Pancreas

Lies behind stomach

Endocrine & Exocrine

Endocrine (Islets of Langerhans)

--Insulin (Beta Cells) = BI → ↓ sugar levels

--Glucagon (Alpha Cells) = AG → ↑ sugar levels

--Somatostatin (Delta Cells) = BRAKES

Exocrine

--Secretion of digestive enzymes through ducts that empty into

duodenum.

Adrenal Glands

Tent shaped organs on top of kidneys

Cortex and Medulla

Cortex (Rt. Kidney) Medulla (Lt. Kidney)

Mineralcorticoids (Aldosterone)

Corticosteroids (Glucocorticoids:

Carbs, Proteins, Fat Metabolism)

Catecholamines (“Fight or Flight”)

--Norepinephrine

--Epinephrine

Hormones

Radioimmunoassay tests hormones in the blood. It is sensitive & specific that uses

radiolabeled and unlabeled substances in an immunological (antibody-antigen) reaction.

M G O A T F L A P

M

E

L

A

N

I

N

G

H O

X

Y

T

O

C

I

N

A

D

H

T

S

H

↑

priority

F

S

H

L

H A

C

T

H

P

R

L

PP PP

A.P. ADDISON’S A.P

↓ (Hypocortisolism) ↓

A.P. CUSHING’S A.P.

↑ (Hypercortisolism) ↑

Cause/s: Adrenal Gland Hypofunction

--Primary: TB, Autoimmune, Cancer

--Secondary: Sudden stop of prednisone

(most common), Hypophysectomy,

Pituitary tumors, Crisis → Stress → can

be Life Threatening

Assessment: --S/S: Fatigue, N/V,

Diarrhea, ↑ pigmentation (Bronze Skin),

Vitiligo (↓ pigment), Weak muscles, Joint

Pain, ↓ BP, ↓ Wt., ↓ H20 (Hypovolemia).

–Labs: ↓ Na+ (Hyponatremia) = Salt

Crave, ↑ K+, ↓ Glucose, ↑ Ca+, ↓ H &H,

↑ BUN

Interventions: -- Hormones, -- Give Salt,

-- VS q 1 – 4 hrs., -- ↑ H20 intake, Wt. q

d, I & O-- Give Florinef & Prednisone

Cause/s:

--Cortisol = 𝑶𝒖𝒕𝒔𝒊𝒅𝒆 →𝐶𝑜𝑟𝑡𝑖𝑠𝑜𝑙 𝐷𝑟𝑢𝑔𝑠

𝑰𝒏𝒔𝒊𝒅𝒆 →𝑇𝑢𝑚𝑜𝑟

--Think AIRBAG → Too much cushion

smothers you.

Assessment: -- S/S: ↑ Wt., ↑ BP, ↑ H20

(Hypervolemia), Buffalo Hump, Moon Face,

Hirtutism (Fine Hair), Large Trunk w/Thin

arms, Ecchymosis (Bruising), Skin Blotches,

Marrow Loss/Thin Bones, Amenorrhea,

Anemia, “Stretch Marks.” – Labs: ↑ Na+

(Hypernatremia), ↓ K+, ↑ Glucose, ↓ Ca+, ↑

Aldosterone, ↓ RBC, ↓ WBC

Interventions: -- Stay away from people d/t ↑

risk of infection, -- Iron, Weekly lab, ↑ Ca+, ↑

Vit. D, ↑ Protein. ↓ Na + & H20, ↓ Carbs.

CUSHING’S Disease (Hypercortisolism)

Surgical Management

HYPOPHYSECTOMY

--Remove Pituitary Gland/Adenoma

--Transphenoidal → incision ↑ lip,

--Transfrontal Craniotomy → if

tumor large

ADRENALECTOMY

--Bilat.: N/V → Go to ED → Cannot

lose cortisol replacement therapy

--Adrenal gland/tumor removed

--Unilateral or Bilateral

PRE-OP POST-OP

-- Correct fluid imbalance -- CCU → Monitor for shock, VS

-- Give Glucocorticoid prep before/during -- Bilat. → Lifelong gluco/mineral

SX to stop adrenal crisis. -- Unilat. → 2 yr. replacement

More

HYDROCORTISOLISM

Congenital Adrenogenital Syndrome

Severe Form → 2 – 3 weeks after birth

for S/S → poor feeding, vomiting,

dehydration, Dysrrhythmias (Assess

Telemetry Reading), Electrolyte ’s

Girls → ↑ Hair, Enlarged clitoris

Boys → Enlarged penis w/normal

testes, Deep voice

Pheochromocytoma

Tumors → Epinephrine/Norepinephrine

Cause → Unknown, Inherited, on Hippel-

Lindau Disease

S/S → H/A’s, Palpitations, Extreme

Diaphoresis, Flushing, Apprehension, CP, Abd,

Pain, N/V, HTN Crisis → 180/110 or ↑.

