12

Unit

Endocrine and
Reproductive Systems
T
he purpose of this unit is to study the structure 3. The disorder that happens when there is not enough
and function of the endocrine and reproductive insulin needed by the body is called:
systems. The endocrine system is the hormone a. Hypothyroidism
system of the body. The body produces multiple b. Cancer
hormones, each having a different function. The c. Diabetes mellitus
reproductive system is the body system concerned d. Kidney failure
with sexuality and continuation of the species. Age-
related changes and some common disease processes 4. The glands that produce the male sex hormones are
are described. called the:
a. Testes
1. Chemicals produced by the glands of the endocrine b. Ovaries
system are called: c. Pituitaries
a. Nerves d. Thyroid
b. Hormones
c. Sweat 5. One of the symptoms of hypoglycemia includes:
d. Target cells a. Thirst
b. Lack of urination
2. The thyroid gland is located in the: c. Weight gain
a. Neck d. Hunger
b. Stomach
c. Left side of the chest
d. Groin

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OBJECTIVES which produce chemicals called hormones. Hormones

After completing this unit, the learner will be able to: are chemical messengers that carry information and
1. Define the key terms listed in this unit. signals from one part of the body to another. The
2. Discuss the basic structure and function of the endocrine system has the same primary function as
endocrine and reproductive systems. the nervous system: communication and control. The
3. Identify age-related changes in the elderly related endocrine system provides slower and longer-lasting
to the endocrine and reproductive systems. control. Hormones target every cell in the body and
4. Describe disorders common in the elderly related regulate metabolism, growth and development, and
to the endocrine system. reproduction. Hormones are carried in the bloodstream.
5. Describe the general care needs of the resident Disorders of the endocrine system result in the
with diabetes. overproduction or underproduction of hormones.
6. Recognize the signs and symptoms of diabetic
reactions. Endocrine glands are located throughout the body
and include the hypothalamus, pituitary, parathyroid,
Objective 1: Define the key terms listed in this unit. thyroid, thymus, adrenals, ovaries, testes and
pancreas.

Key Terms
nAdrenals nKussmaul respirations 1
nCortex nMedulla 2
nDiabetes mellitus nMenopause
nDiabetic coma nMenstruation
Endocrine 4
nEndocrine nOvaries System
nEstrogen 3 5
nOvulation
nFallopian tubes nOvum (ova) 1 Hypothalamus
nFertilization nPancreas 2 Pituitary gland
nGenitalia nPituitary 3 Parathyroids
nGland nPolydipsia 4 Thyroid gland
nGlucose 5 Thymus gland 6
nPolyphagia 7
nGlycogen
nPolyuria 6 Adrenal glands
nHormone
nHyperglycemia
nProgesterone 7 Pancreas
nReproduction 8 Ovaries
nHyperthyroidism
nHypoglycemia nScrotum 9 Testicles (male)
nHypothyroidism nSperm
nInsulin nTarget cells
nTestes 8
nInsulin shock / insulin
reaction nTestosterone
nIslets of Langerhans nThyroid 9
nKetoacidosis nUterus
nKetones nVagina

Pituitary
ANATOMY AND PHYSIOLOGY OF THE The pituitary gland is called the master gland. The
ENDOCRINE AND REPRODUCTIVE SYSTEMS hormones that it secretes coordinate the activity of
other endocrine glands. It is located at the base of the
Objective 2: Discuss the basic structure and function brain. The pituitary gland hormones stimulate:
of the endocrine and reproductive systems. „„  Melanin for pigment in skin.
„„  Breast development and milk secretion during
Endocrine System and after pregnancy.
The endocrine system consists of organs called glands, „„  Growth in all cells.

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 Unit 12 | Endocrine and Reproductive Systems

„„  Retention of water by the kidneys. and potassium in the blood.

„„  Uterine contraction during labor. „„  Trigger too strong or too weak allergic response.

