phrm 11 endocrine

• Hypothalamus


  The almond-sized hypothalamus is located below the thalamus and sits just above the brainstem. All vertebrate brains have a hypothalamus. Its primary function is to maintain homeostasis (stability of the internal environment) in the body. The hypothalamus links the nervous and endocrine systems by way of the pituitary gland. Its function is to secrete releasing hormones and inhibiting hormones that stimulate or inhibit production of hormones in the anterior pituitary. Specialized neuron clusters called neurosecretory cells in the hypothalamus produce the hormones Antidiuretic Hormone (ADH) and Oxytocin (OXT), and transport them to the pituitary, where they are stored for later release.
• Pituitary gland


  A pea-sized, reddish-gray body that stores hormones from the hypothalamus and releases them into the bloodstream. Pituitary gland is often called the "Master Gland" because its hormones control other parts of the endocrine system, namely the thyroid gland, adrenal glands, ovaries, and testes. Pituitary gland consist of 2 different lobe: Anterior lobe (adenohypophysis) and Posterior lobe (neurohypophysis). Anterior pituitary hormones are produced by separate group of cells: Somatotrophs (human growth hormones), Lactotrophs (prolactin), Gonadotrophs (FSH and LH), Corticotrophs (ACTH and MSH), and Thyrotrophs (TSH). Posterior lobe: vasopressin and oxytocin.
• Pituitary disorders


  • Pituitary disorders can cause a range of symptoms. They can also be challenging to diagnose. The pituitary gland may raise or lower one or more hormones. A hormone imbalance can cause physical or mood changes. At the same time, pituitary disorders often develop slowly. It may take a long time until you notice symptoms. Symptoms of pituitary disorders are similar to those of other diseases. Many people are misdiagnosed or go undiagnosed.
• Causes of pituitary disorders

  • Tumors, mostly non-cancerous pituitary tumors
  • Head injury
  • Bleeding in or near the pituitary gland
  • Some medications and cancer treatments
• Common pituitary disorders


  • Posterior pituitary disorders: Diabetes insipidus, Empty Sella Syndrome
  • Anterior pituitary disorders: Acromegaly, Cushing's syndrome, Hypopituitarism, Tumors or Pituitary Adenomas
• Signs and symptoms of pituitary disorders


  • Anxiety or depression
  • Diabetes
  • Hair loss
  • High blood pressure
  • Irregular menstrual periods
  • Unexpected breast milk production
  • Low energy or low sex drive
  • Stunted growth or unusual growth spurts
  • Unexplained weight gain
  • Vision changes
• Anterior pituitary hormone drugs


  • Growth hormone agonists: somatropin
  • Growth hormone antagonists: bromocriptine, lantreolide, octreotide, pegvisomant
  • Other Drugs Affecting Anterior Pituitary Hormones: Chorionic gonadotropin, corticotropin, cosyntropin, menotropin, thyrotropin alfa
• Posterior pituitary hormone drugs


  • Drugs Affecting Posterior Pituitary Hormones: conivaptan, desmopressin, tolvaptan
• Somatropin


  Some brands can be given IM or under the skin. Indications: Growth failure, Growth hormone deficiency, Intestinal disorder (short bowel syndrome), HIV-related weight loss or wasting, To increase height in children with certain disorders such as Noonan syndrome, Turner syndrome, idiopathic short stature. Side effects: Headache, Nausea, Vomiting, Tiredness, Muscle pain, Weakness. Serious side effects: Nausea/vomiting that doesn't stop, Development of limp, Unusual tiredness, Unexplained weight gain, Cold intolerance, Fast/slow heart beat, Ear pain, Hearing problems, Joint/hip/knee problems, Numbness/tingling, Increase in thirst and urination, Swelling hands/ankles/feet, Change in appearance or size of any mole, Abdominal pain.
• Pegvisomant


  A growth hormone receptor antagonist. Indication: Acromegaly (too much growth hormone in the body). Side effects: Bleeding/blistering/burning/coldness or discoloration of skin at site of injection, Bloating/swelling of face, arms, hands, lower legs or feet, Blurred vision, Chest pain, Chills, Cough, Dizziness, Feeling of pressure, Fever, Headache, Hives, Hoarseness, Nervousness, Lower back or side pain, Painful urination, Rapid weight gain, Pounding in the ears, Slow or rapid heart beat, Tingling of hands or feet, Infection/lump at the site of injection.
• Bromocriptine


  Drug to lower hormone levels (dopamine agonist); may help lower levels of GH and IGF-1 in some people. These drugs may also help decrease tumor size. Activates dopamine receptors in the CNS. Decreases prolactin secretion. Indications: Tumor, Acromegaly, Tremors in Parkinsonism, Infertility in hyperprolactinemia. Side effects: Nausea, Vomiting, Stuffy nose, Tiredness, Dizziness, Sleep problems, Mood changes, Confusion, Hallucination, Nightmares, Burning eyes, Pulmonary infiltrates, Effusions, Hypotension, Anorexia, Dry mouth, Metallic taste, Urticaria, Leg cramps, Digital vasospasm in acromegaly.
• Somatostatin analogues (Lantreotide, Octreotide)

  Taking one of these drugs signals the pituitary gland to produce less GH, and may even reduce the size of the pituitary tumor. Indications: Pituitary tumors, Acromegaly. Side effects: Blurred vision, Gaseous abdominal or stomach pain, Headache, Lightheadedness, dizziness, or fainting, Recurrent fever, Slow, fast, or irregular heartbeat, Stomach fullness, Troubled breathing with exertion.
• Antidiuretic hormone (ADH)


