ENDOCRINE DISORDERS
ADRENAL CORTEX HYPERFUNCTION
• May be secondary to secretions of glucocorticoids (hypercortisolism) or excessive secretion of
aldosterone(hyperaldosteronism)
● Think of your pituitary glands as your thermostat
Disorders of the Anterior Pituitary Gland
• May be caused by an increase or decrease in secretion of hormones from hypothalamus or
anterior pituitary gland itself
• Primary disorders(alterations in functions in endocrine glands ie: adrenal cortex or thyroid
glands)
• Secondary disorders-alterations in hormone secretion from anterior pituitary gland and tertiary
disorders (alteration in hormone secretion from hypothalamus)
• Disorders may relate to one specific hormone or rare cases, panhypopituitarism
(hyposecretion of all hormones from the hypothalamus)
- Pan culture involves the whole body
Hypopituitarism
• Hyposecretion of hormones from anterior pituitary gland
• Hormones released regulate from adrenal cortex, thyroid gland, and gonads
• Alterations in hormonal release affect many body functions
• Etiology often secondary to pituitary tumor or damage to hypothalamus
What Else Can Affect Perfusion to the Hypothalamus?
• Increased ICP secondary to head trauma
• CNS Infections(meningitis, brain tumor)
• Postpartum hemorrhage-large amount of blood loss/hypotension severe hypoperfusion
A Little Pathophysiology(all those hormones!!!!
• Deficiency of anterior pituitary hormones =changes in metabolic or sexual function
• Decrease in ACTH(adrenocorticotropic hormone =decrease in release of aldosterone and
cortisol
• Decrease in thyroid-hormones (decreased secretion of TSH
• Decreased LH and FSH
• Decrease in growth hormone(differs depend on age of client) (did it happen when you were a
child or when you were older?)
• Children before closure of epiphyses,dwafism develops
• Lack of growth hormone in adults doesn't affect bone length but affects bone density and
osteoporosis(decreased bone density, may develop
A Little Peds Info.......
,• What is growth hormone deficiency? Growth hormone deficiency (GHD), also known as
dwarfism or pituitary dwarfism, is a condition caused by insufficient amounts of growth hormone
in the body. Children with GHD have abnormally short stature with normal body proportions.
Hypopituitarism-Clinical manifestations...
- General clinical manifestations of hypopituitarism include weakness, fatigue, decreased
appetite, weight loss, sensitivity to cold, and swollen facial features or body. Let's look at
the clinical manifestations below....
-
- Important to know- low sodium can cause seizure, and hyperkalemia is a problem- can
cause dysrhythmia
Medical Management
• Diagnosis: evaluation of hypopituitarism focuses on particular hormones and target
cells/glands affected by the lack of trophic hormone.
• ACTH stimulation test
• Measurement of TSH,FSH,LH,prolactin
• Growth Hormone
• CT or MRI if brain or pituitary tumor suspected
PHARMACOLOGY
• Goal of medical management: restore target hormone levels to normal
• Hormone replacement guided by specific hormone
• Supportive therapies: fluid and electrolyte replacement
• Replaced hormones: cortisol, thyroid hormone, testosterone, or estrogen
,• Decreased bone density treatment- focused on pathophysiologic processes associated with
decreased bone density and osteoporosis (adequate intake or supplementation of vitamin D and
calcium)
COMPLICATIONS(Hypopituitarism)
• Life threatening emergencies-especially with panhypopituitarism
• Lack of ACTH,decrease in glucocorticoids and mineralocorticoids is a LIFE-THREATENING
CONDITION!!!!Unable to maintain adequate fluid volume
• Lack of TSH-very dangerous in relation to metabolism of medications
Nursing Management- Assessment (Analyzing Cues)
• Common findings:
● Hypoglycemia related to decreased secretion of ACTH, resulting in decreased secretion of
cortisol
● Decreased ability to cope with stress secondary to decreased secretion of cortisol
● Hyponatremia and hypotension secondary to decreased aldosterone secretion
● Hyperkalemia secondary to decreased aldosterone secretion
● Decreased bone density secondary to decreased growth hormone secretion
NURSING DIAGNOSES
● Fluid volume deficit related to decreased glucocorticoid and mineralocorticoid secondary to
decreased secretion of ACTH from the anterior pituitary gland
● Risk for injury: Falls related to osteoporosis and weakened bone density associated with
decreased growth hormone
● Impaired mobility related to increased risk of pathological fractures secondary to decreased
bone density
Nursing Interventions-Assessments Vital Signs
● Vital signs
- Hypotension and tachycardia develop secondary to decreased secretion of ACTH,
leading to decreased secretion of glucocorticoid and mineralocorticoid, resulting in
sodium and water loss.
