This document provides an overview of the endocrine system and endocrine disorders. It begins by outlining the objectives of learning about endocrine disorders. It then defines the endocrine system and describes some common endocrine disorders like those of the pituitary, thyroid, parathyroid, and adrenal glands. The rest of the document goes into further detail about the anatomy and physiology of the endocrine system, focusing on the pituitary gland and disorders like diabetes insipidus. It discusses the assessment, diagnosis, and manifestations of endocrine disorders.

1. ENDOCRINE SYSTEM
DISORDER
BY RUACH JAMES
1

2. Objectives
2
At the end of the course the you will be able to:
 Differentiate causative/risk/contributing factors of endocrine disorders.
 Describe the clinical manifestations of patients with endocrine disorders
 Explain pathophysiologic process of endocrine disorders
 Discuss diagnostic procedures/evaluations used in the diagnosis of endocrine
disorders
 Explain the medical and/or surgical managements of patients with endocrine
disorders
 Apply nursing process in managing nursing care of patients with endocrine
disorders.

3. 3
What is endocrine system ?
The endocrine system is a series of glands that produce and
secrete hormones that the body uses for wide range of
functions

4. Endocrine system disorders
4
The endocrine system plays a vital role:
 in growth and development,
 the metabolism of energy,
 muscle and adipose tissue distribution,
 sexual development,
 fluid and electrolyte balance, and
 inflammation and immune responses (Porth & Matfin, 2009
Disorders of the endocrine system are common and
manifested as hyperfunction and hypofunction

5. Endocrine system disorders
5
The most common endocrine disorders are
 pituitary,
 thyroid,
 parathyroid, and adrenal glands disorders;
 Pancreas –unique functions (endocrine and exocrine)
This interconnected network of glands is closely linked with the
nervous and immune systems regulating the functions of

6. Anatomic and Physiologic Overview
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 The endocrine system - release chemical substances known
as hormones to regulate and integrate body functions.
 these hormones are produced by the endocrine glands, but
some are also produced by other tissues.
 GI mucosa produces hormones like gastrin, enterogastrone, secretin,
cholecystokinin - important in the digestive process;
 kidneys produce erythropoietin- stimulates the bone marrow to produce
red blood cells; and
 white blood cells produce cytokines (hormonelike proteins) -actively
participate in inflammatory and immune responses

7. Anatomic and Physiologic Overview
7
 The immune system and the nervous system have unique
relationships with the endocrine system.
 Chemicals such as neurotransmitters (eg, epinephrine) released by
the nervous system can also function as hormones when needed.
 The immune system responds to the introduction of foreign agents
by means of :
 chemical messengers (cytokines), which are hormonelike proteins (subject
to regulation by adrenal corticosteroid hormones)

8. Anatomic and Physiologic Overview
8
Glands of the Endocrine System
 The endocrine system composed of several glands:
 Pituitary gland,
 thyroid gland,
 parathyroid glands,
 adrenal glands, pancreatic islets, ovaries, and testes.
 Unlike the exocrine glands, most hormones secreted from
endocrine glands are released directly into the bloodstream.
 Exocrine glands, such as sweat glands, secrete their products
through ducts

9. Anatomic and Physiologic Overview
9
Function and Regulation of Hormones
 Hormones help to regulate organ function in concert with the
nervous system.
 This dual regulatory system, in which rapid action by the nervous
system is balanced by slower hormonal action,
 permits precise control of organ functions in response to varied
changes within and outside the body.
 No ducts are present, but the glands have a rich blood supply, so
the hormones they produce enter the bloodstream rapidly.

10. Anatomic and Physiologic
Overview
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11. Major action and source of selected
hormones
11

12. Function and Regulation of
Hormones
12
 In the healthy physiologic state, hormone concentration in the
bloodstream is maintained at a relatively constant level.
 Negative feedback is the mechanism for regulating hormone
concentration in the bloodstream.
 When the hormone concentration increases, further
production of that hormone is inhibited.
 Conversely, when the hormone concentration decreases, the
rate of production of that hormone increases

13. Conti…………………………………
13
 Although most hormones released by endocrine glands
can be transported to distant target sites for action,
some hormones and hormonelike substances never
enter the bloodstream.
 Some hormones act locally in the area where they are
released; called paracrine action (the effect of sex
hormones on the ovaries).
 Others may act on the actual cells from which they were
released; called autocrine action (the effect of insulin

14. Assessment
14
Health History
 Some common signs and symptoms of endocrine imbalances
include:
 changes in energy level,
 tolerance to heat or cold,
 weight, fat and fluid distribution,
 secondary sexual characteristics, sexual dysfunction,
 memory, concentration, sleep patterns, and mood.

