The Endocrine System


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  • >1 hormone- Pancreas >1 gland- Testosterone- adrenal cortex, testes >1 organ function Ovaries- estrogen, production of eggs >1 hormone function ADH- water reabsorption/blood vessel constriction
  • FSH- Growth of follicle LH- Triggers ovulation, corpus luteum Both are gonadtropins
  • Acromegaly- Enlarged hands/feet Frontal bossing/enlarged mandible Hypertension Excessive sweating Oily skin Fatigue
  • Thyroid hormone regulate the rate of metabolism – not OFF/ON function * Heat production * Stimulate reaction in which glycogen is broken down * Increase numbers of target cell receptors for Epi/Norepi * Increase rate/force of heart contractions * Normal growth and development in children Calcitonin- Decrease serum calcium (osteoblast formation)
  • Hypothyroidism-
  • Vitamin D promotes the absorption of Ca ++ from digestive tract The Vit D which is absorbed from sunlight through skin is inactive Vit D just as Vit D which is absorbed through diet. These inactive forms are converted to active Vit D by the liver and kidneys. In this way, the skin can be called an endocrine organ.
  • Sodium reabsorption leads to retention of water, thus raising fluid levels & BP (osmosis) Aldosterone is stimulated to be released secondary to the enzyme renin (released by kidneys in response to low BP)
  • Cortisol mobilizes amino acids, & fatty acids from adipose tissue- transports to liver to use in gluconeogenesis so that more gylcogen is available
  • Cushing’s- Increased cortisol leads to: HTN Osteoporosis Thinning of skin Edema- face/trunk Muscle atrophy, weakness Addison’s- Low BP Profound weakness Weight loss N/V Abdominal pain/diarrhea or constipation High K, low Na, Cl, HCO3- (decreased aldosterone) Salt cravings Body tan (increased melanin production)
  • Muscle glycogen cannot be released into general circulation like liver glycogen. Can only be used by muscles
  • If oxygen is present, pyruvate enters Krebs cycle- releasing 32 ATP molecules, and CO2/H2O
  • 1 in 25 persons develop diabetes Untreated can cause irreversible damage to blood vessels and nervous system Heart Disease Visual problems Renal failures Neuropathy- unnoticed sores/injuries Acidosis and death
  • The Endocrine System

    1. 1. The Endocrine System
    2. 2. Endocrine System <ul><li>Endocrine vs. Exocrine </li></ul><ul><li>Organs are not physically connected </li></ul><ul><li>Alters activities of target organs/cells </li></ul><ul><li>Purpose: Growth/Development </li></ul><ul><ul><ul><ul><ul><li>Reproduction </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Regulation </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Stress Reactions </li></ul></ul></ul></ul></ul>
    3. 3. Hormones are Activated By <ul><li>Hormonal </li></ul><ul><li>Humoral </li></ul><ul><li>Neural </li></ul>
    4. 4. Gland/Hormone Functions <ul><li>Some glands produce >1 hormone </li></ul><ul><li>Some hormones produced by >1 gland </li></ul><ul><li>Some organs have >1 function </li></ul><ul><li>Some hormones have >1 function </li></ul>
    5. 5. Functions of Endocrine Glands <ul><li>Endocrine Functions only </li></ul><ul><li>Production </li></ul><ul><li>Secretion </li></ul><ul><li>Contained within other organs which have other functions </li></ul>
    6. 6. Categories of Glands <ul><li>Central: Pituitary </li></ul><ul><ul><li>Hypothalamus </li></ul></ul><ul><li>Peripheral: Thyroid Pineal </li></ul><ul><ul><li>Adrenals Gonads </li></ul></ul><ul><ul><li>Parathyroids Pancreas </li></ul></ul><ul><ul><li>Thymus Others </li></ul></ul>
