Medical Nursing

Management of patient with

Endocrine disorders
Dr./ Mona Nadr
Professor of Medical Surgical Nursing
2025
Outline
• Introduction
• Brief anatomy and physiology of endocrine system
• Specific endocrine Disorders and Nursing Management
❑ disorders of pituitary gland
❑disorders of thyroid gland
❑ Diabetes mellitus
 ENDOCRINE SYSTEM
Endocrine system is the collection of glands that produce
hormones that regulate metabolism, growth and development,
tissue function, sexual function, reproduction, sleep, and mood,
among other things.
ENDOCRINE GLANDS
Endocrine glands are glands of the endocrine system that secrete
their products, hormones, directly into the blood rather than
through a duct. like the pituitary gland, pancreas, ovaries, testes,
thyroid gland, parathyroid gland, hypothalamus and adrenal 3
glands.
▪ The Endocrine
Glands are the
organs of the
Endocrine System.
▪ They produce and
secrete (release)
Hormones.
▪ They are located all
over your body.

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 Introduction

• The endocrine system involves the release of chemical transmitter

substances known as hormones play vital roles:
1- Transportation of chemicals across cell membranes.
2- Growth and development.
3- Metabolism.
4- Fluid and electrolyte balance.
5- Acid–base balance.
6- Adaptation, and reproduction
Glands of the
Endocrine System
❖Hypothalamus
❖Posterior Pituitary
❖Anterior Pituitary
❖Thyroid
❖Parathyroids
❖Adrenals
❖Pancreatic islets
❖Ovaries and testes
Gland What it Regulates( in general)
Pituitary “Master Gland” that regulates all other Endocrine Glands, also
releases growth hormone
Thyroid Metabolism, body heat, bone growth
Parathyroids Use of Calcium and Phosphorous
Hypothalamus Links nervous system to endocrine system
Adrenal Response in emergency or stressful situations, metabolism,
blood pressure, salt balance
Pancreas Blood sugar
Ovaries Production of eggs; female characteristics
Testes Production of sperm; male characteristics

Thymus Parts of the immune system

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 Pituitary Gland
Anterior lobe Hormonal Function:
1. Thyrotropin releasing Hormone
2. Thyrotropic Hormone (TSH) : stimulates the thyroid gland
3. Growth Hormone (GH) : Stimulates growth of body tissue and
bones.
4. Prolactin (PRL) : Stimulates mammary tissue growth and lactation
5. Adrenocorticotropic Hormone (ACTH) : Stimulates steroid
production by the adrenal cortex.
6. Gonadotropic Hormones (LH-FSH). : Affect growth, maturity and
functioning of primary and secondary sex organs.
7. Melanocyte – stimulating Hormone (MSH) : May stimulate adrenal
cortex and may affect pigmentation.
Posterior lobe Hormonal function:
Oxytocin : Stimulates ejection of milk from mammary alveoli into the
ducts.
Stimulates uterine contractions
Anti diuretic Hormone (ADH. Vasopressin) : Promotes reabsorption of
water by the distal tubules and collecting ducts of the kidney. Thus
decreasing urine output.
 Disorders of pituitary gland
• Hyperpituitarsim • Complications:
• It is the over secretion of Hormones from the anterior • Damage of the pitutitary gland
pituitary usually a combination of Hormones is hyper • Increased morbidity related to atherosclerotic
secreted disease
Acromegaly (in adults): • Respiratory disease
• It is excessive growth hormone secretion. It occurs in men • Hypertension
more than women. • D.M.
Etiology: • Gastrointestinal cancer
• Abnormal hypothalamic function
Medical management:
• Tumor in the pituitary gland
• Radiation therapy is used if pharmacologic and
Clinical manifestations:
surgical interventions have failed. It may retard
• Local overgrowth of bone in skull and mandible
tumor growth or relieve signs and symptoms.
• Soft tissue overgrowth
Nursing management
• Weight gain
• pain management
• Paresthesia
• ambulation
• Glucose intolerance
• health education about hormone replacement
• Coarse facial features
• encourage moderate activity
• Enlargement of hands or feet
• Visual field defects
 Disorders of pituitary gland
• Hyperpituitarsim
• It is the over secretion of Hormones from the anterior • Complications:
pituitary usually a combination of Hormones is hyper • Damage of the pitutitary gland
secreted • Increased morbidity related to atherosclerotic
Acromegaly (in adults):
disease
• It is excessive growth hormone secretion. It occurs in men
more than women.
• Respiratory disease
Etiology: • Hypertension
• Abnormal hypothalamic function • D.M.
• Tumor in the pituitary gland • Gastrointestinal cancer
Clinical manifestations: Medical management:
• Local overgrowth of bone in skull and mandible • Radiation therapy is used if pharmacologic and
• Soft tissue overgrowth surgical interventions have failed. It may retard
• Weight gain tumor growth or relieve signs and symptoms.
• Paresthesia Nursing management
• Glucose intolerance • pain management
• Coarse facial features • ambulation
• Enlargement of hands or feet • health education about hormone replacement
• Visual field defects • encourage moderate activity
 Disorders of pituitary gland
Diabetes Insipidus
Definition:
Medical management:
Non pharmacologic interventions:
It is disorder of the posterior pituitary gland in ▪ Increase oral fluids, especially water
which hyposecrretion of the (ADH) or in some
cases, results in failure of the kidney to reabsorb Pharmacologic interventions
water. • Intravenous fluids replacement
• Antidiuretic hormone
Clinical manifestations: replacement therapy
• polyuria and nocturia
• Loss of weight and polydipsia • Nursing management:
• Assess intake and output
• dry skin and mucous • Administer IV fluid
replacement
membranes • Monitor vital signs
• Monitor serum electrolytes
• electrolyte imbalance and • Assess for signs and symptoms
hypotension worsen. of Dehydration
 Thyroid Hormones
Hormone Function

