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Prepared by: Zyrine M. Salomon,R.N
Assessment and Management of
Patients with Endocrine Disorders
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Definition of HormonesChemical messengers of the body
Act on specific target cells
Regulated by negatie feedbac!
"oo much hormone, then hormone release reduced
"oo little hormone, then hormone release increased
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#ypothalamus
Posterior Pituitary
Anterior Pituitary
"hyroid
Parathyroids
Adrenals
Pancreatic islets
$aries and testes
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Glands of the Endocrine
System
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Hypothalamus
Sits bet%een the cerebrum and brainstem
#ouses the pituitary gland and hypothalamus
Regulates:
"emperature&luid olume
'ro%th
Pain and pleasure response#unger and thirst
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Hypothalamus Hormones
Releasing and inhibiting hormones
Corticotropin(releasing hormone
"hyrotropin(releasing hormone
'ro%th hormone(releasing hormone
'onadotropin(releasing hormone
Somatostatin()(inhibits '# and "S#
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Pituitary Gland
Sits beneath the hypothalamus
"ermed the *master gland+
iided into:
Anterior Pituitary 'landPosterior Pituitary 'land
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Anterior Pituitary Gland
Promotes gro%th
Stimulates the secretion of si- hormones
Controls pigmentation of the s!in
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Anterior Pituitary Gland
Hormones
'ro%th #ormone((Adrenocorticotropic hormone
"hyroid stimulating hormone
&ollicle stimulating hormoneoary in female,
sperm in males
/uteini0ing hormonecorpus luteum in females,
secretion of testosterone in males
Prolactinprepares female breasts for lactation
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Actions of the major hormones of the anterior pituitary.
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Posterior Pituitary Hormones
Antidiuretic #ormone
$-ytocincontraction of uterus, mil! e1ection
from breasts
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Adrenal orte!
Mineralocorticoidaldosterone. Affects sodium
absorption, loss of potassium by !idney
'lucocorticoidscortisol. Affects metabolism,regulates blood sugar leels, affects gro%th, anti(
inflammatory action, decreases effects of stress
Adrenal androgensdehydroepiandrosterone and
androstenedione. Conerted to testosterone in the
periphery.
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Adrenal Medulla
2pinephrine and norepinephrine
sere as neurotransmitters for sympathetic system
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"hyroid Gland
3utterfly shaped
Sits on either side of the trachea
#as t%o lobes connected %ith an isthmus
&unctions in the presence of iodineStimulates the secretion of three hormones
4noled %ith metabolic rate management and
serum calcium leels
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"hyroid
&ollicular cells e-cretion of triiodothyronine 5"67and thyro-ine 5"874ncrease 3MR, increase bone
and calcium turnoer, increase response to
catecholamines, need for fetal '9
"hyroid C cellscalcitonin. /o%ers blood calcium
and phosphate leels
3MR: 3asal Metabolic Rate
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Parathyroid Glands
2mbedded %ithin the posterior lobes of the thyroidgland
Secretion of one hormone
Maintenance of serum calcium leels
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Pancreas
/ocated behind the stomach bet%een the spleenand duodenum
#as t%o ma1or functions
igestie en0ymes
Releases t%o hormones: insulin and glucagon
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Pancreatic Hormones
4nsulin ( a hormone made by the pancreas that allo%s your body touse sugar 5glucose7 from carbohydrates in the food that you eat for
energy or to store glucose for future use. 4nsulin helps !eeps your
blood sugar leel from getting too high 5hyperglycemia7 or too lo%
5hypoglycemia7.
'lucagon stimulates glycogenolysis and
glyconeogenesis
Somatostatin decreases intestinal absorption of
glucose
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#nsulin
Produced by the 3eta cells in the islets of/angerhans
Regulates blood glucose leels
Mechanisms
2ases the actie transport of glucose into muscle and
fat cells
&acilitates fat formation
4nhibits the brea!do%n and moement of stored fat
#elps %ith protein synthesis
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(continued' Action of insulin and glucagon on $lood glucose le%els. &(' Low $lood
glucose is raised $y glucagon release.
