Resort
 Exercise – Moderate 3 – 5 times/week
 Avoid Stress – Increase Cortisol – Increase Sugar
 Action – Increases usage of glucose.
 WOF: Hypoglycemia
 Oral Hypoglycemic Agents: Drug of Choice
 Never given to DM1 and Pregnant
 Biguanides – Metformin
o Blocks production of glucose by the liver.
o Withheld prior to use of contrast dye – Could cause Renal Failure and Lactic
Acidosis
 Pathophysiology:
o DM1 and DKA:
 Increase Glucose – Insulin – To Let Glucose Enter the Cells – Starvation – Polyphagia –
Breakdown Protein = Thin – Breakdown Fats – Increase Ketone (Lungs – Fruity Odor Breath,
Kidneys – Ketonuria, Brain – Decreased LOC) = DKA (Metabolic Acidosis) – Decrease PH and
Sodium Bicarbonate = Expels Carbon Dioxide – Hyperventilation “Deep and Labored”
(Kussmaul’s Respiration)
 Serum Osmolarity: High or Normal
 High Viscosity – Poor Circulation – Chronic Complication
 Hyperglycemia – Kidneys (SGLT-2 Reabsorption of Glucose: 200mg/dl) if it exceeds = glycosuria –
attracts water (osmotic diuresis) – Fluid Volume Deficit – Polydipsia
o DM2 and HHNS:
 Increase Glucose – Insulin – Cells – Starvation – Polyphagia – No Breakdown/Ketosis
 Serum Osmolarity: High or Normal
 High Viscosity – Poor Circulation – Chronic Complication
 Hyperglycemia – Kidneys (SGLT-2 Reabsorption of Glucose: 200mg/dl) if it exceeds = glycosuria –
attracts water (osmotic diuresis) – Fluid Volume Deficit (Could die from Dehydration) –
Polydipsia
o DKA and HHNS:
 Stress (Infection, Surgery, Trauma) – Increase Cortisol – Increase Sugar
 Management:
 IV – NSS – To Improve Ciruclation
 IV – Regular (Short) Insulin
 WOF: 250mg/dl – Add Dextrose
  WOF: Cerebral Edema
 Important Electrolyte: Potassium
o Hypoglycemia: < 70mg/dl
 Similar – Hunger
 Early – SNS “Diaphoresis”
 Tremors
 Nervousness
 Increased HR and Palpitation
 Late – Neurogenic – Light Headedness
 Weakness
 Decreased LOC
 Management:
 Conscious – 15/15 3x Rule
o 15g of Simple Carbohydrates (Sweet)
o Recheck After 15 Minutes
 Unconscious/4th Checking – 1g 5050D
o 1mg Glucagon
o 50ml 50% Dextrose
 Both Parenteral