🧠 Endocrine System Study Guide (A&P, Patho, Assessment, and Nursing Care)

🧩 1. Major Glands and Hormones

Gland Hormone(s) Function

CRH, TRH, GnRH, GHRH,

Hypothalamus Controls pituitary hormone release
Somatostatin

Pituitary GH, TSH, ACTH, FSH, LH, Stimulates growth, thyroid, adrenal cortex,
(Anterior) Prolactin gonads

Pituitary Water reabsorption, uterine contraction, milk

ADH (vasopressin), Oxytocin
(Posterior) letdown

Thyroid T3, T4, Calcitonin Regulates metabolism and calcium levels

Parathyroid PTH Increases serum calcium

Stress response, Na⁺/K⁺ balance, secondary

Adrenal Cortex Cortisol, Aldosterone, Androgens
sex traits

Adrenal Medulla Epinephrine, Norepinephrine “Fight or flight”

Pancreas Insulin, Glucagon Lowers/raises blood glucose

Ovaries/Testes Estrogen, Progesterone, Testosterone Reproductive function

🔁 2. Hormone Cascade Example (Thyroid Axis)

Hypothalamus (TRH) → Pituitary (TSH) → Thyroid (T3, T4)
➡️Increased T3/T4 inhibits TRH & TSH (negative feedback loop).

👵 3. Age-Related Changes
 ↓ Hormone production (especially sex hormones, GH, T3/T4)
 ↓ Metabolism → cold intolerance, weight gain
 ↓ ADH sensitivity → risk for dehydration, orthostatic hypotension
 Slower response to stress

🧪 4. Diagnostic Tests
Stimulation Tests:
Used when hypofunction is suspected (e.g., ACTH stimulation test → checks adrenal response).
Suppression Tests:
Used for suspected hyperfunction (e.g., Dexamethasone suppression test → checks cortisol suppression in
Cushing’s).
Urine Tests:
 24-hour urine for cortisol or catecholamines (pheochromocytoma).
 Discard first void, collect all urine for 24 hours, keep on ice.

💧 5. DI vs SIADH

Feature Diabetes Insipidus (DI) SIADH

Patho ↓ ADH or kidney nonresponse ↑ ADH secretion

Urine output ↑↑ (dilute) ↓ (concentrated)

Serum sodium ↑ (hypernatremia) ↓ (hyponatremia)

Fluid restriction, hypertonic saline,

Treatment Desmopressin (DDAVP), fluids
demeclocycline

Therapeutic effect ↓ urine output, ↑ urine specific

(DI) gravity

🦴 6. Acromegaly
 Cause: Excess growth hormone (GH) after epiphyseal closure (usually pituitary tumor)
 S/S: Large hands/feet, jaw, deep voice, organ enlargement
 Treatment: Surgery (hypophysectomy), octreotide (GH suppressor)
 Post-op care: Avoid coughing, sneezing, straining; monitor for CSF leak (clear drainage with
glucose)

🧠 7. Hypophysectomy (Pituitary Removal)

 Assessment: Monitor neuro status, vision changes, DI symptoms (urine output, specific gravity)
 Education: Avoid straining, bending, brushing teeth; report clear nasal drainage; hormone
replacement lifelong.

🦋 8. Thyroid Disorders
Condition Hyperthyroidism Hypothyroidism

Patho Excess T3/T4 (Graves’) Deficient T3/T4 (Hashimoto’s)

Weight loss, heat intolerance, tachycardia, Weight gain, cold intolerance,

S/S
exophthalmos bradycardia, fatigue

Antithyroid meds (methimazole, PTU), beta-blockers,

Treatment Levothyroxine
radioactive iodine, thyroidectomy

Myxedema coma (life-threatening

Complication Thyroid storm (life-threatening ↑ metabolism)
↓ metabolism)

⚠️Myxedema Coma
 Cause: Untreated hypothyroidism, stress, infection
 S/S: Hypothermia, bradycardia, hypotension, hypoventilation
 Tx: IV levothyroxine, warming, airway support

🧮 9. Parathyroid Disorders

Condition Hypoparathyroidism Hyperparathyroidism

Causes Post-thyroidectomy, autoimmune Adenoma, CKD

Calcium ↓ (hypocalcemia) ↑ (hypercalcemia)

S/S Tetany, tingling, Chvostek/Trousseau signs Fatigue, bone pain, kidney stones

Tx Calcium + vitamin D supplements Fluids, furosemide, calcitonin

Nursing Monitor Ca²⁺, airway, seizure precautions Encourage mobility, hydration

💊 Levothyroxine (Synthroid)
 Take on empty stomach, same time daily (morning).
 Avoid switching brands.
 Lifelong therapy.
 Monitor HR >100 (report).
 Improvement: ↑ energy, ↓ weight gain, improved mood.