Disorders of the pituitary gland can have many The adrenal glands also produce two hormones that
effects. Underproduction or overproduction of activate our stress response. These hormones work
hormones can trigger some of the following increases together with the autonomic nervous system during
or decreases: the fight or flight response. This allows the body to
„„  Thyroid functioning. resist stress for a longer period of time.
„„  Function of the adrenal glands.
„„  Hormone production of testes and ovaries. Too much or too little of these hormones can have
„„  Melanin in skin: Irregular changes in skin permanent negative effects on the cardiovascular
coloration. system. Examples include chronic hypertension,
„„  Breast development. anxiety and heart damage.
„„  Growth hormone can result in undergrowth or
overgrowth of the body or to specific bones. Ovaries and Testes
„„  Water retention: The kidneys may retain too The ovaries in females and the testes in males produce
much water and cannot eliminate waste, or the sex hormones. Sex hormones are responsible for
release too much water and trigger dehydration. the secondary sex characteristics and the production
„„  Early labor or contractions that are too weak for of the cells of reproduction, sperm and ovum.
delivery of the fetus. Decreases in any of these hormones can result in
infertility. Increases in the hormones can result in
Thyroid early development of sex characteristics or in excess
The thyroid is located in the neck just below the voice characteristics such as facial hair or changes in the
box. Two of the three thyroid hormones control the menstrual cycle.
speed at which energy is produced in all other body
cells. Energy, growth and development all depend on Pancreas
thyroid functioning. The third thyroid hormone helps The pancreas produces insulin. Insulin works to move
the body store calcium in the bones. glucose out of the blood and into the cells for use
or for storage. Insulin is
Too much of the thyroid hormones can result in responsible for utilization
increased metabolism, weight loss, irritability, of glucose by body cells for
increased appetite and anxiety. Calcium remains in the energy.
bloodstream and does not get stored in the bones. Lack
of thyroid hormones results in decreased metabolism, If too much insulin is
weight gain, depression and lack of energy. Too much produced, too much glucose
calcium is pulled out of the blood and deposited in the is removed from the cells. If
bones. too little insulin is produced,
not enough glucose is
The pancreas produces
Adrenal Glands removed from the blood and
insulin. If too little insulin is
The adrenal glands are attached to the top of each produced, not enough glucose diabetes mellitus may result.
kidney. Hormones produced by the adrenal glands is removed from the blood and Diabetes mellitus will be
help regulate fluid balance, blood glucose levels, blood diabetes mellitus may result. discussed later in this unit.
pressure and the body’s response to allergies. The
adrenal glands produce a small amount of the sex Reproductive System
hormones. Underproduction or overproduction of Reproduction, sexual gratification and hormone
these hormones can: production are functions of the reproductive system.
„„  Change blood pressure. The hormones of the reproductive system permit the
„„  Cause retention or excess loss of fluids. development of sex characteristics of the male and
„„  Alter blood glucose levels. female, and normal functioning of the reproductive
„„  Cause too much or too little amounts of sodium systems.

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Male Reproductive System The female reproductive organs are also classified as
essential organs and accessory organs. The essential
organs are the ovaries (two), which contain ovum.
Hormone production occurs in the ovaries.

Ovaries produce the ovum and the hormones

estrogen and progesterone. Ova are female sex cells
that contain the genetic material that will be inherited
by the baby if fertilization takes place. Hormones
stimulate the female sex characteristics, and have
significant roles in menstruation, pregnancy and
bone density.
7 6
5
8 When the ovum is released from the ovary, ovulation
has occurred. The ovum travels through the accessory
1 structures. During this period, fertilization of the
ovum can occur and a pregnancy will result. The
2
4 accessory organs of the female reproductive system
consist of the fallopian tubes, uterus and vagina.
3
The ovum is carried to the uterus through the
1 Penis 5 Pubic bone fallopian tubes. If fertilization takes place in the
2 Urethra 6 Prostate gland tubes, the fertilized egg attaches itself to the wall of
3 Scrotum 7 Urinary bladder
4 Testes (two) 8 Rectum Internal Organs