    7. 7. Hypothalamus <ul><li>Found on floor of diencephalon </li></ul><ul><li>Neural and endocrine functions </li></ul><ul><li>Biofeedback mechanism for: </li></ul><ul><li>Osmotic pressures </li></ul><ul><li>Temperature regulations </li></ul><ul><li>Metabolic functions </li></ul>
    8. 8. Pituitary <ul><li>Extends from Hypothalamus-behind sphenoid bone </li></ul><ul><li>“Master Gland” of body </li></ul><ul><li>Anterior- Portal network </li></ul><ul><li>Posterior- Neural-contains axons of </li></ul><ul><li> Hypothalamus neurons </li></ul>
    9. 9. Anterior Pituitary <ul><li>GH- Growth Hormone </li></ul><ul><li>Prolactin </li></ul><ul><li>TSH- Thyroid Stimulating Hormone </li></ul><ul><li>ACTH- Adrenocorticotropic </li></ul><ul><li>FSH- Follicle Stimulating Hormone </li></ul><ul><li>LH- Luteinizing Hormone </li></ul>
    10. 10. Posterior Pituitary <ul><li>ADH- Anti-Diuretic Hormone </li></ul><ul><li>Oxytocin </li></ul>
    11. 11. Pituitary Disorders <ul><li>Acromegaly- Hypersecretion of GH </li></ul><ul><li>Dwarfism- Hyposecretion of GH </li></ul>
    12. 12. Thyroid <ul><li>Inferior to larynx </li></ul><ul><li>2 Lobes </li></ul><ul><li>T 3 - Triiodothyronine </li></ul><ul><li>T 4 - Thyroxine </li></ul><ul><li>Calcitonin </li></ul>
    13. 13. Thyroid Disorders <ul><li>Hypothyroidism- Hyposecretion </li></ul><ul><li>Hyperthyroidism- Hypersecretion </li></ul><ul><ul><li>Graves Disease </li></ul></ul><ul><li>Goiters- iron deficiencies </li></ul>
    14. 14. Parathyroids <ul><li>4 small glands posterior surface of thyroid </li></ul><ul><li>Parathyroid hormone </li></ul><ul><li>Responsible for osteoclast of bone </li></ul><ul><li>Decreases blood phosphate levels </li></ul><ul><li>(By way of kidneys) </li></ul><ul><li>Enhances activation of Vitamin D </li></ul>
    15. 15. Parathyroid Disorders <ul><li>Hyperparathyroidism </li></ul><ul><li>“Moan and groan, stones and bones” </li></ul>
    16. 16. Pineal Gland <ul><li>Forms part of diencephalon </li></ul><ul><li>Melatonin </li></ul><ul><li>Inhibits hypothalamus release of gonadotropins </li></ul><ul><li>Melatonin-decreases in light/increase in dark ( circadian rhythm) </li></ul>
    17. 17. Thymus Gland <ul><li>Posterior to sternum, around great vessels </li></ul><ul><li>Thymosin </li></ul><ul><li>Both lymphatic and endocrine </li></ul><ul><li>Lymphatic- produces T-lymphocytes </li></ul><ul><li>Endocrine- ‘programs’ T-cells </li></ul>
    18. 18. The Adrenals <ul><li>Located on superior end of each kidney </li></ul><ul><li>Medulla- inner gland </li></ul><ul><li>Cortex- outer gland </li></ul>
    19. 19. Adrenal Medulla <ul><li>Sympathetic preganglionic fibers synapse on cells in medulla </li></ul><ul><li>Release of epinephrine/norepinephrine into general circulation </li></ul>
    20. 20. Adrenal Cortex <ul><li>Produce over 30 steroid hormones </li></ul><ul><li>Three main cortical hormones </li></ul><ul><li>Mineralocorticoids </li></ul><ul><li>Glucocorticoids </li></ul><ul><li>Sex hormones </li></ul>
    21. 21. Mineralocorticoids <ul><li>Regulate levels of electrolytes and water in extracellular fluid </li></ul><ul><li>95% are aldosterone </li></ul><ul><ul><li>Sodium reabsorption </li></ul></ul><ul><ul><li>Potassium excretion </li></ul></ul>
    22. 22. Glucocorticoids <ul><li>Influence carbohydrate metabolism </li></ul><ul><li>Important in body’s response to stress </li></ul><ul><li>95% cortisol (hydrocortisone) </li></ul><ul><li>stimulates gluconeogenesis </li></ul><ul><li>secretion is regulated by ACTH </li></ul>
    23. 23. Sex Hormones <ul><li>Androgens (testosterone) </li></ul><ul><li>Estrogens </li></ul><ul><li>Both are secreted in greater numbers by gonads </li></ul>
