Part 1-MIDTERM - 117 LEC

NCM 117- LECTURE
CHAPTER 52
Assessment and Management of Patients with Endocrine Disorders

acromegaly: progressive enlargement of peripheral body parts resulting from excessive secretion of
growth hormone
Addison disease: chronic adrenocortical insufficiency due to inadequate adrenal cortex function
addisonian crisis: acute adrenocortical insufficiency; characterized by hypotension, cyanosis, fever,
nausea/vomiting, and signs of shock
adrenalectomy: surgical removal of one or both adrenal glands
adrenocorticotropic hormone (ACTH): hormone secreted by the anterior pituitary, essential for
growth and development
adrenogenital syndrome: masculinization in women, feminization in men, or premature sexual
development in children; result of abnormal secretion of adrenocortical hormones, especially
androgens
androgens: male sex hormones
basal metabolic rate: chemical reactions occurring when the body is at rest
calcitonin: hormone secreted by the thyroid gland; participates in calcium regulation
Chvostek sign: spasm of the facial muscles produced by sharply tapping over the facial nerve in front
of the parotid gland and anterior to the ear; suggestive of latent tetany in patients with hypocalcemia
corticosteroids: hormones produced by the adrenal cortex or their synthetic equivalents; also referred
to as adrenal-cortical hormone and adrenocorticosteroid; consist of glucocorticoids, mineralocorticoids,
and androgens
Cushing syndrome: group of symptoms produced by an over secretion of adrenocorticotropic
hormone; characterized by truncal obesity, “moon face,” acne, abdominal striae, and hypertension
diabetes insipidus: condition in which abnormally large volumes of dilute urine are excreted as a result
of deficient production of vasopressin
dwarfism: generalized limited growth resulting from insufficient secretion of growth hormone during
childhood
endocrine: secreting internally; hormonal secretion of a ductless gland
euthyroid: state of normal thyroid hormone production
exocrine: secreting externally; hormonal secretion from excretory ducts
exophthalmos: abnormal protrusion of one or both eyeballs
glucocorticoids: steroid hormones secreted by the adrenal cortex in response to adrenocorticotropic
hormone; produce a rise of liver glycogen and blood glucose
goiter: enlargement of the thyroid gland
Graves disease: a form of hyperthyroidism; characterized by a diffuse goiter and exophthalmos
hormones: chemical transmitter substances produced in one organ or part of the body and carried by
the bloodstream to other cells or organs on which they have a specific regulatory effect; produced
mainly by endocrine glands
hypophysectomy: removal or destruction of all or part of the pituitary
gland
mineralocorticoids: steroid hormones secreted by the adrenal cortex
myxedema: severe hypothyroidism; can be with or without coma
negative feedback: regulating mechanism in which an increase or decrease in the level of a substance
decreases or increases the function of the organ producing the substance
pheochromocytoma: adrenal medulla tumor
syndrome of inappropriate antidiuretic hormone (SIADH) secretion: excessive secretion of
antidiuretic hormone from the pituitary gland despite low serum osmolality level
thyroidectomy: surgical removal of all or part of the thyroid gland
thyroiditis: inflammation of the thyroid gland; may lead to chronic hypothyroidism or may resolve
spontaneously
thyroid-stimulating hormone (TSH): released from the pituitary gland; causes stimulation of the
thyroid, resulting in release of T3 and T4
thyroid storm: severe life-threatening hyperthyroidism precipitated by stress; characterized by high
fever, extreme tachycardia, and altered mental state
thyrotoxicosis: condition produced by excessive endogenous or exogenous thyroid hormone
thyroxine (T4): thyroid hormone; active iodine compound formed and stored in the thyroid; deiodinated
in peripheral tissues to form triiodothyronine; maintains body metabolism in a steady state
triiodothyronine (T3): thyroid hormone; formed and stored in the thyroid; released in smaller
quantities, biologically more active, and with faster onset of action than T4; widespread effect on cellular
metabolism
Trousseau sign: carpopedal spasm induced when blood flow to the arm is occluded using a blood
pressure cuff or tourniquet, causing ischemia to the distal nerves; suggestive sign for latent tetany in
hypocalcemia
vasopressin: antidiuretic hormone secreted by the posterior pituitary
Endocrine System
- plays a vital role in orchestrating cellular interactions, metabolism, growth, reproduction,

aging, and response to adverse conditions
Anatomic and Physiologic Overview
Involves the release of chemical transmitter substances called HORMONES

Hormones:
GI MUCOSA - gastrin, enterogastrone, secretin, cholecystokinin
KIDNEY - erythropoietin, a hormone that stimulates the bone marrow to produce red blood cells; and
the white blood cells produce cytokines (hormonelike proteins) that actively participate in inflammatory
and immune responses.
GLANDS OF ENDOCRINE GLAND

Function and Regulation of Hormones
Hormones help regulate organ function in concert with the nervous system.
The rapid action by the nervous system is balanced by slower hormonal
action.
endocrine glands are composed of secretory cells arranged in minute
clusters known as ACINI.
To prevent accumulation, these hormones must be inactivated continuously
by a negative feedback system so that when the hormone concentration
increases, further production of that hormone is inhibited.
Classification and Action of Hormone

