Adult Health, Exam 2
ASSESSMENT AND MANAGEMENT OF PATIENTS WITH
ENDOCRINE DISORDERS Chapter 45
Endocrine System
• Vital role in cellular interactions, metabolism, growth, reproduction, aging, and response to
adverse conditions
• Involves the release of chemical transmitter substances, hormones, which regulate and
integrate body functions by acting on local or distant target sites
• Composed of the pituitary gland, adrenal glands, thyroid gland, parathyroid glands,
pancreatic islets, ovaries, testes
• In a eudynamic states hormone concentrations remain balanced; when hormone
concentrations rise, hormone production decreases, and when hormone concentrations fall,
hormone production rises
• Hormones classified according to their structure:
• Amines and amino acids
• Peptides, polypeptides, proteins and glycoproteins
• Steroids
• Fatty acid derivatives
Chart 45-1 pg. 1448 Genetics in Nursing Practice
Assessment
Health History
• Are there changes in energy level, tolerance to heat or cold, weight changes (without
attempting), thirst, frequent urination
• Measure BMI, abdominal circumference,
• Changes in sexual characteristics, vision, sexual dysfunction, menstrual cycle, memory,
concentration, sleep cycle
Physical Assessment
• Head to toe inspection
• Changes in physical appearance
• Thinning hair
• Facial hair on women
• Moon face
• Buffalo hump
• Exophthalmos
• Truncal obesity
• Increase in size of hands and feet
• Changes in mood or behavior
Diagnostics
• Blood tests (hormone levels, autoantibodies, etc.)
,• Urine tests (UA, 24-hour)
• Stimulation tests – confirm hypofunction of an endocrine organ
• Suppression tests – confirm hyperfunction of an endocrine organ
• CT, MRI, PET, DEXA scan, Genetic screening – presence of gene mutation , DNA testing
Pituitary Gland
• “Master Gland”
• Influences secretion of hormones by other endocrine glands
• Controlled by the hypothalamus
• Located on the inferior aspect of the brain
• Divided into anterior and posterior lobes
• Anterior pituitary • Posterior pituitary
• FSH, LH, Prolactin, • Vasopressin (ADH) – controls
adrenocorticotropic (ACTH) , excretion of water by the kidney
TSH, GH • Oxytocin – stimulated during
• Main function of ACTH, TSH, LH, pregnancy and at childbirth
and FSH is the release of
hormones from other glands
• PRL acts on the breast to
stimulate lactation
• GH regulates growth in children
and energy and metabolism in
adults
Hypersecretion or Hyposecretion
Anterior Pituitary
• Cushing syndrome Posterior Pituitary
• Hypersecretion of ACTH in adults • Diabetes insipidus
• Acromegaly • Deficient production of
• Hypersecretion of GH in adults vasopressin
• Gigantism • May also occur secondary after
• Hypersecretion of GH in children brain surgery, TBI, CNS infection,
• Dwarfism post hypophysectomy, renal
• Insufficient secretion of GH in tubule failure to respond to ADH,
children etc.
• Hypopituitarism
• May result from destruction of
anterior lobe
Pituitary Tumors
,• Most are benign but cause pituitary gland dysfunction
• Primary or secondary, functional or nonfunctional
• Principal types of pituitary tumors represent overgrowth of
• Eosinophilic cells
• Gigantism
• Acromegaly
• Basophilic cells
• Cushing syndrome
• Chromophobic cells
• 90% of pituitary tumors
• Usually produces no hormones but destroys the pituitary gland
• Causes hypopituitarism: obese, loss of libido, lowering of basal metabolic
rate, etc.
