(1)

Endocrine System Disorders AHN II KMU IHS Swat

Endocrine System Disorders

(Abrar Husssain)
KMU

Objectives At the end of this unit, the students will be able to:
 Define Endocrine system
 Identify Endocrine glands and Endocrine tissues present in the body
 Discuss types of Hormones, target cells, target organ
 Discuss the location and structure of pituitary gland.
 Discuss the role of hypothalamic hormones in the regulation of pituitary
gland secretions.
 Discuss the functions of the hormones secreted by anterior and posterior
pituitary gland.
 Briefly discuss the structure, function & hormones of the following glands
• Thyroid
• Para Thyroid
• Pineal
• Adrenal
• Pancreas
 (2)
Endocrine System Disorders AHN II KMU IHS Swat

Definitions
Endocrine system: The system of glands that produce cellular secretions
which help to control bodily metabolic activities.
➢ It maintains the stability of internal environment.

Hormone is a chemical released by a cell or a gland in one part of the body

that usually affects cells in other parts of the body.

Ligand: A substance which binds with receptor

Types of glands
Exocrine gland: Exocrine glands secrete their substances through ducts onto
your body's surfaces.

Endocrine gland: Endocrine glands secrete their substances directly into

your bloodstream.

Hormones

Hormones are chemical messengers that are secreted into the blood stream and
stimulate the physiology of cells in another tissue or organ, often considerable
distance away. Hormones travel anywhere the blood goes, but they affect only
those cells that have receptors for them.

Classification of Hormones
Classified into three:
1. Steroid Hormones
2. Protein Hormones
3. Derivatives of Amino acid called Tyrosine

Steroid Hormones
• Aldosterone
• Cortisol
• Corticosterone
• Testosterone
 (3)
Endocrine System Disorders AHN II KMU IHS Swat

• Estrogen
• Progesterone
• Vit D

Protein Hormones
• GH
• TSH
• ACTH
• FSH
• LH
• Prolactin
• ADH
• Paratharmone
• Insulin
• Glucagon
• Somatostatin
• HCG

Derivatives of Tyrosine
• T3
• T4
• Epinephrine
• Norepinephrine
• Dopamine

Mechanism of Hormone Action

1. By altering permeability of cell membrane
2. By activating intracellular enzyme
3. By acting on genes
➢ The response to a hormone depends on both the hormone and the target
cell.
➢ Various target cells respond differently to the same hormone. Insulin, for
example, stimulates synthesis of glycogen in liver cells and synthesis of
triglycerides in adipose cells.
➢ The response to a hormone is not always synthesis.
 (4)
Endocrine System Disorders AHN II KMU IHS Swat

➢ Other hormonal effects include changing the permeability of the plasma

membrane, transportation of substances across the plasma membrane,
causing smooth muscle contraction, etc

Endocrine Glands

Endocrine glands include:

• Pituitary glands
• Pineal glands
• Thyroid glands
• Parathyroid glands
• Adrenal glands
In addition, several organs and tissues are not exclusively classified as
endocrine glands but contain cells that secrete hormones. These are:
• Hypothalamus
• Ovaries
• Testes
• Placenta
• Kidneys
• Stomach
• Small intestine
• Liver
• Pancreas
• Heart, Skin, Adipose tissues
1. Hypothalamus
Hypothalamus, a small region of the brain below the thalamus, is the major link
between the nervous system and endocrine system.
➢ It receives input from the limbic system, cerebral cortex, thalamus and
reticular activating system.
➢ It also receives sensory signals from the internal organs and the retina.
➢ Painful, stressful, and emotional experiences cause changes in
hypothalamic activity.
 (5)
Endocrine System Disorders AHN II KMU IHS Swat

➢ In turn, the hypothalamus controls the autonomic nervous system and

regulates body temperature, thirst, hunger, sexual behavior, and defensive
reactions such as fear and rage.
➢ The hypothalamus is an important regulatory center in the nervous system
as well as a crucial endocrine gland.
➢ Cells in the hypothalamus synthesize at least nine different hormones
releasing factors.
➢ Hypothalamus is the master gland of pituitary gland.