15. Assessment
15
Health History : should include;
 the severity of these changes,
 the length of time the patient has experienced these
changes,
 the way in which these changes have affected the
patient’s ability to carry out activities of daily living, and
 the effect of the changes on the patient’s self-perception.
 Possible genetics-related issues may also be important

16. Assessment
16
Physical Assessment;
The physical examination should include
 vital signs,
 a visual head-to-toe assessment, and tactile examination.
 Changes in physical characteristics such as
 appearance of facial hair in women, “moon face,” “buffalo hump,”
 exophthalmos,,
 thinning of the skin, obesity of the trunk,
 thinness of the extremities,
 increased size of the feet and hands,

17. 17

18. 18

19. 19

20. Assessment
20
Physical Assessment
 Exophthalmos and other eye symptoms -occur with hyperthyroidism
and Graves’ disease.
 Alteration in skin texture - associated with hypofunction and
hyperfunction of the thyroid gland.
 Elevated BP- occur with hyperfunction of the adrenal cortex or
tumor of the adrenal medulla.
 Decreased BP may occur with hypofunction of the adrenal cortex.
 Behavioral changes such as agitation, nervousness, or a lack of
concern about personal appearance may also be present.

21. Assessment
21
Diagnostic evaluation
A variety of diagnostic studies are used to evaluate the
endocrine system.
 Blood tests -used to determine hormone blood levels.
 Knowing the serum levels of a specific hormone - provide
information about whether there is hypofunction or
hyperfunction of the endocrine system and the site of
dysfunction.
 Radioimmunoassay are radioisotope- antigen tests used to
measure the levels of hormones or other substances.

22. Assessment
22
Diagnostic evaluation
 Urine tests - used to measure the amount of hormones or the
end products of hormones excreted by the kidneys.
 One-time specimens are obtained, or in some disorders 24-
hour urine specimens are collected to measure hormones
or their metabolites.
 E.g. urinary levels of free catecholamines (norepinephrine,
epinephrine, and dopamine) may be measured in patients
with suspected tumors of the adrenal medulla

23. Assessment
23
Diagnostic evaluation
 Stimulation tests - determine how an endocrine gland
responds to the administration of stimulating hormones that
are normally produced or released by the hypothalamus or
pituitary gland.
 If the endocrine gland responds to this stimulation, the
specific disorder may be in the hypothalamus or pituitary.
 Failure of the endocrine gland to respond to this stimulation
helps identify the problem as being in the endocrine gland

24. Assessment
24
Diagnostic evaluation
 Suppression tests - used to determine whether negative
feedback mechanisms that normally control secretion of
hormones from the hypothalamus or pituitary gland are intact.
 They test the effect of administration of an exogenous dose
of the hormone on the endogenous secretion of the
hormone or on the secretion of stimulation hormones from
the hypothalamus or pituitary gland.

25. Assessment
25
Diagnostic evaluation
 Imaging studies : MRI and CT,
 Genetic screening - DNA testing lead to the identification of
specific genes associated with endocrine disorders, selective
targeting for drug development, and increased understanding
of the function of the endocrine system
 used to determine the presence of a gene mutation that may
predispose an individual to a certain condition.

26. 26
The Pituitary gland disorders

27. Pituitary gland
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 The pituitary gland, or the hypophysis, is a round
structure about 1.27 cm (1⁄2 inch) in diameter
located on the inferior aspect of the brain.
 It is divided into the anterior, and posterior lobes.
 Commonly referred to as the master gland, the
pituitary secretes hormones that control the
secretion of hormones by other endocrine glands.
 The pituitary itself is controlled by the
hypothalamus.

28. 28

29. Anterior Pituitary gland…
29
The major hormones of the anterior pituitary gland are
 Follicle stimulating hormone (FSH),
 Luteinizing hormone (LH),
 Prolactin,
 ACTH,
 Thyroid-stimulating hormone (TSH), and
 Growth hormone (also referred to as somatotropin).

