Endocrine System

- Major organs:
• Hypothalamus
• Pituitary gland
• Thyroid gland
• Adrenal gland
• Pancreas
• Parathyroid gland (on dorsal aspect of thyroid gland)
• Gonads (Ovaries and Testes)

1. Pituitary gland
- “Hypophysis”
- Master gland of hormones
➢ Direct
➢ Indirect
- Location:
➢ Base of the brain
➢ Below the hypothalamus
- Removal: Hypophysectomy
- Most common route of removal: Transphenoidal (passes the sinus)
➢ Look for frequent swallowing poster surgery (use flashlight and check back of throat)
- Parts:

A. Anterior Pituitary Gland

➢ “Adenohypophysis”
➢ Hormones:
o Thyroid stimulating hormone (TSH)
o Follicle stimulating hormone (FSH)
o Luteinizing hormone (LH)
o Melanocyte stimulating hormone (MSH)
o Growth hormone (GH)
o Adrenocorticotropic stimulating hormone (ACTH)
o Interstitial stimulating hormone (ICTH)
➢ Produces stimulating hormones

B. Posterior Pituitary Gland

➢ “Neurohypophysis”
➢ Acts as storage and releasing of hormones
➢ Doesn’t produce any hormone

- Hypothalamus: producer of hormones

- Hormones:
OXYTOCIN • Uterine contraction
• 5 – 6 cm
• Milk let down reflex
• Everything goes out: baby, placenta, milk
ANTIDIURETIC • “Vasopressin”
HORMONE (ADH) • Conserves all fluids (not only urine) directly to the vascular area
and kidneys
o 1st space (Vascular) = most important = systemic
• Vasoconstrictor
o Conserves water
• BP regulation

Diabetes Insipidus (DI) Syndrome of Inappropriate

Antidiuretic Hormone (SIADH)

Deficiency/Absence/Resistance “I = Increase” or Elevated

to ADH
Types:
• Neurogenic
- PPG/Hypothalamus
- Low production/absence
of ADH
- More common than
nephrogenic
- Low storage
o Increased ICP
o CVA/Stroke
o Infection (meningitis
etc)
o Cancer
o Simmon’s Disease –
hypopituitarism; can
lead to DI
o Traumatic Bain Injury
• Nephrogenic
- Increased resistance to
ADH
o Renal failure
S/s: S/s:
• Polyuria >4L • Oliguria <30cc/hr
o Normal: 30-60ml/hr • Anuria (absence of urine)
o “Daghan ihi” • Urine concentration
• Polydipsia • Water retention
*No sugar problem but has • Fluid excess/overload
polyuria & polydipsia • Water intoxication
• Diluted urine • Metabolic alkalosis
• Water loss • Hypervolemia
• Fluid deficit • Hemodilution – late sign
• Metabolic acidosis • Hypertension
• Respiratory alkalosis • Weight gain
• Hypovolemia • Jugular vein distension –
• Hypotension vessel will enlarge
• Weight loss * NO edema — since fluid is
• Dehydration (sunken found in vascular (3rd spacing =
eyeballs, dry skin) – edema)
vascular WOF:
• Viscous blood ❖ Dilutional Hyponatremia –
• Hemoconcentration low sodium, seizures,
arrhythmia

Caused by: Caused by:

• Shock • Adenoma(benign tumour)
• Modified Trendelenberg in pituitary
gland/hypothalamus on
vital organs and glandular
• Hyperpituitarism
• Increased ICP
Diagnostic Test: Diagnostic Test:
• CT scan, MRI, PET scan • CT scan, MRI, PET scan
*gram = iodine • Kidney Function Test (KFT)
• Kidney Function Test (KFT) - For renal failure due to
- Creatinine clearance = 24H oliguria
urine collection test • ABG
• ABG • ECG and EEG
• Ultrasound of KUB - Measures electrical activity
• Water deprivation test • Serum electrolytes esp.
- Don’t drink water Sodium
- Despite deprivation, there • Specific gravity test
is still increase urine - Urinalysis
output - Checks urine concentration
- Too risky - Range = 1.010 – 1.030
• Specific gravity test - >1.030
- Urinalysis
- Checks urine concentration • Serum Osmolarity
- Range = 1.010 – 1.030 - Range = 280 – 295 mosm
- < 1.010 - Decreased
• Serum Osmolarity - Less than 280 mosm
- Range = 280 – 295 mosm
- Elevated
- More than 295 mosm
Management: Management:
• Hormonal Replacement • High sodium diet, limit
Therapy fluids
- VASOPRESSIN - Fast foods, can goods
- Give ADH for life • Diuretics
 - -pressin - Loop diuretic
- Ex: Vasopressin (Pitressin), Furosemide (Lasix),
Desmopressin Etacrynic Acid, Torsemide
(DDAVPressin) (Demadex)
- Route: Intranasal or IV - Fastest diuretic
• Chlorpropramide - Potassium wasting
(Diabenase) - Half life of drug = 6 hours
- Oral Hypoglycemic Agent - Side effect =
in low dosage photosensitivity and
- Stimulates ADH release ototoxicity
• IVF/Oral Fluid intake • Antihypertensives
• Anticoagulants PRN • Anticonvulsants
• Monitor I and O - For seizures
• Weigh daily • Sodium replacement as
- Weigh in the morning with needed
same clothe • Monitor I and O
- Best indicator for fluid • Weigh daily
status • Drug of choice:
- Accurately detect DEMECLOCYCLINE
how/much fluid (antibiotic)
- 1kg = 1000ml/cc - Decreases ADH production
• Monitor and correct - s/e: weight loss (THINK OF
electrolyte imbalance DI)
• Treat underlying cause • Surgery
- Hypophysectomy
- Post op: HRT
PARATHORMONE • Parathyroid gland
(PTH) - In front of neck
- Posterior
- Butterfly shaped gland
- 4 nodules
• Hormone: Parathormone (PTH)
• Calcium and Phosphorus regulation
- Gets calcium from bone and bring it out to the blood (transfers
to) —> causes Demineralisation since CALCIUM WENT TO THE
BLOOD
- PTH acts as a withdrawer
- Naturally activates if there is hypocalcemia/hyperphosphatemia
(Calcium & Phosphorus = inversely proportional)
➢ Calcium
o “Cement”
o Hardening
o Calcium range = 8 – 10 mg/dl OR 4.5 – 5.5 meq/L
➢ Bone
o “Bank”
o Excess calcium is stored in the bones
 ➢ Fibrinogen
o Clotting factor 1
o More calcium, more fibrinogen, more clots your body
make
HYPERparathyroidism HYPOparathyroidism
Excess or overproduction of PTH Absence or low production of
PTH
Leads to: Leads to:
• Excess demineralisation • Excess calcium deposit in
(rapid breakdown) = Bones bones
• Over accumulation = • Failure to replace calcium
Calcium in blood
Cause: Cause:
• Adenoma in PTG (benign • Atrophy of PTG (decrease
tumor) activity or absence)
- Overactivity • Cancer
- Capsulated cell - benign • Autoimmune (damage)
- Scrambled cell wall - - Antibody attacked it too
malignant, metastasize much destroying it
• Hypertrophy/Hyperplasia • Over treatment
- Hypertrophy – increase size - Radiation
of cell - Chemotherapy
- Hyperplasia – increase • Surgery
number of cells - Iatrogenic – condition due
• Over treatment of HRT to medical
• Autoimmune procedure/treatment
(inflammation) - Ex. Chemotherapy causing
- Attack causes swelling Iatrogenic Anemia
S/s: S/s:
• Weak, brittle, spongy bones • Big, heavy, strong/rigid
• Decreased bone density bones
- Bowing of bones (bending) • Weight gain
- Middle ear has bones = • Increase bone density =
malleus, incus, stapes thick bones
(smallest) • Pain
• Conductive hearing loss • Conductive hearing loss
- Sensory is for nerves - Sensory is for nerves
• Risk for fractures, • Hypocalcemia
osteoporosis (systemic - Due to increase
bone loss) Phosphorus
- Primary osteoporosis: - Risk for bleeding
natural cause like - Bruising
menopause, dietary, age - Ecchymosis
- Secondary osteoporosis: • Arrhythmia
came from disease • Muscle weakness
condition (ex.cancer, renal • Tetany
 failure, - Parenthesia
hyperparathyroidism) - Muscle twitching
- Pathological fracture: due - Carpopedal spasms
to disease
• Pain WOF:
• Abnormal postures ❖ Laryngo broncho spasm
- Kyphosis – “Dowagers ❖ Chvostek Sign
Hump”; common - Tapping the CHEEK
- Lordosis - Hypocalcemia
- Osteoporosis - CN 7
• Hypercalcemia ❖ Trousseau Sign
- Decrease Phosphorus – - BP cuff on arm
Dysrrytmia/Arrythmia - Hypocalcemia
• Risk for clotting
• Renal calculi
- “Lith” – stones
- Calcium oxalate stones
• Vascular/Valvular
calcification –> stenosis —>
hypertension
Diagnostic test: Diagnostic test:
• X-RAY • X-RAY
• Bone scan (Bone • Bone scan (Bone
Densimeter) Densimeter)
• Serum electrolyte level • Serum electrolyte level
• Bleeding/clotting • Bleeding/clotting
parameters parameters
• ECG • ECG
• Ultrasound of the kidney, • Ultrasound of the kidney,
PTG PTG
• CT scan, MRI, PET scan • CT scan, MRI, PET scan
• Serum PTH level • Serum PTH level
• Alkaline Phosphatase Level • Alkaline Phosphatase
Level
Management: Management:
• Drug of choice: CALCITONIN • Drug of choice: HRT of
- Calcium goes in PTH for life
- Gets calcium from blood to • Calcium supplements
go to the bones - Calcium gluconate,
• Low calcium diet lactate, carbonate
- Can’t give a high calcium - S/e: constipation
diet even if there is • Vitamin D supplements
osteoporosis/fracture due • High calcium, Hight
to HYPERparathyroidism = vitamin D, High fibre, Low
too much calcium in the Phosphorus
blood already
 • Analgesics – for pain • Analgesics as needed – for
• Radiation treatment as pain
needed • Anti arrhythmia
• Antineoplastic as needed • Tranexamic acid
(ex. Methotrexate) (Hemostan) – stop the
• Steroids as needed bleeding
(autoimmune) • Bedside: Et set,
• Mild to moderate activities, Trachesostomy set, Bag
handle extremities very valve mask
gently • Aluminum Hydroxide
- No contact sorts since you (Amphogel)
are prone to injury - Antacid
• Anticoagulants PRN - Phosphorus binder
• Anti arrhythmia as needed
• Surgery:
Parathyroidectomy
(subtotal)
- Subtotal is a better option
since removing whole can
pose risks
- Total

Note:
- Fluid compartments:
Vascular • Most important 2 Types of Dehydration:
Cellular • Second important - Vascular is more
important
- Cells are easily
replaced
Interstitial • Biggest space

- Urine Serum Osmolarity for SIADH or DI: [U.S.]

o I = Increase
o D = Decrease
Urine Serum
SIADH ⬆️ ⬇️
DI ⬇️ ⬆️