Endocrine Assessment

ENDOCRINE
ASSESSMENT
BY: ROMMEL LUIS C. ISRAEL III
BY: ROMMEL LUIS C. ISRAEL III 1

2
Purpose
Provide an overview of basic
endocrine assessment including
normal and abnormal findings.

3
Objectives
●Discuss the components of a

focusedendocrine assessment.
●Discuss history questions
which will helpyou focus your
assessment.
●Identify common endocrine
disorders

4
Things to
remember:
The endocrine system acts to maintain
equilibrium at the cellular level and is a
vital link in homeostasis.
When abnormalities occur, illness or death

can result.
A thorough understanding of the endocrine

system and how it functions is necessary
inaccurately assessing and treating
endocrine disorder
Review of
Endocrine
Glands,
Hormones
&Symptomol
ogy

Review of
Endocrine
Glands,
Hormones
&Symptomol
ogy
6
The hypothalamus known as the 7
"master“ gland, produces and releases
hormones that stimulate the pituitary
gland
● Growth hormone releasing hormone
(GRH)
● Thyrotropic-releasing hormone (TRH)
● Corticotropin releasing hormone
(CRH)

Assessing Common Endocrine Abnormalities
When conducting assessment on your patient, begin with a thorough history of their
chief complaints.\
You will need to elicit information about any experienced signs or symptoms of
endocrine disease or disorders.
Endocrine disorders and diseases usually manifest according to which endocrine

hormone is being overproduced and secreted, or under-produced, at any given age.
The key to discovering the nature of the symptoms lies in your understanding of the
functions of the endocrine hormone

The Problem-Focused Endocrine Assessment
● Endocrine assessment is necessary after a comprehensive assessment indicates a

potential endocrine abnormality.
●This assessment may also be necessary when an interval or abbreviated assessment

shows a change in status from your last assessment or report you received.
●When a new symptom emerges or the patient develops any distress, consider a
focused endocrine assessment.
●The advantage of this assessment is that it allows you to ask about symptoms and
move quickly to conducting a focused physical exam

Subjective and Objective data
Chief Complaint
• Present health status
• Past health history
• Current lifestyle
• Psychological status
• Family history
• Physical assessment
Communication during the history and physical must be respectful
and performed in a culturally-sensitive manner. Privacy is vital.
Take into consideration that a patient’s ethnicity and culture may

affect the history that the patient provides.

OBJECTIVE DATA
PHYSICAL EXAM TECHNIQUES
INSPECTION AUSCULTATION PERCUSSION PALPATION
13
During inspection, you are looking for conditions you
can observe with your eyes, ears or nose.
Generalized appearance
• Skin color
• Location of lesions
• Bruises or rashes
• Symmetry
• Size of body parts
• Abnormal sounds or odors
Auscultation is used in your
focused endocrine assessment
before percussion or palpation.
• Murmurs
• Cardiac irregularities
• Adventitious breath sounds
• Alterations in bowel sounds
• During light palpation, compress the skin
about ½ inch to 3/4 inch with the pads of
your fingers.
• When using deep palpation, use your
finger pads and compress the skin about
1½ inches to 2 inches
• Palpation allows you to assess for texture,
tenderness, temperature, moisture,
pulsations, masses, and internal organ
Percussion allow you to elicit tenderness or sounds that point to
underlying problems
● When percussing directly over suspected areas of tenderness,

monitor the patient for signs of discomfort.
● Examples of endocrine abnormalities you may percuss are an

enlarged pancreas, a pleural effusion associated with specific
endocrine abnormalities, or a hormone-secreting tumor.

SUBJECTIVE DATA

Feelings of
depression,
Fatigue or lethargy Weight gain or loss Dizziness
irritability,
oranxiety
Nausea and Changes in urinary

Pain Decreased libido
vomiting or bowel habits
Intolerance to heat
Changes in vision Change in appetite
or cold
19
PITUITARY
DISORDERS
• The endocrine system is comprised of a
number of different glands, each linked
in a unique manner to
the hypothalamus.
• The pituitary gland, also known as the
hypophysis
• Is a pea-sized gland located at the base
of the brain
Two Glands
The anterior pituitary produces growth hormone

(GR), thyroid stimulating hormone (TSH), and
adrenocorticotropin (ACTH) hormone.
The posterior pituitary produces anti diuretic

hormone (ADH), also known as vasopressin

Syndrome of
inappropriate anti
diuretic hormone
secretion (SIADH)

Possible causes
Occurs with above
include: a)ADH
normal ADH release,
secreting tumor,
which causes impaired
b)Chemotherapy , c)
water excretion.
Oat cell carcinoma

