INTRODUCTION AND PHYSIOLOGY

Ma’am Anabelle S. Santos → Medical-Surgical Nursing

REVIEW OF ANATOMY AND PHYSIOLOGY NEGATIVE FEEDBACK MECHANISMS

ENDOCRINE SYSTEM GLANDS

ENDOCRINE SYSTEM → plays a vital role in orchestrating cellular
interactions, metabolism, growth, reproduction, aging and response
to adverse reactions.
● This interconnected network of glands is closely linked with
the nervous and immune systems, regulating the functions of
multiple body organs.
GLOSSARY
● HOMEOSTASIS - a steady state within the body; the stability
of the internal environment
○ Coordinated by compensatory processes that respond to
changes in the internal environment HYPOTHALAMUS
○ Any change initiates a "RIGHTING" response to
minimize the change (under involuntary control) ● Controls the “master gland” [PITUITARY GLAND]
● METABOLISM - the chemical reactions in the body's cells that ● MAJOR ACTION: Releasing and inhibiting hormones; controls
change food into energy, which our body needs to do the release of pituitary hormones
everything. ● Releases “-tropic hormones”
● ANABOLISM – biochemical process in metabolism where the ● "-TROPIC HORMONES" → releasing factors
simple molecules combine to generate complex molecules. ○ reach the pituitary by way of the bloodstream in a
● CATABOLISM – a kind of metabolism in which complex special circulation called the PITUITARY PORTAL
compounds are broken down into smaller molecules. BLOOD SYSTEM.
● BASAL METABOLIC RATE - the number of calories you burn ○ stimulate the pituitary to "release" specific hormones.
as your body performs basic (basal) life-sustaining functions; TARGET
chemical reactions occurring when the body is at rest. HORMONES OF THE HYPOTHALAMUS
TISSUE
○ Basically, the calories burned if you stayed in bed all
day. CRH Corticotropin-releasing hormone
● ENDOCRINE – secreting internally; hormonal secretion of a TRH Thyrotropin-releasing hormone
ductless gland GHRH Growth hormone-releasing hormone Pituitary
● EXOCRINE – secreting externally; secretion from excretory Gland
ducts GnRH* Gonadotropin-releasing hormone
● HORMONES - chemical transmitter substances produced in SOMATOSTATIN Inhibits GH and TSH
one organ or part of the body and carried by the DOPAMINE Inhibits prolactin, FSH and LH
bloodstream to other cells or organs on which they have a
specific regulatory effect;
PITUITARY GLAND
○ produced by endocrine glands
○ substances that regulate and integrate body functions ● also called "hypophysis"
by acting on local or distant target sites ● commonly referred to as the "master gland" because of the
● NEGATIVE FEEDBACK – regulating mechanism in which an influence it has on secretion of hormones by other endocrine
increase or decrease in the level of a substance decreases glands.
the function of the organ producing the substances.
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM ● Round structure
● about 1.27 cm in diameter
RENIN-ANGIOTENSIN- ALDOSTERONE SYSTEM – a hormone ● located on the inferior
system that regulates blood pressure, fluid and electrolyte balance, aspect of the brain
and systemic vascular resistance. ● divided into anterior and
posterior lobes.

SOURCE/ MAJOR ACTION TARGET

HORMONE TISSUE
ANTERIOR PITUITARY

GH Growth hormone; stimulates Bone,

(Somatostatin) growth of bone and muscle, Muscle
promotes protein synthesis and
fat metabolism, decreases
carbohydrate metabolism