T3/T4  metabolic rate

 protein synthesis
 energy production
Most important hormone in day today
regulation of metabolic rate

Calcitonin  blood calcium concentration

 the reabsorption of Ca and Ph from bones to
blood
Calcitonin “tones” down serum Ca levels
 Disorders of Thyroid gland
Hypothyroidism Clinical manifestations:
• Fatigue.
Definition: • Constipation.
• Apathy
Hypothyroidism is under activity of the hyroid, • Bradycardia.
hypo secretion of thyroid hormone and • Hypothermia.
• Weight gain.
decreased body metabolism and heat • Memory and mental impairment and decrease
production. It is effects women 4 times more concentration.
often than it effects men. • Mask like face.
Etiology: • Menstrual irregularities and loss of libido.
▪ Primary → due to thyroid failure such as antithyroid • Loss of hair
drugs, surgery, radiation therapy or chronic inflammation Treatment
of the thyroid. • Lifelong Thyroid Hormone Replacement
▪ Secondary → occurs when TSH fails to stimulate the
• levothyroxine sodium ( Synthroid, T4 )
thyroid gland.
Nursing intervention
• Teach about S&S of hyperthyroidism with
replacement therapy
 Disorders of Thyroid gland
• Hyperthyroidism
Clinical Manifestations
Hyperthyroidism is the second most prevalent (thyrotoxicosis):
endocrine disorder, after diabetes mellitus. • Heat intolerance.
Graves' disease: the most common type of • Palpitations, tachycardia, elevated
hyperthyroidism, results from an excessive
systolic BP.
output of thyroid hormones.
• Increased appetite but with weight loss.
Etiology:
 May appear after an emotional shock, stress, • Increased serum T4, T3.
or an infection • Exophthalmos (bulging eyes)
 Other causes: thyroiditis and excessive • Perspiration
ingestion of thyroid hormone • Insomnia.
Incidence • Fatigue and muscle weakness
✓Affects women 8X more frequently than men • Nervousness, irritability
• Diarrhea.
 Disorders of Thyroid gland
• Hyperthyroidism Nursing management
Diagnostic test • Reassurance r/t the emotional reactions
experienced
❑ serum T3, T4.
• May need eye care if has exophthalmos
❑ serum TSH
❑ ECG
• Maintain normal body temperature
❑Chest and neck x-ray: show descend of thyroid gland to • Adequate caloric intake
thorax and mediastanal shifting in retrosternal goitre. • Managing potential complications such as
❑CT scan :show thyroid size and if there is compression to dysrhythmias and tachycardias
trachea • Educate about potential s/s of hypothyroidism
following any antithyroid drugs
Treatment
 Radioactive therapy
 Medications
 Antithyroid drugs: blocks thyroid hormone
production e.g., Propylthiouracil and methimazole
 Dexamethasone as anti-inflammatory effect
 Beta-blockers : to control cardiac manifestations
 Hormones of the pancreas
CELLS HARMONE EFFECT