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Video:
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tu.be/0NH
T8ERUBo0
?feature=s
hared
25
SUBJECTIVE ASSESSMENT OBJECTIVE ASSESSMENT
Anorexia Weight Gain
Nausea Vomiting
Headache Muscle Weakness
Fatigue Muscle Spasms or Cramps
Irritability Hallucinations
Decrease Level of Consciousness (LOC)
Confusion
Low Serum Sodium
Low Serum Osmolarity
High Urine Osmolarity
Normal Sodium Urine Excretion
Low Edema
Possible Coma
Therapeutic
Interventions
• Fluid Restrictions
• Hypertonic parenteral Fluids
• Hypertonic solutions, used to help re-
establish equilibrium in electrolyte and
acid-base imbalances, include
electrolyte replacement solutions and
parenteral nutrition solutions
Nursing
Interventions
• Monitor Vital signs, Intake and Output and Daily weight
• Monitor Fluid and electrolyte status
• Restrict fluid intake: administer hypertonic intravenous
solution as ordered
• Institute seizure precautions and protect from injury
• Diuretics may be given as ordered if along with fluid
restriction if severe hyponatremia is present
• Close monitoring of urine and blood chemistries and
neurologic status

29
Diabetes Insipidus
(DI)
30
ADH release or under-

production of ADH can
result in Diabetes Insipidus.

Watch this
Video:
https://youtu.
be/75JrAx4hB
C0?feature=s
hared

Possible causes
Cerebral Hypothalamic-
Cranial trauma
vascular pituitary
or surgeries
accident (CVA) tumors
Drugs (lithium
Alcohol
Hereditary and phenytoin
(transient DI)
[Dilantin])
Abrupt onset of polydipsia and polyuria Fluid intake 5-20 L/day
Nocturia Urine output of 2-20 L/day of dilute

urine
Sleep disturbances related to nocturia
Fatigue Changes in LOC
Headache Fever
Visual Disturbances Orthostatic hypotension (can result in

dizziness or momentary loss of
consciousness: SYNCOPE)
Tachycardia
Pharmacologic
Therapy

Desmopressi
n ( DDAVP)
• use to treat the
disease
• Administered
intranasally, one to
two administration
every 12 to 24
hours
• Decrease in urine
output
Vasopressin
tannate in oil
• Administered
intramuscularly
at night, 24 to
96 hours
• abdominal
cramping is the
side effect
Clofibrate
has
Hypolipidemic
antidiuretic
agent
effect

Thiazide
diuretics
• For mild forms of
the disease
• Potentiate the action of
vasopressin
• Rotation of injection sites is
necessary to prevent from
lipodytrophy (Lipodystrophy
is a condition in which the
amount and/or distribution
of adipose tissue (fat
tissue) in the body is
abnormal)
Nursing Management
• Monitor Fluid and Electrolytes status, Intake and
output, daily weight and skin turgor
• Replace fluids
• Monitor response to ADH replacement
• Advise to avoid alcohol (Alcohol- suppress ADH
secretion)
• Vasopressin (antidiuretic action on the collectic
ducts of the kidney): Watch for acute coronary
disease because it can cause vasoconstriction
Hypopituitarism

• Hypopituitarism is the deficiency of one or
more anterior pituitary hormones
• Total absence of
pituitary hormones( Panhypopituitarism)-
Simmond’s disease
• Occurs when there is a destruction of the
anterior lobe of the gland by trauma, tumor
or hemorrhage
• Clinical findings vary with target organs
affected
Watch this
Video:
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.be/hbIsel20
bHM?
feature=shar
ed
42
CLINICAL FINDINGS
Lethargy Decreased Temperature
Loss of strength and Libido Postural Hypotension
Decreased levels in GH, ACTH, TSH, FSH and LH
Hypoglycemia

44
Hyperpituitaris
m

• Hyperpituitarism results from overactivity
of the gland or adenoma
• Caused by excessive secretion
concentration of pituitary hormone
(GH, ACTH, Prolactin) in the blood
• Overactivity
• Changes in the anterior lobe of the pituitary
gland
• GH overproduction: Gigantism, acromegaly
Watch this
Video:
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.be/OQQjsorl
_sA?
feature=shar
ed
46
CLINICAL FINDINGS
Headache Increased soft tissue and
bone thickness
Depression Change in facial features
Weakness Enlarge hand and feet
Increased in GH, ACTH and Prolacti
n Amenorrhea
Increased in Intracranial pressure
Diabetes and hyperthyroidism may
occur

An adenoma is a benign tumor
of epithelial tissue with glandular
origin, glandular characteristics,
or both. Adenomas can grow
from many glandular organs,
including the adrenal glands,
pituitary gland, thyroid, prostate,
and others.
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Acromegaly is a disorder
marked by progressive
enlargement of the head, face,
hands, feet, and chest due
to excessive secretion of
growth hormone by the
anterior lobe of the pituitary
gland.
Watch this Video:
https://youtu.be/rHTzuWKAH-k?feature=shared

