What is the action of the endocrine system?
- Secrete products directly into the blood stream (hormones)
- Hormones regulate organ function along with the nervous system
- Neuro= fast
- hormonal= slow regulation
- Hormone concentration in blood is usually at a constant level. It is controlled by the negative feedback loop.
What are the general S/S of Endocrine malfunction?
- changes in energy level/fatigue
- changes in heat/cold tolerance
- changes in weight
- changes in sexual function
- changes in secondary sexual characteristics (deep voice, beard, boobs)
- changes in mood, memory, ability to concentrate, and sleep patterns
Pituitary Gland
- Under control of the hypothalamus
- Controls the function of most other endocrine glands
- Contains 2 lobes- anterior and posterior
- Anterior: GH, TSH, ACTH, Follicle stimulating and luteinizing hormones, prolactin, Melanocyte stimulating hormone
- Posterior: Oxytocin and ADH (Vasopressin)
- Although this is the master gland, most hyper/hypo conditions are due to the target gland itself.
Disorders of the Pituitary
- May be due to organic defects or have an idiopathic etiology
- Single hormonal problem or a combination with other hormonal deficiencies
- Clinical manifestations depend upon the hormone involved
- May result in an overproduction or hormone deficiency
Hypopituitary effects what target glands?
Usually the thyroid or the gonads.
Pituitary tumors
- usually benign
- Usually result in overproduction
- If they have surgery
- Watch for spinal fluid coming from eh nose
- Check for glucose in the nasal drainage because spinal fluid has glucose in it.
- Notify the provider immediately
- Surgery to remove tumor is called hypophysectomy
- Diagnose through CT or MRI
- Blood work on: Pituitary hormones, GH
Hormone classification
- Steroids (Hydrocortisone) • Penetrate the cell wall and works with the receptor • Modify cell metabolism • Take a while to work - Peptides (Insulin) • Reacts with the receptor site • Stimulates the cellular environment • Slow acting - Amines (epinephrine) • Fast acting • Works in seconds
Growth Hormone Deficiency
- Consequences depend upon the degree of dysfunction
- Inhibits overall somatic growth, short height (dwarfism) in children
Diagnostic Evaluation: •Family history - Growth patterns and health history - Physical examination - Psychosocial evaluations - Radiographic survey - Endocrine studies
S/S:
- Short in stature
- Bones and muscles not strong
- Weight gain
- Not a lot of energy
- Quality of life is usually not good
- Prone to pathological fractures
Treatment
- Replacement of GH is successful in 80% of affected children. Can be given by the week. Dosage is increased as the time of epiphyseal closure nears. Stop giving once the growth plate closes
Nursing care:
- Identifying and assisting with the diagnosis
- Family support needs
- Emotional adjustment of the child
- Preparation for testing and medication administration
Pituitary Hyperfunction
- Excess GH before closure of epiphyseal shafts results in overgrowth of long bones
- Diagnostic evaluation:
History of excessive growth during childhood•Evidence of increased levels of GH•Radiographic studies•Endocrine studies - S/S: Reach heights of 8 feet or more(Giantism), Vertical growth plus increased muscle, Weight generally in proportion to height. Typical facial features include overgrowth of:–Head–Lips, tongue, jaw, nose–Nasal, mastoid sinuses–Malocclusion of the teeth
- Excess GH after epiphyseal closure is called acromegaly
- Therapeutic management: •Surgical treatment to remove tumor•Radiation and radioactive implants•Hormone replacement therapy after surgery in some cases (Thyroid extract–Cortisones–Sex hormones)
- Nursing Care Management
•Early identification of children with excessive growth rates•Early treatment for improved outcomes•Emotional support•Body image concerns
Precocious Puberty
- Defined as sexual development > age 9 in boys or > age 8 in girls
- Occurs more frequently in girls
- Potential causes: Disorder of gonads, adrenal glands, or hypothalamic-pituitary gonadal axis. 95% of cases have no known causative factor.
