Endocrine

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Endocrine

• BS Chapter 12

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The Endocrine System

• Consists of a group of glands that make hormones

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Endocrine vs. exocrine

• Exocrine has tubes and ducts
• Endocrine is ductless, hormones travel
  magically through the body this way
• Pancreas is the only exocrine and endocrine
  organ. It releases pancreatic enzyme for
  digestion in exocrineand releases insulin for
  blood sugar in endocrine

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Nervous system Endocrine system

• These 2 systems work together to control and
  coordinate all other systems in the body

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Hormones

• Are chemical messengers that control specific
  cells or organs in the body
• Hormones regulate growth, metabolism,
  reproduction and behavior

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Target Tissue

• Depending on what cells affect which hormones is
  referred to as target tissue, for example,
• Growth hormone affects many tissues that grow,
  without growth hormone, a person will not grow
  properly
• Thyroid hormone acts only on the thyroid gland

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8 Endocrine Glands

• Refer to next slide --------------- gtgt
• Pineal deep in the brain
• Pituitary deep in the brain
• Thyroid in the neck on top of the trachea
• Parathyroid in the neck on each upper and lower
  side of the thyroid
• Thymus in the neck region behind the sternum
• Adrenals on top of the kidneys
• Islets of Langerhans in the pancreas
• Ovaries/testes

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The Pituitary

• Also called the hypophysis
• Its a small gland the size of a cherry located
  deep in the brain
• The pituitary is divided into 2 parts
• 1. Anterior lobe
• 2. Posterior lobe

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The Master Gland

• The pituitary gland is often called the master
  gland because it releases hormones that affect
  the working of other glands
• See next slide --------------------------?

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Anterior lobe of the Pituitary(FRONT)

• (many ants in the whole)
• Releases
• Prolactin to the breast
• Growth hormone to bones and soft tissue
• FSH, LH to ovaries
• FSH, LH, (ICSH) to testes
• ACTH to adrenals
• TSH to thyroid

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Prolactin (Ant. Pituitary)

• This hormone is sent to the breast to stimulate
  the production of milk in females

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Growth Hormone (Ant. Pituitary)

• Also called somatotropin,
• Acts directly in most body tissue
• It promotes protein manufacture that is essential
  for growth, it causes increase in size and height
  to occur in youth before the closure of the
  epiphysis of long bones
• GH is needed throughout life, without it, the
  person will remain small

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Growth Hormone

• Decrease in Growth Hormone Dwarfism
• GH malfunctions, usually extremely small

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Dwarfism
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Growth Hormone

• Excess in GH Giantism or Gigantism
• GH malfunctions during childhood and growth
• Usually extremely tall

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Who do you know that is this tall

• 8ft 11 1/10 inch 272cm
• Shoe size at 18 y.o. size37
• Hint its not Shaq
• He died at age 22 in 1940
• he weighed 490 lbs

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Growth Hormone

• In adulthood, when GH continues to be active,
  this is referred to as Acromegaly
• Malfunction after growth is completed
• President Nixon and Abe Lincoln have this.
• Features include nose widening, jaw protrudes and
  fingers widen
• There is no where else for the growth to go
  except out

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Acromegaly
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(FSH) Follicle Stimulating Hormone(Ant.
Pituitary)

• This hormone stimulates the development of eggs
  in the ovaries and sperm cells in the testes

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(LH) Luteinizing (Ant. Pituitary)

• Causes ovulation in females and sex hormone
  secretion in both males and females
• Ovaries make estrogen to prepare the uterine
  lining and 2ndary sex characteristics such as
  body hair growth, development of breasts

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(ICSH) (Ant. Pituitary)

• Its like LH in women, in men, its called (ICSH)
  interstitial cell-stimulating hormone
• Causes the testes to make testosterone and 2ndary
  sex characteristics such as growth of body hair,
  deepening of voice

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(ACTH) Adrenocorticotropic Hormone

• This stimulates the cortex of the adrenal glands.
  ACTH is the messenger to the adrenal glands
• Just like theres 2 parts to the pituitary,
  Anterior and Posterior, there are 2 parts to the
  adrenal glands, adrenal cortex and adrenal
  medulla ( we will learn about these later)