Interventions → Unilateral or Bilateral

Adenalectomy, Ø Abd. Auscutation, palpating,

or percussion. POST-OP → Nutrition,

Comfort, Adequate Tissue Perfusion

DX Tests → 24 hr. urine w/↑ of VMA, MRI, or

CT

ADDISON’S vs CUSHING’S

Mnemonic

Some People Get Colds

(Sodium, Potassium, Glucose, Calcium)

ADDISON’S

Addison’s [Start w/D ↓]

CUSHING’S

Cushing’s [IC = Start w/C ↑]

S = ↓

P = ↑

G = ↓

C = ↑

S = ↑

P = ↓

G = ↑

C = ↓

A.P. HYPOpituitarism A.P. A.P. HYPERpituitarism A.P.

Causes: Tumors, Fast Wt. ↓,

Hypotention, Malnutrition, Shock, Head-

Trauma, Infection, Radiation, Head/Brain

SX, AIDS, Idiopathic Hypo Pit

Assessment: --S/S: ↓ Hair, ↓ BP, Cachexia

(muscle waste), Men: ↓ Libido/Impotence,

Women: Ø period, Dry Skin, ↓ Breast Sz.,

Dyspaunia (painful sex), H/A’s, Dwarfism,

Simmonds Disease (complete pit atrophy, Ø

thyroid function), Sheehan’s Syndrome

(postpartum Hypo), Visual Acuity, peripheral

vision, Diplopia, ↓ eye movement, --Lab: ↓

T3, ↓ T4, ↓ ACTH & TSH → most life

threatening, ↓ LH & FSH (sex hormones), ↓

Testosterone, ↓ Estradiol

Interventions: Androgen and

Estradiol → thrombus w/smoker for

life

Causes: Tumors/Hyperplasia, --Genetics

→ Multiple Endocrine Neoplasia, --

Pituitary Adenoma → most common,

benign tumor, prolactin-secreting tumor:

most common pit adenoma, inhibits sex

hormones (galactorrhea, amenorrhea,

infertility)

Assessment: Gigantism, Acromegaly, ↑

GH, Arthralgias, H/A’s, ↑ body part sizes

(face, hands, feet), ↑ PRL, ↓ sex function

Interventions: Ask about ’s in size,

Fatigue, Lethargy, Parlodel – causes Ortho

Hypotension & Constipation → ↑ Fiber, Start

↓ & ↑, Give w/meals; Sandostatin – inhibits

GH thru Neg. Feedback; Radiation – Too

slow; Gamma Knife - ↑ accuracy of radiation

therapy

More

HYPERPITUITARISM

Surgery TX: HYPOPHYSECTOMY

--Removes pituitary gland & tumor

POST-OP

--Monitor: Neuro q hr. x 1st 24 hrs., then q 4 hrs

--Assess: postnasal drip/drainage ( for presence of glucose → call HCP ASAP

if +, ↑ HOB, Ø coughing or bending, Ø bowel straining, hormone replacement

started ASAP (Vasopressin (ADH), assess for Meningitis

--Educate: Ø toothbrushing, ↓ sense of smell for 3 – 4 mos., Incision

numbness. Report clear or yellow drainage from the nose or incision site.

A.P. HYPOthyroidism A.P. A.P. HYPERthyroidism A.P. Most Common Cause of HYPO =

Hashimoto’s Disease

Hypometabolism = SLOW Primary → most common -

Body attacks self; Secondary – Hormones fail;

Tertiary – Hypothalamus fails

S/S: ↓ energy, Fluid imbalance, COLD

intolerance, Hypoxia → monitor ABG’s,

Cretnism, Myxedema (non-pitting edema that

forms everywhere) coma, Dysrrhthmias, ↑ acid

in lungs, ↓ GI → constipation, AMS, ↓ urine,

↓ HR, ↓ BP, May have Metabolic Acidosis or

Respiratory Acidosis Labs: ↓ T3, ↓ T4, ↑ Ca+, ↓ Vit. D, ↓ Na+

Interventions: Hold BP meds, Ø Beta-

Blockers, Vent support, Dysrrythmias,

Warm w/blankets, ↑ Fiber d/t constipation,

Give stool softener, ↑ veggies, ↑ H2O, Give

Vit. D, ↓ Natural Iodine, Monitor: I & O &

Wt., Drugs: Give Synthroid

A.P. → TSH → Antibodies attack Thyroid →

Thyrotoxicosis

Grave’s Disease

Hypermetabolism = FAST

Most Common & Autoimmune

S/S: Report ASAP → Palpitations, CP,

Vertigo; ↑ HR (bounding), Other S/S: ↑ BP,

Dyspnea, Irritable/Depressed, ↑ energy,

HEAT intolerance, ↑ GI → Diarrhea, ↑ urine,

↑ appetite Pretibial Myxedema, Goiter, Bruits,

Exopthalmos – “Big Eyes”