ACTH Adrenocorticotropic hormone; Adrenal

stimulates synthesis and secretion cortex
of adrenal cortical hormone

TSH Thyroid stimulating hormone; Thyroid

stimulates synthesis and secretion

BSN 3A - Marjorie D. Solayao

 SYNTHESIS OF THYROID HORMONES
of thyroid hormone
● THYROID HORMONES → produced and stored in the
FSH, LH, Stimulate synthesis and release thyroid gland
Prolactin* of male and female hormones ○ amino acids that contain iodine molecules bound to the
amino acid structure.
POSTERIOR PITUITARY ● IODIDE IONS → absorbed from the GI tract are converted
to iodine molecules, which interact with tyrosine, to form the
ADH Antidiuretic hormone; increase Kidney thyroid hormones.
water reabsorption by kidney
● SECRETION OF T3 AND T4 → controlled by TSH
(thyrotropin) from the anterior pituitary gland.
Prolactin* Stimulates contraction of ○ T4 → relatively weak, maintains body metabolism in a
pregnant uterus, milk ejection steady state
from breasts after childbirth
○ T3 → 5x as potent as T4 and has a more rapid
metabolic action
GROWTH HORMONE
● THYROID-BINDING HORMONES - transport:
● also called somatotropin ○ Thyroxine-binding globulin (TBG)
● the most abundant pituitary hormone ○ Transthyretin
● CHILDREN: regulates growth ○ Albumin
● ADULTS: regulates energy and metabolism. HYPOTHALAMIC-PITUITARY-THYROID AXIS
○ Increases protein synthesis in many tissues
○ Increases the breakdown of fatty acids in adipose tissue
○ Increases blood glucose levels Requires other hormones,
e.g., thyroid and insulin, to function well
● Growth hormone secretion:
○ INCREASED → Deep sleep, stress, exercise, fasting,
malnutrition, hypoglycemia, trauma, hypovolemic shock
○ DECREASED → Presence of obesity, depression,
hypothyroidism
VASOPRESSIN
● also called antidiuretic hormone (ADH)
● synthesized in the hypothalamus and stored in the pituitary
(THYRO) CALCITONIN
gland.
● Controls the excretion of water by the kidney
● Secretion is stimulated by an increase in the osmolality of the
blood or by a decrease in blood pressure
THYROID GLAND
● the largest endocrine gland
● butterfly-shaped organ located in the lower neck, anterior to
the trachea.
● Two lateral lobes connected by an isthmus 5 cm long, 3 cm
wide, weighs about 30 g
● Very high blood flow (about 5 ml/min/gram of thyroid
tissue) → 5x the blood flow to the liver
PARATHYROID GLAND
SOURCE/ MAJOR ACTION TARGET ● normally four
HORMONE TISSUE ● situated in the neck and embedded in the posterior aspect of
THYROID (FOLLICULAR CELLS) the thyroid gland
● PARATHYROID HORMONE (PARATHORMONE) →
Triiodothyroni T3 → ACTIVE FORM of the produced and stored in the parathyroid gland
ne (T3) thyroid hormone ○ Regulates calcium and phosphorus metabolism
● Plays vital roles in the body's ○ Regulates serum calcium levels by bone resorption when
Thyroxine (T4) metabolic rate, heart and calcium levels are low
digestive functions, muscle ○ Tends to lower the blood phosphorus level
control, brain development PARATHYROID HORMONE
and function, and the Cells
maintenance of bones.
● Increase the metabolic rate,
increase protein and bone
turnover; increase
responsiveness to
catecholamines; necessary for
fetal and infant growth and
development.

(Thyro-) Lowers blood calcium and

Calcitonin phosphate levels

BSN 3A - Marjorie D. Solayao

 ADRENAL GLAND FIGHT OR FLIGHT
ADRENAL GLANDS (2) → attached to the upper portion of each
kidney.
● CORTEX → outer portion
○ secretes steroid hormones;
○ SECRETION → regulated by the
hypothalamic-pituitary-adrenal axis
■ Glucocorticosteroids (glucocorticoids) - CORTISOL
■ Mineralocorticosteroids (mineralocorticoids) -
ALDOSTERONE
● MEDULLA - inner/center portion;
○ secretes catecholamines;
○ part of the autonomic nervous system (sympathetic)
■ Epinephrine, norepinephrine
○ About 90% of secretion is epinephrine (adrenaline)
HYPOTHALAMIC-PITUITARY-ADRENAL AXIS
○ CATECHOLAMINES → regulate metabolic pathways to
promote catabolism of stored fuels to meet caloric
needs
○ MAJOR EFFECT: "fight-or-flight response" (to prepare
to meet a challenge; the stress response)

SOURCE/ MAJOR ACTION TARGET

HORMONE TISSUE
ADRENAL CORTEX

Mineralocortic Increases sodium reabsorption, Kidney

osteroids potassium loss by kidney
(Aldosterone)
PANCREAS
Glucocorticost Affects metabolism of ALL nutrients; ● INSULIN → Lowers blood glucose
eroids ● stimulates protein catabolism; ● GLUCAGON → Increases blood glucose
(Cortisol) ● stimulates liver uptake of amino ● SOMATOSTATIN → Delays intestinal absorption of glucose
acids and conversion to glucose
(GLUCONEOGENESIS); SOURCE/ MAJOR ACTION TARGET
● inhibits glucose uptake; HORMONE TISSUE
● regulates blood glucose levels, PANCREAS
● affects growth,
● has anti inflammatory action, Insulin (B-cells ● Lowers blood glucose by
● decreases effects of stress of the islets of facilitating glucose transport Cells
langerhans) across cell membranes of
Adrenal Have minimal intrinsic androgenic muscle, liver and adipose tissue
Androgens activity; converted to testosterone ● metabolizes glucose for energy
and dihydrotestosterone (DHT) in ● Stimulates storage of glucose in
the periphery the liver and muscle (in the form
ADRENAL MEDULLA of GLYCOGEN)
● Signals the liver to stop the
Epinephrine Serve as neurotransmitters for the release of glucose
sympathetic nervous system. ● Enhances storage of dietary fat
● Decreases blood flow to tissues in adipose tissue
that are NOT needed in ● Accelerates transport of amino
emergency situations (e.g., the Sympat acids (derived from dietary
GI tract) hetic protein) into cells
● Increases blood flow to tissues Nervous ● Also inhibits the breakdown of
that are important for effective system stored glucose, protein, and fat
Norepinephri fight or flight (e.g., cardiac and
ne skeletal muscles) Glucagon Increase blood glucose Liver
● Induces the release of fatty concentration by stimulation of
acids, increase the basal glycogenolysis and
metabolic rate, elevate blood glyconeogenesis
glucose level
Somatostatin Delays intestinal absorption of
glucose