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Glucagon
Produced by the alpha cells in the islets of /angerhans
'lucagon released %hen blood glucose falls belo% ;
mg
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Glucagon
Preents blood glucose from decreasing belo% acertain leel
&unctions:
Ma!es ne% glucose
Conerts glycogen into glucose in the lier and
muscles
Preents e-cess glucose brea!do%n
ecreases glucose o-idation and increases blood
glucose
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Adrenal Glands
Pyramid(shaped organs that sit on top of the!idneys
2ach has t%o parts:
$uter Corte-
4nner Medulla
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Adrenal orte!
Secretion of t%o hormones'lucocorticoids: cortisol
Mineralocortocoids: aldosterone
4noled %ith blood glucose leel, anti(
inflammatory response, blood olume, and
electrolyte maintenance
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Adrenal Medulla
Secretion of t%o hormones
2pinephrine
Norepinephrine
4noled %ith the stress response
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)%aries
2strogenProgesteroneinportant in menstrual
cycle,=maintains pregnancy,
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"estes
Androgens, testosteronesecondary se-ualcharacteristics, sperm production
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"hymus
Releases thymosin and thymopoietinAffects maturation of " lymphocetes
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Pineal
MelatoninAffects sleep, fertility and aging
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Prostaglandins
>or! locallyReleased by plasma cells
Affect fertility, blood clotting, body temperature
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M?@22MA C$MA
occasionally called my!edema
crisis* is a rare life+threatening
clinical condition that represents
se%ere hypothyroidism with
physiological DE .compensation
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The condition usually occurs inpatients with long-standing,undiagnosed hypothyroidism and isusually precipitated by infection,cerebrovascular disease, heart failure,trauma, or drug therapy. Patients withmyxedema coma are generallyseverely-ill with signicant
hypothermia and depressed mentalstatus.
M,-EDEMA )MA
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MANAGEMENT:
Air%ay management
( Mechanical ventilation is commonly required during
the first 6!"# hours, $ut some %atients require
%rolonged res%iratory su%%ort for as long as 2! &ee's.
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29/11/201054
ADRENAL CRISIS
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ADRENAL CRISIS
also 'no&n as (ddisonian crisis and
acute adrenal insufficiency, a medical
emergency and %otentially life!threatening
situation requiring immediate emergency
treatment. )t is a constellation of sym%tomsthat indicate severe adrenal insufficiency
caused $y insufficient levels of the hormone
cortisol.
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auses* incidence* and ris
factors/(drenal crisis occurs if the adrenal gland is
deteriorating *(ddison+s disease, %rimary adrenal
insufficiency, if there is %ituitary gland in-ury
*secondary adrenal insufficiency, or if adrenal
insufficiency is not adequately treated.is' factors for adrenal crisis include %hysical stress
such as infection, dehydration, trauma, or surgery,
adrenal gland or %ituitary gland in-ury, and ending
treatment &ith steroids such as %rednisone orhydrocortisone too early.
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MANIFESTATIONS:eadache, Profound &ea'ness, atigue
lo&, sluggish movement, ausea and 3omiting
4o& $lood %ressure, 5ehydration
igh fever, ha'ing chills, onfusion or coma
a%id heart rate, 7oint %ain, ($dominal %ain
8nintentional &eight loss
a%id res%iratory rate *see tachy%nea
8nusual and ecessive s&eating on face and/or %alms
'in rash or lesions may $e %resent
lan' %ain
4oss of a%%etite
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;mergency Management for (ddisonian risisMaintain air&ay, $reathing, and circulation in %atients &ith
adrenal crisis.
8se coma %rotocol *ie, glucose, thiamine, naloone.
8se aggressive volume re%lacement thera%y *detrose 5
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Emergency Management for Addisonian risis
8se detrose
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Emergency Management for Addisonian risis
Bnce the %atient sta$iliCes, usually $y the second day,
the corticosteroid dose may $e reduced and thenta%ered. Bral maintenance can usually $e achieved $y
the fourth or fifth day.