Assessment/Diagnostic
• History and Physical Medical/Surgical Management
• Including visual acuity and visual • Hypophysectomy (treatment of choice
fields in Cushing’s)
• CT / MRI • Transsphenoidal, transfrontal,
• Serum levels of pituitary hormones subcranial, oronasal
• Target organ serum hormone levels • Stereotactic radiation therapy
(thyroid, adrenal) • Conventional radiation therapy
• bromocriptine (Parlodel, dopamine
antagonist), octreotide (Sandostatin,
synthetic analog of GH)
*these medications inhibit production or
*** Absence of the pituitary gland alters release of GH
many system functions; menstruation stops, • octreotide and lanreotide (Somastatin
infertility occurs, replacement therapy w/ depot) may be used preop to improve
corticosteroids and thyroid hormone is clinical condition and to shrink the
necessary tumor
Diabetes Insipidus
• Deficiency of ADH (vasopressin)
• Clinical Manifestations
• Output of urine > 250 ml/hr
• Dilute with specific gravity of 1.001-1.005
• No abnormal substances such as glucose, protein
• Excessive thirst 2-20 liters per day (polydipsia)
• Assessment/Diagnostic
• Fluid deprivation test
• Withholding fluid for 8-12 hours or until 3-5% body weight is loss
• Plasma and urine osmolality at beginning and end of test
• Inability to increase urine specific gravity and osmolality is indicative of DI
, • Test terminated if patient becomes tachycardic, hypotensive, or has excessive
weight loss
• Serum levels of ADH (without action of the ADH on the distal nephron of the kidney,
daily output greater than 250ml/hr of very dilute urine occurs)
• Trial of desmopressin and hypertonic IV fluids
• Medical Management (replace ADH, ensure adequate fluid replacement, and
identifying/correct the underlying issue)
• Goals of therapy
• Replace ADH
• Adequate fluid replacement
• Identification and correction of underlying intracranial pathology or nephrogenic
issue
• Pharmacological therapy
• DDAVP- given intranasally once or twice daily
• chlorpropamide and thiazides – potentiate effects of DDAVP
• Nephrogenic form – thiazides, mild salt depletion, and prostaglandin inhibitors
(ibuprofen, ASA, indomethacin)
• Nursing Management
• Physical assessment, patient education, medical bracelet
Syndrome of Inappropriate Antidiuretic Hormone Secretion
• Excessive ADH secretion
• Cannot excrete a dilute urine, retain fluids, and develop dilutional hyponatremia
• May be seen with bronchogenic carcinoma, pneumonia, pneumothorax, head injury, brain
surgery or tumor and infection
• Eliminate underlying cause, if possible
• Fluid restriction
• Furosemide
• Monitor I&O; daily weight; monitor urine and blood chemistries
• Monitor neurologic status
Thyroid Gland
• Largest endocrine gland
• Anterior to the trachea
ASSESSMENT AND MANAGEMENT OF PATIENTS WITH
ENDOCRINE DISORDERS Chapter 45
Endocrine System
• Vital role in cellular interactions, metabolism, growth, reproduction, aging, and response to
adverse conditions
• Involves the release of chemical transmitter substances, hormones, which regulate and
integrate body functions by acting on local or distant target sites
• Composed of the pituitary gland, adrenal glands, thyroid gland, parathyroid glands,
pancreatic islets, ovaries, testes
• In a eudynamic states hormone concentrations remain balanced; when hormone
concentrations rise, hormone production decreases, and when hormone concentrations fall,
hormone production rises
• Hormones classified according to their structure:
• Amines and amino acids
• Peptides, polypeptides, proteins and glycoproteins
• Steroids
• Fatty acid derivatives
Chart 45-1 pg. 1448 Genetics in Nursing Practice
Assessment
Health History
• Are there changes in energy level, tolerance to heat or cold, weight changes (without
attempting), thirst, frequent urination
• Measure BMI, abdominal circumference,
• Changes in sexual characteristics, vision, sexual dysfunction, menstrual cycle, memory,
concentration, sleep cycle
Physical Assessment
• Head to toe inspection
• Changes in physical appearance
• Thinning hair
• Facial hair on women
• Moon face
• Buffalo hump
• Exophthalmos
• Truncal obesity
• Increase in size of hands and feet
• Changes in mood or behavior
Diagnostics
• Blood tests (hormone levels, autoantibodies, etc.)
