endocrine

• Endocrine system


  A complex network of glands and organs that uses hormones to control and coordinate your body's metabolism, energy level, reproduction, growth and development, and response to injury, stress, and mood
• Glands and organs of the endocrine system

  • Hypothalamus
  • Pineal gland
  • Pituitary gland
  • Thyroid gland
  • Parathyroid glands
  • Thymus
  • Adrenal glands
  • Pancreas
  • Testes
  • Ovaries
  • Placenta (during pregnancy)
• Endocrine problems


  • Cushing Syndrome
  • Addison's Disease
  • Diabetes Mellitus
  • Gigantism
  • Hyperthyroidism
  • Hypothyroidism
  • Polycystic Ovarian Syndrome (PCOS)
• Cushing's Syndrome


  A disorder that occurs when your body makes too much of the hormone cortisol over a long period of time
• Cushing syndrome is rare, affecting 40 to 70 people out of 1 million each year and affecting 25-50 year olds
• Causes of Cushing's Syndrome

  • Tumor of adrenal gland
  • Tumor of pituitary gland
  • Tumor of other organs
  • Extensive use of cortisone meds
  • Administration of ACTH or corticosteroids
  • Excessive secretion of adrenal androgen
• Pathophysiology of Cushing's Syndrome

  1. Ineffective feedback mechanism

  2. Resulting to excess adrenal cortical hormone

  3. Inadequate control of hormone secretion

  4. Hypercortisolism
• Complications of untreated Cushing's Syndrome

  • Infections
  • Blood clots in lower extremities
  • Depression
  • Heart attack
  • Weight gain
  • Memory Problems
  • High blood pressure/high cholesterol
  • Broken bones
  • Type II DM
• Symptoms of Cushing Syndrome

  • Rapid weight gain in the face, abdomen, back of the neck
  • Red, round face
  • Wounds that heal poorly
  • High blood pressure
  • Excessive hair growth on the face, neck, chest, abdomen, breasts and thighs
  • Balding
  • Diabetes
  • Purple stretch marks over the abdomen
  • Easy bruising on the arms and legs
  • General weakness and tiredness
  • Blurry vision and dizziness
  • Weak muscles and thinner arms and legs
  • Libido changes and erectile dysfunction
  • Stunted growth in children
• Diagnostic Exams for Cushing's Syndrome

  • Pituitary or adrenal scans
  • Blood samples (ACTH levels)
  • Physical Examination
  • 24-hr urinary cortisol test
  • Midnight salivary cortisol test
  • Low dose dexamethasone suppression test
• Medical Management of Cushing's Syndrome

  • Chemotherapy
  • Radiation therapy
  • Surgery
  • Steroidogenesis inhibition medications (Metyrapone, Ketoconazole, Mitotane, Aminoglutethimide, Trilostane, Etomidate)
  • Hypothalamic-pituitary neuromodulatory agents (Dopamine agonists, PPAR-g receptor agonists, Somatostatin analogues)
  • Agents blocking cortisol action
• Nursing Management of Cushing's Syndrome

  • Promote rest
  • Health Education
  • Patient safety (protective environment)
  • Monitoring for infection and slow wound healing
  • Promoting balance between rest and activity
  • Maintaining skin integrity
  • Nutritional support for improving body image and safety (Low Carb, Sodium, high protein, calcium and vitamin D diet)
  • Addressing psychosocial issues
  • Monitoring vital signs, including blood pressure and glucose levels
  • Educating patients on medication adherence and potential side effects
  • Promoting a balanced diet and regular exercise to manage weight and blood sugar levels
• Addison's Disease


  A chronic condition in which the adrenal glands don't produce enough of the hormones cortisol and aldosterone
• Addison's disease can affect people of all age groups, but it's most common in people 30 to 50 years old. Addison's disease is rare, affecting 1 in 100,000 people in the United States.
• Causes/Contributory Factors of Addison's Disease

  • Type I DM
  • Pernicious Anemia (lack of B12)
  • Grave's Disease (hyperthyroidism)
  • Chronic Thyroiditis
  • Vitiligo (autoimmune disease)
  • Myasthenia Gravis (chronic neuromuscular disease)
• Pathophysiology of Addison's Disease

  1. Decreased Aldosterone/cortisol production

  2. Destruction of adrenal gland or cortex/other autoimmune diseases including TB
• Signs and Symptoms of Addison's Disease

  • Lassitude
  • Weakness
  • Postural dizziness
  • Nausea and vomiting
  • Abdominal pain
  • Constipation/diarrhea
  • Weight loss
  • Hyperpigmentation (bronzing)
  • Hypotension
  • Vitiligo
  • Craving for salty food
• Medical Management of Addison's Disease

  • Physical Examination
  • Lab review (high K, low Na)
  • ACTH stimulation test
  • CT scan
  • Cortisol replacements usually lifetime (fludrocortisone)
  • Increase Salt intake
  • IV (fluid resuscitation)
  • Hormonal replacement
• Nursing Management of Addison's Disease