🩺 10. Thyroid Surgery Care

 Assess airway first!
  Keep trach set, oxygen, suction at bedside.
 Watch for laryngeal stridor (airway emergency).
 Monitor for hypocalcemia (tingling, twitching).
 Support neck when moving; semi-Fowler’s position.
 Avoid neck flexion.

⚡ 11. Thyroid Storm vs. Myxedema Coma

Thyroid Storm Myxedema Coma

Hyperthyroid crisis Severe hypothyroidism

↑ Temp, ↑ HR, ↑ BP ↓ Temp, ↓ HR, ↓ BP

Tx: Antithyroid meds, beta-blockers, cooling Tx: IV levothyroxine, warming, airway

😰 12. Pheochromocytoma
 Tumor of adrenal medulla → excess catecholamines
 S/S: Severe HTN, tachycardia, diaphoresis, headache
 Dx: 24-hr urine for metanephrines (no caffeine/bananas before)
 Tx: Adrenalectomy; pre-op alpha blockers (phenoxybenzamine)

🟤 13. Addison’s Disease

 Patho: Adrenal cortex insufficiency → ↓ cortisol, ↓ aldosterone
 S/S: Fatigue, hypotension, hyperpigmentation, ↓ Na⁺, ↑ K⁺
 Role of Aldosterone: Maintains Na⁺/K⁺ balance, BP
 Education: Never stop steroids suddenly; carry medical alert bracelet
 Addisonian Crisis: Life-threatening ↓ cortisol → shock, hypoglycemia
Tx: IV hydrocortisone, fluids, glucose

🐃 14. Cushing’s Disease/Syndrome

Syndrome (from
Disease (pituitary cause)
steroids/tumor)

Excess ACTH → ↑ cortisol External or internal cortisol

 Syndrome (from
Disease (pituitary cause)
steroids/tumor)

excess

S/S: Moon face, buffalo hump, truncal obesity, muscle wasting, striae,
high glucose

Tx: Taper steroids, surgery/radiation for tumor, monitor glucose

⚖️15. Metabolic Syndrome

Cluster of risk factors for diabetes & heart disease:
 ↑ waist circumference
 ↑ triglycerides
 ↓ HDL
 ↑ BP
 ↑ fasting glucose
Tx: Weight loss, diet, exercise, manage BP & glucose.

🍬 16. Hypoglycemia
 S/S: Shakiness, sweating, tachycardia, confusion, irritability
 Tx: 15g fast-acting glucose (juice, candy), recheck in 15 min
 If unconscious: Glucagon IM or 50% dextrose IV

💉 17. Diabetes Mellitus (Type 1 vs Type 2)

Type 1 Type 2

Autoimmune, no insulin Insulin resistance

Younger onset Adult onset

Requires insulin May need oral meds or insulin

Risk: DKA Risk: HHS

🔥 18. DKA vs. HHS

Feature DKA HHS

Cause Insulin deficiency (Type 1) Stress/illness (Type 2)

Glucose >250 mg/dL >600 mg/dL

Ketones Present None/minimal

ABG Metabolic acidosis Normal pH

IV fluids, insulin, monitor

Tx: IV fluids, insulin, monitor K⁺
K⁺

🧾 19. Diabetes Diagnostic Tests

 Fasting glucose ≥126 mg/dL
 A1C ≥6.5% (average glucose over 3 months)
 Education: NPO 8 hours for fasting test; A1C no prep needed.

💊 20. Diabetic Medications

 Hold oral agents (e.g., metformin) before contrast dye studies → risk for lactic acidosis.
 Monitor for hypoglycemia with insulin, sulfonylureas.