The male reproductive system includes essential organs

and accessory organs. The essential organs are the
testes, which are located in the scrotum. This is where
sperm and testosterone are produced.
2
3
Sperm are the sex cells that contribute genetic
material that a baby will inherit if fertilization occurs. 1
Testosterone is the primary male hormone and
produces masculine characteristics such as facial hair 4
and voice deepening, and promotes and maintains 5 6
male accessory organs.
10
Female Reproductive System

External 7
Genitals 8
1 Clitoris 9
2 Urethral meatus 1 Uterus 6 Urinary bladder
3 Vagina 2 Fallopian tubes (two) 7 Urethra
4 Perineum 3 Ovaries (two) 8 Urethral meatus
5 Anus 4 Cervix 9 Vagina
5 Vagina 10 Rectum

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 Unit 12 | Endocrine and Reproductive Systems

the uterus and pregnancy occurs. The vagina is the CONDITIONS COMMON IN THE ELDERLY
birth canal and connects the uterus to the external
genitalia. If fertilization does not occur the ovum is Objective 4: Describe disorders common in
released through the vagina during menstruation. the elderly related to the endocrine system.

Objective 3: Identify age-related changes in the elderly Endocrine Disorders

related to the endocrine and reproductive systems. Most medical conditions of the endocrine and
reproductive systems result from hyperactivity or
AGE-RELATED CHANGES hypoactivity of hormones by the endocrine glands.
The endocrine system has few functional declines in Some of the most common disorders in the elderly are
response to aging. The organs and tissues where the thyroid dysfunction, diabetes mellitus and impotence.
hormones are targeted may become less responsive
and more resistant to hormones. The decrease in Thyroid Dysfunction
response to hormone changes may be one reason the Hypothyroidism is caused by the underproduction of
elderly seem to have difficulty responding to stress and a thyroid hormone. Lack of this hormone causes all
illness. activities in the body to slow down. Treatment includes
thyroid replacement medication.
The prostate gland of most men enlarges with age
and can restrict the flow of urine from the bladder. Hyperthyroidism occurs when there is too much
There is a gradual decline in testosterone production. thyroid hormone secreted by the thyroid gland.
Reproductive ability does not stop with aging in men. Treatment requires limiting the thyroid gland’s ability
More time may be required to become aroused. There to produce and secrete hormones.
may be a decrease in sexual desire in both sexes. The
most significant change in the female reproductive Symptoms of Symptoms of
system is menopause. During menopause, Hypothyroidism Hyperthyroidism
menstruation ends, hormone production is decreased, Poor appetite Weight loss
and eggs are no longer released. The ability to Dry skin Heat intolerance
reproduce ceases. Vaginal dryness may occur, causing
Intolerance to cold Poor appetite
discomfort or pain with intercourse.
Hair loss Anxiety
Fatigue Palpitations
Both males and females continue to desire and enjoy
sexual activity throughout their lifespan unless a Memory loss Increased heart rate
chronic illness or disability affects the reproductive Slowed thought Dry skin
system. Sexuality is part of a person’s physical and processes
emotional identity. Self-care activities to promote Weight gain Insomnia
attractiveness and desirability increase self-esteem. Lowered pulse Hair loss
Companionship and physical sexual activities all Lowered blood Poor concentration
contribute to meeting a person’s sexual needs. pressure
Lowered body
Most barriers to sexual activities in long-term care temperature
are the result of the situation and the environment
rather than impotence or other physical problems. Diabetes Mellitus
Loss of spouse, lack of privacy and negative attitudes Diabetes impairs the body’s ability to use glucose
from staff and other residents are all barriers. Lack of for energy. Insulin is the primary hormone involved
privacy is a challenge in most long-term care settings. with diabetes. The purpose of insulin is to carry
Being discrete and respecting the resident’s preferences glucose from the bloodstream into the cells for use
are important. Negative attitudes cause residents to as energy and fuel. When there is not enough insulin
feel uncomfortable or inadequate when talking about present, glucose does not get to the cells and the
intimacy and sexuality. cells “starve” because they do not receive the energy

