ENDOCRINE SYSTEM

ENDOCRINE GLANDS
- Ductless glands

➢ HYPOTHALAMUS
- Lower central part of the brain
- Regulation of satiety (hunger and thirst mechanism) and temperature
- Links to the endocrine system through the pituitary gland

Hormones released by the hypothalamus:

1. Growth hormone releasing hormone
2. Thyrotropin releasing hormone
3. Prolactin releasing hormone
4. Corticotropin releasing hormone
5. Gonadotropin releasing hormone

➢ PITUITARY GLAND (hypophysis)

LOBES:
Anterior lobe (adenohypophysis) Posterior lobe Intermediate lobe (pars
Hormones: (neurohypophysis) intermedia)
a. Growth hormone (somatotropin) Hormones: Hormone:
b. Thyroid stimulating hormone a. Antidiuretic hormone Melanocyte stimulating hormone
(TSH) (ADH) / vasopressin - Stimulates production of
c. Luteinizing hormone - For water reabsorption of melanin (for skin and eye
- Works in ovaries to produce the kidneys color)
estrogen b. Oxytocin
- Works in testes to produce - Responsible for milk
testosterone through Leydig’s ejection and uterine
cells contraction

d. Follicle stimulating hormone

- Works in ovaries to produce
estrogen
- Works in testes through Sertoli
cells for the maturation of sperm
(spermatogenesis)

e. Prolactin
- Responsible for milk production

➢ PINEAL GLAND
- Receives information from the eyes

Hormone:
Melatonin
- Regulates sleep cycle & mood

Day = ↓ melatonin Night = ↑ melatonin

➢ THYROID GLAND
- Located in front of trachea

Hormones:
1. T3 (triiodothyronine) controls the body’s
2. T4 (thyroxine) metabolism
 3. Calcitonin
- Decreases CALCIUM levels in the blood
- Increases absorption of calcium in the bones

➢ PARATHYROID GLAND
- Has two pairs (each pair embedded in each side of thyroid)

Hormone:
Parathyroid hormone
- Increases CALCIUM levels in the bone
- Decreases calcium levels in the blood
- Regulates CALCIUM and PHOSPHATE balance

➢ THYMUS GLAND
- Located above the heart

Hormones:
1. Thymosin fuels the production of
2. Thymopoietin T-lymphocytes

➢ PANCREAS
- Lies behind the stomach
- Has endocrine and exocrine function
- Inside the pancreas, there are different cells:

ACINAR CELLS
- Exocrine function
- Produce enzymes
a. Pancreatic amylase – conversion of polysaccharide to sugar
b. Lipase – fats to fatty acids
c. Protease – proteins to amino acids

ALPHA CELLS OF ISLETS OF LANGERHANS BETA CELLS OF ISLETS OF LANGERHANS DELTA CELLS OF ISLETS OF LANGERHANS
Glucagon Insulin Somatostatin
– increases blood sugar levels – decreases blood sugar levels – maintains constant level of
blood sugar

➢ ADRENAL GLANDS
- There are two adrenal glands, each one located above each kidney

I. ADRENAL CORTEX
3 Layers:
1. Zona glomerulosa – secretes MINERALOCORTICOIDS (ALDOSTERONE)
➔ Sodium retention and water reabsorption

2. Zona fasciculata – secretes GLUCOCORTICOIDS (CORTISOL)

➔ Suppresses immune system
= decreases pain (inflammatory
response)
➔ Released due to stress
➔ Increases osteoblastic activity = may lead
to osteoporosis
3. Zona reticularis – secretes ANDROGENS
➔ Men: growth of prostate gland
➔ Women: increases sexual libido
 II. ADRENAL MEDULLA
- Inner section

Hormones: CATECHOLAMINES
1. Adrenaline / Epinephrine fight or flight response
2. Noradrenaline / Norepinephrine Produced in response to stress

➢ GONADS
Ovaries produce ESTROGEN secondary sex characteristics
Testes produce TESTOSTERONE

➢ KIDNEYS
RENIN – water and electrolyte balance
ERYTHROPOIETIN – for RBC production

◼ ENDOCRINE DISORDERS

Causes of endocrine disorders:

1. Genetics
2. Tumors – benign & malignant
3. Increased / decreased endocrine hormones

1. GIGANTISM
- Abnormally elevated growth hormone
- Overproduction of growth hormone BEFORE epiphyseal closure during CHILDHOOD
- Affects LONG BONES !!
CAUSES:
- Tumor in the pituitary gland

SIGNS AND SYMPTOMS:

- Height increases 7-8 ft

2. ACROMEGALY
- Elevated growth hormone during ADULTHOOD
- Overproduction of growth hormone AFTER epiphyseal closure
- Affects SHORT BONES !!

