Chapter 52

Assessment: 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-

andkey” 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.

• With positive feedback, increasing hormone levels cause another gland to release a hormone

that then stimulates further release of the first hormone

• 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.

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• 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 required 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 made 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

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• The adrenal glands are small, paired, highly vascularized glands found on the upper part of

each kidney. The adrenal gland is composed of the adrenal medulla and the adrenal cortex. •

The adrenal medulla secretes the catecholamines epinephrine (major hormone),

norepinephrine, and dopamine.

• The adrenal cortex secretes several steroid hormones, including glucocorticoids,

mineralocorticoids, and androgens.

• Cortisol helps regulate blood glucose concentration, inhibit inflammatory action, and support

the stress response.

• Aldosterone is a potent mineralocorticoid that maintains extracellular fluid volume.

• The small amounts of androgens secreted are converted to testosterone in men and estrogen in

women in the peripheral tissues.

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

changes in circadian rhythms.

• Subtle changes of aging often mimic manifestations of endocrine disorders and endocrine

disorders can mimic subtle changes of aging.

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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 excess hormone secretion, transport

abnormalities, an inability of the target tissue to respond to a hormone, or inappropriate

stimulation of the target-tissue receptor.

• Ask about the 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 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. Inspect the hair distribution pattern of the genitalia

• 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.

• Palpate the thyroid for its size, shape, symmetry, and tenderness, as well as for any nodules.

Only an experienced clinician should palpate an enlarged thyroid gland.

• Assess the size, shape, symmetry, and general proportion of hand and feet.

DIAGNOSTIC STUDIES OF ENDOCRINE SYSTEM

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• Laboratory tests usually involve blood and urine testing. They may include direct measurement

of the hormone level or involve an indirect measure 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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