  • VS monitoring
  • Safety
  • Prevent Infection
  • Hydration
  • Medication compliance
  • Self-care, including adequate sodium intake in the diet, monitoring weight loss, and blood pressure
  • Get regular checkups with their clinician
  • Understand and be alert for the signs of an Addisonian crisis
• Diabetes Mellitus


  A group of metabolic diseases characterized by increased levels of glucose in the blood (hyperglycemia) resulting from lack of production/secretion, insulin action or both
• It is estimated 29.1 million people in the United States have diabetes, although almost one third of these cases are undiagnosed. The number of people older than 20 years newly diagnosed with diabetes increases by 1.7 million per year.
• If this trend continues, one in every three adults in the United States could have diabetes by 2050. In 2014, the worldwide estimate of the prevalence of diabetes was 422 million people and by 2040, this is expected to increase to more than 642 million.
• Native Americans and persons of Hispanic origin are more likely to develop diabetes. Diabetes can have far-reaching and devastating physical, social, and economic consequences, diabetes is the leading cause nontraumatic amputations, blindness in working-age adults, and end-stage kidney disease (ESKD).
• In 2017, Diabetes is the 6th leading cause of death among Filipinos over the years. In 2021 almost 4 million Filipino adults have diabetes. The Philippines ranked 5th in western Pacific behind China, Indonesia, Japan and Thailand.
• Risk Factors/Causes of Diabetes Mellitus

  • Family history of diabetes
  • Obesity > 20% over desired body weight or body mass index >30 kg/m²
  • Race/ethnicity
  • Age equal to or greater than 45 years
  • Previously identified impaired tasting glucose or impaired glucose tolerance
  • Hypertension (>140/90 mm Hg)
  • High-density lipoprotein (HDL) cholesterol levels <35 mg/dl (0.90 mmol/L) and/or triglyceride level > 250 mg/dL (2.8 mmol/L)
  • History of gestational diabetes or delivery of a baby over 9 lbs
• Classification of Diabetes Mellitus

  • Type 1
  • Type 2
  • Gestational Diabetes
  • Latent Autoimmune Diabetes of Adult
  • Diabetes Associated with other conditions (Pre-diabetes)
• Type 1 Diabetes


  Characterized by the destruction of the pancreatic beta cells, leading to insulin deficiency and diabetic ketoacidosis
• Type 1 diabetes affects approximately 5% of adults. Combined genetic, immunologic, and possibly environmental factors are thought to contribute to beta cell destruction.
• Type 2 Diabetes


  Occurs more commonly among people who are older than 30 years and obese, characterized by insulin resistance and impaired insulin secretion
• Approximately 95% of the adults with diabetes have type 2 diabetes.
• Pathophysiology of Type 2 Diabetes

  1. Insulin resistance leads to increased demand for insulin to maintain normal glucose levels

  2. If the beta cells cannot keep up with the increased demand, glucose level rises and type 2 diabetes develops

  3. Insulin resistance may also lead to metabolic syndrome
• History related to the diagnosis of diabetes

  • Symptoms of hyperglycemia
  • Symptoms of hypoglycemia (frequency, timing, severity, and resolution)
  • Results of blood glucose monitoring
  • Status, symptoms and management of chronic complications of diabetes (eye, kidney, nerve, genitourinary and sexual, bladder, gastrointestinal, cardiac, peripheral vascular)
• The two main problems related to insulin in type 2 diabetes are insulin resistance and impaired insulin secretion
• To overcome insulin resistance and to prevent the buildup of glucose in the blood, increased amounts of insulin must be secreted to maintain the glucose level at a normal or slightly elevated level
• If the beta cells cannot keep up with the increased demand for insulin, the glucose level rises, and type 2 diabetes develops
• Insulin resistance may also lead to metabolic syndrome, which is a constellation of symptoms, including hypertension, hypercholesterolemia, abdominal obesity, and other abnormities
• History related to the diagnosis of diabetes

  • Symptoms of hyperglycemia
  • Symptoms of hypoglycemia (frequency, timing, severity, and resolution)
  • Results of blood glucose monitoring
  • Status, symptoms and management of chronic complications of diabetes: eye, kidney; nerve genitourinary and sexual, bladder, and gastrointestinal
  • Cardiac; peripheral vascular; foot complications associated with diabetes
  • Adherence to/ability to follow prescribed dietary management
  • Adherence to prescribed exercise regimen
  • Adherence to follow pharmacologic regimen
  • Use of tobacco, alcohol and over the counter medication
  • Lifestyle , cultural, economic factors that may affect diabetes treatment
• Laboratory Examination


  • Fasting lipid profile
  • HgbA,c (A1C)
  • Test for microalbuminuria
  • Serum creatinine level
  • Urinalysis
  • Electrocardiogram
• Need for Referrals


  • Ophthalmologist
  • Podiatrist
  • Diabetes educator
  • Dietitian
  • Others if indicated
• Symptoms of diabetes plus casual plasma glucose concentration equal to or greater than 200 mg/dL (11.1 mmol/L). Casual is defined as any time of day without regard to time since the last meal. The classic symptoms of diabetes include polyuria, polydipsia, polyphagia and unexplained weight loss