● Serum glucose level
- Hypoglycemia results secondary to lack of ACTH, leading to decreased secretion of
glucocorticoid.
● Changes in fertility
- Decreased testosterone may lead to sterility in male individuals. Decreased LH or FSH
may lead to amenorrhea and infertility in female individuals.
, ● Signs of decreased bone density
- A lack of growth hormone, FSH, and LH in adults affects bone density, and the patient is
at risk for osteoporosis.
NURSING ACTIONS
● Implement safety measures
- Risk of injury related to falls and pathological fractures increases secondary to
decreased secretion of growth hormone.
● Increase vitamin D and calcium intake
- Treats osteoporosis secondary to decreased growth hormone, vitamin D promotes
absorption of calcium in the gastrointestinal tract.
● Hormone replacement
- Supplementation of sex hormones may be administered to treat hypofunction of the
gonads.
● Collaborate with physical therapy to maximize mobility
- Osteoporosis increases the risk for falls, and the physical therapist can provide input into
safe transfers from bed to chair and measures to decrease the incidence of falls.
● Consult with dietitian/nutritionist
- Because of the need to increase calcium and vitamin D, the dietitian can help ensure the
patient understands which foods to increase in their diet.
CLIENT TEACHING
● Clinical manifestations of acute adrenal insufficiency
- Infection, injury, and stress lead to an increased need for ACTH. Because of underlying
hypopituitarism, the patient may require exogenous glucocorticoids in the event of stress
(physiological or psychological).
● Importance of taking hormone supplements in the morning
ADRENAL CORTEX HYPERFUNCTION
• May be secondary to secretions of glucocorticoids (hypercortisolism) or excessive secretion of
aldosterone(hyperaldosteronism)
● Think of your pituitary glands as your thermostat
Disorders of the Anterior Pituitary Gland
• May be caused by an increase or decrease in secretion of hormones from hypothalamus or
anterior pituitary gland itself
• Primary disorders(alterations in functions in endocrine glands ie: adrenal cortex or thyroid
glands)
• Secondary disorders-alterations in hormone secretion from anterior pituitary gland and tertiary
disorders (alteration in hormone secretion from hypothalamus)
• Disorders may relate to one specific hormone or rare cases, panhypopituitarism
(hyposecretion of all hormones from the hypothalamus)
- Pan culture involves the whole body
Hypopituitarism
• Hyposecretion of hormones from anterior pituitary gland
• Hormones released regulate from adrenal cortex, thyroid gland, and gonads
• Alterations in hormonal release affect many body functions
• Etiology often secondary to pituitary tumor or damage to hypothalamus
What Else Can Affect Perfusion to the Hypothalamus?
• Increased ICP secondary to head trauma
• CNS Infections(meningitis, brain tumor)
• Postpartum hemorrhage-large amount of blood loss/hypotension severe hypoperfusion
A Little Pathophysiology(all those hormones!!!!
• Deficiency of anterior pituitary hormones =changes in metabolic or sexual function
• Decrease in ACTH(adrenocorticotropic hormone =decrease in release of aldosterone and
cortisol
• Decrease in thyroid-hormones (decreased secretion of TSH
• Decreased LH and FSH
• Decrease in growth hormone(differs depend on age of client) (did it happen when you were a
child or when you were older?)
• Children before closure of epiphyses,dwafism develops
• Lack of growth hormone in adults doesn't affect bone length but affects bone density and
osteoporosis(decreased bone density, may develop
A Little Peds Info.......
