ALTERATION IN HORMONAL ACTH


REGULATION ADRENAL GLAND
→ hormones are specific

HORMONAL REGULATION
Hypothalamus CORTEX MEDULLA
 1. Cortisol 1. Epinephrine
Pituitary Gland 2. Aldosterone 2. Norepinephrine
 3. Androgen
Hormone 4. Estrogen

Target Cell/ Organ  Cortisol → anti-inflammatory effect
 → Cushing’s syndrome
Effect
 Aldosterone → regulates sodium secretion
→ Needed for water retention
 Androgen → development of secondary male characteristics
→ responsible for  libido
 Estrogen → insignificant effect
 Epinephrine  sympathetic reaction
 Norepinephrine prolongs / mimic

Sympathetic Parasympathetic
 V/S  V/S
 GIT activities  GIT activities
EMERGENCY Rest & repair
Ejaculation Erection
GH
MSH
Summary of DISTURBANCES
Prolactin Oxytocin
FSH
Anterior Pituitary Gland
LH
TSH A P ADH
1. GH pedia → gigantism
ACTH 7 2
adult → acromegaly
 dwarfism (less than 4 feet)
a) Froliche → above N I.Q
breast, promote longitudinal bone
Growth Hormone → b) Simmond Syndrome → below N I.Q.
muscles, liver growth
Melanocyte 2. MSH  darkening
→ skin skin pigmentation
Stimulating Hormone  albinism
mammary 3. FSH/LH  menstrual
Prolactin → promotes milk production
gland  disturbances
FSH ovary maturity of ovary and
→ 4. TSH  Grave’s Disease
LH testis testes
 hyperthyroidism (cretinism / myxedema)
Thyroid Stimulating T3 & T4 needed to  BMR
→ thyroid gland 5. ACTH  Cushing’s
Hormone Calcitonin
 Addison’s
stimulates the adrenal
Adrenocorticotrophic 6. Prolactin  lactation
→ adrenal gland gland to produce its own
Hormone  decrease milk production
hormone
mammary
promotes milk ejaculation
Oxytocin → gland and Posterior Pituitary Gland
contraction of uterus
uterus
prevents formation of 1. ADH  SIADH
Antidiuretic Hormone → kidneys  diabetes insipidus
large volume of urine Adrenal Gland → seen on top of the
kidneys
Estrogen Progesterone 2. Oxytocin  ruptured uterus
1. inhibits FSH release 1. inhibits LH release  muscle atony
2. causse proliferation of 2. increases vascularity in
endometrial lining the uterus
3.  cervical mucous 3. maintains the course of FSH & LH → (FE/LP) felp [FSHestroLHprogestro]
production (+ spinnbarkeit) pregnancy 1. Menstrual Phase (EP)
4. causes water retention 1. Proliferative Phase / Estrogenic Phase / Follicular Phase /
5. elevation of BMT Post-menstrual phase (EP)
Other Endocrine Glands: 2. Secretory Phase / Progesterone Phase / Luteal Phase / Pre-
menstrual Phase
1. Pineal Gland → melatonin (responsible for RAS)
2. Thymus Gland → thymosin (T-cell differentiation)
All surgery of Head → elevated head 30-40 degrees
3. Pancreas → Endocrine → Islet of Langerhands
▪ Inorder to prevent venous pooling
* Alpha – glucagon -  bld sugar
* Beta – insulin -  bld sugar
▪ Bleeding
4. Kidneys → Erythropoietin → stimulate bone marrow
▪  ICF
5. Parathyroid → Parathormone →  Ca level in the blood
6. Placenta → functions beginning 2nd trimester (4th month)
* Estrogen
* Progesterone
* HCG (maintain the activity of corpus luteum)
Transphenoidal Hypophysectomy Drug Therapy:
* Maintain head elevated Antacids

