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NURSING OF ADULTS (NURS 3561) Chapter 52 Notes - Endocrine Disorders

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John Marsh
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Chapter 52 notes – endocrine disorders

The University of Texas at Arlington

NURSING OF ADULTS (NURS 3561)

CHAPTER 52 – ENDOCRINE SYSTEM
Endocrine system involves the release of hormones
Hormones aren’t only produced by endocrine glands but also specialized tissues e.g. GI mucosa
produces hormones like gastrin, secretin; kidneys produce erythropoietin. Neurotransmitters can
also act like hormones.
The rapid action of nervous system is balanced by slower hormonal action
Diagnostic tests
Stimulation tests – to confirm hypo function of an organ
Suppression tests – to detect hyper function of an organ
Glands of the endocrine system
1. Pituitary gland
2. Thyroid gland
3. Parathyroid gland
4. Adrenal gland
5. Pancreatic islets
6. Ovaries
7. Testes
2
PITUITARY GLANDS
Also known as hypophysis
Is a master gland because it affects secretion of hormones by other glands
Two lobes: anterior & posterior
Hypophysectomy
– Removal of pituitary gland through an endoscopic transnasal approach
– Don’t brush teeth, blow nose or bend at the waist postop (can lead to IICP)
– Monitor drainage (glucose or clear white means CSF)
– Encourage deep breathing but no coughing
ANTERIOR PITUITARY
Hypothalamus releases releasing factors  pituitary portal blood system  hormones secreted
by anterior pituitary
Major hormones: FSH, LH, Prolactin, ACTH, TSH & GH
Main function of FSH, LH, ACTH & TSH is to release hormones from other glands
Oversecretion of anterior pituitary commonly involves ACTH or GH and results in Cushing
syndrome or acromegaly
Under secretion usually involves all hormones & is called panhypopituitarism
POSTERIOR PITUITARY
Hormones include vasopressin (ADH) and oxytocin
These hormones are produced in the hypothalamus & travel to the posterior pit for storage
3
Diabetes insipidus
Caused by deficiency of ADH
Types:
– Primary neurogenic: defects in hypothalamus or pituitary gland
– Secondary neurogenic: infections, tumors or trauma near hypothalamus or pituitary
gland
– Nephrogenic: renal tubules don’t react to ADH (kidney damage, meds like lithium or
demeclocycline)
Symptoms: polydipsia (2-20 L/day), polyuria (urine output 4-30 L), tachycardia, hypotension,
dry membranes
Lab findings:
– DILUTE urine
– CONCENTRATED blood
Diagnostic tests
Fluid deprivation test
– Withhold fluids for 8-12 hours till 3-5% body weight is lost.
– SQ vasopressin  produces urine with increased specific gravity
– If urine does become more concentrated  neurogenic
– If urine doesn’t become concentrated  nephrogenic DI or psychogenic polydipsia
– Plasma and urine studies should be done at the beginning & end of test
– Inability to increase specific gravity & osmolarity are signs of DI
– Stop if more than 2 kgs lost
Treatment
1. Ensure adequate fluid replacement
2. Replace ADH – Desmopressin, a synthetic ADH administered intranasally, orally or
parenterally w/o vascular effects & longer duration.
3. Diuretics like thiazide to facilitate vasopressin action (for neurogenic DI)
4. Correct the underlying pathology
5. May need laxatives
6. Avoid trauma to oral mucosa
Give vasopressin with caution  can cause vasoconstriction in people with CAD + monitor for
water intoxication

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NURSING OF ADULTS (NURS 3561) Chapter 52 Notes - Endocrine Disorders

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