🩺 21. Type 1 DM Teaching

 Sick days: Continue insulin even if not eating; check glucose q4h; drink fluids.
 Exercise: Avoid during peak insulin; snack before activity.
 Nutrition: Balanced carb intake, avoid skipping meals.
 Insulin administration: Rotate sites; monitor glucose regularly.
1) Major glands & the hormones they produce — essentials
 Hypothalamus — releasing/inhibiting hormones (TRH, CRH, GHRH, GnRH, somatostatin) →
controls pituitary.
 Pituitary (anterior) — GH, TSH, ACTH, FSH, LH, prolactin.
 Pituitary (posterior) — ADH (vasopressin), oxytocin.
 Thyroid — T4 (thyroxine), T3 (triiodothyronine), calcitonin.
 Parathyroids — PTH (raises serum Ca²⁺).
 Adrenal cortex — cortisol (glucocorticoid), aldosterone (mineralocorticoid), androgens.
  Adrenal medulla — epinephrine, norepinephrine.
 Pancreas (islets) — insulin (β), glucagon (α), somatostatin (δ).
 Gonads — estrogen, progesterone, testosterone.
Quick function mnemonics
 TSH → thyroid → ↑ metabolism.
 PTH → ↑ serum Ca²⁺ (bone resorption).
 Aldosterone → ↑ Na⁺ retention, ↑ K⁺ excretion → ↑ BP.

2) Hormone cascade / feedback (how to think)

 Hypothalamus → releasing hormone → anterior pituitary → stimulating hormone → target gland
→ hormone → negative feedback to hypothalamus & pituitary.
o Example: TRH → TSH → T3/T4 → ↓ TRH & ↓ TSH.

3) Age-related endocrine changes to know

 ↓ GH, ↓ sex hormones (estrogen/testosterone) → decreased bone density, muscle mass.
 Thyroid: slight ↓ T3, minor ↓ metabolic rate → cold intolerance, weight gain.
 Pancreas: insulin secretion & sensitivity may decline → increased risk T2DM.
 ADH sensitivity ↓ → risk for dehydration & hypernatremia.

4) Stimulation & suppression tests — purpose & interpretation

 Stimulation tests: give a stimulus (e.g., ACTH stimulation) to evaluate hypofunction. If gland
fails to respond → primary failure.
o Example: Cosyntropin (ACTH) stimulation test for Addison’s (adrenal insufficiency).

 Suppression tests: give an inhibitory agent (e.g., dexamethasone) to evaluate hyperfunction.

Failure to suppress means autonomous overproduction.
o Example: Dexamethasone suppression test for Cushing’s.

5) Urine tests/collection used in endocrine dx

 24-hour urine collections:
o Cortisol (Cushing’s), VMA/metanephrines (pheochromocytoma), catecholamines.

o Key: discard first void, collect all urine thereafter for 24 hrs, keep refrigerated.
  Urine osmolality / specific gravity for DI vs SIADH.
 Urine ketones in DKA.

6) Diabetes insipidus (DI) vs SIADH — compare & nursing care

Diabetes insipidus (DI)
 Patho: ADH deficiency (central) or renal insensitivity (nephrogenic) → inability to concentrate
urine.
 S/S: Polyuria (large volumes), polydipsia, hypotension, dehydration, urine specific gravity
<1.005, ↑ serum sodium, ↑ serum osmolality.
 Dx tests: water deprivation test (central vs nephrogenic), urine specific gravity/osmolality, serum
Na⁺.
 Interventions & nursing: monitor I&O, daily weights, VS, skin turgor, mucous membranes,
neuro status, replace fluids, monitor electrolytes, patient safety for dehydration.
 Medications: Desmopressin (DDAVP) — synthetic ADH (central DI).
o Therapeutic effect: ↓ urine output, ↑ urine specific gravity, improved hydration, ↓ serum
sodium.
 Education: carry emergency meds, fluid intake advice, recognize dehydration signs.
SIADH
 Patho: Excess ADH → water retention → dilutional hyponatremia.
 S/S: Low urine output, concentrated urine (↑ specific gravity), hyponatremia, weight gain,
confusion, seizures if severe.
 Interventions: fluid restriction, hypertonic saline cautiously for severe hyponatremia,
demeclocycline (inhibits ADH effect), seizure precautions, monitor Na ⁺ and neuro signs.

7) Acromegaly
 Cause: Excess GH in adult (pituitary adenoma).
 S/S: Enlarged hands/feet, coarse facial features, prognathism (jaw), enlarged tongue, joint pain,
insulin resistance.
 Treatment: transsphenoidal surgery to remove pituitary tumor (hypophysectomy), octreotide
(somatostatin analog), radiation.
 Nursing: pre/post op endocrine & visual field checks, diabetes monitoring, monitor for CSF leak.

8) Hypophysectomy (transsphenoidal) — care & teaching

  Post-op assessment priorities:
o Neuro status, visual acuity/fields, CSF leak (clear drainage; test for glucose), nasal drip,
s/s DI (polyuria, low urine SG), infection.
 Nursing interventions:
o HOB elevated (30°), avoid coughing/sneezing/straining/ bending, no toothbrushing for
~10 days (use mouth care), small frequent meals, monitor electrolytes.
o Keep nasal packing/drip pad; report clear fluid from nose (CSF) immediately.