Gigantism is a
generalized increase
in size, especially in
children involving the
long bones
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Therapeutic Interventions
Replace hormones
Intervene surgically if tumor is present
Medications: sandostatin, dopamine agonist bromocriptine (Parlodel) and other medications that
can relieve clinical findings of other endocrine imbalances resulting from pituitary hyperfunctioning
Surgical Interventions: Hypophesectomy-irradiation of the pituitary
A hypophysectomy is a brain surgery to remove all or part of the pituitary gland

• Monitor effects of hormone
replacement therapy
• Discuss the importance of
adhering to medical regimen
to a long-term basis
Nursing • Provide rest period
managem • Encourage to express
ent feelings
• Help understand the change
in sexual functioning
55
Care after hypohesectomy
Let your patient know that a decreased sense of smell is expected

for about the first month after the procedure,
do not brush teeth but use dental floss
need lifelong hormone replacement therapy

After a hypophysectomy
procedure, the patient’s nose
will drain. It’s important to
monitor that drainage for
signs and symptoms of a
cerebrospinal fluid (CSF) leak.
•One sign of CSF leak is a halo sign
in the drainage. This means there
is clear or bloody fluid in the center
of the drainage, but a yellow ring
outside that drainage. If you see
this halo sign, it can mean the
patient has a CSF leak.
Another sign of CSF leak is if the
patient complains of a headache
and also indicates that their drainage
tastes sweet. If you test the drainage
and it’s positive for glucose, that is
another sign of CSF leak and will
need to be further investigated

THYROID DISORDERS

The Thyroid gland lies in the anterior portion of the neck and
straddles the trachea.
It secretes two hormones that play a major role in the body’s

metabolism: a) Thyroxine (T4) and b) Triiodothyronine (T3)
Absence of these hormones may decrease the body’s basal

metabolic rate by 60% and
an excess of these hormones may increase the body’s basal

metabolic rate by 100%
Possible causes include:
• Thyroid gland dysfunction
• Inadequate release of TRH or TSH from
the hypothalamic-pituitary
Hypothyroid axis (hypophysectomy or pituitary
ism - radiation)
Chronic • Surgical removal or radio-iodine
ablation with hyperthyroidism
deficiency
• Hashimoto's thyroiditis (chronic
of T4& T3 inflammation of the thyroid)
TRH - Thyrotropin-releasing hormone

TSH - thyroid-stimulating hormone.
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SUBJECTIVE ASSESSMENTNNN OBJECTIVE ASSESSMENT
Diminished hearing Bradycardia

Cold intolerance Decreased LOC
Fatigue Hypothermia
Lethargy Hypoventilation
Complaints of constipation Hypoactive bowel sounds
Weight gain
Elevated TSH
Decreased T3, T4, free T4
Elevated CK-MB
Increased pCO2
Decreased P02, Ph
Hypoglycemia
triiodothyronine (T3)
Tyroxine-T4
Creatine kinase-MB (CK-MB)
Hypoventilation - The state in which are duced amount of air enters the alveoli in the lungs
Reduced (hypoactive) bowel sounds include a reduction in the loudness, tone, or regularity of the
sounds.

Nursing
Interventions
• Assess and monitor vital signs; watch for bradycardia, and decreased
respirations
• Encourage self-care; schedule activities for times when the patient has
the most energy
• Administer Medication: Levothyroxine
• Monitor food intake and appetite; encourage healthy food choices, avoid
comfort foods
• Assess skin integrity; dry skin and brittle hair; apply moisturizers
and encourage adequate hydration
• Provide a comfortable environment and limit exposure to cold
• Monitor weight regularly

The decreased thyroid hormone levels slow all the body processes, including
respiration and cardiac output
Fatigue is one of the biggest complaints among patients with

hypothyroidism. Encourage patients to engage in self-care and activities
during the period of high erenergy and allow for rest periods as needed.
BY: ROMMEL LUIS C. ISRAEL III . 67

Give medication in the morning on an empty stomach approximately 1
hour before meal for most effective treatment.
Patients often have a decreased appetite but continue to gain weight.

Take note of a patient’s eating habits and provide nutrition
recommendations

•- As the metabolism slows, skin
and hair begin to dry out and become
thin and brittle. Encourage
moisturizers applied to the skin after
bathing and conditioner for hair. Note:
any excoriations or wounds as healing
may also be impaired.
Patients are more sensitive to colder temperatures
and often complain of being cold, even in hot
weather. Provide blankets as needed.
Patients tend to gain weight but should begin to

lose weight as the medication takes effect

Myxedema Coma - Acute
deficiency of T4& T3
• Insufficient thyroid hormone or
supplementation, together with an
acute stressor, can lead to a
myxedema coma, or acute deficiency
of T4 and T3.
stressor, can lead to a myxedema coma, oracute deficiency

or T4 and T3. 71
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Insufficient thyroid supplementation
Increased stressors in patients with