Control of pituitary secretion

➢ Pituitary gland can’t secrete hormones at steady rate at its own will. The
timing and number of secretions from both lobes is regulated by the
hypothalamus.
For example,
➢ GH is secreted mainly at night.
➢ LH peaks at the middle of the menstrual cycle. Oxytocin surges during
labor and nursing.
➢ The posterior lobe is controlled by neuroendocrine reflex. Suckling of an
infant, for example, stimulates nerve endings in the nipple. On receiving
sensory signals through the spinal cord and brainstem, the hypothalamus
causes the release of oxytocin to eject milk.
2. Pituitary Gland
The pituitary gland or hypophysis is a pea shaped structure that measures about
1 cm in diameter and lies in the hypophysealfossa of the sphenoid bone.
➢ It is attached to the hypothalamus by a stalk, called
infundibulum(=funnel).
➢ It has two lobes,
1) Anterior lobe or adenohypophysis
2) Posterior lobeor neurohypophysis
➢ The posterior pituitary gland contains about 10,000 axon terminals whose
cell bodies are lying in the hypothalamus
➢ Anterior pituitary gland secretes seven different hormones which are
stimulated by releasing hormones and suppressed by inhibiting hormones
from the hypothalamus.
➢ It regulates other endocrine glands.
1. Growth Hormone (GH)
 (6)
Endocrine System Disorders AHN II KMU IHS Swat

➢ General metabolic hormone

➢ Major effects are directed to growth of skeletal muscles and long bones
➢ Causes amino acids to be built into proteins
➢ Causes fats to be broken down as a source of energy

Functions of Other Anterior Pituitary Hormones

2. Prolactin (PRL)
➢ Stimulates and maintains milk production following childbirth
➢ Function in males is unknown
3. Adrenocorticotropic hormone (ACTH)
➢ Regulates endocrine activity of the adrenal cortex
4. Thyroid-stimulating hormone (TSH)
➢ Influences growth and activity of the thyroid

• Gonadotropic hormones

 Regulate hormonal activity of the gonads

5. Follicle-stimulating hormone (FSH)
Stimulates follicle development in ovaries
Stimulates sperm development in testis
6. Luteinizing hormone (LH)
➢ Triggers ovulation
➢ Causes ruptured follicle to become the corpus luteum
➢ Stimulates testosterone production in males
➢ Referred to as interstitial cell-stimulating hormone (ICSH).

Hormones of the Posterior Pituitary

1. Oxytocin
➢ Stimulates contractions of the uterus during labor
➢ Causes milk ejection
2. Antidiuretic hormone (ADH)
➢ Can inhibit urine production
➢ in large amounts, causes vasoconstriction leading to increased blood
pressure (vasopressin)

Pituitary disorders
Hyperactivity
 (7)
Endocrine System Disorders AHN II KMU IHS Swat

• Gigantism
• Acromegaly
• Cushing disease
Hypoactivity
• Dwarfism
• Acromicria
• Simmond disease
• Diabetes insipidus
3. Thyroid Anatomy
➢ The thyroid lies over the trachea below larynx.
➢ The thyroid gland consists of two lobes of endocrine tissue joined in the
middle by a narrow portion of the gland called isthmus.
➢ The major Hormone secretory Cells are Follicular cells

Hormones of Thyroid Gland

Thyroid gland secretes three hormones:

1. Tetraiodothyronine or T4 (thyroxine)
2. Triiodothyronine or T3
3. Calcitonin
➢ Both T4 and T3 are iodine-containing derivatives of amino acid
tyrosine.
➢ T4 forms about 90% of the total secretion, whereas T3 is about 10%.

Functions of Thyroid Hormones

Thyroid hormones have two major effects on the body:
i. To increase basal metabolic rate
ii. To stimulate growth in children.

Thyroid Hormones:
T3 (Triiodothyronine) and T4 (Thyroxin)
Increase BMR, stimulate synthesis of protein, Increase glucose and fat
consumption for ATP production, accelerate body growth, and contribute to the
development of nervous system.
 (8)
Endocrine System Disorders AHN II KMU IHS Swat

Calcitonin (CT):
➢ Calcitonin is secreted by the parafollicular cells or clear cells (C cells),
situated among the follicles in thyroid gland.
➢ High blood Calcium levels stimulate its secretion and low levels inhibit it.
➢ It lowers blood Calcium and HPO4 2-level by uptake into bone and
inhibiting bone resorption

Thyroid Disorders
Hypothyroidism
• Myxedema
• Cretinism
• Non toxic goiter
Hyperthyroidism
• Grave’s Disease
• Toxic goiter
4. Parathyroid Gland
Human beings have four parathyroid glands, which are situated on the posterior
surface of upper and lower poles of thyroid gland.
➢ Parathyroid glands are very small in size, measuring about 6 mm long, 3
mm wide and 2 mm thick, with dark brown color.
➢ Parathormone (PTH) is secreted by the chief cells of the parathyroid
glands.