Hormones are classified into four categories according to their structure:
1. amines and amino acids (e.g., epinephrine, norepinephrine, and thyroid
hormones)
2. peptides, polypeptides, proteins, and glycoproteins (e.g. thyrotropin-
releasing hormone [TRH], follicle-stimulating hormone [FSH], and growth
hormone [GH])
3. steroids (e.g., corticosteroids, which are hormones produced by the adrenal
cortex or their synthetic equivalents)
4. fatty acid derivatives (e.g., eicosanoid, retinoids)
Hormones that never enter in the bloodstream that:
Act locally in the area where they are released:
paracrine action – (e.g., the effect of sex hormones on the ovaries).
Act on the actual cells from which they were released:
autocrine action - (e.g., the effect of insulin from pancreatic beta cells on those
cells)
cyclic 3′,5′- Adenosine Mono-Phosphate (AMP)
- Alters enzymes activity

- “SECOND MESSENGER” that links the peptide hormone at the cell surface to
change in the intracellular environment.
 PROTEIN AND PEPTIDE hormones also act by changing membrane

permeability and act within seconds or minutes
 AMINE hormones similar with peptide
 STEROID hormones – has smaller size and higher lipid solubility, penetrate
cell membranes and interact with intracellular receptors.
 mRNA - then stimulates protein synthesis within the cell.

ASSESSMENT
Health History
Thorough health history and review of systems:
1. Asked if they have experienced changes in:
 energy level, tolerance to heat or cold
 weight, thirst, frequency of urination
 fat and fluid distribution
 secondary sexual, characteristics such as loss or growth of hair, menstrual cycle
 memory, concentration, sleep patterns, and mood, as well as vision changes
 joint, pain, and sexual dysfunction
2. DOCUMENT:
 Severity of these changes
 Length of time the patient has experienced these changes
 Way in which these changes have affected the patient’s ability to carry out activities of daily
living
 Effect of the changes on the patient’s self-perception
 Family history
Physical Assessment
Physical examination should include taking:
 vital signs
 head-to-toe inspection and palpation of skin, hair, and thyroid
 Findings should be compared with previous findings, if available.
 Physical, psychological, and behavioral changes should be noted.
changes in physical characteristics on examination may include appearance of facial hair in

women, “moon face,” “buffalo hump,” exophthalmos (abnormal protrusion of one or both
eyeballs), vision changes, edema, thinning of the skin, obesity of the trunk, thinness of the
extremities, increased size of the feet and hands, edema, and hypo- or hyperreflexia.
 May also exhibit changes in mood and behavior such as nervousness, lethargy, and fatigue
Diagnostic Evaluation
1. BLOOD TEST
- 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). The serum
levels of a specific hormone may provide information to determine the presence of hypofunction or
hyperfunction of the endocrine system and the site of dysfunction. Radioimmunoassays are
radioisotope-labeled antigen tests that are commonly indicated blood tests used to measure the levels
ofhormones or other substances
2. URINE TEST
- used to measure the amount of hormones or the end products of hormones excreted by the kidneys.
One-time specimens or, in some disorders, 24-hour urine specimens are collected to measure
hormones or their metabolites. For example, urinary levels of free catecholamines (norepinephrine,
epinephrine, and dopamine) may be measured in patients with suspected tumors of the adrenal medulla
(pheochromocytoma). Several disadvantages related to urine tests that must be considered are that
patients may be unable to urinate at schedule intervals and that some medications or disease states
may affect the test results
Additional Diagnostic Test:

3. STIMULATION TEST
- used to confirm hypofunction of an endocrine organ. The tests determine how an endocrine
gland responds to the administration of stimulating hormones that are normally produced or
released by the hypothalamus or pituitary gland.
4. SUPRESSION TEST
- used to detect hyperfunction of an endocrine organ. They determine if the organ is not
responding to the negative feedback mechanisms that normally control secretion of hormones
from the hypothalamus or pituitary gland.
5. IMAGING TEST
- radioactive scanning, magnetic resonance imaging (MRI), computed tomography (CT),
ultrasonography, positron emission tomography (PET), and dual-energy x-ray absorptiometry
(DEXA)
6. GENETIC SCREENING
- used to determine the presence of a gene mutation that may predispose an individual to a certain
condition
7. DNA testing
- used for the identification of specific genes associated with endocrine disorders

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NCM 117- LECTURE

Assessment and Management of Patients with Endocrine Disorders

- plays a vital role in orchestrating cellular interactions, metabolism, growth, reproduction,

Anatomic and Physiologic Overview

Involves the release of chemical transmitter substances called HORMONES

GLANDS OF ENDOCRINE GLAND

Classification and Action of Hormone

Act locally in the area where they are released:

paracrine action – (e.g., the effect of sex hormones on the ovaries).

Act on the actual cells from which they were released:

cyclic 3′,5′- Adenosine Mono-Phosphate (AMP)

- Alters enzymes activity

 PROTEIN AND PEPTIDE hormones also act by changing membrane

 AMINE hormones similar with peptide

 mRNA - then stimulates protein synthesis within the cell.

 Physical, psychological, and behavioral changes should be noted.

changes in physical characteristics on examination may include appearance of facial hair in

Additional Diagnostic Test:

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