(l&ays treat the underlying %ro$lem that %reci%itated
the crisis. )nfectious etiologies commonly %reci%itateadrenal crisis. ecognition and treatment of causative
factors are crucial as%ects of managing adrenal
hy%ofunction.
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( t $l hi h i hi$it th ff t f d li
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• (eta $locers* which inhi$it the effect of adrenaline,
re!"# $% &'!r e)r# *e)#$%+ 're "'-"& )%. -$# "e
/'re e#) *"'er )"' e" ee *"''. ee" 'e%
)%. re")e. *& "'-$%+ #e re"e)e '/ ) )r#$!")re%&e /r' $.%e& E)"e '/ *e#) *"'er $%"!.e
)#e%'"'" (Te%'r$%, e#'r'"'" (L're'r, T'r'" )%.
r'r)%'"'" (I%.er)", I%%'r)% S$.e e//e# )& $%"!.e
/)#$+!e, !e# #'), e).)e, .$$%e,'%#$)#$'%, .$)rre), $rre+!")r e)r#*e)#, .$//$!"#&
*re)#$%+ )%. -e""$%+ $% #e "$*
• )ther medications #)# "'-er *"''. re!re )& *e
rer$*e. $/ *"''. re!re $ %'# #)*$"$e. -$# )")*"'er )%. *e#) *"'er
Surgery
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Surgery
•#n most cases* the entire adrenal gland with a pheochromocytoma
is remo%ed with laparoscopic* or minimally in%asi%e* surgery.
Surgeon will mae a few small openings through which he or sheinserts wand+lie de%ices e4uipped with %ideo cameras and small
tools.
•"he remaining healthy adrenal gland carries out the functions
normally performed $y two* and $lood pressure usually returns tonormal. #n some unusual situations* such as when the other
adrenal gland has already $een remo%ed* a surgery may $e
considered to e!tract only the tumor and spare some of the healthy
tissue.
•#f a tumor is cancerous &malignant'* surgery may $e effecti%e only
if the tumor and any metastasi5ed tissues are isolated. Howe%er*
e%en if all of the cancerous tissues are not remo%ed* surgery may
limit hormone production and pro%ide some control of $lood
pressure.
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;ERGLCEMIA
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;ERGLCEMIA
a term referring to high blood glucose leels ( the
condition that often leads to a diagnosis of diabetes.
igh $lood glucose levels are the defining feature of
dia$etes, $ut once the disease is diagnosed,
hy%erglycemia is a signal of %oor control over the
condition.
y%erglycemia is defined $y certain high levels of $lood
glucose@
asting levels greater than A.0 mmol/4 *126 mg/d4
:&o!hours %ost%randial *after a meal levels greater than
11.0 mmol/4 *200 mg/d4.
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S t f h l
i
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:hirst and hunger
5ry mouthrequent urination, %articularly at night
:iredness
ecurrent infections, such as thrush
Eeight loss
3ision $lurring.
Symptoms of hyperglycemia/
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C / " $
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C)!e '/ &er+"&e$):
;ating more or eercising less than usual
)nsufficient amount of insulin treatment *more
commonly in cases of ty%e 1 dia$etes
)nsulin resistance in ty%e 2 dia$etes
Psychological and emotional stress:he Fda&n %henomenonF or Fda&n effectF ! an early
morning hormone surge.
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Emergency treatment for se%ere
hyperglycemia
&luid replacement. (dminister fluids — either orally
or through intravenously — until %atient is rehydrated.
:he fluids re%lace those lost through ecessive
urination, as &ell as hel% dilute the ecess sugar in the
$lood.
2lectrolyte replacement. ;lectrolytes are minerals in
the $lood that are necessary for the tissues to function
%ro%erly. :he a$sence of insulin can lo&er the level of
several electrolytes in the $lood.
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Thank You !!
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Never Stop Learning,because life never
stops teaching…- Zyrine Salomon
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