Functions of PTH
PTH maintains blood calcium level by acting on:
• Bones
• Kidney
• Gastrointestinal tract.
➢ PTH Regulates the levels of Ca++, Mg2+, and HPO4 2- ions in blood.
Osteoclastic activity is specific (bone resorption)
➢ It promotes the formation of calcitriol (active form of Vit D)by kidneys
which increases dietary Ca++, HPO4 2- and Mg+2absorption.
 (9)
Endocrine System Disorders AHN II KMU IHS Swat

Parathyroid Disorders
➢ Hypoparathyroidism and
➢ Hyperparathyroidism
➢ Hypocalcemia and Tetany (neuromuscular hyperexcitability
5. Adrenal Gland
Parts of Adrenal Gland
Adrenal gland is made of two distinct parts:
 Adrenal cortex: Outer portion, constituting 80% of the gland
 Adrenal medulla: Central portion, constituting 20% of the gland.
Adrenal Glands
There are two adrenal glands. Each gland is situated on the upper pole of each
kidney. Because of the situation, adrenal glands are otherwise called suprarenal
glands.
➢ Each gland weighs about 4 g.

Physiology
Two parts adrenal cortex and adrenal medulla

1. Hormones of Adrenal Cortex

Adrenocortical hormones are steroids in nature, hence the name
‘corticosteroids.
Based on their functions, corticosteroids are classified into three groups:
1. Mineralocorticoids
2. Glucocorticoids
3. Sex hormones.
Synthesis:
➢ All adrenocortical hormones are steroid in nature and are synthesized
mainly from cholesterol that is absorbed directly from the circulating
blood.
 (10)
Endocrine System Disorders AHN II KMU IHS Swat

➢ Small quantity of cholesterol is also synthesized within the cortical cells

from acetyl-CoA.
➢ Adrenal Cortex—Mineralocorticoids (affect minerals homeostasis—Na+
and K+ and also excrete H+ in the urine)
➢ Glucocorticoids (affect glucose homeostasis), secretes cortisone,
corticosterone, cortisol and small amount of Androgens.
➢ It causes glucose formation, protein break down, lipolysis, resistance to
stress, anti-infamatory effects, Immunity suppression.
1) Adrenal Cortex
Sex Hormones
Adrenal sex hormones are transported by another special plasma protein
known as sex hormone binding globulin.
Mineralocorticoids
Mineralocorticoids are the corticosteroids that act on the minerals (electrolytes),
particularly sodium and potassium. • Mineralocorticoids are:
1. Aldosterone
2. 11-deoxycorticosterone.
Source of Secretion
Mineralocorticoids are secreted by zona glomerulosa of adrenal cortex.
Functions of Mineralocorticoids
Ninety percent of mineralocorticoid activity is provided by aldosterone. Life-
saving Hormone
Aldosterone is very essential for life and it maintains the osmolarity and volume
of ECF. It is usually called life-saving hormone because, its absence causes
death within 3 days to 2 weeks. Aldosterone has three important functions
It increases:
1. Reabsorption of sodium from renal tubules
2. Excretion of potassium through renal tubules
Secretion of hydrogen into renal tubules.
2) Adrenal Medulla hormone:
 (11)
Endocrine System Disorders AHN II KMU IHS Swat

3) Epinephrine and norepinephrine— sympathetic response

Adrenal Disorders
Hypersecretion of adrenocortical hormones leads to the following conditions:
1. Cushing syndrome
2. Hyperaldosteronism
3. Adrenogenital syndrome
Adrenocortical Hypo secretion leads to
Addison disease which is the failure of adrenal cortex to secrete corticosteroids.

