At the end of this session,
Student are able to
1. Explain etiology and pathophysiology of adrenal cortex disorder
2. Identify the clinical manifestation related
3. Explain the diagnostic investigation related
4. Discuss the treatment, intervention and possible complication
5 Apply nursing art / caring value towards patient ~ nursing care
1. NURSING MANAGEMENT
OF PATIENT WITH
ENDOCRINE DISORDER
Prepared by : Intan Baiduri Badri
18 September 2018
Health Campus, Kubang Kerian
2. INTRODUCTION
• Effects almost every cell, organ, and function of
the body
• The endocrine system is closely linked with the
nervous system and the immune system
• The nervous system and the interconnected
network of glands known as the endocrine
system control body systems.
• Endocrine disorders are the consequences of
hypo function and hyper function of each
endocrine gland.
3. ENDOCRINE
• Made up of gland in many tissues and organs in
difference body areas
• Main features of all endocrine gland is the
secretion of hormones
• Responses to stress injury
• Growth and development
• Energy metabolism
• Reproduction
• electrolyte, acid base balance
5. HORMONES
• Secreted by endocrines glands
• Endocrine glands are composed of secretory
cells arranged in minutes cluster known as
acini
• Glands are ductless with rich with blood
supply, so hormones they produce enter the
bloodstream rapidly
6. HORMONES
• Hormone concentration in bloodstream is
maintained at a relatively constant level
• When the hormone concentration increase,
further production of that hormones is
inhibited
• Are natural chemical substances that initiate
or regulate activity and exert their effect on
specific tissues known as Target Tissues
7. TARGET TISSUES
• Are usually located some distance from the
endocrine gland with no direct physical
connection between the endocrine gland and
its target tissue
• The endocrine gland are called “ductless”
gland and must be used the blood to transport
secreted hormones to the target tissue.
8. NEGATIVE FEEDBACK
• The level of hormone in the blood is regulated
by the homeostasis called Negative Feedback.
• Ex : control of insulin secretion
• Increase level of blood glucose, the hormone
insulin is secreted thus increase glucose
uptake by the cells- > causing a decrease in
blood glucose
9. CLASIFFICATION OF HORMONES
• Steroid hormones : hydrocortisone
• Peptide or protein hormones : insulin
• Amine Hormone : epinephrine
• Fatty acid derivatives : retinoids
10. HYPOTHALAMUS
• Located between the cerebrum and brainstem
• Houses the pituitary gland and hypothalamus
• Regulates:
– Temperature
– Fluid volume
– Growth
– Pain and pleasure response
– Hunger and thirst
12. PITUITARY GLAND
• Located beneath the hypothalamus
• Also known as the “master gland”
• Divided into:
– Anterior Pituitary Gland
– Posterior Pituitary Gland
13. ANTERRIOR PITUITARY
1. Thyroid stimulating hormone (TSH)
– Stimulates thyroid growth and secretion of the thyroid
hormone
2. Andrenocorthropic hormone (ACTH)
– Stimulates adrenal cortex growth and secretion of
glucocorticoids
3. Growth hormone (GH) – stimulate growth
4. Prolactin / Lactogen
– Stimulate breast development during pregnancy and
milk secretion after delivery
14. ANTERRIOR PITUITARY
5. Follicle stimulating hormone (FSH)
– Stimulates ovarian follicles to mature and produce
oestrogens; in the male stimulates sperm production
6. Luteinizing hormone (LH)
– Acts with FSH to stimulate estrogen production;
causes ovulation; stimulates progesterone production
by corpus luteum; in male stimulate testes to produce
testosterone
7. Melanocytes stimulating hormone
– Synthesis and spread of melanin in the skin
15. POSTERIOR PITUITARY
• ADH antidiuretic hormone
– Stimulate water retention by kidneys to decrease
urine secretion
• Oxytocin
– Stimulate uterine contraction, causes breast to
release milk into ducts
17. ADRENAL GLANDS
• Pyramid-shaped organs that located on top of
the kidneys
• Each has two parts:
– Outer Cortex
– Inner Medulla
17
18. ADRENAL CORTEX
• Mineralocorticoid
– Regulates electrolyte and fluid homeostasis
– Aldosterone.- affects sodium absorption, loss of
potassium by kidney
• Glucocorticoids—cortisol & hydrocortisone
– Affects metabolism, regulates blood sugar levels,
– Affects growth, anti-inflammatory action,
– Decreases effects of stress
• Adrenal androgens (sex hormone)
– Stimulates sexual drive in females; in male negligible
effect
18
19. ADRENAL MEDULLA
• Secretion of two hormones
– Epinephrine : Prolongs and intensifies sympathetic
nervous response to stress
– Norepinephrine : Prolongs and intensifies
sympathetic nervous response to stress
• Serve as neurotransmitters for sympathetic
system
• Involved with the stress response
19
20. THYROID
• Follicular cells—excretion of triiodothyronine (T3)
and thyroxine (T4) - Increase Basal Metabolic
Rate (BMR), increase bone and protien turnover,
increase response to catecholamines, need for
infant for growth & develop
• Thyroid C cells—calcitonin. Lowers blood calcium
and phosphate levels
20
21. THYROID GLAND
• Butterfly shaped
• Located on either side of the trachea