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(TSH) Thyroid Stimulating Hormone (Ant. Pituitary)

• Other name for TSH is thyrotropin
• This stimulates the thyroid gland to produce
  thyroid hormones such as Triodothyronin (T3)
• and
• Thyroxine. (T4)
• T3 T4 increase metabolism

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Posterior lobe of the pituitary

• (2 stamps on a postage letter)
• ADH sent to the kidney
• Oxytocin sent to the uterus and breast
• These hormones are made in the hypothalamus and
  are stored in the posterior pituitary

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• ADH (anti-diuretic hormone) also called
  vasopressin or pitressin sent to the kidney,
  promotes the re-absorption of water from the
  kidneys and decreases the excretion of water, so
  we dont become completely dehydrated.
• Inadequate amts of ADH cause excessive loss of
  water Diabetes Insipidus
• Oxytocin sent to the uterus and breast.
  Stimulates uterine contractions during childbirth
  and are released during breastfeeding for the
  letdown of milk

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Antidiuretic Hormone

• Excess(SIADH) DeficitDiabetes
  Insipidus (DI)
• (Syndrome of inappropriate ADH)
• Your body is holding onto the you dont have
  enough
• water too much, you get ADH and you
  keep
• filled with water and puffy peeing( you
  have
• 
  diuretic hormone)
• BP increase BP decrease
• Specific gravity gt1.030 Specific gravity
  lt1.005
• Concentrated Diluted
• Normal specific gravity is 1.005-1.030 as a whole
  range
• urine is usually 1.010-1.020

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Which of the following would be a common sign of
symptom for a patient with diabetes insipidus

• Hypertension
• Hyperglycemia
• Poor skin turgor (lots of peeing)
• D. Specific gravity of urine1.035

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Who controls the pituitary

• The hypothalamus controls the pituitary
• Remember the hypothalamus rings the pituitary
  ring, ring and tells it what to send
• The hypothalamus sends its hormones to the
  pituitary by way of the portal system which is
  the ductless system

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Hypothalamus controls the pituitary
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The Thyroid Gland

• Largest of the endocrine glands
• The thyroid is located in the neck
• The thyroid looks like a butterfly

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The Thyroid Gland

• Produces 2 hormones that regulate metabolism
• T3 Triodothyronin (tri-o-do-THI-ro-nin)
• T4 Thyroxine
• These increase energy metabolism and protein
  metabolism
• Calcitonin is also produced in the thyroid which
  is needed for calcium metabolism, lowers calcium
  levels

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Iodine

• The Thyroid gland needs an adequate supply of
  iodine in the blood to produce these hormones

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Where to find iodine

• Table salt
• Shell fish
• Vegetables
• Dairy foods
• Processed foods
• Havent we said not to eat salt in foods and to
  stay away from processed foods? Salt is in a lot
  of food, even if you try an avoid it, salt is
  there

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3rd world countries

• Do not eat salt in their foods, its not
  available
• The hypothalamus tells the pituitary to send a
  messenger called TSH (thyroid stimulating
  hormone) for metabolism but when the hypothalamus
  sends a message to the pituitary, the pit. Sends
  TSH but no T3 or T4 can be made because theres
  no salt in the diet, this process keeps happening
  and TSH keeps sending a message, this activity
  causes a goiter to form

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Disorders of the Thyroid Gland

• GOITER - Enlargement of the thyroid gland

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Goiter
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Hypothyroidism

• Underactive thyroid
• Can occur in newborns or in adulthood

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Cretinism (creet-in-ism)

• Failure of the thyroid gland to form during fetal
  development (hypothyroidism)
• Infant suffers lack of physical growth, and lack
  of mental development, MR
• Treatment is with replacement hormone
• These pts have the same symptoms as Morbid
  Matilda ? see next slide

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Myxedema Or Hypothyroidism
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Myxedema (mix-edema)

• The result of atrophy of the thyroid or wasting
  of the thyroid in adults
• Patient becomes sluggish both physically and
  mentally
• Large tongue, slow speech
• Skin and hair become dry
• Peculiar swelling of the tissues of the face
• Wt gain even if you dont eat much
• TREATMENT Synthroid