SIGNS AND SYMPTOMS:

- Bulging fontanel - Large tongue
- Bulbous nose - Headache
- Huge jaw (macrognathia) - Impaired vision
- Thick lips - Decreased libido

NORMAL GROWTH HORMONE LEVELS

Men < 5 ng / mL
Women < 10 ng / mL
Children 0 – 20 ng / mL

DIAGNOSIS:
a. Careful assessment of physical appearance
b. Insulin-like growth factor 1 (IGFR 1) = hormone produced by the liver
c. Oral Glucose Tolerance Test (OGTT)
 - A day before the test, patient is place NPO
- POSITIVE: Increased GH = increased OGTT

d. MRI scan
- Determines the size and location of the tumor

TREATMENT:
Goal – to reduce GH production and alleviate symptoms associated with increased GH

1. RADIATION THERAPY
- Used in conjunction with medications

2. SUGERY: TRANSSPHENOIDAL HYPOPHYSECTOMY

- Removal of pituitary gland

3. MEDICATIONS
- Bromocriptine
- Cabergoline
- Octreotide
- Lanreotide
- Pegvisomant

NURSING MANAGEMENT:

1. BEFORE surgery, teach deep breathing exercises → for lung expansion

2. Assist patient preoperatively and postoperatively.
3. VS q4 hrs, I & O q shift
4. AFTER surgery, instruct to avoid vigorous coughing, blowing of nose, sneezing
5. Medication administration as ordered.

1. DWARFISM
- Decreased production of growth hormone
- Proportionate or disproportionate body parts
- Short stature ↓ 4 ft

TREATMENT:
Injection of growth hormone
 SUMMARY TABLE

ENDOCRINE GLANDS HORMONES

HYPOTHALAMUS 1. Growth hormone releasing hormone
2. Thyrotropin releasing hormone
3. Prolactin releasing hormone
4. Corticotropin releasing hormone
5. Gonadotropin releasing hormone
PITUITARY GLAND ANTERIOR LOBE (adenohypophysis) POSTERIOR LOBE (neurohypophysis) INTERMEDIATE LOBE (pars intermedia)
(hypophysis) 1. Growth hormone (somatotropin) 1. Antidiuretic hormone (ADH) / 1. Melanocyte stimulating hormone
2. Thyroid stimulating hormone (TSH) vasopressin
3. Luteinizing hormone 2. Oxytocin
4. Follicle stimulating hormone
5. Prolactin
PINEAL GLAND Melatonin
THYROID GLAND 4. T3 (triiodothyronine)
5. T4 (thyroxine)
6. Calcitonin
PARATHYROID GLAND Parathyroid hormone
THYMUS 3. Thymosin
4. Thymopoietin
PANCREAS ACINAR CELLS ALPHA CELLS BETA CELLS DELTA CELLS
1. Pancreatic amylase Glucagon Insulin Somatostatin
2. Lipase
3. Protease
ADRENAL GLANDS ADRENAL CORTEX ADRENAL MEDULLA
1. Zona glomerulosa – MINERALOCORTICOIDS (ALDOSTERONE) 1. Adrenaline / Epinephrine
2. Zona fasciculata – GLUCOCORTICOIDS (CORTISOL) 2. Noradrenaline / Norepinephrine
3. Zona reticularis – ANDROGENS
GONADS Ovaries – ESTROGEN
Testes – TESTOSTERONE
KIDNEYS RENIN
ERYTHROPOIETIN
RENIN ANGIOTENSIN ALDOSTERONE SYSTEM (RAAS)
- Is a hormonal system that controls BLOOD PRESSURE

JUXTAGLOMERULAR CELLS
- Specialized cells in the arteries / walls of nephron
- Produces hormone / enzyme called PRORENIN
Acts when there is a LOW BLOOD PRESSURE
Stimulates production of RENIN

RENIN → stimulates LIVER

produces

ANGIOTENSIN 1

LUNGS
produce
ANGIOTENSIN-CONVERTING ENZYME (ACE) – converts angiotensin 1 to angiotensin 2

ANGIOTENSIN 2

acts on the ADRENAL GLANDS → produces ALDOSTERONE

increases GLOMERULAR FILTRATION RATE
acts on systemic circulation

result → INCREASE BLOOD PRESSURE

ALDOSTERONE
- Causes sodium and water reabsorption
goes into general circulation

POTASSIUM (K)
- reabsorbed in the KIDNEYS
- excreted through urine

SYNERGISTIC EFFECT – increase the action of two drugs

PRIMARY HYPERALDOSTERONISM (Conn’s Syndrome)