,• Urine tests (UA, 24-hour)
• Stimulation tests – confirm hypofunction of an endocrine organ
• Suppression tests – confirm hyperfunction of an endocrine organ
• CT, MRI, PET, DEXA scan, Genetic screening – presence of gene mutation , DNA testing
Pituitary Gland
• “Master Gland”
• Influences secretion of hormones by other endocrine glands
• Controlled by the hypothalamus
• Located on the inferior aspect of the brain
• Divided into anterior and posterior lobes
• Anterior pituitary • Posterior pituitary
• FSH, LH, Prolactin, • Vasopressin (ADH) – controls
adrenocorticotropic (ACTH) , excretion of water by the kidney
TSH, GH • Oxytocin – stimulated during
• Main function of ACTH, TSH, LH, pregnancy and at childbirth
and FSH is the release of
hormones from other glands
• PRL acts on the breast to
stimulate lactation
• GH regulates growth in children
and energy and metabolism in
adults
Hypersecretion or Hyposecretion
Anterior Pituitary
• Cushing syndrome Posterior Pituitary
• Hypersecretion of ACTH in adults • Diabetes insipidus
• Acromegaly • Deficient production of
• Hypersecretion of GH in adults vasopressin
• Gigantism • May also occur secondary after
• Hypersecretion of GH in children brain surgery, TBI, CNS infection,
• Dwarfism post hypophysectomy, renal
• Insufficient secretion of GH in tubule failure to respond to ADH,
children etc.
• Hypopituitarism
• May result from destruction of
anterior lobe
Pituitary Tumors
,• Most are benign but cause pituitary gland dysfunction
• Primary or secondary, functional or nonfunctional
• Principal types of pituitary tumors represent overgrowth of
• Eosinophilic cells
• Gigantism
• Acromegaly
• Basophilic cells
• Cushing syndrome
• Chromophobic cells
• 90% of pituitary tumors
• Usually produces no hormones but destroys the pituitary gland
• Causes hypopituitarism: obese, loss of libido, lowering of basal metabolic
rate, etc.
Assessment/Diagnostic
• History and Physical Medical/Surgical Management
• Including visual acuity and visual • Hypophysectomy (treatment of choice
fields in Cushing’s)
• CT / MRI • Transsphenoidal, transfrontal,
• Serum levels of pituitary hormones subcranial, oronasal
• Target organ serum hormone levels • Stereotactic radiation therapy
(thyroid, adrenal) • Conventional radiation therapy
• bromocriptine (Parlodel, dopamine
antagonist), octreotide (Sandostatin,
synthetic analog of GH)
*these medications inhibit production or
*** Absence of the pituitary gland alters release of GH
many system functions; menstruation stops, • octreotide and lanreotide (Somastatin
infertility occurs, replacement therapy w/ depot) may be used preop to improve
corticosteroids and thyroid hormone is clinical condition and to shrink the
necessary tumor
Diabetes Insipidus
• Deficiency of ADH (vasopressin)
• Clinical Manifestations
• Output of urine > 250 ml/hr
• Dilute with specific gravity of 1.001-1.005
• No abnormal substances such as glucose, protein
• Excessive thirst 2-20 liters per day (polydipsia)
• Assessment/Diagnostic
• Fluid deprivation test
• Withholding fluid for 8-12 hours or until 3-5% body weight is loss
• Plasma and urine osmolality at beginning and end of test
• Inability to increase urine specific gravity and osmolality is indicative of DI
, • Test terminated if patient becomes tachycardic, hypotensive, or has excessive
weight loss
• Serum levels of ADH (without action of the ADH on the distal nephron of the kidney,
daily output greater than 250ml/hr of very dilute urine occurs)
• Trial of desmopressin and hypertonic IV fluids
• Medical Management (replace ADH, ensure adequate fluid replacement, and
identifying/correct the underlying issue)
• Goals of therapy
• Replace ADH
• Adequate fluid replacement
• Identification and correction of underlying intracranial pathology or nephrogenic
issue
• Pharmacological therapy
• DDAVP- given intranasally once or twice daily
• chlorpropamide and thiazides – potentiate effects of DDAVP
• Nephrogenic form – thiazides, mild salt depletion, and prostaglandin inhibitors
(ibuprofen, ASA, indomethacin)
• Nursing Management
• Physical assessment, patient education, medical bracelet
Syndrome of Inappropriate Antidiuretic Hormone Secretion
• Excessive ADH secretion
• Cannot excrete a dilute urine, retain fluids, and develop dilutional hyponatremia
• May be seen with bronchogenic carcinoma, pneumonia, pneumothorax, head injury, brain
surgery or tumor and infection
• Eliminate underlying cause, if possible
• Fluid restriction
• Furosemide
• Monitor I&O; daily weight; monitor urine and blood chemistries
• Monitor neurologic status
Thyroid Gland
• Largest endocrine gland
• Anterior to the trachea
