Assessment of endocrine system PDF

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Assessment of the endocrine system: Endocrine glands: -

Hypothalamus Pituitary Thyroid Parathyroid Adrenals Pancreas Ovaries Testes Pineal gland

Hormones: table 47-1 and figure 47-6 -

Chemical messengers that control and regulate and target certain cells or organs Catecholemines: secreted by adrenals Lipid soluble: bound to plasma proteins and travel to target cells Water soluble: circulate freely in the blood act directly on target tissues

Regulation: -

Positive feedback: stimulating further increase Negative feedback: opposite of what body wants to happen: will cause an increase or decrease

Nervous system: -

Stressors stimulate the nervous system to modulate hormone secretion When stress is sensed by CNS, the SNS secretes catecholemines

Rhythm: Circadian rhythm: 24hr sleep wake cycle(diurnal) Ultraradian: longer than 24 hours; reproductive cycles

Hypothalamus: -

Regulates hormone secretion or inhibition by pituitary gland Receives input from CNS Coordinates expression of complex behaviors

Pituitary gland: hypophysis -

Infundibular(hypophyseal) stalk connects to hypothalamus to relay info Anterior lobe: adenohypophysis Posterior lobe: neurohypophysis

Anterior lobe: -

Tropic hormones: control secretion of hormones by other glands TSH: stimulates thyroid to secrete hormones ACTH: stimulates adrenal cortex to secrete corticosteroids FSH: stimulates secretion of estrogen in women and the development of ova: stimulates development of sperm in men LH: stimulates ovulation in women and secretion of sex hormones in both women and men GH: affects growth an development of body tissues Prolactin: stimulates breast development necessary for lactation after childbirth

Posterior lobe: ADH: arginine vasopressin; -

regulate fluid volume by causing renal tubules to reabsorb water increases plasma osmolality osmoreceptors in hypothalamus secrete ADH potent vasoconstrictor

Pineal gland: -

composed of photoreceptive cells secretes melatonin helps regulate circadian rhythms regulates the reproductive system at the onset of puberty

Thyroid gland: -

highly vascular Thyroxine(T4): 90% of hormone produced by thyroid Triiodothyronine(T3): much more potent and has more metabolic affects Iodine is needed for synthesis of both Thyrotropin releasing hormone (THR): causes anterior pituitary to release TSH Calcitonin: made by parafollicular cells in thyroid

Calcitonin: lowers serum calcium levels by -

Inhibits transfer of calcium from bone to blood Increasing calcium storage in the bone Increasing renal excretion of calcium and phosphorus

Parathyroid: -

2-6 glands PTH increases serum calcium levels o By acting on kidneys, bone, and indirectly on GI tract o Transfer of calcium fro bone to blood o Promotes calcium reabsorption and phosphate excretion o Stimulates renal conversion of vit D to active form

Adrenal glands: -

On top of each kideny 2 parts: medulla and cortex

Medulla: -

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Secretes catecholemines o Epinephrine o Norepinephrine o colemine catecholamines are considered neurotransmitters when secreted by neurons and hormones when secreted by adrenal medulla

Cortex: -

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secretes steroid hormones o glucocorticoids o mineralocorticoids: essential for maintaining f&e balance o androgens inhibit anti-inflammatory response Cortisol: secreted in a diurnal pattern negative feedback mechanism corticotrophin releasing hormone (CRH): from hypothalamus stimulates secretion of ACTH by anterior pituitary regulates blood glucose concentration by stimulating gluconeogenesis inhibits peripheral glucose use in the fasting state inhibits protein synthesis

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stimulates the mobilization of glycerol and free fatty acids maintains vascular integrity and fluid volume decreases inflammatory response stress, burns, infection, fever, acute anxiety, hypoglycemia increase cortisol levels

Aldosterone: -

potent mineralcorticoid maintained ECF volume acts on renal tubules to promote renal absorption of sodium and excretion of potassium and hydrogen ions synthesis and secretion are stimulated by angiotensin II, hyponatremia, hyperkalemia ANP and hypokalemia inhibit synthesis and release

Adrenal androgens: -

Secretes small amounts of androgens that are converted to sex steroids (testosterone and estrogen) Dehydropiandrosterone(DHEA) and androstenedione: precursor sex steroids that act similar to them

Pancreas: -

Exocrine and endocrine function Isle of langerhans: o Alpha cells: secrete glucagon o Beta cells: make and secrete insulin and amylin o Delta cells: secrete somatostatin o F(PP) cells: secrete pancreatic polypeptide

Glucagon: -

Released in response to low blood glucose levels, protein ingestion, and exercise Increases blood glucose by glycogenolysis(glycogen to glucose), gluconeogenesis( making glucose from non carb sources), ketogenesis Works with insulin to maintain normal glucose levels

Insulin: -

Principle regulator of metabolism and storage of ingested carbs, fats, and proteins

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Facilitates transport of glucose into cells, amino acids across muscle membranes, and synthesis of amino acids into protein in peripheral Storage of nutrients(anabolism) Low blood glucose: glucagon, somatostatin, hypokalemia, catecholemines usually inhibit insulin secretion

Older pts and endocrine system: 47-3 pgs 1108-1109 -

Decreased hormone production Altered hormone metabolism and biologic activity Decreased responsiveness of target tissue to hormones Altered circadian rhythms

Assess for: table 47-4 -

Fatigue Weakness f&e imbalances Altered tissue perfusion Inadequate coping mechanisms Alteration in cardiac rhythm Changes in skin integrity Menstrual irregularities Weight changes Onset of symptoms gradual or sudden Changes in appetite Changes in libido Changes in mental acuity Changes in emotional stability Changes in energy levels

Meds: -

Ask about the meds taken, otc and prescribes and well as herbal supplements Ask about any hormones taken or meds that could affect hormones

Surgery: -

Assess for surgical history

Functional health: -

Family history Changes in appetite and weight Elmination pattern: frequency and consistency Activity and exercise Sleep and rest Cognitive and perceptual changes Self-perception Role-relationship Sexuality/reproductive changes Coping/stress changes Value-belief pattern

Hirsutism: facial hair

Physical exam: table 47-5 and focused assessment (pg 1114) -

Vital signs Variations in temperature, HR, BP BMI Assess orientation, alertness, memory, cognitive abilities, personality, and anxiety

Integument: -

Texture of skin and hair Pigmentation and bruising Moisture Hair distribution Delayed wound healing

Head: -

Size and contour Facial features Reflexes: chvosteks sign(hyperflexia) Eyes Mouth Nose

Neck: -

Bulges

Thorax: -

Shape Breasts Lungs sounds Heart sounds Skin

Extremities: -

Size Shape Symmetry General proportion of hands and feet Pigmentation, lesions, edema Muscle strength and reflexes Tremors Muscular spasms

Genetalia: -

Hair distribution

Dx studies: table 47-6 -

Imaging studies Blood test U/A...