 Teaching: lifelong hormone replacement may be needed; avoid strenuous activity; report
polyuria, severe headaches, fever, visual changes.

9) Thyroid disorders — hyper vs hypo (compare)

Hyperthyroidism (e.g., Graves)
 S/S: Heat intolerance, weight loss, tachycardia, anxiety, tremor, exophthalmos.
 Dx: ↓ TSH (if primary), ↑ free T4/T3, radioactive iodine uptake ↑.
 Treatment: antithyroid meds (methimazole, PTU), beta-blockers for symptoms, radioactive
iodine ablation, thyroidectomy.
 Complications: Thyroid storm — fever, extreme tachycardia, HTN, delirium. Emergency
treatment: beta-blockers, PTU/methimazole, iodide, cooling, fluids.
Hypothyroidism
 S/S: Cold intolerance, weight gain, bradycardia, dry skin, fatigue, constipation.
 Dx: ↑ TSH (primary), ↓ T4.
 Treatment: Levothyroxine (thyroid hormone replacement).
 Complication: Myxedema coma — severe hypothyroidism, hypothermia, bradycardia,
hypoventilation, hypotension, altered mental status. Life-threatening → treat with IV
levothyroxine, supportive care, airway, warming.

10) Hypothyroidism — when life-threatening? (Myxedema coma)

 Triggers: infection, cold exposure, surgery, opiates, untreated hypothyroidism.
 Treat: airway support, IV levothyroxine, IV glucocorticoids (until adrenal insufficiency
excluded), passive rewarming, treat precipitating cause.

11) Parathyroid disorders — assessment, which causes hypocalcemia, treatment

 Hyperparathyroidism
 o Patho: ↑ PTH → hypercalcemia.

o S/S: Bones (bone pain), stones (kidney stones, polyuria), groans (constipation),
psychiatric overtones.
o Tx: Hydration, loop diuretics (furosemide) to increase Ca excretion, calcitonin,
bisphosphonates, parathyroidectomy.
 Hypoparathyroidism
o Cause: Post-thyroidectomy (iatrogenic) commonly causes hypocalcemia.

o S/S: Paresthesias, muscle cramps, tetany, positive Chvostek & Trousseau signs,
laryngospasm
o Tx: IV calcium gluconate for acute symptomatic hypocalcemia, oral calcium + vitamin D
(calcitriol), monitor airway (laryngospasm risk), seizure precautions.

12) Patient education with levothyroxine

 Take in morning on empty stomach (30–60 min before breakfast).
 Lifelong therapy; don’t switch brands without provider.
 Monitor for signs of hyperthyroidism (tachycardia, palpitations) — overdosing risk.
 Interactions: iron, calcium, antacids reduce absorption — space dosing.
 Regular TSH monitoring (4–6 weeks after dose changes).

13) Thyroid surgery — nursing assessments & interventions

 Priority: airway patency — have trach set at bedside, oxygen, suction.
 Monitor for bleeding/hematoma (neck swelling, drainage, sensation of pressure) — emergency.
 Assess voice changes & stridor (stridor = immediate concern).
 Monitor Ca²⁺ (tetany signs).
 Position: semi-Fowler’s, avoid neck flexion; support head when moving.
 Education: avoid heavy lifting, do not brush teeth vigorously, report fever/neck stiffness/
bleeding/ severe headache/ visual changes/ numbness.

14) Thyroid storm vs Myxedema coma — quick comparison

 Thyroid storm: acute hyperthyroid crisis → extremely high T, tachycardia, delirium. Tx: beta-
blocker, PTU/methimazole, IV fluids, cooling.
  Myxedema coma: severe hypothyroidism → hypothermia, bradycardia, hypoventilation. Tx: IV
levothyroxine, airway support, warming, corticosteroids.

15) Pheochromocytoma — patho & care

 Patho: catecholamine-secreting adrenal medulla tumor.
 S/S: severe paroxysmal HTN, headache, diaphoresis, palpitations, tremor.
 Dx: 24-hour urine for metanephrines/catecholamines (avoid foods/drugs that interfere).
 Pre-op: α-blockade (phenoxybenzamine) then β-blockade. Monitor BP closely.
 Surgery: adrenalectomy — monitor for huge BP swings during surgery.