hypothyroidism (e.g. trauma, cold, anesthesia,
infection)
Diminished hearing Anasarca
Cold intolerance Horseness
Complaints of constipation Pericardial & pleural effusions
Fatigue Diminished hearing
Lethargy Paralytic ileus
Unresponsiveness
Decreased breathing
Hypotension
Hypoglycemia
Hypothermia
Objective assessment findings are similar to signs & symptoms of hypothyroidism
but even more pronounced
Anasarca
- An accumulation of serous fluid in various tissues and cavities of

the body.
Paralytic ileus
- is the occurrence of intestinal blockage in the absence of an actual

physical obstruction

Nursing Interventions
Monitor vital signs, including heart rate and rhythm.
Administer thyroid replacement, levothyroxine sodium (Synthroid) is most commonly prescribed.
Instruct the client about thyroid replacement therapy.
Instruct the client in low-calorie, low-cholesterol, low-saturated-fate diet.
Assess the client for constipation; provide roughage and fluids to prevent constipation

• Provide a warm environment for the client.
• Avoid sedatives and narcotics because of increase
sensitivity to these medications.
• Monitor for overdose of thyroid medications,
characterized by tachycardia, restlessness,
nervousness, and insomnia.
• Instruct the client to report episodes of chest pain

immediately

Hyperthyroidi
sm
Hyperthyroidism
is a chronic
increase in T4and
T3 levels.

Watch this Video:
https://youtu.be/Urwbo61a6Po?feature=shared

• Adenoma
• Thyroiditis
• Over treatment of hypothyroidism
• Discontinuation of thyroid supplements
• Stress
• Iodine load with pre-existing hyperthyroid state
• Pituitary tumor

Irritability Tachycardia
Restlessness Atrial arrhythmias
Heat intolerance Premature atrial contractions (PACs)
Complaints of diarrhea Premature ventricular contractions
(PVCs)
Complaints of diarrhea Dyspnea
Palpitations
Weight loss
Hyperthermia
Elevated T4 and T3

OBJECTIVE ASSESSMENT
Decreased TSH
Increased TSH if from a TSH secreting
tumor (in pituitary)
Positive test for thyroid antibodies(Grave's
Disease)
Hyperglycemia
Diaphoresis

Administer sedatives as Provide a cool and quiet
Provide adequate rest.
prescribed. environment.
Nursing
Interventi Obtain weight daily.
Provide a high-calorie
diet.
Avoid the administration
of stimulants.
ons
Administer antithyroid
medications(propylthiour
acil [PTU]) that block
thyroid synthesis, as
prescribed

• Administer iodine preparations that

inhibit the release of thyroid
hormone as prescribed.
Nursing • Administer propranolol (Inderal) for

tachycardia as prescribed.
Interventi • Prepare the client for radioactive

iodine therapy, as prescribed, to
ons destroy thyroid cells.

• Prepare the client for
thyroidectomy if prescribed
84
An acute increase in T4 and T3 can
cause thyrotoxicosis or an acute
Thyrotoxico thyroid storm.
sis or
Thyroid The possible cause
Storm is Decompensating of a pre-existing
hyperthyroid state after stressor
(e.g. surgery, anesthesia, infection,
trauma)

Watch this Video:
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=shared

Restlessness Tachycardia
Agitation Diaphoresis
Changes in LOC Fever
Diarrhea
Confusion
Signs and symptoms
associated with CHF and
pulmonary edema

Observe patients carefully and
provide aggressive and supportive
nursing care during and after the
Nursing acute stage of illness
Managem
ent Care provided for the patient with
hyperthyroidism is the basis for
management of patients with
thyroid storm

Thyroiditis
Inflammation, abrosis
or lymphocytic
infiltration of the
thyroid gland-cause
by staphylococcus
aureus
• Chronic ( Hashimoto ) -
Occurs most in women (30-
50 years old)- Most
common cause of
hypothyroidism in adults-
autoimmune thyroiditis- Not
accompanied by pain,
pressure symptoms, fever
and thyroid activity are
usually normal or low-
If untreated-hypothyroidism
• autoimmune thyroiditis -
the immune system the
thyroid gland
• Acute- Can occur in
postpartum period-
autoimmune reaction
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Clinical Manifestations
• Anterior neck pain and swelling, fever dysphagia, dysphonia
• Pharyngitis or pharyngeal pain
• Warmth, erythema and tenderness of the thyroid gland
• Multiple nodules, mild tenderness, diffuse goiter with irregular
surface, rubbery or firm, tender pyramidal lobe, hard fibrous
variant
• Fatigue, sluggish, pale skin, constipation and increased
sensitivity to col
Dysphonia - refers to having an abnormalvoice. It is also known

as hoarseness.
Medical Management
Antimicrobial agents and
fluid replacement
Surgical incision and drainage

if abscess is present
Thyroid hormone therapy
Surgery is performed when

pressure symptom persist

Thyroid hormone therapy - to
reduce the size of the thyroid gland
and prevent hypothyroidism and if
hypothyroid symptom is present