    24. 24. Adrenal Disorders <ul><li>Cushing’s disease- </li></ul><ul><li>cortisol over-production secondary to </li></ul><ul><li>increased ACTH </li></ul><ul><li>Addison’s Disease- </li></ul><ul><li>cortisol/aldosterone deficiencies </li></ul>
    25. 25. Gonads <ul><li>Testes- males </li></ul><ul><li>Testosterone </li></ul><ul><li>Ovaries- females </li></ul><ul><li>Estrogens </li></ul><ul><li>Progesterone </li></ul><ul><li>Both produce hormones/gametes </li></ul>
    26. 26. Pancreas <ul><li>Retroperitoneal-posterior to stomach </li></ul><ul><li>Exocrine & Endocrine </li></ul><ul><li>Endocrine- islets of Langerhans </li></ul><ul><li>Alpha </li></ul><ul><li>Beta </li></ul><ul><li>Delta </li></ul>
    27. 27. Alpha cells <ul><li>20% of islets </li></ul><ul><li>Hormone glucagon </li></ul><ul><li>Stimulates breakdown of glycogen in liver- raises glucose levels in blood </li></ul><ul><li>(glycogenolysis & glyconeogenesis) </li></ul>
    28. 28. Beta Cells <ul><li>75% of islets </li></ul><ul><li>Hormone- insulin </li></ul><ul><li>Decreases glucose levels </li></ul>
    29. 29. Glucose Metabolism <ul><li>Organic components of food: </li></ul><ul><li>Carbohydrates (instant-energy) </li></ul><ul><li>Glucose </li></ul><ul><li>Fats </li></ul><ul><li>Fatty acids/glycerols </li></ul><ul><li>Proteins </li></ul><ul><li>Amino acids </li></ul>
    30. 30. Carbohydrate Metabolism <ul><li>Insulin is released by humoral, hormonal, neural means </li></ul><ul><li>Increased glucose </li></ul><ul><li>Parasympathetic stimulation </li></ul><ul><li>Gastrointestinal hormones </li></ul>
    31. 31. Carbohydrate Metabolism <ul><li>60% of carbohydrates are stored as </li></ul><ul><li>glycogen in liver </li></ul><ul><li>If muscles are not exercised after eating-stored as muscle glycogen </li></ul>
    32. 32. Glycolysis <ul><li>Glucose is broken down into pyruvate </li></ul><ul><ul><li>and lactate- releasing 2ATPs </li></ul></ul><ul><ul><li>(Anaerobic metabolism) </li></ul></ul><ul><ul><li>Krebs Cycle </li></ul></ul>
    33. 33. Fat Metabolism <ul><li>A third of any glucose passing through liver is converted to fatty acids </li></ul><ul><li>Fatty acids are converted to triglycerides and stored in adipose tissue </li></ul>
    34. 34. Fat Metabolism <ul><li>Without insulin, fat is broken back down into triglycerides/cholesterol  CAD </li></ul><ul><li>Fatty acids are also broken down into ketone bodies </li></ul>
    35. 35. Protein Metabolism <ul><li>In absence of insulin- protein storage stops and breakdown begins (muscle) </li></ul><ul><li>Amino acid breakdown for energy leads to increased urea in urine  organ dysfunction </li></ul>
    36. 36. Pancreas Disorders <ul><li>Diabetes- </li></ul><ul><ul><li>Type 1- Juvenile onset </li></ul></ul><ul><ul><li>Type 2- Mature onset </li></ul></ul><ul><ul><li>Gestational diabetes </li></ul></ul>
    37. 37. Type 1 Diabetes <ul><li>Insulin dependant </li></ul><ul><li>S/S: polyuria </li></ul><ul><ul><ul><li>polydipsia </li></ul></ul></ul><ul><ul><ul><li>polyphagia </li></ul></ul></ul><ul><ul><ul><li>blurred vision </li></ul></ul></ul><ul><ul><ul><li>weight loss </li></ul></ul></ul>
    38. 38. Type 2 Diabetes <ul><li>Generally non-insulin dependant </li></ul><ul><li>Has ability to make small amounts of </li></ul><ul><li>insulin </li></ul><ul><li>Can develop into insulin dependant </li></ul>
    39. 39. Gestational Diabetes <ul><li>Develops during pregnancy </li></ul><ul><li>Deficiencies in insulin leads to inability to metabolize carbohydrates </li></ul><ul><li>Generally disappears after delivery </li></ul>
    40. 40. Insulin Agents <ul><li>Early- porcine, bovine </li></ul><ul><li>Recent- genetic engineered human insulin </li></ul><ul><li>Protein </li></ul><ul><li>Rapid, intermediate and long-term </li></ul><ul><li>Combination of long-term, rapid each day </li></ul>
