Bahir Dar University

College of Medicine & Health Sciences

Department of Adult Health Nursing

Management of Patients with Endocrine Disorders

By Tadesse Dagget (MSc. N, MPH, Asst. Prof.)

Feb, 2023
 Outline

Overview of Endocrine System

Endocrine Glands

Endocrine Disorders

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 Endocrine System
System of ductless glands

Regulates body functions via hormones secreted into the bloodstream.

Endocrine system - glands, tissues, and cells that secrete hormones

Endocrinology – the study of endocrine system and the diagnosis and

treatment of its disorders

Endocrine glands – organs that produce hormones

Hormones - chemical messengers transported by the bloodstream that

stimulate responses in another tissue or organ, often far away.

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 Glands of the Endocrine System

 Hypothalamus Pineal gland

Hypothalamus

Posterior Pituitary Pituitary gland

Thyroid gland
Anterior Pituitary Thymus

Thyroid Adrenal gland

Pancreas

Parathyroids Parathyroid
glands Trachea
Posterior view

Adrenals Gonads:
Ovary (female)
Testis (male)
Pancreatic islets

Ovaries and testes 4

 Anatomy of Hypothalamus
shaped like a flattened funnel

forms floor and walls of third ventricle of the brain

regulates primitive functions of the body from water balance and

thermoregulation to sex drive and childbirth
many of its functions carried out by pituitary gland

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 Hypothalamus
Releasing and inhibiting hormones

Growth hormone-releasing hormone (GHRH)

Thyrotropin-releasing hormone (TRH)

Corticotropin-releasing hormone (CRH)

Gonadotropin-releasing hormone (GnRH)

Somatostatin = inhibits GH and TSH

 Prolactine releasing hormone (PRH)

 Prolactine inhibiting hormone (PIH) 10

 Pituitary Gland (Hypophysis)
Suspended from hypothalamus by a stalk – infundibulum

Size and shape of kidney bean

Composed of two structures with independent origins and separate

functions
Adenohypophysis (Anterior pituitary)

Neurohypophysis (posterior pituitary)

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 Anterior and Posterior Pituitary
 Anterior pituitary (AP) is anterior 3/4 of pituitary

linked to hypothalamus by hypophyseal portal system

• primary capillaries in hypothalamus connected to a second set in AP

• hypothalamic hormones regulate AP cells

• Posterior pituitary (PP) is posterior 1/4 of pituitary

 Nerve tissue, not a true gland

• nerve cell bodies in hypothalamus pass down the stalk as hypothalamo-hypophyseal tract
and end in posterior lobe
• hypothalamic neurons secrete hormones that are stored in PP until released into blood
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 Hypothalamic Hormones
Eight hormones produced in hypothalamus
Six regulate the anterior pituitary
Two are released into capillaries in the posterior pituitary (oxytocin and antidiuretic
hormone)

Releasing and inhibiting hormones stimulate or inhibit the anterior

pituitary
TRH, CRH, GnRH, and GHRH are releasing hormones
PIH inhibits secretion of prolactin, and somatostatin inhibits secretion growth
hormone & thyroid stimulating hormone by the anterior pituitary

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 Anterior Pituitary Hormones
anterior lobe of the pituitary synthesizes and secretes six principal hormones

 Two gonadotropin hormones that target gonads

1) FSH (follicle stimulating hormone)

stimulates secretion of ovarian sex hormones, development of ovarian follicles, and
sperm production
2) LH (luteinizing hormone)
stimulates ovulation, stimulates corpus luteum to secrete progesterone, stimulates
testes to secrete testosterone
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 Anterior Pituitary Hormones
3) TSH (thyroid stimulating hormone)
stimulates secretion of thyroid hormone

4) ACTH (adrenocorticotropic hormone)

stimulates adrenal cortex to secrete glucocorticoids

5) PRL (prolactin)
after birth stimulates mammary glands to synthesize milk, enhances secretion of
testosterone by testes