BSN 3A - Marjorie D. Solayao

NEGATIVE FEEDBACK MECHANISM: REGULATION OF
BLOOD GLUCOSE

BSN 3A - Marjorie D. Solayao

ENDOCRINE SYSTEM DISORDERS
Ma’am Anabelle S. Santos → Medical-Surgical Nursing
ENDOCRINE SYSTEM DISORDERS URINE TESTS
● used to measure the amount of hormones or the end products
Abnormalities of the endocrine system are caused by (METABOLITES) of hormones excreted by the kidneys
● OVERSECRETION (hyperfunction) or ● one-time specimens, 24-hour urine specimens
● UNDERSECRETION (hypofunction) ● E.g. URINARY LEVELS OF FREE CATECHOLAMINES
of any of the hormones produced by the gland involved. (norepinephrine, epinephrine, and dopamine) → to
determine presence of adrenal medulla tumors
RESPONSES TO ALTERED ENDOCRINE FUNCTION
IMAGING STUDIES
ASSESSMENT ● radioactive scanning
● magnetic resonance imaging (MRI)
Changes in:
● computed tomography (CT)
● Energy levels ● Menstrual cycle
● Ultrasonography
● Tolerance to heat or cold ● Memory
● positron emission tomography (PET)
● Weight ● Concentration
● dual-energy x-ray absorptiometry (DEXA)
● Thirst ● Sleep patterns
● Frequency of urination ● Mood ADDITIONAL DIAGNOSTIC TESTS
● Fat and fluid distribution ● Vision changes ● GENETIC SCREENING → DNA testing for the identification
● Secondary sexual ● Joint pain of specific genes associated with endocrine disorders,
characteristics (e.g. loss ● Sexual dysfunction. selective targeting for drug development, and increased
or growth of hair) understanding of the function of the endocrine system.
→ HISTORY ○ Used to determine the presence of a gene mutation that
It is important to document: may predispose individual to a certain condition
1. The severity of these changes ● STIMULATIONS TESTS → used to confirm hypofunction of
2. The length of time the patient has experienced these changes an endocrine organ.
3. The way in which these changes have affected the patient's ○ To determine how an endocrine gland responds to the
ability to carry out activities of daily living (ADLs) administration of stimulating hormones that are normally
4. The effect of the changes on the patient's self-perception, and produced or released by the hypothalamus or pituitary
5. Family history gland
● SUPPRESSION TESTS → used to detect hyperfunction of
an endocrine organ.
PHYSICAL ASSESSMENT
○ To determine if the organ is not responding to the
● Vital signs negative feedback mechanisms that normally control
● Head-to-toe inspection secretion of hormones from the hypothalamus or
● Palpation of skin, hair, and thyroid pituitary gland
● Findings should be compared with previous findings
● Physical, psychological, and behavioral changes should be
noted

EXAMPLES OF FINDINGS:
● Appearance of facial hair
in women
● "moon face"
● "buffalo hump"
● EXOPHTHALMOS, vision
change
● edema, thinning of the skin
● obesity of the trunk
● thinness of the extremities
● increased size of the hands
and feet, edema
● hypo- or hyperreflexia
● Changes in pigmentation

DIAGNOSTIC EVALUATION
BLOOD TESTS
● determine the levels of circulating hormones, the presence of
autoantibodies, and the effect of a specific hormone on other
substances
● e.g., the effect of insulin on blood glucose levels
● SERUM LEVELS OF A SPECIFIC HORMONE → may provide
information to determine the presence of hypofunction or
hyperfunction, and the site of dysfunction
● RADIOIMMUNOASSAYS - radioisotope-labeled antigen
tests commonly indicated to measure levels of hormones or
substances

BSN 3A - Marjorie D. Solayao