ADRENAL
DISORDERS
The adrenal glands are two organs located at the top of each
kidney, which are responsible for the secretion of:
• Mineralocorticoids
• Glucocorticoids
• Corticosteroids:
- Epinephrine and Norepinephrine. Aldosterone accounts for
95%
of all mineralocorticoids produced and is secreted by the
adrenal
cortex.
- Cortisol is the primary glucocorticoid secreted by the
adrenal
cortex.
- Epinephrine and norepinephrine are hormones secreted
from
the adrenal medulla
Primary • Addison's
disease is the
Adrenal chronic
deficiency
Insufficiency or secretion of
cortisol from
or Addison’s the adrenal
cortex. Aldoster
Disease one is usually
unaffected

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ure=shared

• Secondary
Secondar adrenal
insufficiency is
y Adrenal
the chronic
deficiency of
ACTH from the
Insufficie anterior pituitary,
which stimulates
cortisol release
ncy from the adrenal
cortex.

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Possible causes of adrenal
insufficiency include:
• Autoimmune destruction of the adrenal gland
• Adrenal destruction from surgery, trauma,
sepsis, infection, tuberculosis, hemorrhage, or
bilateral adrenelectomy
• Suppression of gland related to medications
• Pituitary hypofunction (surgery, trauma,
ischemia)

Did you Know?
The most common reason for ACTH suppression is the use of glucocorticoid medications.
These include cortisone, hydrocortisone, prednisone, prednisolone, and dexamethasone.
Other medications which can suppress the anterior pituitary include ketoconazole(Nizoral), rifampin (Rifadin),
and phenytoin (Dilantin)
(National Adrenal Diseases)

Nausea Hyperpigmentation (only in primary adrenal
insufficiency)
Abdominal Pain Orthostatic hypotension
Fatigue Decreased cardiac size and output
Malaise Weak & irregular pulse
Weakness X-rays may show adrenal calcification(only in
primary adrenal insufficiency)
Decreased cortisol levels
Elevated plasma ACTH levels (in primary
adrenal insufficiency due to disorder of the
adrenal gland)
Decreased plasma ACTH (when dysfunction is
a result of the hypothalamic-pituitary axis)
Other endocrine abnormalities (in
secondary adrenal insufficiency due to
pituitary abnormality)
Orthostatic hypotension -
Hyperpigmentation - is a
is a sudden drop in blood
condition that causes skin
pressure when you stand
to darken-excess
from a seated or prone
production of melanin
(lying down) position

• Assess the patient
• Monitor and mange
Nursing addisonian crisis

• Restore fluid
Interventi
balance
• Improve activity
intolerance
ons • Promote home,

community-based
and transitional
care

Adrenal crisis - is
an acute decrease
in aldosterone and
Adrenal
cortisol from the
adrenal cortex or
an acute deficiency
Crisis of ACTH from the

anterior pituitary
which stimulates
cortisol release
from the adrenal
cortex.

WATCH THIS VIDEO:
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e=shared

Decompensation
Abrupt cessation
in a patient with
of chronic steroid
chronic adrenal
administration
insufficiency

Nausea Hypoglycemia
Abdominal Pain Hyponatremia
Fatigue Hypovolemia
Malaise Hypotension
Weakness Tachycardia

OBJECTIVE ASSESSMENT
Hyperkalemia
Hypercalcemia
Vomiting
Decreased cortisol levels
Increased BUN
Elevated plasma ACTH levels
Metabolic acidosis (in primary adrenalinsufficiency due to
disorder of the adrenalgland)
Decreased plasma ACTH (whendysfunction is a result of
thehypothalamic-pituitary axis)
X-Rays may show adrenal calcification
• Providing and monitoring response to fluid and cortisol
replacement therapies
• Providing a safe environment
• Evaluating and maintaining nutritional needs
• Preventing complications of immobility
• Supporting the patient and family in crisis
• Beginning the educational process to avoid future
adrenal crisis situations.