- rare, hereditary defect
- INCREASE aldosterone production

Causes:
1. Tumors (adenomas)
➔ Benign tumor (non-cancerous)
➔ Malignant tumor (cancerous)
2. Hyperplasia of pituitary gland

DIAGNOSTIC TESTS
Blood tests for electrolytes 24 hour urine test Magnetic resonance imaging
Sodium = 135 – 145 mEq / L Aldosterone = 3 – 25 mcg / 24 o
(MRI)
Potassium = 3.5 – 5 mEq / L Identify location of tumor
Aldosterone = < 15 ng / dL
 SIGNS AND SYMPTOMS
1. HIGH BLOOD PRESSURE 2. HIGH SODIUM 3. LOW POTASSIUM
- Headache - High blood pressure - Muscle cramps
- Nausea & vomiting - Muscle weakness
- Visual disturbances

TREATMENT:
1. Adrenalectomy
2. Aldosterone antagonist
- Spironolactone
- Eplerenone
- Finerenone
3. Low Na diet

NURSING MANAGEMENT:
1. Monitor VS, I & O, weight pt daily.
2. Maintain pt on low Na diet as ordered.
3. Administer K supplements & K rich foods (banana, pineapple, orange).
4. Provide care for pt undergoing surgery.
5. Provide health teaching & discharge planning:
- Use & side effects of aldosterone antagonist.
- Signs and symptoms of hypo/hyperaldosteronism.
- Need for frequent BP checks.

DIABETES INSIPIDUS
- Hereditary characterized by a deficiency of ADH

TYPES:
1. CENTRAL DI 2. NEPHROGENIC DI 3. DIPSOGENIC DI 4. GESTATIONAL DI
- most common - normal or - Defect in - Placenta
Causes: hereditary, adequate hypothalamus produces
idiopathic, tumors, amount of ADH enzymes that
infection, head injury Causes: hereditary, breakdown ADH
intrinsic kidney disease,
drug (lithium)

SIGNS AND SYMPTOMS:

1. Polyuria – frequent urination
2. Polydipsia – increased thirst
3. Increased urine volume
4. Colorless, pale urine
5. Nocturia – waking up at night to urinate
6. Sleep disturbances d/t nocturia

DIAGNOSTIC TESTS:
1. Water Deprivation Test
- Pt is instructed to abstain water for 8 hours
- Positive result: continues to excrete large amounts of concentrated urine

2. Vasopressin Levels
ADH normal level = 1 – 5 pcg / mL

3. Hypertonic Saline Infusion Test

- Mixture of H2O and salt is given
TREATMENT:
1. Treat underlying cause
2. Hormonal replacement of vasopressin = DESMOPRESSIN
3. Surgery = HYPOPHYSECTOMY
4. Vasopressin releasing drugs = chlorpropamide, carbamazepine, clofibrate
5. Prostaglandin inhibitors = aspirin, indomethacin, ibuprofen
6. Thiazides = DECREASED GLOMERULAR FILTRATION RATE
= have PARADOXICAL EFFECTS (meds give side effects that produce effect that is the exact
opposition of therapeutic effect)

PROLACTINOMA
- Tumor that causes pituitary gland to have INCREASED SECRETION OF PROLACTIN
Normal prolactin level blood test
Men < 20 ng/mL (425 ug/L)
Nonpregnant women < 25 ng/mL (25 ug/L)
Pregnant women 80 – 400 ng/mL (80 – 400 ug/L)

ACE INHIBITORS (Angiotensin ARBS (Angiotensin II Receptor ALDOSTERONE ANTAGONISTS

Converting Enzyme inhibitors) Blockers)
They prevent angiotensin- They block receptors that the They completely inhibit
converting enzyme from hormone angiotensin II acts on, aldosterone at the distal tubules,
converting angiotensin I to which is angiotensin II receptor also promoting sodium excretion
angiotensin II. It decreases type 1. This interferes the action of & potassium retention. This
aldosterone, reducing sodium angiotensin II on vascular smooth results to a decrease in blood
and water retention and blood muscle, decreasing blood pressure.
pressure. pressure.
Benazepril Trandolapril Azilsartan Valsartan Spironolactone
Captopril Ramipril Candesartan Losartan Eplerenone
Enalapril Quinapril Eprosartan Irbesartan Finerenone
Fosinopril Perindopril Olmesartan Telmisartan
Lisinopril Moexipril