* Maintain nasal packing Glucocorticoids ( Hydrocortisone) → drug of choice

Mineralococorticoids ( Fludrocortisone)
→ exerts direct pressure of surgical
site to prevent bleeding Nursing Management:
* Do not brush teeth 1. Be prepared to administer I.V. hydrocortisone and saline solution
* Provide oral care → just use padded promptly if patient is in adrenal crisis.
tongue depressor 2. Administer IV fluids to maintain hydration and prevent
* Do not gargle addisonian crisis.
* Do not blow-off nose 3. Do not allow the patient to sit or stand quickly to avoid orthostatic
hypotension.
4. Monitor for signs and symptoms of addisonian crisis (profound
weakness, fatigue, nausea and vomiting, hypotension,
Adrenocorticitropic Hormone (ACTH) dehydration and , occasionally, high fever followed by
hypothermia)
Hyposecretion:
Addison’s Disease
- also called Adrenal Hypofunction Hypersecretion:
- occurs when the adrenal gland fails to secrete sufficient
mineralocorticoids, glucocorticoids, and androgens. Cushing’s Syndrome
- Addisonian Crisis (Adrenal Crisis) is a critical deficiency - also called Hypercorticolism
of adrenal hormones. - is the hyperactivity of the adrenal cortex. It results in
excessive secretion of glucocorticoid, particularly
Causes: CORTISOL.
▪ Autoimmune disease
▪ Histoplasmosis Causes:
▪ Idiopathic atrophy of adrenal glands ▪ Carcinoma of the adrenal cortex
▪ Metastatic lesions from lung cancer ▪ Carcinoma of the pituitary gland
▪ Pituitary Hypofunction ▪ Excessive or prolonged administration of glucocorticoids
▪ Surgical removal of adrenal gland ▪ Exogenous secretion of corticotropin by malignant
▪ Trauma neoplasms in the lungs or gallbladder
▪ Tuberculosis ▪ Hyperplasia of the adrenal glands
Assessment Findings: ▪ Hypothalamic stimulation of the pituitary gland
* Anorexia
* Decreased pubic hair and axillary hair Assessment Findings:
* Dehydration and thirst (most common precipitating factor) ▪ Acne
* Depression and personality changes ▪ AMENORRHEA
* HYPOGLYCEMIA (coz adrenals are crucial during stress) ▪ Decreased libido
* WEIGHT LOSS ▪ Ecchymosis
▪ Edema
PATHOGNOMONIC SIGN: Bronze Pigmentation / Tanning of the skin ▪ Enlarged clitoris
(common in whites / fair complexion) ▪ Fragile skin → easily bruised
MOST COMMON CAUSE OF DEATH: Vascular collapse (shock) ▪ Gynecomastia
▪ Hirsutism → due to  androgen
▪ HYPERTENSION
▪ MOOD SWINGS
▪ MUSCLE WASTING
▪ Pain in joints
▪ Poor wound healing
▪ Recurrent infection
▪ Weakness and Fatigue
▪ WEIGHT GAIN, TRUNCAL OBESITY, BUFFALO HUMP,
MOONFACE (cardinal signs)

Management:
• High-Carbohydrate, high-protein, high-sodium, low-
potassium diet in small frequent feedings before steroid
therapy; High-potassium and low-sodium diet while on steroid
therapy
• In adrenal crisis, I.V. Hydrocortisone administered promptly
along with 3 to 5 liters of normal saline solution.
Management:
▪ Hypophysectomy or Adrenalectomy
▪ Low-sodium, low-carbohydrate, low-calorie, high-potassium
and high-protein diet
▪ Radiation Therapy
▪ Potassium supplements
▪ Drug Therapy
*Adrenal Suppressants: METYRAPONE
*Antidiabetic agents
*Diuretics
Nursing Interventions:
1. Perform postoperative care to patient.
2. Assess edema to detect signs of fluid volume excess
3. Limit water intake to prevent fluid volume excess.
4. Weigh the patient daily to detect fluid retention.
5. Administer medications as prescribed.
6. Provide rest periods to prevent fatigue.
7. Maintain standard precaution to prevent infection.
Nursing Diagnoses
1. Body Image Disturbance
2. Fluid Volume Deficit
3. Impaired Skin Integrity

Thyroid Stimulating Hormone (TSH)