• Cushing's
Syndrome - is
Cushing’s the over-
production or
Syndrome over-secretion
of cortisol
from
the adrenal
cortex
Cushing’s Disease
• Cushing's disease - is the over-

production or secretion of ACTH
from the anterior pituitary, which
stimulates cortisol release from the
adrenal cortex
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Cortisol secreting tumor (20% of cases),such as oat cell

carcinoma of the lung with destruction of the adrenal gland
Adrenal carcinoma
Pituitary cortisol-secreting adrenal tumor(usually benign)

Weakness Pathologic Structures
Increase Appetite Purple Striae
Irritability Facial Edema
Emotional Ability Acne
Headache Buffalo Hump
Complaints of Easy bruising Poor Wound Healing
Reports symptoms associated with Peptic Ulcer
decreased stress and
immunologicresponse
Hypertension
Left Ventricular Hypertrophy

Preparing Encouraging
Decrease risk Decrease risk
Patient for Rest and
for injury for infection
surgery activity
Monitor and
Promote Skin Improve body Improve
manage
Integrity image coping
complications
Educate about
self care

• Pheochromocyto
ma - is an
adrenal neoplasm
resulted by the
Pheochromocyt increase
epinephrine and
oma (Adrenal norepinephrine
from the adrenal
Neoplasm) medulla. The
possible cause of
this disorder is
a tumor of the
adrenal medulla

Watch This Video:
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Headache Hypertension
Palpitation Hyperglycemia
Dizziness Dyslipidemia
Complaints of Irregular Heart Rate
Constipation
Anxiety Diaphoresis
Syncope
Syncope - is a temporary loss of consciousness usually related
to insufficient blood flow to the brain.
Dyslipidemia - is an abnormal amount of lipids(e.g.

triglycerides, cholesterol and/or fat phospholipids) in the
blood.
Diaphoresis - sweating, especially to an unusual degree as a

symptom of disease or aside effect of a drug.

Nursing
Interventions
• Monitor vital signs, especially blood pressure
changes
• Administer antihypertensive medications as
ordered
• Promote rest and decrease stressful stimuli
• Monitor urine tests for glucose and acetone
• For clients on 24-hour VMA testing
Nursing
Interventions
• Provide high-calorie, well-balanced diet
• Instruct patient to avoid smoking and
stimulants like coffee and tea
• For clients with an adrenalectomy, observe for
BP changes
• Provide client teaching on possibility of lifelong
steroid replacement (for bilateral
adrenalectomy)
- severe hypertension can precipitate a cerebrovascular accident and/or sudden blindness
- acute attacks may be precipitated by emotional stress, physical exertion, and change in position
- clients with pheochromocytoma may present with manifestations of diabetes mellitus
-> instruct to avoid vigorous and prolonged exercise and intake of coffee, tea, chocolate, bananas, and vanilla-
flavored food at least two days prior to and during urine collection(note: clinicians may also order client to stop
taking medications like methyldopa, L-Dopa, paracetamol at least three days prior to urine collection as well)

- may influence catecholamine release
- clients are at risk for shock due to a drastic drop in
catecholamine.
The most common reason that a patient may need to

have the adrenal gland removed isexcess hormone
production by a tumor located within the adrenal

• Also known as Conn’s
syndrome
• Primary aldosteronism is
Primary the result of an increase

in production and
secretion of aldosterone
Aldosteron from adrenal cortex.
The possible cause of this
ism is from a benign tumor of

the adrenal gland, which
occurs in people between
30 and 50 years of age

Aldosterone, the hormone
responsible for balancing potassium
and sodium in the body, thus having
an effect on blood pressure

Watch this
Video:
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u.be/36xx8J
sS0VI?featu
re=shared

Headache Hypernatremia
Muscle Weakness Hypovolemia
Fatigue Hypertension
Numbness Hypokalemia
Elevated Plasma
Elevated Urinary Aldosteronism

Nursing Management
• Eat a healthy diet.

• Achieve a healthy weight.
• Exercise
• Don't smoke.

Nursing Management
• Diets that highlight a healthy variety offoods
— including grains, fruits,vegetables and
low-fat dairy products —can help with weight
loss and help lowerblood pressure. Try the
Dietary Approaches to Stop Hypertension
(DASH)diet — it has proven benefits for
yourheart. A healthy diet also limits
sodium,added sugar, saturated fat and
alcohol
Nursing Management
• If your body mass index (BMI) is 25 or

more, losing as little as 3% to 5% of
your body weight may lower your blood
pressure

Nursing Management
• Regular aerobic exercise — taking a
moderately paced walk for 30 minutes
most days of the week can improve
your health. Try walking with a friend at
lunch instead of dining out

Nursing Management
• Quitting smoking improves your

overallheart and blood vessel
health. Talk toyour doctor about
medications that canhelp you stop
smoking.

PANCREATIC
DISORDERS
The pancreas is an oblong,
flattened gland located deep in
the abdomen, and plays a major
role in both the digestive and
endocrine systems.

As an endocrine gland, the pancreas produces several important
hormones, including: 1) Insulin, 2) Glucagon, 3) Somatostatin. ll
three of these hormones play a significant role in carbohydrate, fat,
and protein metabolism.
As a digestive organ, the pancreas secretes pancreatic juice

containing digestive enzymes that assist the absorption of
nutrients and the digestion in the small intestine.