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Hyperthyroidism

• Its the overactivity of the thyroid with
  excessive secretion of the hormone T4
• Causes
• Excess of iodine (salt), Goiter due to an
  overproduction of thyroid hormones
• Graves Disease eyeballs popping out

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Graves Disease

• Causes exopthalmicbulging out of the eyes
• Intense nervousness
• Wt loss
• Increased pulse and R.R.
• Metabolism is too quick
• Increased appetite
• Sweating
• Diarrhea
• palpitations

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Graves Disease
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Exopthalmia
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Treatment of Hyperthyroidism

• 1) Suppression of hormone production with
  anti-thyroid meds such as Tapazole or
  Propylthiouracil (PTH)
• 2) Radioactive iodine to destroy thyroid tissue,
  pt must flush toilet 2-3xs after each use for 3
  days so others wont be exposed to radioactive
  iodine
• 3) Surgical removal of part of the thyroid. A
  solution called Lugols is given 1st to prevent
  post-op bleeding and thyroid storm

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Your patient has Graves Disease,Which of the
following would be textbook Vital signs

• Pulse 98 Resp. 22 Temp.98.4 BP 110/68
• Pulse 74 Resp. 22 Temp.97.8 BP 124/78
• Pulse 115 Resp. 24 Temp.99 BP 144/78
• D. Pulse 56 Resp. 12 Temp.97. BP 100/56

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Your patient has Graves Disease, Which medication
would they be taking

1. Pitocin
2. Pitressin
3. Synthroid
4. Anti-thyroid propylthiouricil or Tapazole

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Thyroid Storm

• An even more exaggerated form of hyperthyroidism
• If left untreated, can be fatal
• Comes on suddenly as a fever, sweating,
  tachycardia, pulmonary edema, CHF, tremulousness,
  restlessness
• It usually starts before infection, trauma or a
  surgical emergency

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Tests of the thyroid

• Blood work can be obtained to check the T3 T4
  levels to determine if levels are too high or too
  low
• Also, TSH levels

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The Parathyroid Glands

• Located behind the thyroid gland
• 4 tiny glands are there
• NOT CONTROLLED BY THE ANTERIOR PITUITARY, this
  gland is on its own, it has its own negative
  feedback mechanism, unlike the hypothalamus
  telling the pituitary theres trouble
• Parathyroid glands secrete PTH or parathyroid
  hormone, this increases blood calcium levels In
  the blood and this is how

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Parathyroid

• When the parathyroid is working well, parathyroid
  hormone is released and goes into the bones to
  push calcium out into the blood.
• The blood needs calcium for its ion charge
  (Ca), the brain needs calcium.
• If the parathyroid isnt working, no PTH is being
  pushed into the bone and NO calcium is coming out
  to the blood where its needed a low level of
  calcium in the blood causes problems

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Serum Calcium

• 8.5 10.5

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Hyperparathyroidism

• Too much PTH is pushing into the boneoh nothe
  bone releases too much calciumhypercalcemiabone
  weaknessfractures and breaks in the bones
• Serum ca levels of gt10.5

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Hypoparathyroidism

• Not enough PTH is pushing into a bone then there
  will be no calcium coming out oh
  nohypocalcemiatetany
• serum ca levels lt8.5

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Parathyroid gland

• Calcitonin produced by the thyroid gland lowers
  the amount of calcium circulating in the blood,
  it does this by depositing calcium in bone tissue
  when theres too much

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Disorders of the parathyroid glands (low levels
of PTH)

• HYPOPARATHYROIDISM
• If the parathyroid is removed or damaged,
  inadequate levels of PTH are made and this causes
  a series of muscle contractions in hands and
  face, this is called tetany, (this is not like
  lockjaw tetanus). If there is no parathyroid
  hormone, there are then low levels of calcium in
  the blood, low levels of calcium a condition
  called tetany

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Tetany

• Chvostek's sign (a spasm of facial muscles occurs
  when the facial nerve is tapped) indicating low
  serum levels of calcium.