Hyperthyroidism
- is the increase synthesis of thyroid hormone. It can result
from overactivity or a change in the thyroid gland.
(Grave’s disease, Thyrotoxicosis)
- also  iodine intake Treatment:
 ❖ High-protein, High-carbohydrate, high-calorie diet;
PATHOPHYSIOLOGY: restricting STIMULANTS
 stimulation of thyroid gland by pituitary ❖ Radiation Therapy (to  activity of thyroid gland)
 ❖ Thyroidectomy
due to  iodine intake
 Drug Therapy
causing hypertrophy of thyroid gland (Goiter) ❖ Adgrenergic Blocking Agents
❖ Antithyroid Agents
Causes:  Propylthiuracil (PTU) [inhibits thyroid hormone synthesis]
▪ Autoimmune disease THYROID STORM
❖ Digitalis (to increase cardiac output) [due to  blood volume]
▪ Genetic → criticial
❖ Glucocorticoids
▪ Infection → death due to heart failure
due to  BMR ❖ Iodine Preparation
▪ Pituitary tumors
▪ Thyroid Adenomas Enlargement: seen in both Nursing Interventions:
hypo & hyper 1. Assess cardiovascular status to detect signs of hyperthyroidism,
Assessment Findings: such as tachycardia, increased BP, palpitations, atrial
▪ Anxiety and mood swings arrhythmias.
▪ ATRIAL FIBRILLATION 2. Avoid stimulants such as drugs and foods that contain caffeine.
▪ BRUIT or THRILL over thyroid (because of over activity) 3. Administer IV fluids to promote hydration.
4. Weigh the patient daily to provide consistent readings.
▪ DIAPHORESIS (due to BMR)
▪ Diarrhea 5. Provide postoperative nursing care to promote healing and
▪ Dyspnea prevent complications.
▪ Exopthalmos (PATHOGNOMONIC SIGN) Caring for the Thyroidectomy Patient:
▪ Fine Hand tremors 1. Keep the patient in Fowler’s position to promote venous
▪ Flushed, smooth skin return from the head and neck and to decrease oozing into the
▪ Fine and silky hair incision.
▪ Heat intolerance (due to BMR) 2. Watch for signs of respiratory distress (tracheal collapse,
▪ Hyperhidrosis Tracheal mucus accumulation, Laryngeal edema)
▪ Increased hunger (due to BMR) 3. Note that vocal cord paralysis can cause respiratory
▪ Increased systolic pressure (only: not HPN but HPN) obstruction, with sudden stidor and restlessness.
▪ PALPITATIONS 4. Keep tracheostomy tray at the patient’s bedside for 24 hours
▪ TACHYCARDIA after surgery and be prepared to assist with emergency
▪ WEIGHT LOSS tracheostomy if necessary.
▪ Weakness (in the end) 5. Assess for signs of hemorrhage. (slip hand under neck)
6. Assess for hypocalcemia
PATHOPHYSIOLOGY OF HYPOTENSION in HYPERTHYRODISM: * Chvostek Sign drug of choice
HYPERTHYRODISM * Trousseau’s Sign
 6. Keep Calcium Gluconate available for emergency IV
 BMR administration.
 7. Be alert for signs of thyroid storm (tachycardia, hyperkinesis,
 fluid loss fever, vomiting and hypertension)
(hyperhydrosis / diaphoresis) Nursing Diagnoses:
 1. Decrease Cardiac Output (because tachtcardia)
 blood volume 2. Risk for Altered Body Temperature (because of BMR)
 3. Risk for Injury (because of tremors)
HYPOTENSION

Diagnostic Test Results:

• Blood chemistry shows increased T3, T4 and free thyroxine  T3
levels
• Radioactive Iodine Uptake(RAIU) increased BMR
• Thyroid Scan shows nodules T4
Hypothyroidism Antidiuretic Hormone (ADH) or Vasopressin
- a disorder that affects women more than men, occurs when
the thyroid gland fails to produce sufficient thyroid hormone. Diabetes Insipidus
- stems from deficiency of ADH resulting in excessive
Causes:
urination, excessive thirst, and excessive fluid intake.
▪ Hashimoto’s Disease
▪ Malfunction of the Pituitary Gland Causes:
▪ Overuse of Antithyroid drug • Brain Surgery
▪ Thyroidectomy • Head Injury “We call it Diabetes because
▪ Use of Radioactive Iodine • Idiopathy there is Polyuria & Polydipsia”
Assessment Findings: • Meningitis
▪ Coarse hair and alopecia • Trauma to Neurohypophysis
▪ Cold intolerance • Tumor to Neurohypophysis
▪ Constipation Assessment Findings:
▪ Decreased diaphoresis • Dehydration → main problem
▪ Dry, flaky skin and thinning nails
• Fatigue
▪ Edema because of fluid & electrolyte imbalance
▪ Hypothermia • Headache
▪ Menstrual Disorders • Muscle weakness and pain
▪ Mental Sluggishness • POLYDIPSIA ( 4 – 40 Liters/day)
▪ Weight gain and anorexia • POLYURIA ( greater than 5L/day)
• Tachycardia
• Weight loss
Diagnostic Test Results
• Blood chemistry shows decreased ADH by immunoassay
• Urine Chemistry shows Urine Specific Gravity less than 1.004,
decreased pH
Treatment
• IV Therapy: Hydration
• Regular Diet with restriction of foods that exert a diuretic
effect. (Ex. Ice Tea, Alcohol, Coffee)
Drug Therapy
• ADH Replacement: Desmoressin → nasal spray
Pitressin parenteral
Lypressin
Nursing Interventions
1. Assess fluid balance to avoid dehydration
2. Monitor and record vital signs, intake and output, and
laboratory studies.
3. Maintain patient’s diet to provide nutritional balance.
4. Force fluid to keep intake and output equal.
5. Administer IV fluids
6. Maintain patency of indwelling catheter
7. Administer medication as ordered.
8. Weigh the patient daily
Nursing Diagnoses:
1. Fluid Volume Deficit
2. Risk for Altered Body Temperature
Diagnostic Test Results
• Blood chemistry shows decreased in T3, T4 and free
thyroxine hormones.
• RAIU is decreased Diabetes Mellitus
Treatment: - is a group of metabolic disease characterized by elevated
• High-fiber, High-protein (to T3T4) and Low-calorie diet levels of glucose in the blood resulting from defects in insulin
(because of BMR) secretion, insulin action, or both.
Drug Therapy Classification of Diabetes:
• Stool softener: Docusate Sodium (for constipation) 1. Type 1 (IDDM) → DKA
• Thyroid Hormone Replacement (‘til euthyroid state) 2. Type 2 (NIDDM) → HHNK
T3 – Liothyronine (Cytomel)
T4 – Levothyroxine (Synthroid) Type 1 (there is little or no insulin) (patient needs insulin)
- also called Juvenile Diabetes, Juvenile-onset Diabetes, Ketosis-
Nursing Interventions: prone Diabetes, Brittle Diabetes, IDDM
1. Avoid sedation (BMR leads to more depression) - approximately 5%-10% of people with diabetes
2. Assess fluid volume balance - acute onset, usually before age 30
3. Check for constipation and edema to detect early changes. - requires injection of insulin to control their blood glucose level
4. Monitor and record vital signs, intake and output, and laboratory studies to
determine fluid status.
6. Administer medication as prescribed. Type 2 (ketosis-resistant)
7. Encourage the patient to express feelings of depression to - also called Adult-onset Diabetes, Maturity-onset Diabetes,
promote coping mechanism. Ketosis-resistant Diabetes, Stable Diabetes, NIDDM
8. Encourage physical activity and mental stimulation to enhance - approximately 90%95% of people with diabetes
self-esteem. - onset is common to people older than 30 years and obese
9. Provide a warm environment to promote comfort because
Clinical Manifestation
the patient maybe sensitive to cold.
Polydipsia 4TH P
10. Turn the patient every 2 hours and provide skin care to
Polyuria PATHOGNOMONIC SIGN Poor wound healing
prevent skin breakdown.
Polyphagia
11. Provide frequent rest periods because patients are often
Weight loss
fatigued.
Diagnostic Findings:
Nursing Diagnosis:
* Fasting Plasma Glucose (to check the minimum level of sugar)
1. Activity Intolerance
levels of 126mg/dl (7.0mmol/L) or more
2. Body Image Disturbance
12 hours NPO
3. Decreased Cardiac Output
 Peak Continous
Duration 24 hours
Things to remember about Insulin:
❖ A fat-soluble hormone
❖ Must be given subcutaneously