• Has two lobes connected with an isthmus
• Functions in the presence of iodine
• Stimulates the secretion of three hormones
• Involved with metabolic rate management
and serum calcium levels
21
25. PARATHYROID GLANDS
• Embedded within the posterior lobes of the
thyroid gland
• Secretion of one hormone
• Maintenance of serum calcium levels
• Parathyroid hormone—regulates serum calcium
(blood calcium concentration)
25
26. PANCREAS
• Located behind the stomach between the spleen and
duodenum – it influence carbohydrate metabolism;
indirectly influence fat and protein metabolism;
produces insulin and glucagon
* Glucagon – raises blood glucose
* Insulin – lower blood glucose
• Has two major functions
– Digestive enzymes
– Releases two hormones: insulin and glucagon
26
27. KIDNEY
• 1, 25 dihydroxyvitamin D—stimulates calcium
absorption from the intestine
• Renin—activates the Renin-Angiotensin
System (RAS)
• Erythropoietin—Increases red blood cell
production
27
32. CLINICAL MANIFESTATION
• Widespread effects on the body and wide
variety of signs and symptoms
• Changes in energy level & fatigue
• Tolerance of heat and cold as well as recent
changes in weight
• Changes in sexual function and secondary sex
characteristic
• Changes in mood, memory, and ability to
concentrate and altered sleep patterns
33. PHYSISCAL ASESSMENT
• General appearance
– Vital signs, height, weight
• Integumentary
– Skin color, temperature, texture, moisture
– Bruising, lesions, wound healing
– Hair and nail texture, hair growth
• Physical appearance
– Buffalo bump, thinning of skin, increased size of
the feet and hands
40. LABAROTORY STUDIES
• Test of thyroid
– To differentiate primary and secondary hypothyroidism
• Serum thyroid stimulating hormone
– To measure the basal serum thyroid stimulating hormone
• Serum thyroxine and triiodothyronine
– To measure concentration of thyroxine T$9T3) in the blood
• Test of parathyroid function
– To measure the concentration of calcium, phosphorus,
alkaline, phosphatase, parathyroid hormone and
osteocalcin in the blood.
41. LABAROTORY STUDIES
• Test of adrenal function
– To measure concentration of adrenocortical hormones
and adrenal medullary hormones through urine and
blood specimen
• Aldosterone level
– Aids in the diagnosis of hyperaldosteronism
• Urine catecholamines
– To assess function of the adrenal medulla
• Test of thyroid structure & function
– To assess the size, shape, position and fucntion of the
thryroid through ulstrasound, MRI, CT scan, &
radionuclide imaging
42. LABAROTORY STUDIES
• Radioactive iodine uptake
– To measure the amount of radioactive iodine in
the thyroid 24H after administration of a
radioiodine isotope through scintillation scanner
• Achilles tendon reflexes
– To diagnose thyroid disorders by measuring the
amplitude and duration of ankle jerk using an
instrument that will help to elicit the reflex
45. HYPERPITUITARISM
• Over secretion of hormone due to tumour or
hyperplasia > compresses brain tissue .
Neurologic sign & symptom (ICP, Visual
impairment & headache
• Hormone affected : growth hormone & ADH
• Resulting to Gigantism if the secretion occurs
in childhood, Acromegaly in adult
46. ACROMEGALY
• Pathology:-GH hypersecretion during adulthood
• Risk: Pituitary adenoma
• Cardinal Signs: large hands and feet; protrusion
of lower jaw(Prognathism). Coarse facial feature
• Nurse Concern: Psychosocial adjustment
to Altered body image; monitor Diabetes
Insipidus
47. DWARFISM
• due to hyposecretion of growth hormone
• Nursing Intervention:
– Assess patient
– Monitor height and weight
– Assess other neurologic functions
– Focus on the family client’s feeling
• Medical Management :
– Biosynthetic growth hormone -Somatrem
48. GIGANTISM
• Results from excessive secretion of growth
hormone
• Clinical manifestation:
– Height more than 8 feet
– Acromegaly
• Medical Management:
– Radiation therapy
– Parlodel
– Transphenoidal hypophysectomy
49. PANHYPOPITUITARISM
(SIMMOND’SDISEASE)
• complete absence of pituitary secretion resulting
to:
– Dwarfism
– Hypoglycemia
– Extreme weight loss
– Hair loss
– Emaciation
– Impotence
– hypometabolism
– absence of gonadal & adrenal function
– Atrophy of all endocrine gland and organs
50. HYPOPITUITARISM
• Result from destruction of the anterior pituitary
gland, hypothalamic dysfunction, trauma, tumour,
vascular lesion, and complication of radiation
therapy to the head and neck area
• S&S:
– -Extreme weight loss
– Emaciation-
– Hypoglycaemia
– Impotence
– Amenorrhea
– Hypometabolism
51. HYPERPROLACTINEMIA
• Results from oversecretion of prolactin
associated with pituitary tumors
• Management and Nursing Management same
as hyperpituitarism
52. PITUITARY TUMOR
Types:
1.Eosinophilic - result to gigantism if developed
early in life and acromegaly if developed during adult
life
2.Basophilic - results to Cushing's syndrome; clinical
manifestation: amenorrhea & masculinization in
females, truncal obesity, osteoporosis &polycytemia
3.Chromophobic -
produces no hormone but destroys the whole
pituitary glands resulting to hypopituitarism.