  ADH is used to regulate the body's fluid balance. This hormone works with the kidneys to manage the amount of water released from the body and in general, decreases the production of urine. It is often administered to treat certain medical conditions, including diabetes insipidus, bleeding disorders and bedwetting problems. ADH, otherwise known as vasopressin or arginine vasopressin (AVP), is a peptide hormone produced in the hypothalamus gland and stored in the pituitary gland. ADH regulates how the kidneys concentrate urine or retain water. It turn, by regulating water retention in the body, ADH helps manage blood pressure and fluid volume.
• Antidiuretic hormone (ADH) effects

  This hormone promotes the reabsorption of water in the kidneys and decreases the excretion of water in the urine. In other words, ADH helps conserve the fluid volume in the body and decreases water dilution of the urine caused by certain health conditions. This results in more water volume in the bloodstream, more concentrated urine, and less water loss. Higher levels of antidiuretic hormone can cause blood vessels to constrict, which increases blood pressure, and is especially useful for treating hypovolemic shock. In the case of diabetes insipidus, low ADH levels can result in excessive urination and thirst. Large amounts of water are then lost through urination and can lead to a depletion of body fluid (dehydration). Desmopressin, which is a synthetic and more potent version of vasopressin, is a first-line therapy for diabetes insipidus.
• Antidiuretic hormone (ADH) drugs

  vasopressin, desmopressin. Indications: Diabetes insipidus, Von Willebrand's disease, Hemophilia A, Abdominal distension before an X-ray of after surgery, Enuresis (bedwetting), Nocturia (excessive nighttime urination). Side effects: Nausea, Vomiting, Diarrhea, Stomach pain, Indigestion, Weakness, Headache, Dizziness, Flushing, Loss appetite. More severe but rare symptoms: Low sodium levels, Mental and mood changes, Allergic reaction. Black box warning: it can cause hyponatremia (low sodium levels). Patients with an increased risk of severe hyponatremia should not take desmopressin. Serum sodium concentrations should be measured before starting desmopressin and monitored during the treatment course.
• Thyroid gland


  The thyroid gland is a small organ, about 2-inch long, that's located in the front of the neck, wrapped around the windpipe (trachea). It's shaped like a butterfly, smaller in the middle with two wide wings that extend around the side of the throat. The thyroid makes hormones that help control many vital functions of the body.
• Hyperthyroidism


  When the body makes too much thyroid hormone, a condition called hyperthyroidism develops.
• Hypothyroidism


  If the body makes too little thyroid hormone, hypothyroidism develops.
• Thyroid gland functions


  Metabolism – breaks down what we eat to make energy. They affect how deep we breathe, how fast our heart beats, gaining or losing weight. Control our body temperature, cholesterol levels and menstrual cycle.
• Causes of hyperthyroidism


  • Graves' disease
  • Thyroid nodules
  • Thyroiditis
  • Consuming excess iodine
• Graves' disease


  An autoimmune condition that causes hyperthyroidism
• Graves' disease is more common in people assigned female at birth than people assigned male at birth
• Graves' disease is the most common cause of hyperthyroidism, making up about 85% of cases
• Thyroid nodule


  A lump or growth of cells in the thyroid gland that can produce more hormones than the body needs
• Thyroid nodules are rarely cancerous
• Thyroiditis


  Inflammation of the thyroid gland, which may be painful or painless (silent)
• Postpartum thyroiditis


  Thyroiditis that happens within a year of delivering a baby
• After experiencing thyroiditis, the thyroid may be unable to recover, which would lead to hypothyroidism
• Consuming excess iodine


  Can cause the thyroid to produce more thyroid hormone if the person is at risk for hyperthyroidism
• Receiving intravenous iodinated contrast (iodine "dye") may also cause hyperthyroidism
• The medication amiodarone, which contains a high amount of iodine, may also cause hyperthyroidism
• Thionamides - they stop the thyroid from producing excess hormones


  • carbimazole
  • propylthiouracil
• Thionamides


  • Used to treat hyperthyroidism
  • Can cause side effects like nausea, high temperature, headaches, aching joints, altered taste, upset stomach, itchy rash, drowsiness
• Thionamides - less common but more serious side effects


  • Decrease in white blood cell count (agranulocytosis)
  • Hepatotoxicity
  • Pancreatitis
  • Edema
  • Vasculitis
• Nursing responsibilities for patients taking thionamides

  1. Advise patient to avoid crowded places, observe personal hygiene and proper handwashing

  2. If patient develops sore throat, persistent cough and increase in temperature, report to physician right away

  3. Arrange for a white blood cell count test

  4. Monitor blood thyroid hormone levels periodically

  5. Monitor for adverse effects and report to doctor right away

  6. Obtain weight daily

  7. Monitor heart rate and blood pressure

  8. Advise patient to avoid driving and other activities that may require alertness

  9. Use with caution in first trimester of pregnancy and when breastfeeding
• Hypothyroidism


  A condition where the thyroid gland does not produce enough thyroid hormones
• Primary cause of hypothyroidism

  A condition that directly impacts the thyroid and causes it to create low levels of thyroid hormones
• Secondary cause of hypothyroidism

  Something that causes the pituitary gland to fail, which means it can't send thyroid stimulating hormone (TSH) to the thyroid to balance out the thyroid hormones
• Hashimoto's disease


  An autoimmune condition that is the most common primary cause of hypothyroidism, where the body's immune system attacks and damages the thyroid
• Other primary causes of hypothyroidism

  • Thyroiditis (inflammation of the thyroid)
  • Treatment of hyperthyroidism (radiation and surgical removal of the thyroid)
  • Iodine deficiency
  • Hereditary conditions