Pancreas
➢ Alpha cells—Glucagon
➢ Beta cells—Insulin
➢ Delta cells-- Somatostatin
Pancreas Insulin decreases the blood glucose level by:
1. Facilitating transport and uptake of glucose by the cells
2. Increasing the peripheral utilization of glucose
3. Increasing the storage of glucose by converting it into glycogen in liver and
muscle
4. Inhibiting glycogenolysis
5. Inhibiting gluconeogenesis.
2. Glucagon – allows glucose to enter the blood from alpha cells Pancreatic
Hormones and Blood Sugar.

Pineal Gland
Pineal gland is a small cone shaped body measuring 10 mm in length that
projects posteriorly from the posterior end of the roof of the third ventricle of
the brain.
➢ Melatonin
➢ Serotonin
 (12)
Endocrine System Disorders AHN II KMU IHS Swat

Thymus
➢ Located posterior to the sternum
➢ Largest in infants and children
➢ Produces thymosin
➢ Matures some types of white blood cells
➢ Important in developing the immune system

Hormones of the Ovaries

Estrogens
➢ Produced by Graafian follicles or the placenta
➢ Stimulates the development of secondary female characteristics
➢ Matures female reproductive organs
➢ Helps prepare the uterus to receive a fertilized egg
➢ Helps maintain pregnancy
➢ Prepares the breasts to produce milk Slide 9.36 Copyright © 2003
Pearson Education, Inc. publishing as Benjamin Cummings Hormones of
the Ovaries
Progesterone
➢ Produced by the corpus luteum
➢ Acts with estrogen to bring about the menstrual cycle
➢ Helps in the implantation of an embryo in the uterus

Hormones of the Testes

➢ Interstitial cells of testes are hormone producing
➢ Produce several androgens
➢ Testosterone is the most important androgen
➢ Responsible for adult male secondary sex characteristics
➢ Promotes growth and maturation of male reproductive system
➢ Required for sperm cell production

Other Hormone and Organs Producing Tissues

➢ Parts of the small intestine
➢ Parts of the stomach
➢ Kidneys
➢ Heart
 (13)
Endocrine System Disorders AHN II KMU IHS Swat

➢ Many other areas have scattered endocrine cells.

Endocrine Function of the Placenta

➢ Produces hormones that maintain the pregnancy
➢ Some hormones play a part in the delivery of the baby
➢ Produces HCG in addition to estrogen, progesterone, and other

Disorders of Pituitary Gland and

Diabetes Mellitus
Lecture 2b Abrar Hussain

Pituitary disorders
Hyperactivity
 Gigantism
 Acromegaly
 Cushing’s Syndrome
Hypoactivity
 • Dwarfism
 • Acromicria
 • Simmonddisease
 • Diabetes insipidus
 • hypopituitarism

Introduction
➢ Overactive pituitary gland is related to the abnormal functions of those
glands which are associated with the hormones of pituitary e.g. Cushing’s
syndrome (hypercortisolism), hyperprolactinemia, and Hyperthyroidism
are example of conditions that result from overactive pituitary gland.
 (14)
Endocrine System Disorders AHN II KMU IHS Swat

➢ In this section, the main focus will be on overproduction of Growth

Hormone.

1. Gigantism

➢ Gigantism also called pediatric acromegaly and pituitary gigantism is

abnormally large growth due to an excess of growth hormones during
childhood, before the bones growth plates have closed. (Growth plates
usually close near the end of puberty. For girls, this usually is when they're
13–15; for boys, it's when they're 15–17.)
➢ It is a very rare condition that happens when a child or adolescent has high
levels of growth hormone (GH) in their body, which causes them to grow
very tall.
Robert Pershing Wadlow
➢ Robert Wadlow “The Alton Giant”
➢ The tallest man ever at the disorder 8’11”, suffered from
➢ Born normal weight & size, died by 22.

Pathophysiology
➢ Growth hormone, also known as human growth hormone (hGH) and
somatotropin, is a natural hormone that acts on many parts of the body to
promote growth in children.
➢ Once the growth plates (epiphyses) in your bones have fused, GH no
longer increases height.
➢ Instead, it helps to maintain normal bone, cartilage and organ structure and
metabolism .
➢ GH is closely connected to insulin-like growth factor 1 (IGF1), a hormone
your liver releases.
➢ These hormones work together to carry out growth and metabolism
functions.
➢ In gigantism, the excessive amount of growth hormone (GH) accelerates
the growth of muscle, bones and connective tissue.
➢ This leads to an abnormally increased height as well as several soft tissue
changes.
 (15)
Endocrine System Disorders AHN II KMU IHS Swat

➢ When left untreated or unmanaged, some people with gigantism have

grown over 8 feet tall.
➢ Because of this, early diagnosis and treatment are crucial in cases of
gigantism.