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High levels of (PTH)

• HYPERPARATHYROIDISM
• If there is a tumor of the parathyroid, calcium
  is removed from its normal storage place in bones
  and released into the bloodstream and high PTH
  pushes into the bone
• The loss of Ca from bones causes fragile bones
  that fracture easily
• The kidneys excrete calcium, and now with too
  much in the blood stream, kidney stones form

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Hashimotos Thyroiditis

• The most common cause of hypothyroidism
• This is an autoimmune disease that causes the
  destruction of essential enzymes that are needed
  for the making of T3 and T4
• Causes enlarged, lumpy goiter
• Synthroid is used for life

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The Adrenal Glands

• The adrenal glands are small in size and sit on
  top of the kidneys. Each adrenal gland has 2
  parts that act as separate glands
• The adrenals get stimulated by the messenger ACTH
  that was sent from the pituitaryremember, the
  hypothalamus rang the pituitary to send a
  messenger called ACTH to reach the adrenals, the
  adrenals send out the sugar, salt and sex
  hormones all at the same time

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2 parts to the adrenal glands

• 1. Adrenal medulla this is the inner area of
  the adrenals
• 2. Adrenal cortex this is the outer portion of
  the adrenals

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Adrenal Medulla

• The hormones that come from this part of the
  adrenal glands are released in response to
  stimulation by the sympathetic nervous system
• These hormones are
• Epinephrine or adrenaline
• Norepinephrine
• These 2 hormones are referred to as the fight or
  flight hormones (remember the bear story)
• These hormones release directly into the blood

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The effects of epinephrine, adrenaline and
nor-epinephrine (think of the bear story)

• Stimulation of the involuntary muscle in the
  walls of the arterioles causing muscles to
  contract and blood pressure to rise
• Conversion of glycogen stored in the liver into
  glucose, this sugar is given to muscles when
  needed allowing them to do extraordinary work
• Increase in the HRT rate so you can run
• Dilatation of the bronchioles so you can take in
  more O2 while running, the smooth muscles of the
  bronchiole walls relax and more O2 can go in

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Adrenal cortex hormones

• Glucocorticoids cortisol
• Mineralcorticoids aldosterone
• Sex Hormones - testosterone

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Adrenal Cortex Glands secrete

• Hormones that regulate
• SUGAR SALT SEX____
• Glucocorticosteroids Mineralcorticosteroids
  Sex hormones
• Called Cortisol Called Aldosterone
  Testosterone

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Glucocorticoids (sugar )

• Such as Cortisol converts
• 1) the carbohydrate reserve in the body is
  maintained and amino acids are converted to
  glucose (sugar) in the liver instead of protein
  or fat
• 2) Suppresses inflammatory response in the body
  naturally, if you get hit in head and start to
  swell, these hormones kick in to help decrease
  swelling
• 3) Aids body in coping with stress by increasing
  the amount of cortisol in the body

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Cortisol

• A.K.A hydrocortisone
• This steroid is given when swelling needs to be
  decreased such as in cranial surgery
• Problem is that when pts take steroids for
  disease like Lupus and that pt has surgery on
  another body part, they dont heal well because
  steroids decrease swelling and you need some
  swelling to heal

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Corticosteroid Drugs

• Prednisone, Solumedrol, Cortisone
• Used mainly as anti-inflammatory drugs
• Side Effects- Poor wound healing, Increased risk
  of infection, moon face, round abdomen, Hungry,
  Euphoria, Increased Blood Sugar, insulin is
  needed at times
• You must wean people off these drugs or person
  will have an adrenal crisis
• Take with food

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Why do we need swelling to heal?

• When the body swells, these factors occur WBCs,
  protein comes to the area for rebuilding cells,
  clotting factors come to help clot.
• But now that the pt takes steroids, healing is
  less because steroid is working to decrease
  swelling and none of the above factors will occur

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Mineralcorticoids (Salt)

• Such as Aldosterone
• Regulates
• 1) electrolyte imbalance
• 2) controls re-absorption of sodium in the kidney

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Disorders of the Adrenal Glands

• Deficient adrenals Addisons Disease,
  adrenals arent working, sugar, salt and sex
  hormones are decreased in amount
• Symptoms are muscle atrophy, weakness, N/V,
  anorexia, bronze skin from the overproduction of
  melatonin and a Na/H2O imbalance, hyoptension,
  dehydration, decreased cardiac output.
• Addisons is an emergency and needs to be treated
  or pt can die
• President Kennedy