Labs: ↑ T3, ↑ T4, ↓ Ca+, Calcitonin out of

body/into bone

Interventions: Monitor VS q 4 hrs., ↓

stimulation, Promote comfort; ↑ Calories,

Proteins, & Carbs. Drugs: Give PTU, Iodine

prep prior to SX, Inderol, Tapazole → ↓ T3 &

T4 production → Call HCP if S/S of fever or

sore throat, → divided doses; take w/meals

Important Endocrine System

Lab Values

Lab Test Normal Reference Interval

BUN 8 – 25 mg/dL

Creatinine 0.6 – 1.3 mg/dL

Potassium 3.5 – 5.0 mEq/L

Sodium 135 – 145 mEq/L

WBC 4500 – 11,000 cells/mm³

Magnesium 1.6 – 2.6 mg/dL

Phosphorus 2.7 – 4.5 mg/dL

Calcium 8.6 – 10 mg/dL

A.P. HYPOthyroidism A.P. A.P. HYPERthyroidism A.P. SYNTHROID – Thyroid Hormone

Replacement

--Start w/↓ dose & ↑ dose q 1 – 3 weeks

--Can Take 1 – 2 mos. to work

--Watch for HTN, ↑ HR, Dyspnea

A-Fib on Warfarin → Synthroid can ↑

effect of this → ↑ risk of bleeding

↑ Insulin need, ↑ Digoxin need, ↑ risk of

kidney stones d/t Ca+ out of bone

Report: CP and Dyspnea

Take as ordered

Frequent Labs

DX Made By: Thyroid Scan, US,

ECG

Drug: SSKI”s (Atomic Bomb –

Potassium Iodide Solution; not tabs)

→ TSH Stopped → Has Iodine in it

TX: RAI → most common →

parafollicular cells, Ø use in

pregnancy, May take 6 – 8 weeks to

work

Monitor for: S/S of Hypothyroidism CRETNISM– Retarded physical & mental

development; Iodine Replacement ASAP

prior to or @ birth S/S: Dwarfism, Puffy face, Lg. tongue,

Umbilical Hernia, Muscle incoordination

Most Common in Ecquador & Himalyas

THYROIDECTOMY Subtotal – Corrects Goiter → only a portion of Thyroid

Total – Cancers, Lifelong Thyroid Replacement

POST-OP – Hemmorhage: 1st 24 hrs., Drainage ↑ 50 mL

in 1st 24 hrs. → call HCP, Support head & neck w/pillows, Cough & Deep breathe, Resp. Distress,

Tetany: Chvostek’s, Laryngeal Nerve Damage

Thyroid Storm

“Hyperthyroidism”

Cause/s: Infection, Trauma,

Emotional Stressor

Key S/S: Fever, Tachycardia,

Systolic HTN

Other S/S: Extreme ↑ BP,

Dysrrhythmias, Extreme Heat

Intolerance

**LIFE THREATENING**

Interventions:

--Patent Airway

--Give Beta-Blockers

--Antihypertensive Drugs

--Ø ASA – releases Thyroxine &

more hormones, so HOLD ASA

--Monitor Neuro (confused)

Thyroiditis

Acute

(Bacterial Infection)

Sub-Acute

(Viral Infection-

Granulomatous)

Chronic

(Hashimoto’s)

S/S: Neck

pain/tenderness,

Malaise, Fever,

Dysphagia.

TX: Resolves

w/Antibiotics

Happens after Cold or

URI

S/S: Fever, Chills,

Dysphagia, Muscle/Joint

Pain, Pain that radiates

to ears/jaw, Hard &

Enlarged Thyroid Gland

**Normal Thyroid

Function**

**Most Common

Hypothyroidism**

Autoimmune, ↓ Thyroid

hormone, ↑ TSH

S/S: Dysphagia, Painless

Enlargement of Thyroid

gland

DX: Based on circulating

antithyroid antibodies and

needle biopsy of thyroid.

