Assessing Clients with

Endocrine Disorders

Endocrine Glands and Location

Function of the Endocrine System

• Hormones which are secreted by the endocrine glands regulate growth, reproduction, sex differentiation, metabolism and fluid and electrolyte balance.

• Endocrine system helps the body adapt to constant changes in the internal and external environment

• See table in book

Endocrine System

• Physiology– hormones are chemical messenger that exert

action on target organs– hormone regulate tissue response– levels are controlled by the pituitary gland– negative feedback - sense changes– positive feedback

Hormones

• Hormone levels are regulated by a process called negative feedback.

• Think of the way a thermostat in a house regulates temperature.

• When too much hormone is released, the target cell sends back a message to reduce its hormone release.

• If too little hormone is released, the target cell sends back a message to increase the hormone to the normal level.

• Video

Hypothalamus

• Located in the brain between the cerebrum and the brainstem.

• Pituitary gland is physically attached to the hypothalamus.

• Hypothalamus controls anterior pituitary function by regulating temperature, fluid volume and growth. Responds to pain, pleasure, hunger and thirst stimuli.

Master Gland!!!!!

• Pituitary Gland- also called hypophysis. It’s hormones regulate many different body functions.

• Anterior Lobe- Secretes six different hormones.

• Posterior Lobe- Releases antidiuretic hormone and oxytocin.

• See book

Thyroid Gland

• Shaped like a butterfly sits on either side of the trachea. Has 2 lobes connected by a structure called the isthmus.

• Needs an adequate supply of iodine in order to secrete thyroid hormone.

• Thyroxin-T4

• Triiodothyronine- T3

• Increases metabolism.

• Secretes calcitonin- hormone that decreases excess calcium levels in the blood

Parathyroid Glands

• Four to six glands are embedded on the posterior lobes of the thyroid gland.

• Secretes parathyroid hormone (PTH).

• PTH secretion increases when calcium levels in the plasma fall and it decreases phosphorous levels.

• Normal levels of vitamin D are necessary for PTH to apply this effect.

Adrenal Glands

• Two glands• Pyramid-shaped organs that sit on top of the kidneys.• Adrenal Cortex- Secretes corticosteroids called• Glucocorticoids- Cortisol affects CHO metabolism it raises

blood glucose levels by increasing gluconeogenesis.• Mineralcorticoids- Aldosterone maintains normal salt and

water balance through it’s action on the kidneys. It is released when blood volume or blood pressure falls below normal levels and acts to save sodium and water, which in turn raises blood volume and pressure.

• Androgens are also released by the adrenal cortex.

Adrenal Glands

• Adrenal Medulla- Produces two hormones catecholamines such as epinephrine and norepinephrine . Both of these increase heart rate and the force of heart contractions and constrict blood vessels.

• Released during times of stress and initiate the fight or flight response.

Pancreas

• Two functions

• 1. secretes digestive enzymes into the duodenum

• 2. release insulin and glucagon into the bloodstream

Endocrine System

Assessment of Endocrine Function

• Health Assessment Interview– medical hx, family hx– physical changes - skin, hair, thirst appetite wt.

energy, sleep

• Physical Assessment– Palpation of thyroid– Inspection of skin hair facial appearance

Assessment (cont)• Physical Assessment (continued)

– Reflexes - musculoskeletal system– ht. wt. and v/s– hypocalcemia

• Abnormal findings– skin

• pigmentation

• texture

• purple striae

• lesions on extremities

Hypothyroidism

Hyperthyroidism

Assessment (cont)

– Hair and Nails• hypothyroid - dry, thick, brittle

– hyperandrenocortico function - excessive hair

• hyperthyroid - thin, soft hair

– Facial Assessment• exophthalmos - protruding eyes

– Thyroid Assessment• enlargement, nodules

Assessment (cont)

– Motor functions• reflexes

– increased with hyperthyroidism

– decreased with hypothyroidism

– Sensory function• peripheral neuropathy

– Musculoskeletal• size - growth hormone

Assessment (cont)

• Hypocalcemia Tetany– Trousseau’s sign - carpal spasm

with inflation of B/P cuff

• Chvostek’s sign - tap front of ear in angle of jaw to

elicit facial muscle contraction

Interview Questions?

Interview Questions?