Lewis: Medical-Surgical Nursing, 10 Edition: Assessment of Endocrine System Key Points

Lewis: Medical-Surgical Nursing, 10th Edition
Chapter 47
Assessment of Endocrine System
KEY POINTS
STRUCTURES AND FUNCTIONS OF ENDOCRINE SYSTEM

 Hormones exert their effects on target tissue.
 The specificity of hormone–target cell interaction is determined by receptors in a “lock-
and-key” type of mechanism.
 The regulation of hormone levels in the blood depends on a highly specialized
mechanism called feedback.
 With negative feedback, the gland responds by increasing or decreasing the secretion of a
hormone based on feedback from various factors.
 The hypothalamus and pituitary gland integrate communication between nervous and
endocrine systems, forming a neuroendocrine system.
Anterior Pituitary
 Several hormones secreted by the anterior pituitary are referred to as tropic hormones
because they regulate the secretion of hormones by other glands.
 Thyroid-stimulating hormone (TSH) stimulates the thyroid gland to secrete
thyroid hormones.
 Adrenocorticotropic hormone (ACTH) stimulates the adrenal cortex to secrete
corticosteroids.
 Follicle-stimulating hormone (FSH) stimulates secretion of estrogen along with
the development of ova in women and sperm in men.
 Luteinizing hormone (LH) stimulates ovulation in women and secretion of sex
hormones in both men and women.
 Because growth hormone (GH) affects protein, lipid, and carbohydrate metabolism, it has
effects on all body tissues.
 Antidiuretic hormone (ADH) regulates fluid volume by stimulating reabsorption of water
in the kidneys.
 Oxytocin stimulates ejection of milk into mammary ducts and contraction of uterine
smooth muscle.
Pineal Gland
 The pineal gland secretes melatonin and helps regulate circadian rhythm and
reproduction.
Thyroid Gland
 The major function of the thyroid gland is the production, storage, and release of the
thyroid hormones: thyroxine (T4) and triiodothyronine (T3).
 Iodine is necessary for the synthesis of thyroid hormones.
 T4 and T3 affect metabolic rate, carbohydrate and lipid metabolism, growth and
development, and nervous system activities.
 Calcitonin is a hormone produced by C cells (parafollicular cells) of the thyroid gland in
response to high circulating calcium levels.
Parathyroid Glands
 The parathyroid glands are four small, oval structures usually arranged in pairs behind
each thyroid lobe. They secrete parathyroid hormone (PTH), which regulates the blood
level of calcium.
Adrenal Gland
 The adrenal glands are small, paired, highly vascularized glands located on the upper
portion of each kidney. The adrenal gland is composed of the adrenal medulla and the
adrenal cortex.
 Adrenal Medulla
 Secretes the catecholamines epinephrine (major hormone), norepinephrine, and
dopamine.
 Adrenal Cortex
 Secretes cortisol, which is the most abundant and potent glucocorticoid.
Cortisol is necessary to maintain life. Its functions include regulating blood
glucose concentration, inhibiting inflammatory action, and support in response
to stress.
 Aldosterone is a potent mineralocorticoid that maintains extracellular fluid
volume.
 The adrenal cortex secretes small amounts of androgens.
 In peripheral tissues, adrenal androgens are converted to testosterone in men
and estrogen in women.
Pancreas
 The pancreas secretes several hormones, including glucagon and insulin.
 Glucagon, a catabolic hormone, increases blood glucose by stimulating
glycogenolysis, gluconeogenesis, and ketogenesis.
 Insulin, an anabolic hormone, is the principal regulator of the metabolism and
storage of ingested carbohydrates, fats, and proteins.
GERONTOLOGIC CONSIDERATIONS: EFFECTS OF AGING ON ENDOCRINE

SYSTEM
 Normal aging results in decreased hormone production and secretion, altered hormone
metabolism and biologic activity, decreased responsiveness of target tissues to hormones,
and alterations in circadian rhythms.
 Subtle changes of aging often mimic manifestations of endocrine disorders and endocrine
disorders can mimic subtle changes of aging.
ASSESSMENT OF ENDOCRINE SYSTEM

 Hormones affect every body tissue, causing great diversity in the signs and symptoms of
endocrine dysfunction.
 Endocrine dysfunction may result from deficient or excessive hormone secretion,
transport abnormalities, an inability of the target tissue to respond to a hormone, or
inappropriate stimulation of the target-tissue receptor.
 Inquire about use of hormone replacements, previous hospitalizations, surgery,
chemotherapy, and radiation therapy, especially of the head and neck.
 Since most endocrine glands are inaccessible to direct physical examination, assessment
focuses on detecting manifestations associated with the specific gland.
 Assessment includes a history of growth and development, weight distribution
and changes, and comparisons of these factors with normal findings.
 Disorders can commonly cause changes in mental and emotional status.
 Note the color and texture of the skin, hair, and nails. Palpate the skin for texture
and presence of moisture.
 When inspecting the thyroid gland, first observe in the normal position
(preferably with side lighting), then in slight extension, and then as the patient
swallows a sip of water.
 The thyroid may be palpated for its size, shape, symmetry, and tenderness, as well
as for any nodules. An enlarged thyroid gland should not be palpated by an
inexperienced practitioner.
 Assess the size, shape, symmetry, and general proportion of hand and feet.
 Inspect the hair distribution pattern of the genitalia.
DIAGNOSTIC STUDIES OF ENDOCRINE SYSTEM

 Laboratory tests usually involve blood and urine testing.
 Ultrasound may be used as a screening tool to localize endocrine growths such as thyroid
nodules.
 Laboratory studies may include direct measurement of the hormone level or involve an
indirect indication of gland function by evaluating blood or urine components affected by
the hormone (e.g., electrolytes, glucose).
 Notation of sample time on the laboratory slip and sample is important for hormones with
circadian or sleep-related secretion.
 Laboratory studies used to assess anterior pituitary function include GH, prolactin, FSH,
LH, TSH, and ACTH levels.
 Tests to assess abnormal thyroid function include TSH (most common), total T4, free T4,
and total T3.

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Lewis: Medical-Surgical Nursing, 10 Edition: Assessment of Endocrine System Key Points

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Lewis: Medical-Surgical Nursing, 10th Edition

Assessment of Endocrine System

STRUCTURES AND FUNCTIONS OF ENDOCRINE SYSTEM

GERONTOLOGIC CONSIDERATIONS: EFFECTS OF AGING ON ENDOCRINE

ASSESSMENT OF ENDOCRINE SYSTEM

DIAGNOSTIC STUDIES OF ENDOCRINE SYSTEM

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