S&S: obesity, somnolence, scanty hair, dry, soft skin,
loss of libido, headache, blindness, polyphagia,
polyuria, and lowered BMR
53. GONADAL DISORDER
• Result from hypothalamic-pituitary
dysfunction resulting to hypo secretion
of gonadotropins may lead to infertility and
hypo-androgenism-
• Collaborative Management :
– Removal of the underlying cause of pituitary
dysfunction
54. POSTERIOR PITUITARY DISORDERS
• Syndrome of Inappropriate Antidiuretic Hormone
(SIADH) - resulting from abnormal increase
of ADH secretion & excessive water retention
leads to include urinary sodium
• Etiology: Bronchogenic carcinoma, head injury,
tumor, infection, and brain surgery
• Cardinal signs: water intoxication, neurologic
signs
• Medical Mgt:
– Diuretics & Demecclocycline (declomycin)
– Eliminate underlying cause
55. DIABETES INSIPIDUS
• A condition characterized by a deficiency in
antidiuretic hormone resulting to excessive fluid
excretion: neurogenic and nephrogenic
• Risk: head trauma, irradiation, removal
of pituitary gland, renal disease
• Manifestation: diluted urine, polydipsia, excessive
urination
• Diagnostic: vasopressin and H20 deprivation test;
serum Na include &Uric Acid
• Cardinal signs: Polyuria, Polydipsia
56. HYPERTHYROIDISM/GRAVES’ DISEASE
• Hyperthyroidism is the second most prevalent
endocrine disorder, after diabetes mellitus.
• Graves' disease: the most common type of
hyperthyroidism, results from an excessive
output of thyroid hormones.
• May appear after an emotional shock, stress, or
an infection
• Other causes: thyroiditis and excessive ingestion
of thyroid hormone
• Affects women 8X more frequently than men
(appears between second and fourth decade)
57. THYROIDITIS
• Inflammation of the thyroid gland.
• Can be acute, subacute, or chronic (Hashimoto's
Disease)
• Each type of thyroiditis is characterized by
inflammation, fibrosis, or lymphocytic infiltration
of the thyroid gland.
• Characterized by autoimmune damage to the
thyroid.
• May cause thyrotoxicosis, hypothyroidism, or
both
58. • Can be being benign or malignant.
• If the enlargement is sufficient to cause a visible
swelling in the neck, referred to as a goiter.
• Some goiters are accompanied by
hyperthyroidism, in which case they are
described as toxic; others are associated with a
euthyroid state and are called nontoxic goiters.
58
THYROID TUMORS
59. THYROID CANCER
• Much less prevalent than other forms of cancer;
however, it accounts for 90% of endocrine
malignancies.
• Diagnosis: thyroid hormone, biopsy
• Management
– The treatment of choice surgical removal. Total or
near-total thyroidectomy is performed if possible.
Modified neck dissection or more extensive radical
neck dissection is performed if there is lymph node
involvement.
– After surgery, radioactive iodine.
– Thyroid hormone supplement to replace the
hormone. 59
61. PANCREAS
• Lies horizontally behind the stomach at the level of the 1st and 2nd
lumbar vertebrae
• The head attached to the duodenum, tail reaching to the spleen
• With exocrine and endocrine function
• Produced two Importance hormones:
1. Insulin: beta cells of islets of Lagerhans - Decrease glucose
levels:
- transcellular membrane transport of glucose;
- inhibits/breakdown of fats and protein;
- requires sodium for transport protein
- requires potassium for production
62. GLUCAGON
• Alpha cells of Islets of Lagerhans
• Stimulates release of glucose by the liver
• Increases glucose levels(gluconeogenesis)