30. Anterior Pituitary gland…
30
 The secretion of these major hormones is controlled
by releasing factors secreted by the hypothalamus.
 These releasing factors reach the anterior pituitary
by way of the bloodstream in a special circulation
called the pituitary portal blood system.
 The hormones released by the anterior pituitary
enter the general circulation and transported to their
target organs.
 The main function of TSH, ACTH, FSH, and LH is
the release of hormones from other endocrine

31. Anterior Pituitary gland…
31
 GH is a protein hormone that
 protein synthesis in many tissues,
 the breakdown of FAs in adipose tissue, and the glucose
level in the blood.
 stimulates growth in childhood
 It also affects fat distribution in the body.
 These actions of GH are essential for normal
growth,
 Stress, exercise, and low blood glucose levels
increase the secretion of growth hormone.
 The half life of GH activity in the blood is 20 to 30
minutes; the hormone is largely inactivated in the

32. Anterior Pituitary gland
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 FSH:
 promotes sperm production in men
 stimulates the ovaries to produce estrogen and develop
eggs in women.
 LH :
 stimulates testosterone production in men and
 egg release (ovulation) in women.
 Prolactin-
 stimulates breast milk production after childbirth.
 affects sex hormone levels from ovaries in women and
from testes (testicles) in men

33. Anterior Pituitary gland
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 ACTH: stimulates the production of Cortisol by the
adrenal glands.
 Cortisol, a "stress hormone," is vital to our survival. It
helps to maintain BP and blood glucose levels,
 produced in larger amounts when we’re under stress—
especially after illness or injury.

34. Pituitary gland…
34
Posterior Pituitary
 Pituitary gland secretes vasopressin (ADH) and oxytocin.
 These hormones are synthesized in the hypothalamus and
travel from the hypothalamus to the posterior pituitary gland for
storage.
 Vasopressin, ADH, regulates water balance in the body.
 It conserves body water by reducing the amount of water lost in urine.
 its secretion is stimulated by an increase in the osmolality of

35. Pituitary gland…
35
 Oxytocin: facilitates milk ejection during lactation
and increases the force of uterine contractions
during labor and delivery.
 Oxytocin secretion is stimulated during pregnancy
and at childbirth.

36. Pituitary Disorders
36
Pathophysiology
 Abnormalities of the anterior and posterior pituitary
function are caused by
 over secretion or
 under secretion of any of the hormones produced or
released by the gland.

37. Pathophysiology
37
Hypofunction of the PG (hypopituitarism) can result from:
 disease of the PG itself or disease of the hypothalamus;
 radiation therapy to the head and neck area,
 total destruction of the PG by trauma, tumor, or vascular lesion
 removes all stimuli that are normally received by the thyroid, the gonads,
and the adrenal glands.
 The result is 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.

38. Anterior Pituitary disorders
38
 Hyper secretion of ACTH- results in Cushing’s syndrome.
 Hypersecretion of GH- Acromegaly, an excess of GH in adults,
results in bone and soft tissue deformities
 In children, over secretion of GH results in gigantism, with a person
reaching 7 or even 8 feet tall
 Conversely, insufficient secretion of GH during childhood results in
generalized limited growth and dwarfism.
 Pan Hypopituitarism: under secretion (hypo secretion) commonly
involves all of the anterior pituitary hormones
 In this condition, the thyroid gland, the adrenal cortex, and the
gonads atrophy (shrink) because of loss of the trophic-stimulating
hormones.

39. Anterior Pituitary disorders
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 Postpartum pituitary necrosis (Sheehan’s syndrome)
is another uncommon cause of failure of the anterior
pituitary ( more likely to occur in women)
 It is caused by insufficient blood supply to the pituitary
gland due to:
 Copious or Severe blood loss ( Hemorrhage) associated
with premature separation of the placenta during childbirth.
 Hypovolemia
 Intravascular clotting

40. Posterior Pituitary disorders …
40
 The most common disorder related to posterior lobe
dysfunction is diabetes insipidus, a condition in
which abnormally large volumes of dilute urine are
excreted as a result of deficient production of
vasopressin.

41. Diabetes insipidus
41
Diabetes insipidus: is a disorder of the posterior lobe
of the pituitary gland.
 It is characterized by a deficiency of antidiuretic
hormone (ADH), or vasopressin.
 Great thirst (Polydipsia) and large volumes of dilute
urine characterize the disorder.