• Diabetes
mellitus (DM) is
the result of the
Diabetes absolute
decreased
production of
Mellitus insulin(Type I) or
resistance of
cells to
circulating insulin
(Type II)

Watch this Video:
https://youtu.be/-B-RVybvffU?feature
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Type I: genetics, autoimmune

Type II: genetic factors, obesity
disease, viralinfections
Gestational: pregnancy induced

Did You Know?
• The Centers for Disease Control and

Prevention (CDC) estimate that
approximately 27.8% of the population
with diabetes is undiagnosed.

Headache Hyperglycemia
Fatigue Polyuria
Lethargy Polydipsia
Reduced Energy level Polyphagia
Irritability Anorexia
Emotional lability Muscle Cramps
Vision Changes Type I presents usually emergently
Numbness Type II presents insidiously
Tingling

• Lability - refers to something that
is constantly undergoing change or
is likely to undergo change.

Pancreatitis
Pancreatitis - may cause impairment of

insulin production and secretion.
Inflammation of the pancreas occurs

due to edema, hemorrhage, or necrosis.
Watch this Video:
https://youtu.be/HPNJQi_b7NM?feature=shared

Possible Causes include:
Alcoholism Trauma Peptic ulcer disease Biliary tract disease
Drugs (sulfonomides,
Pancreatic cysts or thiazides,
Kidney failure Organ transplantation
tumors•\ birthcontrol pills,
NSAIDs)
Endoscopic exam of
the biliary tree

Anorexia Mottled Skin (skin that has patchy andirregular
colors)
Nausea Tachycardia
Malaise Dehydration
Severe, knife-like mid-epigastric abdominal Hypovolemia

pain, which can radiate to the back
Hemodynamic instability
Crackles in lung bases
Abdominal Distention
Pleural Effusions
Increased serum amylase, lipase, and glucose

• Hypoglycemia-
(low blood
glucose
Hypoglyce levels)may be
caused by
increased insulin
mia production,
secretion, and/or
administration.

Watch This Video:
https://youtu.be/SRSJILKSx18?featur
e=shared

Dizziness Pallor
Weakness Cool, clammy skin
Nervousness Diaphopretic
Agitation Polyphagia
Headache Tachycardia
Mental Dullness Palpitation
Confusion
Blurred Vision
Paresthesia
Seizures
Comma
Decreased blood glucose level (<60-80mg/dL)

• Diaphjoretic - heavy sweating
• Polyphagia - excessive or extreme hunger/hyperphagia,
• Paresthesia - is an abnormal sensation of the skin
(tingling, pricking, chilling, burning, numbness) with no
apparent physical cause
• Normal Blood Glucose Level:
The expected values for normal fasting blood glucose
concentration are between 70 mg/dL (3.9 mmol/L) and 100
mg/dL (5.6 mmol/L). When fasting blood glucose is
between 100 to 125 mg/dL (5.6 to 6.9 mmol/L)
• Diabetic Ketoacidosis
(DKA) Hyperglycemia (high
blood glucose levels)may be
caused by decreased insulin
Diabetic
administration in Type I
diabetics.
• Diabetic ketoacidosis (DKA)
Ketoacidosis
is a potentially life-
threatening complication
inpatients with diabetes
mellitus.
(DKA) • DKA results from a shortage

of insulin; in response the
body burns fatty acids for
energy and produces acidic
ketone bodies that cause
most of the symptoms and
complications

Watch This Video:
https://youtu.be/r2tXTjb7EqU?featur
e=shared

Lack of circulating insulin in Type I diabetics leading to a hyperosmolar and hyperglycemic state with ketone
production
New onset diabetes
Inadequate insulin use in a known diabetic patient
Stress (MI, CVA, trauma, surgery, emotional upset) in a known Type I diabetic
Medications (steroids, beta blockers, thiazide diuretics)
Alcohol use

Myalgia Increased blood glucose levels(approximately
300-700mg/dL)
*normal fasting blood glucose concentration
are between 70 mg/dL (3.9 mmol/L) and 100 mg/dL
(5.6 mmol/L)
Flu-like S/S Warm, Dry skin
Lethargy Polyuria (due to osmotic diuresis)
Nausea Polydipsia
Decrease LOC Increased BUN, Hct, Hgb, acetone
breath(exhalation of ketones)
Coma Dehydration
Positive Urine and Serum Ketones
Kussmaul's respirations
Increased serum osmolarity
Metabolic Acidosis

Polydipsia - is excessive thirst or excess drinking
Kussmaul's respirations – Kussmaul breathing is characterized by a deep, rapid breathing pattern
Metabolic acidosis – bicarbonate is high, ph is low
The serum or plasma osmolality is a measure of the different solutes in plasma
blood urea nitrogen test, which is also called a BUN or serum BUN test, measures how much of the
waste product you have in your blood