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and food needed to function. In response to the

“starving” cells, the body’s liver breaks down stores Signs and Symptoms
of a compound called glycogen into glucose. This of Hyperglycemia
glucose is released into the bloodstream in an attempt nFrequent/unusual thirst hunger (polyphagia)
to “feed” the cells. The result is higher levels of (polydipsia) nUnusual weight loss
glucose in the blood, and the cells still do not receive nFrequent urination
(polyuria) nExtreme fatigue
the energy they need to function. Normally, insulin
nFrequent/extreme nIrritability
is released by the pancreas within minutes of a rise in
the amount of glucose in the blood, for example, after
a meal. The glucose level reaches a peak in 30 minutes People with Type 2 diabetes, because there can be
and returns to baseline within three hours. Between few if any symptoms in the early stages, may go
periods of food intake, the blood level of insulin undiagnosed for years. People with Type 2 may also
remains low. have the same symptoms as a person with Type 1
diabetes. Many people may not be diagnosed until they
Insulin is important in fat metabolism. Insulin develop symptoms associated with complications of
prevents fat from being broken down into excessive
the disease.
amounts of substances called ketones. When there are
too many ketones circulating in the blood, a condition
Type 2 diabetes, formerly called non-insulin
known as ketoacidosis results. This condition is
dependent diabetes mellitus (NIDDM) or adult-onset
harmful to the normal function of all cells because it
diabetes, accounts for 90 to 95 percent of all cases
further prevents them from using glucose for energy.
of diabetes. Type 2 diabetes is a result of cells not
Insulin is also important in protein utilization by the
being able to use insulin properly and/or inadequate
body. When there is not enough glucose in the cells to
insulin production in the pancreas in response to
use for energy, the body will break down proteins to
elevated blood glucose levels. It is possible to have
use for fuel. If there is no insulin available, the body
Type 2 diabetes for a long period of time before actual
will not be able to use sufficient amounts of protein
for tissue growth and repair. This is generally what symptoms occur. Management of Type 2 diabetes
causes weight loss and delayed wound healing in many usually includes diet, exercise, oral hypoglycemic
residents with diabetes. medications (medications that lower blood glucose),
and possibly periodic injections of insulin.
According to the American Diabetes Association, there
are two main types of diabetes: Type 1 and Type 2 Symptoms of
diabetes. Type 2 Diabetes
nFrequent infections n Cuts or bruises that
Type 1 diabetes, previously called insulin-dependent
of the skin, gums or are slow to heal
diabetes mellitus (IDDM) or juvenile-onset diabetes, bladder n Tingling or numbness
develops when the body’s own immune system nBlurred vision in the hands or feet
destroys the cells in the pancreas that make insulin.
As a result, there is no insulin available to carry
glucose to the cells. This form of diabetes usually Diabetes and Aging
strikes children and young adults but may occur As the body ages, the cells become more resistant to
at any age. Several injections of insulin a day or the effects of insulin, and as a result, an older adult has
an insulin pump are required for these people to more trouble using glucose (for fuel and energy). The
survive and manage their diabetes. Individuals with cells in the pancreas that produce insulin become less
Type 1 diabetes may develop symptoms of marked sensitive with age and do not produce insulin quickly
hyperglycemia, or high blood glucose, early in the enough to respond to the rise of glucose in the blood.
disease. These symptoms are related to the high Because of normal physical changes associated with
levels of glucose in the blood and the lack of energy aging, elderly diabetic residents rarely present with the
available to the body’s cells. These symptoms usually typical symptoms. The normal senses of vision, taste,
develop suddenly. and smell are changed with age as are the abilities to