do not massage site

can cause acute glycemia

❖ important measure is the peak not

the onset
❖ regular insulin → is a clear insulin
→ the only that can be given IV
❖ NPH → is a cloudy insulin
❖ When mixing insulin, draw regular first then followed by NPH
❖ RN → Regular →NPH
❖ If skin is cold & clammy, give candy
❖ If skin is warm to touch, insulin is rush → Hyperglycemic
❖ Refrigerate insulin
 INSULIN

CHON CHO FATS

 metabolism  metabolism  metabolism
Diabetes Management (NEMPE)   
Nutritional Management tissue wasting hyperglycemia  fatty acid
(N° 80 – 120 mg/dL)
Exercise
(> 120 mg/dL)
Monitoring Polyuria
Pharmacologic Therapy wt. loss  ketones
Education  viscosity
(DKA)
Nutritional Management Polydypsia
Polyphagia pass the BBB
• Nutrition, diet and weight control are the foundation of diabetes (compensation)
sluggish blood flow
management
BP
Caloric Requirements Diabetic Coma
Carbohydrates 50%-60% To replace  tissue perfusion
Fat 20%-30% CHON loss 
Protein 10% Poor wound healing
Exercise
- it lowers blood glucose & reducing cardiovascular risk factors if in eyes: organ dysfunction
blood vessels rupture develops
- lowers blood glucose because it  O2 & energy demand
-  increases sensitivity to insulin 
Diabetic Retinopathy
General Precaution for Exercise
1. Use proper footwear and, other protective
equipment.
2. Avoid exercise in extreme heat and cold DIFFERENCE
3. Inspect feet daily after exercise Hyperglycemic
4. Avoid exercise during periods of poor metabolic Diabetic Ketoacidosis
Hyperosmolar Non-ketotic
control.
(if sugar levels is not regulated) common in type 1 common in type 2
Monitoring
develops ketosis none ketotic
Best monitoring device: Hemoglucose Testing
* prick at the sides (less nerve endings)
develops metabolic acidosis no acidosis
Signs of hyperglycemia:  thirst, fever & fruity breath
Signs of hypoglycemia: hunger, shaking, sweating, pale cool
positive for ketone breath negative for ketone breath
clammy skin, irritability
Pharmacologic Therapy evident Kausmull’s respiration
Rapid-acting slight elevation of blood sugar sugar level is highly elevated
Lispro(Humalog); Aspart(Novolog)
Onset 10-15 minutes
level
Peak 1 hour results from hypoglycemia
Duration 3hours causing  H2O loss & retention of
Short-acting sugar leads to dehydration leading
Regular Insulin; Humalog R; Novolin R; Iletin II Regular to hypokalemia & hypernatremia
Onset ½ - 1 hour
Peak 2-3 hours Education
Duration 4-6 hours > Proper foot care (toe nail care)
Intermediate-acting → trim straight across
NPH; Humulin N; Iletin II Lente; Iletin II NPH; Novolin L (Lente);
Novolin N → soak in tap H2O first (because cold/warm  risk for injury)
Onset 2-4 hours > Instruct regular physical examination → to assess degree of
Peak 6-12 hours
Duration 16-20 hours
Long-acting Onset → time it takes effect
Ultralente (UL) Peak → maximum effect of a drug
Onset 6-8 hours
Peak 12-16 hours
Duration 20-30 hours Example:
Very Long-acting If rapid-acting insulin is administered at 8:00 a.m., hypoglycemia
Glargine (Lantus) may be possibly experienced at 9:00 a.m.
Onset 1 hour