42. Diabetes insipidus…
42
Causes…
 head trauma, brain tumor, or surgical ablation or
irradiation of the pituitary gland.
 Infections of CNS(meningitis, encephalitis, Tb)
 Tumors (metastatic disease).
 Failure of the renal tubules to respond to ADH

43. Diabetes insipidus…
43
Clinical Manifestations
 an enormous daily output of very dilute, waterlike urine with
a specific gravity of 1.001 to 1.005 occurs.
 No abnormal substances such as glucose and albumin in
the urine.
 Because of the intense thrust, patient tends to drink 2 to 20
liters of fluid daily and craves cold water.
 In the hereditary form of DI, the primary symptoms may
begin at birth.
 In adults, the onset of diabetes insipidus may be abrupt or

44. Diabetes insipidus…
44
 The disease cannot be controlled by limiting fluid
intake because the high-volume loss of urine
continues even without fluid replacement.
 Attempts to restrict fluids cause the patient to
experience an insatiable craving for fluid and to
develop hypernatremia and severe dehydration.

45. Diabetes insipidus…
45
Assessment and Diagnostic Findings
 The fluid deprivation test is carried out by withholding fluids for 8 to
12 hours or until 3% to 5% of the body weight is lost.
 Plasma and urine osmolality studies are performed at the
beginning and end of the test.
 Low specific gravity and osmolality of urine
 Weight loss,
 Rising serum osmolality, and
 Elevated serum sodium levels.
 Plasma levels of ADH (vasopressin)

46. Medical Management
46
The objectives of therapy are:
 to replace ADH (which is usually a long-term
therapeutic program),
 to ensure adequate fluid replacement,
 to identify and correct the underlying intracranial
pathology.

47. Pharmacologic therapy….
47
 Desmopressin (DDAVP), a synthetic vasopressin.
 It is administered intranasally; the patient sprays the
solution into the nose through a flexible calibrated
plastic tube.
 One or two administrations daily or every 12 to 24
hours usually control the symptoms.
 ADH (IM), which is used when the intranasal route is not
possible. It is administered every 24 to 96 hours.
 The vial of medication should be warmed or shaken
vigorously before administration.
 Rotation of injection sites is to prevent lipodystrophy.

48. Pharmacologic therapy…
48
 Clofibrate- a hypolipidemic agent and have an
antidiuretic effect on patients with diabetes
insipidus
 Chlorpropamide and thiazaid diuretics - used in
mild forms of the disease because they potentiate
the action of vasopressin. The S/E - hyperglycemia
is possible.
 If the DI is renal in origin, the previously described
treatments are ineffective.
 Thiazide diuretics, mild salt depletion, and
prostaglandin inhibitors (ibuprofen, Indomethacin,
and aspirin) are used to treat the nephrogenic form

49. Nursing Management
49
 inform the patient and family about follow-up care
and emergency measures.
 provide specific verbal and written instructions,
show the patient how to administer the medications,
and observe return demonstrations as appropriate.
 advises to wear a medical identification bracelet
and to carry medication and information about this
disorder at all times.
Vasopressin must be administered with caution for pt
with coronary artery disease (vasoconstriction).

50. Syndrome of inappropriate antidiuretic hormone secretion
(SIADH)
50
 SIADH secretion includes excessive ADH secretion from the
pituitary gland even in the face of subnormal serum osmolality.
 Patients cannot excrete a dilute urine, retain fluids, and develop a
sodium deficiency known as dilutional hyponatremia.
 SIADH is often of nonendocrine origin; for instance, the syndrome
may occur in patients with bronchogenic carcinoma in which
malignant lung cells synthesize and release ADH.
 SIADH occurred in patients with severe pneumonia, pneumothorax,
and other disorders of the lungs, as well as malignant tumors that
affect other organs

51. Syndrome of inappropriate antidiuretic hormone secretion
(SIADH)
51
 Disorders of the central nervous system, such as
 head injury, brain surgery or tumor,
 infection, are thought to produce SIADH by direct stimulation of the
pituitary gland.
 Some medications –
 vincristine [Oncovin],
 phenothiazines, tricyclic antidepressants,
 thiazide diuretics and nicotine have been implicated in SIADH; they
either directly stimulate the pituitary gland or increase the sensitivity of
renal tubules to circulating ADH.

52. Syndrome of inappropriate antidiuretic hormone secretion
(SIADH)
52
 Interventions include the elimination of the underlying cause,
if possible, and restricting fluid intake.
 Because retained water is excreted slowly through the
kidneys, the extracellular fluid volume contracts and the
serum sodium concentration gradually increases toward
normal.

53. Syndrome of inappropriate antidiuretic hormone
secretion (SIADH)
53
 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.
 Supportive measures and explanations of procedures and
treatments assist the patient in managing this disorder.