16) Addison’s disease & Addisonian crisis

 Addison’s (primary adrenal insufficiency):
o S/S: Weakness, fatigue, weight loss, hyperpigmentation, orthostatic hypotension,
hyponatremia, hyperkalemia.
o Aldosterone role: conserves Na⁺, excretes K⁺ — loss → Na⁺ loss, K⁺ retention,
hypotension.
o Risk for infection: steroid deficiency → impaired stress response; patients on
replacement immunosuppression risk (if given exogenous steroids).
o Education: lifelong steroid replacement, carry MedicAlert, increase dose with stress
(sick day rules), never abruptly stop.
 Addisonian crisis: profound hypotension, dehydration, hyponatremia, hyperkalemia,
hypoglycemia. Tx: IV hydrocortisone, IV fluids (saline), correct electrolytes.

17) Cushing’s disease vs Cushing’s syndrome

 Cushing disease: excess ACTH from pituitary tumor → ↑ cortisol.
 Cushing syndrome: clinical state of cortisol excess (iatrogenic steroids or tumor).
 S/S: moon face, truncal obesity, buffalo hump, purple striae, hypertension, hyperglycemia,
muscle wasting, osteoporosis.
 Tx: reduce steroid dose if iatrogenic, surgery for tumor, adrenalectomy, meds (ketoconazole,
metyrapone) to inhibit cortisol synthesis.

18) Metabolic syndrome — definition

Presence of 3 or more:
  Waist circumference elevated (men >40 in, women >35 in),
 Triglycerides ≥150 mg/dL,
 HDL low (<40 men, <50 women),
 BP ≥130/85 mmHg,
 Fasting glucose ≥100 mg/dL.
Management: diet, exercise, weight loss, manage lipids, BP, glucose.

19) Hypoglycemia — symptoms & treatment

 S/S: shakiness, palpitations, diaphoresis, hunger, pallor, irritability, confusion, seizures.
 Tx (conscious): 15 g fast-acting carbs (4 oz juice, glucose tabs), recheck 15 min → repeat if low.
Then snack with complex carb + protein if next meal >1 hour.
 Unconscious: IM glucagon or IV 50% dextrose.
 Sick or exercise: adjust insulin/food timing — avoid exercising at peak insulin time.

20) Diabetes mellitus — patho, S/S, treatment

Type 1
 Patho: autoimmune β-cell destruction → absolute insulin deficiency.
 S/S: polyuria, polydipsia, polyphagia, weight loss, DKA risk.
 Tx: insulin therapy (multiple daily injections or pump), glucose monitoring.
Type 2
 Patho: insulin resistance + relative insulin deficiency.
 S/S: often asymptomatic early, may have polyuria/polydipsia, infections, slow wound healing.
 Tx: lifestyle, oral agents (metformin, sulfonylureas, SGLT2, DPP-4 inhibitors), may require
insulin.

21) DKA vs HHS — causes, S/S, treatments & nursing care

DKA (Type 1)
 Cause: absolute insulin deficiency (infection, missed insulin).
 Glucose: >250 mg/dL.
 Ketones: present, metabolic acidosis (low pH, low HCO₃⁻).
 S/S: Kussmaul respirations, fruity breath, dehydration, abdominal pain, AMS.
  Tx: IV fluids (NS → D5 when glucose ~200), IV regular insulin infusion, potassium replacement
(watch K⁺), correct acidosis, monitor electrolytes & EKG.
HHS (Type 2)
 Cause: severe hyperglycemia with dehydration, little/no ketosis.
 Glucose: often >600 mg/dL.
 S/S: profound dehydration, neuro changes, seizures possible.
 Tx: aggressive IV fluids first, then insulin infusion; monitor electrolytes, correct underlying
cause.
Nursing priorities for both: airway, IV access, fluid resuscitation, hourly glucose checks, cardiac
monitoring (K⁺ shifts), neuro checks, education.

22) Diabetes diagnostics & patient prep

 Fasting blood glucose: NPO 8 hours; diabetes ≥126 mg/dL on 2 occasions.
 Random glucose: ≥200 mg/dL with symptoms.
 Oral glucose tolerance test (OGTT): 2-hr ≥200 mg/dL = diabetes.
 Hemoglobin A1C: no fasting needed; reflects 2–3 month avg.
o Normal: <5.7%

o Prediabetes: 5.7–6.4%

o Diabetes: ≥6.5%

 Urine ketone testing when hyperglycemic/ill (DKA risk).