6) GH (growth hormone)
stimulates mitosis and cellular differentiation

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 Growth Hormone
 Also called somatotropin, promote growth

GH has widespread effects on the body tissues

especially cartilage, bone, muscle, and fat

induces liver to produce growth stimulants

insulin-like growth factors (IGF)

• protein synthesis increases

• Increases lipid metabolism – provides energy for growing tissues

• carbohydrate metabolism –makes glucose available for glycogen synthesis and

storage 16
 Growth Hormone…
GH is secreted in adults. Even if the body is not growing in height, some tissues will

require new proteins for repair or replacement

 The secretion of GH is regulated by two hormones from the hypothalamus

GHRH: stimulus :hypoglycemia, during exercise and high blood level of amino

acids
Somatostatin /growth hormone inhibiting hormone (GHIH),

 it decreases the secretion of GH.

produced during hyperglycemia.

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 Posterior Pituitary Hormones
 produced in hypothalamus
transported to posterior lobe
releases hormones when hypothalamic neurons are stimulated

 ADH (Antidiuretic hormone)

increases water retention, thus prevents dehydration

 OT (Oxytocin)
stimulates labor contractions during childbirth
stimulates flow of milk during lactation
released during sexual arousal and orgasm
promotes feelings of sexual satisfaction and emotional bonding between partners
promotes emotional bonding between mother and infant

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 Control of Pituitary:
Feedback from Target Organs

Negative feedback -
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

TRH
1
-
6
increased target organ
Negative feedback
inhibition hormone levels inhibits
+
5
- 4
Target organs
release of hormones
2 +

TSH Positive feedback -

Thyroid hormone stretching of uterus increases
+
oxytocine release, causes
3

Stimulatory effect
contractions, more stretching
+

– Inhibitory effect
of uterus, etc. Until delivery
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 Thyroid Gland
Butterfly-shaped

 secretes thyroxine (T4: 4 iodine atoms) and triiodothyronine (T3)

 increases metabolic rate,

 heat production (calorigenic effect),

 appetite,

 alertness and quicker reflexes

 Parafollicular cells secrete calcitonin with rising blood calcium

 stimulates osteoblast activity and bone formation

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 Thyroid Gland …

Calcitonin decreases the reabsorption of calcium and phosphate from the bones to the

blood

 lowering blood levels of these minerals.

This function of calcitonin helps maintain normal blood levels

of calcium and phosphate and also helps maintain a stable, strong bone matrix.

 stimulus for secretion of calcitonin is hypercalcemia

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 Parathyroid Glands
usually four glands partially embedded in posterior
surface of thyroid gland Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

secrete parathyroid hormone (PTH)

antagonist to calcitonin
Pharynx
(posterior view)

Increases the reabsorption of calcium and Thyroid gland

phosphate from bone to blood Parathyroid

glands
Increases absorption of calcium and phosphate by the
small intestine Esophagus

Trachea
 Increases the reabsorption of calcium and the
excretion of phosphate by the kidneys; activates (a)

vitamin D
Hypocalcemia stimulates secretion.
Hypercalcemia inhibits secretion. 22
 Adrenal Gland
small gland that sits on top of each

kidney/ suprarenal glands

 Each adrenal gland consists of two

parts:
 Inner adrenal medulla and

 An outer adrenal cortex.

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 Adrenal Medulla
adrenal medulla – inner core, 10% to 20% of gland

has dual nature: endocrine gland and sympathetic ganglion of sympathetic nervous
system
when stimulated, releases catecholamines (epinephrine and norepinephrine) directly
into the bloodstream
both secreted in stress situations and help prepare the body for “fight or flight.”
effect is longer lasting than neurotransmitters
increases alertness and prepares body for physical activity –
• mobilize high energy fuels,
increases blood pressure, heart rate, and force of contraction
decreases digestion and urine production