- Types
–Central precocious puberty •80% of children with this disorder due to early maturation & development of gonads & secondary sex characteristics
–Peripheral precocious puberty •Premature development of breasts, sexual hair, and menses
Therapeutic management:
- Treatment of specific cause if known
- May be treated with leuprolide (Lupron)–Slows prepubertal growth to normal rates–Treatment is discontinued at age for normal pubertal changes to resume
- Psychologic support for child and family
Diabetes Insipidus (DI)
- The principal disorder of the posterior pituitary
- Results from hyposecretion of ADH
S/S:
- Produces uncontrolled diuresis
- Cardinal signs: polyuria and polydipsia
- First sign often enuresis
- Infants: At risk for dehydration, Constant wet diaper, irritability relieved with feedings of water, but not milk
- Excessive thirst
- Primary causes: familial or idiopathic
- Secondary causes: trauma, tumors, CNS infection, aneurysm
Diagnose
- Withhold fluids for 8-12 hours
- Will have 3-5% weight loss- because they are still peeing
- Check urine and plasma osmolality – will not have changed
- Specific Gravity=urine osmolality
Therapeutic Management:
- Instruct parents in difference between DI and diabetes mellitus
- Daily vasopressin (ADH) replacement
- Drug of choice: DDAVP–Nasal spray or IV administration–Requires treatment for life
Teach:
- Medication
- Pt. to wear a bracelet
- Carry medication with you at all times
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
- Results from oversecretion of the posterior pituitary (increased ADH). Kidneys reabsorb a lot of water
Who is affected:
- Pituitary problems
- Respiratory problem
What can bring it on?
- Pain
- Stress
- Low sugar
Causes:
- Diabetes meds
- Anticonvulsants
- Chemotherapy
- Antipsychotics
- Aspirin and NSAIDs
- Head injury
- Lung cancer
- ***S/S: Fluid retention and hypotonicity, anorexia, nausea/vomiting, irritability, personality changes
- Symptoms disappear when ADH is decreased
- By keeping all of the fluid inside the body, they are diluting the electrolytes causing hyponatremia
- Lower blood osmolality
- Higher urine osmolality
Test: Restrict fluid, lay flat, look at labs
Nursing Management
- Restrict fluids to 1,000mL/day. If severe, restrict to 500mL/day
- Accurate I&O
- Observe for signs of fluid overload
- Seizure precautions
- Administer ADH-antagonizing medications (diuretics and thiazides)
- Child and family education
- Monitor labs for: Potassium, calcium, specific gravity
- Monitor LOC
- Replenish salt
Adrenal Gland
- Acts as 2 different glands
–Medulla (Center) secretes catecholamines: 90% = epinephrine, 10% = norepinephrine, Fight or flight
–Cortex (Outer) secretes steroids
- Glucocorticoid hormone ( hydrocortisone,cortisol)
- Mineral corticoids (aldosterone & sex hormones)
- Without the cortex, stress could cause circulatory collapse
- Survival – nutritional, electrolyte and fluid replacement PLUS replacement of the appropriate adrenocortical hormones
- Aldosterone increases fluid release
Adrenal cortex secretes what three groups of “steroids”?
–Glucocorticoids (cortisol, corticosterone)
–Mineralocorticoids (aldosterone)
–Sex steroids (androgens, estrogens, & progestins)
*Altered levels of these produce significant dysfunction
Adrenal medulla secretes what?
catecholamines: epinephrine and norepinephrine
* Catecholamine-secreting tumors are the primary cause of adrenal medullary hyperfunction
Acute Adrenocortical Insufficiency: Addison’s disease
- Deficiency in all adrenal hormones
- Rare in children
- Etiology – –genetics, cancer, hemorrhage into gland from trauma, fulminating infections, abrupt withdrawal of exogenous cortisone, failure to increase cortisone during times of stress
- Symptoms appear gradually after 90% of adrenal tissue is nonfunctional
S/S:
- Weak, dizzy tired
- Patches of dark skin, bronzing
- Changes in body hair
- Hypoglycemia
- Hypotension
- Wt loss, dehydration
- GI disturbances n/v/d
Diagnosis:
- Check corticotropin- A similar disorder is caused by malfunctioning pituitary gland (Ck corticotropin)
- Check adrenal gland hormone levels- Cannot have any stimulants (coffee, chocolate, nicotine, nasal spray, stress) for 24 hours before blood work- Deficient aldosterone causes increased K and decreased Na
Treatment:
- Need lifelong supplementation of steroids
- DHEA replacement
- Need extra salt
Watch:
- Fluids
- Electrolytes
- Glucose
- Crisis symptoms (abdominal pain, n/v/d, Low B/P->shock, hyperpyrexia, cyanosis, seizures)
Addison’s Disease Crisis
Why it happens:
- Overexertion
- Exposure to cold
- Salt deficiency
Clinical Manifestations
–extreme weakness–mental confusion–darkening of the skin–dizziness–nausea or abdominal pain–vomiting–fever–a sudden pain in the lower back or legs–a loss of appetite–extremely low blood pressure–chills–skin rashes–sweating–a high heart rate–loss of consciousness
Therapy:
- lay patient dow
- give fluids
- give antibiotics in case of infection
- Vasopressin prn
Medications:
–Addisons kit (has cortisone injections for emergency)–typically get an immediate injection of hydrocortisone– 911–can be injected into a muscle or vein.