    41. 41. Insulin Types <ul><li>Regular- Fast acting </li></ul><ul><li>0.5-1 hour onset </li></ul><ul><li>6-8 hour duration </li></ul><ul><li>NPH- Intermediate </li></ul><ul><li>1-1.5 hour onset </li></ul><ul><li>24 hour duration </li></ul>
    42. 42. Insulin Types <ul><li>Ultralente- Long acting </li></ul><ul><li>4-6 hour onset </li></ul><ul><li>36 hour duration </li></ul><ul><li>Oral agents: </li></ul><ul><ul><li>Diabinese (chlorpropamide) </li></ul></ul><ul><ul><li>Orinase (tolbutamide) </li></ul></ul><ul><ul><li>Micronase (glyburide) </li></ul></ul><ul><ul><li>Glucotrol </li></ul></ul>
    43. 43. Diabetic Emergencies <ul><li>Hypoglycemia </li></ul><ul><li>Hyperglycemia </li></ul><ul><li>Diabetic Ketoacidosis (DKA) </li></ul><ul><li>Hyperosmolar Hyperglycemic Nonketotic Coma (HHNK) </li></ul>
    44. 44. Hypoglycemia <ul><li>Rapid on-set </li></ul><ul><li>< 60 mg/dl </li></ul><ul><li>Causes: too much insulin </li></ul><ul><li>decreased intake salicylates </li></ul><ul><li>excessive activity beta blockers </li></ul><ul><li>emotional stress hypothermia </li></ul><ul><li>chronic alcoholism sepsis </li></ul>
    45. 45. S/S of Hypoglycemia <ul><li>Altered LOCs- irritability, nervousness, </li></ul><ul><li>confusion, combative </li></ul><ul><li>Cool, clammy </li></ul><ul><li>Weak, rapid pulse </li></ul><ul><li>Snoring,  salivation </li></ul><ul><li>Normal BP </li></ul>
    46. 46. Diabetic Ketoacidosis <ul><li>Fat metabolism leads to ketoacids </li></ul><ul><li>Acidosis leads to  K + in circulation & </li></ul><ul><li>hyperkaluria  K + deficiency </li></ul><ul><li>Osmotic diuresis  dehydration, </li></ul><ul><li>electrolyte imbalances </li></ul>
    47. 47. S/S of DKA <ul><li>Warm, dry skin </li></ul><ul><li>Dry mucous membranes </li></ul><ul><li>Tachycardia, thready pulse </li></ul><ul><li>Postural hypotension </li></ul><ul><li>Weight loss </li></ul><ul><li>‘ Polys’ </li></ul>
    48. 48. S/S of DKA <ul><li>Abdominal pain </li></ul><ul><li>Anorexia, nausea/vomiting </li></ul><ul><li>Acetone breath </li></ul><ul><li>Kussmauls </li></ul><ul><li>Decreased LOC </li></ul>
    49. 49. Hyperosmolar Hyperglycemic Nonketotic Coma <ul><li>Generally Type II diabetic </li></ul><ul><li>Osmotic diuresis secondary to  sugars </li></ul><ul><li>Not acidotic as in DKA </li></ul><ul><li>Factors: Geriatric </li></ul><ul><ul><ul><ul><ul><li>Preexisting diseases </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Increased insulin requirements </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Medication use- thiazide, diuretics </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Parenteral/enteral feedings </li></ul></ul></ul></ul></ul>
    50. 50. S/S of HHNK <ul><li>Weakness </li></ul><ul><li>Thirst </li></ul><ul><li>Polyuria </li></ul><ul><li>Weight Loss </li></ul><ul><li>Extreme dehydration </li></ul>
    51. 51. Treatment of Diabetic Emergencies <ul><li>Hypoglycemia- ABCs </li></ul><ul><ul><ul><ul><li>IV- NS </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Monitor ECG </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Oral, IV Dextrose </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Poss. Glucagon IM </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Poss. Thiamine </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Monitor glucose! </li></ul></ul></ul></ul>
    52. 52. Treatment of Diabetic Emergencies <ul><li>Hyperglycemia (DKA, HHNK)- </li></ul><ul><li>ABCs </li></ul><ul><li>O 2 </li></ul><ul><li>IV- NS </li></ul><ul><li>Monitor ECG for abnormalities </li></ul>