TX: Thyroid hormone

prevents Hypothyroid &

Suppresses TSH; Possible

subtotal thyroidectomy

Parathyroid = Ca+ & Phosphate Balance

PTH = Kidneys; Ca+ Resorption & ↑ Phosphate Out

HYPOparathyroidism HYPERparathyroidism

↓ PTH on Target; ↓ Ca+

RARE DX 3 Types:

--Iatrogenic: Most common from

removal of all parathyroid tissue

--Idiopathic: Spontaneous

--Hypomagnesemia: ↓ serum Magnesium

→ malabsorption, chronic kidney disease,

malnutrition

Assessment: for Hypocalcemia

w/Chvostek Sign and Trousseau Sign

Intervention: Correct ↓ Ca+, ↓ Vit. D,

& ↓ Magnesium

↑ PTH (Hyperphosphatemia) ↑ Bone

Reabsorption (Hypercalcemia)

Bone Loss of Ca+

Benign Tumor in 1 parathyroid gland →

most common --↓ Osteoblastic (Bone Production) activity

--↑ Osteoclastic (Bone Destruction) activity

S/S: Bone Fx’s, ↓ Wt., Arthritis,

Constipation, Epigastric Pain, Fatigue,

Lethargy

TX: Parathyroidectomy, Diuretic &

Hydration, Monitor: Cardiac, I & O, Stop

Injury, Phosphates, Calcitonin, &

Hypocalcemia, Drugs → Mithromycin

Thyroid Cancers

Papillary Follicular Medullary Anaplastic

*Most Common

--More in

younger women

--Slow Growing

--Slow Spreading

--Lymph Nodes

1st

--Survival %

Good

TX: Partial/Total

Thyroidectomy

--Older Patients

--Spreads: Blood

vessels, Bone, &

Lung Tissue

--S/S: Dyspnea,

Dysphagia d/t

tumor → trachea,

neck muscles,

great vessels, &

skin

Hoarseness, if

laryngeal nerves

involved

TX: Same as Papillary

↑ 50 yrs.

--Often part of

Multiple

Endocrine

Neoplasia Type II

--Familial D/O

--Tumor

Secretes:

Calcitonin,

ACTH,

Prostaglandins,

Serotonin

TX: Same as

Papillary

--Rapid Growing

--Aggressive

--Invades nearby

structures

S/S: Stridor,

Hoarseness,

Dysphagia

TX: Radiation →

usually already

metastasized

P.P. ↓ SI ADH P.P. ↓ P.P. ↑ DI ADH P.P. ↑

↑ ADH → PP ↓ (PP to body, not in potty)

Hemodilution d/t ↑ H20 in body

Causes: Head Trauma, CV Disease, TB,

Cancer

S/S: **Fluid Overload**, ↓ urine, ↑ H2O,

Bounding Pulse, ↑ BP, ↓ HR, JVD, H/A,

N/V, ↑ Wt., ↓ appetite, in LOC, Fatigue,

Hypothermia, Dark Urine

Labs: ↓ Na+ (Hyponatremia), ↑ Urine

Osmo, ↑ Urine SG = ≥ 1.03

Interventions: ↓ Fluids, Replace Na+,

3% NaCl, ↓ Noise & Light; Drugs:

Declomycin, Vasopressin Antagonist →

Samsca, Vaprisol

Monitor for: Pulmonary Edema, Neuro

↓ ADH → PP ↑ (PP to potty, not in body)

Hemoconcentration d/t ↓ H2O in body

Classifications: --Nephrogenic: inherited, ↓

kidney response, Primary: hypothalamus &

Pituitary Deficiency, Secondary: other

disease, Tumor, Drug Related→Lithium &

Declomycin

S/S: ↑ HR, ↓ BP, ↓ pulse pressure, ↑ Urine

(Polyuria) ≥ 4 L & ≥ than intake, ↑ thirst

(Polydipsia), ↑ hunger (Polyphagia), weak &

thready pulse, poor skin turgor d/t

dehydration, syncope (dizziness), Hypovolemia

Labs: ↓ Urine SG = ≤ 1.005, ↓ Urine Osmo, ↑

Na+

Interventions: Strict I/O, Restrict Fluids,

SG, Wt. q d, Med. Alert bracelet; Drugs:

Diabinese, DDAVP (Desmopressin) → ↓

fluids, sit ↑, Test: Hypertonic Saline test (24

hr.) Urine Collection → Circadian rhythm

Lab Values

Thyroid Disease

Hypo Hyper

T3 Decreased ≤ 70 mg/dL Increased ≥ 205 mg/dL

T4 Decreased ≤ 4 mcg/dL Increased ≥ 12 mcg/dL

T3Ru Decreased ≤ 24% Increased ≥ 30%

TSH

0.3-5.0 (WNL)

High in Primary DX

Low in Secondary or

Tertiary DX

Low in Graves DX

High in

Secondary/Tertiary DX

TSH-RAb

≤ 130% (WNL) No Response No Response