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Diet for the Addisons Pt

• Pts with Addisons disease have low Na levels
  and these need to be replaced
• Replacing Na will help with hypotension (where
  salt iswater follows)
• Choose foods high in natural Na such as
• Milk, cheese, soups, sauces, processed foods

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Care of the Addisons pt

• Nurses must teach these pts to avoid stress,
  salt deprivation, infection, trauma, exposure to
  cold and overexertion
• All of the above can overwhelm the pts ability
  to maintain homeostasis and an Addisonians
  crisis can occur which can be life-threatening

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Excess adrenals

• Excess adrenals Cushings Disease
• Obesity, round face,thin skin, increase in blood
  sugar, decrease in healing, increased risk of
  infection

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Addisons Disease not enough Salt hormone
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Cushings Syndrome too much glucocorticoid
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Hormones NOT associated with the Pituitary

• In the pancreas Insulin
• Formed in the Islets of Langerhans
• Insulin is the key that ALL cells need
• With insulin present,
• 1) glucose can be metabolized for energy, 2)
  amino acids can be transported to cells, 3) the
  liver can change sugar to fatty acids to be
  stored in adipose tissue more quickly

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Normal BG

• 70-110mg/dl

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Classic signs of hyperglycemia

• Blood sugar is above 250
• Polyuria
• Polydypsia
• Polyphagia
• hot dry, sugar is high
• There is too much sugar in the blood and none in
  the cells(cells think they are hungry
  polyphagia) because there is no insulin or key to
  open the cells, All that sugar needs to go
  somewhere so it goes out in urine (polyuria) and
  now you are thirsty (polydypsia)

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Classic signs of hypoglycemia

• Blood sugar is probably below 60
• Cool
• Clammy
• Confused
• Combative
• cool clammy, need some candy

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Glucagon

• This hormone is produced by the Islets of
  Langerhans
• Glucagon works with insulin to regulate blood
  sugar levels
• Glucagon causes the liver to release stored
  glucose into the bloodstream

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Type I Diabetes (IDDM-I)

• Usually juvenile onset
• Disease usually occurs by age 30
• Is caused by a self destruction of the
  insulin-producing cells in the Islets of
  Langerhans
• Treatment Insulin, diet control, and exercise

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Type II Diabetes (NIDDM-II)

• Usually occurs in overweight children and adults
• Cells become resistant or pancreas decreases
  production
• Treatment diet, exercise 1st, use of oral
  hypoglycemics 2nd, then insulin if pills do not
  work 3rd

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Long Term Problems

• Atherosclerosis d/t sugar build-up
• Stroke
• Diabetic retinopathy d/t small vessels being so
  full of sugar for so long, they tear away from
  the eye blindness
• Loss of limbs d/t poor circulation

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The Thymus Gland

• Is a mass of lymphoid tissue
• lies in the upper part of the chest above the
  heart
• It makes the hormone Thymosin
• Thymosin assists in maturation of certain WBCs
  known as T cells, these are helper cells made in
  bone marrow and are found in the immune system

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Some Hormones arent produced from the pituitary

• Kidney produces erythropoietin which stimulates
  RBC production in the bone marrow. This hormone
  is produced when there is a decreased supply of
  O2 in the blood
• Sleep apnea peoplepolycythemia vera

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Prostaglandins

• Are a group of local hormones made by most body
  tissues, can be made synthetically
• They cause an increase in inflammation and
  discomfort in tissue and are used in inducing
  labor or abortion, causes painful cramps of the
  muscles of the uterus, called prostadil

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Aging and the endocrine system

• The 2 systems that are affected most in the aging
  person are
• 1) Pancreas
• 2) Thyroid

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The pancreas in the aged person

• Due to decreased secretion of insulin in the
  elderly, diabetes occurs. Poor diet, decreased
  activity and increased body fat contribute to
  diabetes and thyroid problems

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Other hormones are effected in the aging person

• There is a decline in sex hormones as people age
• There is a decrease in bone mass leading to
  osteoporosis due to a decrease on GH
• Women in menopause can receive sex hormone
  replacement therapy, this has shown to be
  successful

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An endocrine patient complains of feeling cold.
Which might be the cause

1. Diabetes Insipidus
2. Acromegaly
3. Myxedema
4. Graves Disease

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The End
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