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recognize hunger and thirst. Consequently, polydipsia Polyphagia Mood swings

and polyphagia are usually absent. Dehydration is Polydipsia Behavior changes
more common with hyperglycemia because elderly
Fatigue Clumsy/jerky
residents have an altered sense of thirst and do not movement
replace fluids when needed. The aging kidneys are not
Dry, flushed skin Poor concentration,
as efficient, and as a result, the elderly resident with confusion
diabetes may develop very high glucose levels in the
Confusion, poor Tingling sensation
blood. concentration around mouth
Abdominal pain Seizure
Diabetes can easily be overlooked. Loss of physical
Kussmaul respiration Nightmare
and cognitive functional abilities can alter symptoms
of diabetes in the elderly. Decreased physical activity, Slow reflexes Fatigue
multiple diseases, and medications with frequent drug Slurred speech
interactions also affect what and how symptoms will
be present in an elderly diabetic resident. The elderly General Care of a Diabetic Resident
diabetic resident may have vague, general complaints Diabetic residents need to monitor the amount of
such as loss of appetite, weight loss, slow wound carbohydrates eaten throughout the day. This directly
healing, frequent skin/wound infections, mental impacts the amount of insulin required so the cells can
status changes, new incontinence and decreased use the available glucose for energy. Careful record
vision. In the older population, these symptoms may keeping of amounts and types of foods consumed can
often be confused with the normal aging process. It is reduce complications related to diabetes. Residents
important that those caring for the elderly are alert to should not be denied favorite foods because of their
any changes in appetite, weight, mental state, vision, diabetes. Insulin should be adjusted to the resident’s
activity and behavior. carbohydrate intake rather than the food adjusted to
the insulin injection. If there is an increase or decrease
All diabetic residents need to be observed closely for in intake, the nurse should be notified to adjust the
diabetic reactions. Diabetic coma (hyperglycemia) insulin and monitor for complications.
results from a high blood glucose level. Infections,
medications, stress or high food intake may cause it. Objective 5: Describe the general care
The onset of hyperglycemia is usually gradual. Insulin needs of the resident with diabetes.
reaction (hypoglycemia or insulin shock) occurs
with low blood glucose levels. Hypoglycemia can Diabetic residents are prone to poor circulation
result from an overdose of insulin, low food intake, problems, especially in the feet. Special care of the
nausea and vomiting, or alcohol intake. The onset of feet must be taken in order to prevent infections and
hypoglycemia is usually very rapid. Report any signs of skin breakdown. Observe the resident’s feet daily
diabetic reactions immediately to the nurse. for sores and redness. Report any changes to the
nurse per facility policy. Wash the feet daily and dry
Objective 6: Recognize the signs and carefully, especially between the toes. Do not apply
symptoms of diabetic reactions. lotion between the toes unless there is a doctor’s order.
Check shoes and socks to be sure there are no holes or
Symptoms of Diabetic Reactions rough spots that could rub a sore on the feet. A person
Hyperglycemia Hypoglycemia with diabetes should never go barefoot. The toenails
of the diabetic should be trimmed by a foot doctor
Shortness of breath Shakiness
(podiatrist) or a nurse.
Fruity odor to breath Dizziness
Nausea/Vomiting Sweating
OBSERVATIONS
Dry mouth Hunger The endocrine system regulates many activities in
Polyuria Pale, cool, clammy the body, so disorders often show up as symptoms of
skin diseases or disorders of other systems.

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Diabetic reactions: Is there a change in behavior, time and does the resident urinate often?
confusion, restlessness, anxiety or weakness? Does the Thyroid disorders: Is the resident more active or less
skin feel normal? Does the resident have trouble with active than usual? Is there a weight gain or loss? Does the
muscle coordination? Is the resident thirsty most of the resident have more trouble remembering than usual?

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