• Hyperglycemia
and Hyperosmolar hyperglyce
mic state (HHS) is a serious
condition most frequently seen in
older persons. HHS is usually
brought on by illness or infection.
• In HHS, blood sugar levels
Hyperglycemia
rise, and the body attempts to
lower blood glucose levels by
increasing glucose excretion in the
urine.
and HHS • If this state continues, severe

dehydration can result, causing
seizures, coma and eventually
death.
• The possible cause is a lack
of circulating insulin in Type II
diabetics, leading to a
hyperosmolar and hyperglycemic
state without ketone production

Watch this Video:
https://youtu.be/8Jaw4aq0ycM?feature=shared

Watch this Video:
https://youtu.be/sIvcwv2ZjL0?featur
e=shared

Myalgias Warm, dry skin
Flu-like signs and symptoms Increased blood glucose levels(approximately

400-2,000mg/dL)
Lethargy Increased blood glucose levels(approximately

400-2,000mg/dL)
Nausea Severe dehydration
Decrease LOC Increased BUN, Hct, Hgb
Coma Negative urine and serum ketones
Absence of acetone breath (no ketones, no

acidosis)
Increased serum osmolarity (>315mOsm/kg)
*The normal serum osmolarity is 275 to 295
mOsm/L
Wider variety of mental status changes
including hallucinations, seizures, aphasia
Over-all Assessment
• Assessment findings can be

divided into subjective (patient’s
report of symptoms) and objective
(concrete facts) findings, which the
clinician must put together to
obtain a clear clinical picture of
what is occurring in the body
A subjective assessment includes
assessment of four main ideas:
Family history
Mood and memory
Neuromuscular status
Nutrition, energy and gastrointestinal (GI) or gastro-urinary (GU)

An objective assessment includes
• assessment of vital signs, mood,

neuromuscular abnormalities,
nutrition and fluid status, and
assessment of the integumentary
system

Conclusion
• Integrating the health history and physical exam in a focused
endocrine assessment takes experience, and more importantly,
practice. It is not enough to simply ask the right questions and
perform the physical exam.
• As the nurse, you must critically analyze all of the data you obtain,
synthesize the data into a relevant problem focus, and then identify
a plan of care for your patient based upon this synthesis.
• As the plan of care is being carried out, re-assessments must occur
on a periodic basis. How often these re-assessments occur is
unique to each patient, based upon their specific endocrine
disorder.

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ENDOCRINE

BY: ROMMEL LUIS C. ISRAEL III 1

BY: ROMMEL LUIS C. ISRAEL III

●Discuss the components of a

BY: ROMMEL LUIS C. ISRAEL III

When abnormalities occur, illness or death

A thorough understanding of the endocrine

BY: ROMMEL LUIS C. ISRAEL III 5

BY: ROMMEL LUIS C. ISRAEL III

Endocrine disorders and diseases usually manifest according to which endocrine

BY: ROMMEL LUIS C. ISRAEL III 8

● Endocrine assessment is necessary after a comprehensive assessment indicates a

●This assessment may also be necessary when an interval or abbreviated assessment

BY: ROMMEL LUIS C. ISRAEL III 9

Take into consideration that a patient’s ethnicity and culture may

BY: ROMMEL LUIS C. ISRAEL III 11

PHYSICAL EXAM TECHNIQUES

INSPECTION AUSCULTATION PERCUSSION PALPATION

● When percussing directly over suspected areas of tenderness,

● Examples of endocrine abnormalities you may percuss are an

BY: ROMMEL LUIS C. ISRAEL III 17

BY: ROMMEL LUIS C. ISRAEL III 18

Nausea and Changes in urinary

The anterior pituitary produces growth hormone

The posterior pituitary produces anti diuretic

BY: ROMMEL LUIS C. ISRAEL III 22

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ADH release or under-

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Nocturia Urine output of 2-20 L/day of dilute

Fatigue Changes in LOC

Visual Disturbances Orthostatic hypotension (can result in

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SUBJECTIVE ASSESSMENT OBJECTIVE ASSESSMENT

Lethargy Decreased Temperature

Loss of strength and Libido Postural Hypotension

Decreased levels in GH, ACTH, TSH, FSH and LH

BY: ROMMEL LUIS C. ISRAEL III 43

BY: ROMMEL LUIS C. ISRAEL III

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Intervene surgically if tumor is present

Surgical Interventions: Hypophesectomy-irradiation of the pituitary

A hypophysectomy is a brain surgery to remove all or part of the pituitary gland

BY: ROMMEL LUIS C. ISRAEL III 54

Let your patient know that a decreased sense of smell is expected

do not brush teeth but use dental floss

need lifelong hormone replacement therapy

BY: ROMMEL LUIS C. ISRAEL III 56

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It secretes two hormones that play a major role in the body’s

Absence of these hormones may decrease the body’s basal

an excess of these hormones may increase the body’s basal

TRH - Thyrotropin-releasing hormone

BY: ROMMEL LUIS C. ISRAEL III 63