Alpha () Glucagon Glucose synthesis &

cells glycogen breakdown in
liver
 Blood glucose
concentration
Beta () Insulin Stimulation of lipids &
cells glycogen storage &
formation
 Blood glucose
concentration
Delta () Somatostatin Inhibits secretion of insulin
cells & glucagon
 Diabetes Mellitus (DM)
Definition
Diabetes mellitus is a group of metabolic diseases characterized by
hyperglycemia (an elevated level of glucose in the blood) resulting from
defects in insulin secretion, insulin action, or both.
Etiology and Risk factors
Diabetes is caused by the body's inability to make enough or use insulin properly, leading to
high blood sugar.
Type 1 is an autoimmune disease where the body attacks its own insulin-producing cells,
triggered by genetics and environmental factors.
Type 2 is a mix of genetic and lifestyle factors as aging, obesity, lack of physical activity,
and poor diet, which lead to insulin resistance.
There are two major types of DM
• Type I DM is insulin-dependent DM (IDDM): commonly in children
• Type II DM is non-insulin-dependent (NIDDM): commonly in adults after 40 years
 Clinical Manifestations of DM

• Main symptoms of diabetes ( 3. Ps):

1) Polydipsia – increased thirst.
2) Polyphagia – increased hunger
3) Polyuria – increased urination
▪ Other Symptoms include:
▪ fatigue weakness.
▪ sudden vision changes.
▪ Tingling or numbness in hands or feet.
▪ dry skin.
▪ skin lesions or wounds that are slow to heal
▪ Recurrent infections.
Laboratory tests for DM
Complications of DM

• Hypoglycemia
• Diabetic ketoacidosis
• Diabetic retinopathy
• Nephropathy
• Neuropathy
• Hypertension
• Cardiovascular diseases
• Peripheral vascular
disease.
Medical management of DM
• Dietary Management and Physical Activity modifying eating
habits and increasing physical activity are typically the first steps
toward reducing blood sugar levels.
• Blood glucose Monitoring
Regularly checking blood glucose levels via finger pricks or
continuous glucose monitors (CGMs) to determine how well the
treatment plan is working and make daily adjustments.
Weight Management: Losing weight (if overweight or obese) is
especially important for type 2 diabetes and can improve glycemic
control
• Drug therapy :
1) Oral hypoglycemic agents
→ This drug are not insulin but they stimulate the pancreas to
produce insulin such as sulfonylureas and biguanide
2) Insulin Therapy:
Insulin therapy is commonly prescribed twice daily and in insulin
combinations to achieve more consistent systemic control without
major blood sugar fluctuations.
Applying the nursing process of D.M.

• Risk for unstable blood glucose level related to insulin resistance,

impaired insulin secretion, and destruction of beta cells.
• Risk for infection related to delayed healing of open wounds.
• Deficient knowledge related to unfamiliarity with information
regarding disease, insulin therapy, glucose monitoring as manifested
by seeking information
• Risk for impaired skin integrity Due to decreased circulation,
peripheral neuropathy, and prolonged high blood glucose levels that
impair healing
Nursing Management for DM
• Assess for signs of hyperglycemia or hypoglycemia.
• Assess blood glucose levels before meals and at bedtime.
• Monitor the patient’s HbA1c.
• Assess feet for temperature, pulses, color, and sensation.
• Be knowledgeable about dietary management
• Communicate important information to the dietician or other management
specialists
• Reinforce patient understanding
• Support dietary and lifestyle changes
• Provide health education regarding glucose monitoring and insulin
injection.
THANK
YOU