Etiology
The most common cause of gigantism is a benign (noncancerous) tumor on
your child’s pituitary gland (a pituitary adenoma ) that releases excess
growth hormone (GH).
Other causes include:
1. Carney complex
2. McCune-Albright Syndrome
3. Multiple Endocrine Neoplasia type 1 (MENSS-1)

4. Neurofibromatosis.

Signs and Symptoms

➢ The main sign of gigantism is excessive growth.
➢ Children with gigantism grow rapidly in height.
➢ Very prominent forehead and a prominent jaw.
➢ Gaps between their teeth.
➢ Thickening of their facial features.
➢ Large hands and feet with thick fingers and toes.
➢ Enlargement of internal organs, especially your child’s heart.
➢ Excessive sweating (hyperhidrosis ).
➢ Double vision or difficulty with side (peripheral) vision.
➢ Signs and Symptoms
➢ Headaches .
➢ Joint pain .
➢ Delayed puberty .
➢ Irregular menstruation
➢ Sleeping problems (periods). , such as sleep apnea
➢ Muscle weakness. .
➢ If your child experiences these symptoms, it’s important to talk to their
healthcare provider as soon as possible.
 (16)
Endocrine System Disorders AHN II KMU IHS Swat

Diagnosis
➢ Growth hormone and IGF-1 (insulin-like growth factor 1) blood tests
➢ Glucose tolerance test
➢ Imaging tests: MRI , CT Scan which can clearly show the size and
location of a pituitary tumor and help determine the proper treatments.
➢ High prolactin levels.

Treatment
➢ The goals of treating gigantism include:
1. Safely regulating growth hormone (GH) and insulin-like growth
factor 1 (IGF1) levels.
➢ Managing pituitary tumor growth.
➢ Reducing the effects of the pituitary tumor on nearby structures, such as
brain tissue and the optic nerve.
➢ Treating or reducing the effects of GH on other body systems.
➢ Healthcare providers typically use a combination of treatments,
specifically surgery and radiation therapy , for gigantism.
➢ Medications are available and effective in treating acromegaly (excess
GH in adults) but the effects of these drugs on children haven’t been
adequately studied.

Complications
➢ Delayed puberty
➢ Adrenal insufficiency
➢ Diabetes insipidus
➢ Hypogonadism
➢ Hypothyroidism

References • Medical Surgical Nursing by P.K Panwar • Medical

Surgical Nursing 2021-2022 edition by Lackwinder Kaur-Sukhminder Kaur-
Kanta Ajay Kumar.

2. Acromegaly

Acromegaly is a rare condition where the body produces too much growth
hormone, causing body tissues and bones to grow more quickly.
 (17)
Endocrine System Disorders AHN II KMU IHS Swat

➢ Over time, this leads to abnormally large hands and feet, and a wide
range of other symptoms.
➢ Acromegaly is usually diagnosed in adults aged 30 to 50, but it can
affect people of any age

Difference between Gigantism and Acromegaly

➢ Gigantism occurs when hypersecretion of growth hormone occurs before
the fusion of the long bone epiphysis and is characterized by tall stature.
➢ Acromegaly occurs when GH hypersecretion occurs fusion after the of
the epiphysis leading to large extremities and characteristic faces.
➢ Gigantism occurs in children
➢ Acromegaly occurs in adults
➢ Gigantism is rarer than acromegaly.

Etiology
➢ Your pituitary gland is a small, pea-sized endocrine gland located at the
base of your brain below your hypothalamus.
➢ Your pituitary gland releases eight important hormones, including GH
➢ If you have too much GH in your body as an adult, it can result in
irregularly-shaped bones, increased organ size, elevated blood sugar
levels (hyperglycemia ) and other symptoms.

How does acromegaly affect my body?