23) Diabetic medications — hold when & assessment

 Metformin: hold before/after iodinated contrast (48 hrs) or with renal dysfunction (risk lactic
acidosis).
 Oral agents & insulin: held if NPO for procedures? insulin often adjusted, not always held —
follow orders.
 SGLT2 inhibitors: hold before surgery (risk dehydration, euglycemic DKA).
 Assessment before meds: blood glucose values, renal function, ability to eat, NPO status,
allergies, current vitals.

24) Type 1 DM patient teaching (high-yield)

  Sick day rules: never stop insulin; check glucose q3–4h, check ketones if glucose >240 mg/dL;
sip clear fluids; call PHCP if vomiting, high glucose persist, or ketones present.
 Blood glucose testing: before meals & at bedtime (basic regimen); more frequently during
illness.
 Insulin administration: rotate sites, store insulin vials properly, know onset/peak/duration for
types, carry quick sugar, MedicAlert, know hypoglycemia protocol.
 Nutrition: consistent carb counting; do not skip meals.
 Exercise: avoid peak insulin time; carry carb snack; check glucose pre/post exercise.

25) Quick normal/critical lab numbers to memorize

 Serum glucose normal: ~70–100 mg/dL fasting.
 Diabetes diagnostic: fasting ≥126 mg/dL; A1C ≥6.5%.
 Urine specific gravity normal: 1.005–1.030 (DI <1.005).
 Serum Na⁺ normal: 135–145 mEq/L; hyponatremia symptomatic often <125.
 Serum K⁺ normal: 3.5–5.0 mEq/L (watch in DKA/HHS/Addison’s).

26) High-yield exam tips & mnemonics

 DI vs SIADH: DI = Dehydrated, Insufficient ADH → dilute urine. SIADH = water Stuck
(retained).
 DKA triad: Hyperglycemia + Ketones + Metabolic Acidosis.
 Cushing’s mnemonic: “CUSHINGOID” (Central obesity, Urinary glucose ↑, Skin thinning,
Hypertension, Infections ↑, Necrosis? — think high cortisol).
 Hypoglycemia rule (15/15): 15 g fast sugar → wait 15 min → recheck.
 Thyroid storm = HOT & FAST (fever, tachycardia, HTN, agitation). Myxedema coma =
COLD & SLOW.

27) Suggested focused study plan (3 days before exam)

 Day 1: A&P (glands/hormones), feedback loops, lab normals.
 Day 2: DI/SIADH, thyroid disorders (hyper/hypo, storm & myxedema), hypophysectomy care,
parathyroid issues.
 Day 3: Diabetes (patho, DKA/HHS, meds, sick day rules), pheochromocytoma,
Addison/Cushing, sample Qs & rapid recall.
If you want, I can:
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please can you explain this detailed
ChatGPT said:
Absolutely ✅ — let’s go through this step-by-step and in full detail so you have a complete, easy-to-
understand, high-yield study guide for your Maternal Child Nursing (Chapter 51: Endocrine
System).
This will cover A&P, assessments, disorders, treatments, nursing care, and patient education —
everything your test will focus on.
I’ll break it down into logical sections.

🧠 1. Anatomy & Physiology of the Endocrine System

💡 Main Glands & Their Hormones

Gland Hormones Produced Function / Key Notes

Releasing & inhibiting hormones (CRH, Controls the pituitary gland (master
Hypothalamus
TRH, GnRH, GHRH, somatostatin) regulator).

Anterior: GH, ACTH, TSH, LH, FSH,

Pituitary (Master Controls growth, stress, metabolism,
Prolactin
gland) reproduction, water balance.
Posterior: ADH (vasopressin), Oxytocin

T3 (triiodothyronine), T4 (thyroxine), Regulates metabolism, energy, growth,

Thyroid
Calcitonin calcium balance.

Increases blood calcium by stimulating

Parathyroid PTH (Parathyroid hormone)
bone release and kidney reabsorption.

Cortisol (glucocorticoid), Aldosterone Regulates stress, metabolism,

Adrenal Cortex
(mineralocorticoid), Androgens sodium/potassium, and fluid balance.

"Fight or flight" response — raises HR,

Adrenal Medulla Epinephrine, Norepinephrine
BP, glucose.

Pancreas (Islets of Insulin (β cells), Glucagon (α cells),

Regulates blood glucose.
Langerhans) Somatostatin

Gonads Testosterone, Estrogen, Progesterone Reproductive hormones.

Gland Hormones Produced Function / Key Notes

Pineal Melatonin Sleep/wake cycles.