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 Adrenal Cortex

surrounds adrenal medulla

secretes 3 classes of steroid hormones

1. mineralocorticoids

2. glucocorticoids

3. sex steroids

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 Categories of Corticosteroids
1. Mineralocorticoids
 regulate electrolyte balance

 Aldosterone is the most abundant of the mineralocorticoids

 The target organs of aldosterone are the kidneys

 aldosterone stimulates Na+ retention and K+ excretion, water is retained with sodium by osmosis,

so blood volume and blood pressure are maintained.

 stimulation :

• deficiency of sodium,

• loss of blood or dehydration that lowers blood pressure, or

• an elevated blood level of potassium.

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 Categories of Corticosteroids….
2. Glucocorticoids
 regulate metabolism of glucose and other fuels

 especially cortisol, stimulates release of fuels into blood

• Cortisol increases the use of fats and excess amino acids (gluconeogenesis) for energy and decreases the use of

glucose.

 helps body adapt to stress and repair tissues

 anti-inflammatory effect can become immune suppression in long-term use

3. Sex steroids

androgens – sets libido

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 Pancreas
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

Tail of pancreas

Bile duct

(c) Pancreatic islet

Exocrine acinus

Pancreatic Duodenum Head of

ducts pancreas Beta cell
(a) Alpha cell
Delta cell
(b) Pancreatic islet
c: © Ed Reschke

 exocrine digestive gland and endocrine cell clusters (pancreatic islets) found
inferior and posterior to stomach.
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 Pancreatic Hormones…
Glucagon – secreted by alpha () cells

released when blood glucose concentration is falling

stimulates the liver to change glycogen to glucose => glycogenolysis

in liver, stimulates release of glucose into the circulation raising blood

glucose level
use of fats and excess amino acids for energy

production=>gluconeogenesis
 The secretion of glucagon is stimulated by hypoglycemia 29
 Pancreatic Hormones…
Insulin secreted by B or beta () cells

secreted during and after meal when glucose and amino acid blood levels are rising

Insulin increases the transport of glucose from the blood into cells by increasing the

permeability of cell membranes to glucose

• stimulates cells to absorb and lowering blood glucose levels

• promotes synthesis of glycogen, fat, and protein

• suppresses use of already-stored fuels

Secretion of insulin is stimulated by hyperglycemia

insufficiency or inaction is cause of diabetes mellitus

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 Pancreatic Hormones…
Somatostatin

 secreted by D or delta () cells

inhibit the secretion of glucagon and insulin

inhibits nutrient digestion and absorption which prolongs

absorption of nutrients/slow the absorption

stimulated by rising levels of insulin and glucagon

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 Pineal Gland
pineal gland - attached to roof of third ventricle beneath the posterior end
of corpus callosum
after age 7, it undergoes involution (shrinkage)

may synchronize physiological function with 24-hour circadian rhythms of

daylight and darkness
synthesizes melatonin from serotonin during the night

may regulate timing of puberty in humans

 seasonal affective disorder (SAD) occurs in winter or northern climates

depression, sleepiness, irritability and carbohydrate craving
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Endocrine Disorders

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 Disorders of Pituitary Gland
Abnormalities of pituitary function are caused by over secretion or under

secretion of any of the hormones produced or released by the gland

 Hypofunction of the pituitary gland (hypopituitarism) due to

 disease of the pituitary gland itself or

 disease of the hypothalamus

 Hypopituitarism can result from radiation therapy to the head and neck

area.