,• What is growth hormone deficiency? Growth hormone deficiency (GHD), also known as
dwarfism or pituitary dwarfism, is a condition caused by insufficient amounts of growth hormone
in the body. Children with GHD have abnormally short stature with normal body proportions.
Hypopituitarism-Clinical manifestations...
- General clinical manifestations of hypopituitarism include weakness, fatigue, decreased
appetite, weight loss, sensitivity to cold, and swollen facial features or body. Let's look at
the clinical manifestations below....
-
- Important to know- low sodium can cause seizure, and hyperkalemia is a problem- can
cause dysrhythmia
Medical Management
• Diagnosis: evaluation of hypopituitarism focuses on particular hormones and target
cells/glands affected by the lack of trophic hormone.
• ACTH stimulation test
• Measurement of TSH,FSH,LH,prolactin
• Growth Hormone
• CT or MRI if brain or pituitary tumor suspected
PHARMACOLOGY
• Goal of medical management: restore target hormone levels to normal
• Hormone replacement guided by specific hormone
• Supportive therapies: fluid and electrolyte replacement
• Replaced hormones: cortisol, thyroid hormone, testosterone, or estrogen
,• Decreased bone density treatment- focused on pathophysiologic processes associated with
decreased bone density and osteoporosis (adequate intake or supplementation of vitamin D and
calcium)
COMPLICATIONS(Hypopituitarism)
• Life threatening emergencies-especially with panhypopituitarism
• Lack of ACTH,decrease in glucocorticoids and mineralocorticoids is a LIFE-THREATENING
CONDITION!!!!Unable to maintain adequate fluid volume
• Lack of TSH-very dangerous in relation to metabolism of medications
Nursing Management- Assessment (Analyzing Cues)
• Common findings:
● Hypoglycemia related to decreased secretion of ACTH, resulting in decreased secretion of
cortisol
● Decreased ability to cope with stress secondary to decreased secretion of cortisol
● Hyponatremia and hypotension secondary to decreased aldosterone secretion
● Hyperkalemia secondary to decreased aldosterone secretion
● Decreased bone density secondary to decreased growth hormone secretion
NURSING DIAGNOSES
● Fluid volume deficit related to decreased glucocorticoid and mineralocorticoid secondary to
decreased secretion of ACTH from the anterior pituitary gland
● Risk for injury: Falls related to osteoporosis and weakened bone density associated with
decreased growth hormone
● Impaired mobility related to increased risk of pathological fractures secondary to decreased
bone density
Nursing Interventions-Assessments Vital Signs
● Vital signs
- Hypotension and tachycardia develop secondary to decreased secretion of ACTH,
leading to decreased secretion of glucocorticoid and mineralocorticoid, resulting in
sodium and water loss.
● Serum glucose level
- Hypoglycemia results secondary to lack of ACTH, leading to decreased secretion of
glucocorticoid.
● Changes in fertility
- Decreased testosterone may lead to sterility in male individuals. Decreased LH or FSH
may lead to amenorrhea and infertility in female individuals.
, ● Signs of decreased bone density
- A lack of growth hormone, FSH, and LH in adults affects bone density, and the patient is
at risk for osteoporosis.
NURSING ACTIONS
● Implement safety measures
- Risk of injury related to falls and pathological fractures increases secondary to
decreased secretion of growth hormone.
● Increase vitamin D and calcium intake
- Treats osteoporosis secondary to decreased growth hormone, vitamin D promotes
absorption of calcium in the gastrointestinal tract.
● Hormone replacement
- Supplementation of sex hormones may be administered to treat hypofunction of the
gonads.
● Collaborate with physical therapy to maximize mobility
- Osteoporosis increases the risk for falls, and the physical therapist can provide input into
safe transfers from bed to chair and measures to decrease the incidence of falls.
● Consult with dietitian/nutritionist
- Because of the need to increase calcium and vitamin D, the dietitian can help ensure the
patient understands which foods to increase in their diet.
CLIENT TEACHING
● Clinical manifestations of acute adrenal insufficiency
- Infection, injury, and stress lead to an increased need for ACTH. Because of underlying
hypopituitarism, the patient may require exogenous glucocorticoids in the event of stress
(physiological or psychological).
● Importance of taking hormone supplements in the morning