🔄 2. Hormone Cascade Example

(Hypothalamic–Pituitary–Target Gland Axis)
Example: Thyroid Regulation
1. Hypothalamus → releases TRH (Thyrotropin-Releasing Hormone)
2. Pituitary → releases TSH
3. Thyroid → releases T3 and T4
4. Negative feedback: High T3/T4 suppresses TRH and TSH.
🩺 Clinical importance:
 Hyperthyroidism = Low TSH, High T3/T4
 Hypothyroidism = High TSH, Low T3/T4

🧓 3. Age-Related Changes
 ↓ Metabolic rate
 ↓ Hormone production (especially estrogen, testosterone, GH)
 ↑ Risk of glucose intolerance (less insulin sensitivity)
 ↑ Thyroid nodules but ↓ overall thyroid function
 Slower recovery from stress due to ↓ cortisol reserve

⚗️4. Diagnostic Testing

✅ Stimulation Tests
Used when hypofunction suspected.
→ Give a hormone to see if the target gland responds.
Example: Give ACTH → cortisol should increase.
If not → adrenal insufficiency.
🚫 Suppression Tests
Used when hyperfunction suspected.
→ Give a substance to suppress hormone.
Example: Dexamethasone suppression test → should decrease cortisol.
If cortisol stays high → Cushing’s syndrome.
💧 Urine Tests
 24-hour urine collection: Measures hormone levels like cortisol, catecholamines (for
pheochromocytoma).
 Rules:
o Discard first urine of the day, then collect all urine for 24 hr.

o Keep refrigerated or on ice.

o Avoid stress, caffeine, and certain meds (can alter results).

🚰 5. Diabetes Insipidus (DI) vs SIADH

Feature Diabetes Insipidus (DI) SIADH

↓ ADH (neurogenic) or kidneys don’t

Cause ↑ ADH secretion
respond to ADH (nephrogenic)

Urine Output Polyuria (up to 20 L/day) Oliguria (very little urine)

Urine Specific
< 1.005 (dilute) > 1.030 (concentrated)
Gravity

Sodium ↑ Hypernatremia ↓ Hyponatremia

S/S Polydipsia, dehydration, low BP Edema, confusion, seizures

Fluid restriction, diuretics (furosemide),

Tx Desmopressin (DDAVP), fluids
hypertonic saline if severe

Evaluation ↓ urine output, ↑ specific gravity ↑ urine output, ↓ edema

🩺 Therapeutic Effect of Desmopressin: Decrease in urine output, normalization of sodium and BP.

🦴 6. Acromegaly
 Cause: Excess Growth Hormone (GH) after epiphyseal closure (usually pituitary tumor)
 S/S: Enlarged hands, feet, jaw; organ enlargement; thick skin; headache; visual disturbances.
 Tx:
o Surgery: Transsphenoidal hypophysectomy

o Meds: Octreotide (GH suppressant)

o Radiation if tumor persists.

🧠 7. Hypophysectomy Care
Post-op Assessment:
 Monitor for CSF leak (clear nasal drainage, test for glucose)
 No coughing, sneezing, bending, or straining
 Monitor for DI (↑ urine output, low specific gravity)
 Watch for visual changes
Education:
 Lifelong hormone replacement (thyroid, cortisol, sex hormones)
 Avoid blowing nose
 Oral care with soft sponge only
 Call provider if increased thirst or urination.

🦋 8. Thyroid Disorders
Hyperthyroidism (Graves’ Disease)
 ↑ T3, T4; ↓ TSH
 S/S: Weight loss, heat intolerance, tachycardia, tremor, exophthalmos, diarrhea.
 Tx:
o Antithyroid meds (Methimazole, PTU)

o Beta blockers for tachycardia

o Radioactive iodine therapy

o Thyroidectomy if severe.

Complication: Thyroid storm

 Life-threatening ↑ metabolism
 S/S: High fever, tachycardia, HTN, agitation.
 Tx: Maintain airway, cooling blanket, IV fluids, beta blockers, antithyroid meds.

Hypothyroidism
 ↓ T3, T4; ↑ TSH
 S/S: Cold intolerance, weight gain, fatigue, dry skin, constipation, slow HR.
 Tx: Levothyroxine (take in AM before food).
Life-threatening: Myxedema coma
  Triggered by stress, infection, cold exposure.
 S/S: Hypothermia, bradycardia, hypotension, hypoventilation, coma.
 Tx: IV Levothyroxine, warm blankets, airway support.