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 Disorders of Pituitary Gland…
The total destruction of the pituitary gland by trauma,
tumor, or vascular lesion removes all stimuli that are normally
received by the thyroid, the gonads, and the adrenal glands.
The result
extreme weight loss,
emaciation,
atrophy of all endocrine glands and organs,
hair loss,
impotence,
amenorrhea,
hypometabolism, and hypoglycemia.
Coma and death occur if the missing hormones are not replaced. 35
 Disorders of Pituitary Gland…
 Hypersecretion of the anterior pituitary gland most commonly involves
ACTH =>Cushing’s syndrome
GH
• Acromegaly =An excess of GH in adults, results in bone and soft tissue
deformities and enlargement of the viscera without an increase in height
• Gigantism in children
insufficient secretion of GH during childhood results in generalized limited
growth and dwarfism
 Hypopituitarism may result from destruction of the anterior lobe of the
pituitary gland

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The tallest man in the world –
Sultan Kosen (2 m 51 cm)- 2021

Robert Wadlow =2.72m(1940)

The shortest man in the world –

He Pingping (74yrs,61 cm) – died
in the March, 2010 in Italy
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Robert Wadlow =2.72m(1940)
39
 Disorders of Pituitary Gland…
 Acromegally
 DIABETES INSIPIDUS
 most common posterior pituitary lobe dysfunction characterized by a

deficiency of ADH (vasopressin)

 Excessive thirst (polydipsia) and large

volumes of dilute urine characterize the disorder

It may occur secondary to

Head trauma, brain tumor, or surgical ablation or irradiation of the pituitary gland

 Infections of the central nervous system (meningitis, encephalitis, tuberculosis)

 Failure of the renal tubules to respond to ADH

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 DIABETES INSIPIDUS
Clinical Manifestations
 very dilute, water like urine with a specific gravity of 1.001 to 1.005
occurs
 intense thirst, the patient tends to drink 2 to 20 L of fluid daily and craves
cold water
 high-volume loss of urine

The disease cannot be controlled by limiting fluid intake,

Attempts to restrict fluids cause the patient to experience an insatiable

craving for fluid and to develop hypernatremia and severe dehydration.

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 Diabetes Inspidus…
Assessment and Diagnosis
 fluid deprivation test
withholding fluids for 8 to 12 hours or until 3% to 5% of the body weight
is lost.
• Perform plasma and urine osmolality studies at the beginning and end of the test.
The inability to increase the specific gravity and osmolality of the urine is
characteristic of DI
• increasing serum osmolality, and elevated serum sodium
levels
• The patient’s condition needs to be monitored frequently during the test,
• test is terminated if tachycardia, excessive weight loss, or hypotension develops
• plasma levels of ADH
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 Diabetes Inspidus…
Medical Management
The objectives of therapy
(1) to replace ADH (usually a long-term therapeutic program),
(2) to ensure adequate fluid replacement, and
(3) to identify and correct the underlying intracranial pathology.
 Desmopressin- a synthetic vasopressin
 it has a longer duration of action and fewer adverse effects than other preparations previously
used to treat the disease.
 It is administered intranasally; the patient sprays
the solution into the nose one or two administrations daily
 Intramuscular administration of ADH
 If the DI is renal in origin, Thiazide diuretics, mild salt depletion, and prostaglandin
inhibitors (ibuprofen, indomethacin, and aspirin)
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 Syndrome of Inappropriate Antidiuretic Hormone Secretion
(SIADH)
 SIADH includes excessive ADH secretion from the pituitary gland even in the face
of subnormal serum osmolality
 Pt develop dilutional hyponatremia
Causes:
 Disorders of the central nervous system, such as
head injury, brain surgery or tumor, and infection, are thought to produce SIADH
 None-endocrine origin; may occur in patients with
bronchogenic carcinoma in which malignant lung cells synthesize and release ADH.
severe pneumonia, pneumothorax
Some medications (eg, vincristine, phenothiazines, tricyclic antidepressants, thiazide
diuretics) and nicotine
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 SIADH….
Interventions

 the elimination of the underlying cause, if possible,

 restricting fluid intake

 Diuretics such as furosemide (Lasix) may be used along with fluid restriction if

severe hyponatremia is present

Close monitoring of
fluid intake and output,
Daily weight,
urine and blood chemistries, and neurologic status is indicated for the patient at risk for
SIADH 46
 Thyroid Hormone Disorders

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