➢ Growth hormone (GH) signals your liver to produce another hormone
called insulin-like growth factor 1 (IGF-1).
➢ IGF-1 is the hormone that actually causes your bones and body tissue to
grow and also affects how your body processes blood glucose (sugar)
and lipids (fats).
➢ High levels of GH result in high levels of IFG-1, which can lead to Type
2 diabetes , pressure (hypertension) high blood and heart disease

Signs and Symptoms

➢ Adults with acromegaly may experience the following symptoms:
➢ Enlarged hands or feet.
➢ Changes in your face shape, including a more prominent jaw and/or
forehead.
 (18)
Endocrine System Disorders AHN II KMU IHS Swat

➢ Large jaw (pragmatism)

➢ Widely spaced teeth
➢ Increase in size of your lips, nose and/or tongue.
➢ Excessive sweating or oily skin.
➢ Deepening of your voice
➢ Signs and Symptoms
➢ Other symptoms include:
➢ Headaches .
➢ Joint pain .
➢ Vision changes.
➢ Increase in the number of skin tags
➢ Numbness in your hands • Sleep apnea .
➢ Carpal tunnel syndrome . . or spinal cord issues.

Diagnosis
➢ High growth hormone level
➢ High insulin like growth factor 1 (IDF-1) Level
➢ Spine X Ray shows abnormal bone growth • Pituitary MRI show a
pituitary tumor
➢ Echocardiogram may show an enlarged heart, leaky mitral valve, or leaky
aortic valve.

Nursing Diagnosis
➢ Disturbed Body Image related to anxiety over thickened skin and
enlargement of face, hands, and feet.
➢ Ineffective Coping related to change in appearance.
➢ Disturbed Sensory Perception
➢ Disturbed Sleeping Pattern related to soft tissue swelling
➢ Fluid Volume Deficit
➢ Anxiety related to change in appearance
➢ Knowledge Deficit

Management
There are several treatment options for acromegaly.
➢ Your healthcare provider will consider your symptoms and circumstances
before offering treatment options that are right for you.
 (19)
Endocrine System Disorders AHN II KMU IHS Swat

➢ The most common treatments for acromegaly are surgery, medication and
radiation therapy . Treatment The following medications may help in
treatment:
➢ Octreotide ( Sandostatin) or bromocriptine (Parlodel) may control growth
hormone release in some people.
➢ Pegvisomant (Somavert) directly blocks the effects of growth hormones
and has been shown to improve symptoms of acromegaly.
➢ Cabergoline (Dostinex)—given orally
➢ Pergolide (Permax)—given orally

Complications
If left untreated, acromegaly can cause the following complications:
➢ Type 2 diabetes.
➢ High blood pressure (hypertension).
➢ Heart disease.
➢ Cardiomyopathy
➢ Arthritis .
➢ Colon polyps (disease of your heart muscle). , which can potentially turn
into cancer if left untreated.
➢ Organ failure. colon

Nursing management
➢ Assess the body changes of the patient
➢ Give psychological support
➢ Administer medication and IV fluids
➢ Asses the sleeping pattern of patient
➢ Explain the patient about progressive features of disorders

References
• Medical Surgical Nursing by P.K Panwar • Medical Surgical Nursing 2021-
2022 edition by Lackwinder Kaur-Sukhminder Kaur-Kanta Ajay Kumar.
 (20)
Endocrine System Disorders AHN II KMU IHS Swat

 If you want to learn MS OFFICE and HOW TO USE AI IN

EDUCATION to be smart, then follow the channel on
whatssapp:
[Link]
Reliable & Professional MS Office & Digital Services
Delivering high-quality, client-focused solutions — ideal for students,
professionals, and small businesses.
Our Core Services:
 Document Editing & Formatting (Word, Excel, PowerPoint)
 Professional CV & Cover Letter Writing – Make your first
impression count
 Report, Assignment & Thesis Formatting – Clean, academic,
and organized
 Excel Sheet Creation & Data Management – Budgets, tables,
formulas
 PowerPoint Presentation Design – Visually appealing &
impactful slides
 English Typing & PDF Conversion – Fast, accurate & reliable
Why Choose Us?
 On-Time Delivery
 Student-Friendly, Affordable Rates
 Professional, Friendly Communication
Ready to get started?
Contact Now: 0312 5650192