🧮 9. Parathyroid Disorders

Hypoparathyroidism Hyperparathyroidism

Calcium ↓ Hypocalcemia ↑ Hypercalcemia

Tingling lips, muscle cramps,

S/S Fatigue, kidney stones, bone pain
Trousseau’s/Chvostek’s signs

Hydration, avoid thiazides, parathyroidectomy

Tx Calcium & vitamin D supplements
if severe

Which causes hypocalcemia? → Hypoparathyroidism

💊 10. Levothyroxine Education

 Take same time each day, in morning before breakfast
 Lifelong therapy
 Avoid switching brands
 Monitor TSH every 6–8 weeks
 Watch for signs of hyperthyroidism (palpitations, insomnia)

⚕️11. Thyroid Surgery Care

 Assessment: Airway! (stridor, difficulty breathing = emergency)
 Monitor for bleeding, hypocalcemia (tingling lips, fingers)
 Keep tracheostomy set at bedside
 Intervention: Support neck with both hands when moving
 Education: Avoid neck strain, report tingling, maintain medication adherence.

⚡ 12. Pheochromocytoma
 Tumor of adrenal medulla → Excess catecholamines.
 S/S: Severe HTN, palpitations, sweating, headache.
  Dx: 24-hour urine for catecholamines/metanephrines.
 Tx: Adrenalectomy → monitor for HTN crisis pre-op.
 Do NOT palpate abdomen! (can trigger hypertensive crisis)

🧡 13. Addison’s Disease

 ↓ Cortisol & Aldosterone
 S/S: Fatigue, weight loss, hypotension, hyperpigmentation, salt craving.
 Aldosterone role: Retains Na+ and water → maintains BP.
 Risk: Hypotension, dehydration, infection.
 Education: Take corticosteroids daily, ↑ dose during stress, carry medical alert bracelet.
Addisonian Crisis:
 Triggered by stress, infection, steroid withdrawal.
 S/S: Severe hypotension, shock.
 Tx: IV hydrocortisone, fluids, monitor electrolytes.

🌙 14. Cushing’s Disease vs. Cushing’s Syndrome

Cushing’s Disease Cushing’s Syndrome

Caused by pituitary tumor ↑ ACTH Caused by long-term steroid use

Moon face, buffalo hump, central obesity, thin skin, striae,

Same symptoms
hyperglycemia

Tx: Surgery (remove tumor) Gradual withdrawal of steroids

⚖️15. Metabolic Syndrome

 Cluster of risk factors → risk for DM & heart disease.
Criteria (need ≥3):
1. ↑ Waist circumference
2. ↑ Triglycerides
3. ↓ HDL
4. ↑ BP
5. ↑ Fasting glucose
🍬 16. Diabetes Mellitus
Type 1 DM
 Autoimmune destruction of β-cells → no insulin.
 Tx: Insulin dependent.
 Education:
o Sick day rules: Never skip insulin, check glucose q3-4h, stay hydrated.

o Exercise lowers glucose (avoid peak insulin time).

Type 2 DM
 Insulin resistance + low production.
 Tx: Diet, exercise, oral meds (Metformin), insulin if needed.

⚠️17. Complications

DKA (Type 1) HHS (Type 2)

Glucose > 250 mg/dL > 600 mg/dL

Ketones Present None/minimal

pH < 7.3 (metabolic acidosis) Normal/slightly low

S/S Kussmaul respirations, fruity breath Severe dehydration, neuro changes

Tx IV fluids, insulin, K+ replacement IV fluids, insulin, treat cause

🩸 18. Diagnostic Tests for DM

Test Normal Diabetes Education

Fasting blood glucose <100 mg/dL ≥126 mg/dL NPO 8 hours before

A1C <5.7% ≥6.5% Reflects 2–3 month average glucose

Oral glucose tolerance test <140 mg/dL ≥200 mg/dL Avoid caffeine/smoking before

💉 19. Diabetes Medications & Nursing Care

 Metformin: Hold if contrast dye used → risk of lactic acidosis.
 Insulin: Rotate sites, store properly, monitor for hypoglycemia.
Hypoglycemia S/S
 Cool, clammy, shaky, tachycardia, hunger, anxiety.
 Tx: 15g carbs → recheck in 15 min (e.g., juice, glucose tabs).
 If unconscious: Glucagon IM.

🧾 20. Insulin Tips

Type Onset Peak Duration

Rapid (Lispro) 15 min 1 hr 3 hr

Regular 30–60 min 2–4 hr 6–8 hr

NPH 1–2 hr 6–12 hr 18–24 hr

Glargine 1 hr None 24 hr