Gland Hormones/Description

Functions of hormones Disorder Treatment

Thyroid Gland

1.Triiodothyronine (T3) andThyroxine (T4)

2.Throcalcitonin(calicitonin)

Regulate metabolic rate of cellsregulate protein,fat,and carbohydrate metabolisact as insulin antagonistMaintain growth hormone secretion and promote skeletal maturationAffect central nervous systems(CNS) development Affect cardiac rate,force and outputAffect oxygen utilization Stimulate sympathetic nervous system (SNS) activity

It lowers serum calcium levelsIt inhibits osteoclastic activity It lowers phosphate levelsIt decreases calcium and phosphate levelsIt decreases calcium and phosphorus absorption in GI tract

Hyperthyroidism-hypersecretions of thyroid hormones

Hypothyroidism-defiency of thyroid hormones

Provide restProvide non-stimulating,quiet,and cool environmentProvide high-calorie dietLow-fiber dietAvoid stimulants like caffeineReplace fluid Anti-thyroid medications(Iodides(sski),ThioamidesBeta-Blocker:InderalCalcium channel blockersSurgery:Subtotal Thyroidectomy

Monitor VS.Be alert for changes in heart rate and rhythm,which indicate cardiovascular disordersMonitor daily weightsDIET: Low calorie, loe cholesterol, low saturated-fat dietAdminister thyroid replacement theraphy:Synthroid,levothroid,levoxyl,thyrolar,thycar,cytomel

Parathyroid hormones

Parathyroid Hormones

Regulates calcium and phosphorous balanceElevates serum calcium levels by withdrawal of calcium from the bones

Hypoparathyroidism-is hyposecretion of parathormone

Monitor for signs of hypocalcemia and tetanyPlace client on seizure precautionAdminister calcium gluconate/IV for hypocalcemiaDiet:High calcium,low phosphorous dietAdminister phosphate binder

Hyperparathyroidism-hypersecretion of PTH

Administer vitamin D and calcium supplement

Monitor for cardiac dysrrhytmiasMonitor for urine outputMonitor for signs of renal stonesIncrease fluid intakeAdminister Lasix(Furosemide) to lower serum calcium levelsAdminister NSS/IV for hydrationAdminister calcitoninAdminister antihypercalcemicAdminister phosphatesParathyroidectomy

Adrenal medulla

Epinephrine and norepinephrine

Effects of sympatho-adrenomedullary response (SAMR)(every function is high and fast, except GI and GU)

Pheochromocytoma-a tumor that originates from the adrenal medulla

Surgery:adrenalectomyAdminister alpha-adrenergic agentInstruct client to avoid somking, drinking caffeinePromote bed restMonitor clients for the ff (hypertensive crisis, blood glucose and urine for ketones)

Anterior Pituitary

Melanocyte-stimulating Hormone (MSH)

Structure: peptideTarget Tissue: melanocytes in the skin

Increased melanin production in melanocytes to make the skin darker in color. It is necessary for pigmentation, e.g. skin, retina (melanin epithelial pigment layer).

Hypersecretion of the hormone results to hyperpigmentation of the skin (“etemal tan” or bronze appearance of the skin).

-Hyposecretion of the hormone results to albinism (hypopigmentation of the skin). It is characterized by absence of the

For Hyperpituitarism:1.Surgery : Transphenoidal hypophysectomy.●Hypophysectomy is surgical removal of pituitary gland.●The incision is made between the upper lip and upper gum.●The nursing interventions are as follows:-Keep head of bed elevated, atleast for 2 weeks. To promote venous drainage.-Maintain nasal packing in place and reinforced as needed.

Luteinizing hormone (LH)

Follicle-stimulating hormone (FSH)

Structure: GlycoproteinTarget Tissue: ovaries in females; testes in males

Ovulation and progesterone production in ovaries; testosterone synthesis and support for sperm cell production in testes.

Structure: GlycoproteinTarget Tissue: Follicles in ovaries in females; seminiferous tubes in males

Follicle maturation and estrogen secretion in ovaries; sperm cell production in testes.

melanin epithelial pigment of the retina. This results to difficulty in vision during daytime or in the presence of bright light.

Gonadotropins (LH and FSH)

-Hypersecretion of hormones results to precocious puberty,

-Hyposecretion of the hormones results to failure to develop secondary sex characteristics that normally develop at the age of puberty. The manifestations are as follows:Males: -small phallus and testicles.-No growth of body hair-Decreased libido-Impotence-Aspermia

Females:-Failure to develop

-Provide frequent oral care with toothettes. To prevent trauma to the incision.-Instruct client to avoid blowing nose and activities that increase ICP.-Administer glucocorticoids and other hormone replacement as prescribed. This may include vasopressin, growth hormone (somatotropin)2.Radiation therapy as prescribed.3.Pharmacotherapy – Parlodel (Bromocriptine) to lower GH and prolactin levels.

For Hypopituitarism:-Surgical removal of the tumor.-Radiaton therapy-Hormonal replacement therapy (HRT).

ProlactinStructure: ProteinTarget Tissue: Ovaries and mammary glands in females

It is also called mammotropic hormone, lactotropic hormone or luteotropic hormone. It is necessary for breast development and lactation. It regulates reproductive function in males and females. Milk production in lactating women; increased response of follicle to LH and FSH; unclear functions in males

breast-No growth of body hair-No ovulation-No menstruation-Infertility

-Galactorrhea is characterized by excessive milk production and results from hypersecretion of prolactin.

-Absence of milk production during lactation results from hyposecretion of prolactin.

Anterior Pituitary

Growth Hormone (GH)

Stimulates growth tissues of bone and muscle; promotes uptake of amino acids and protein synthesis; promotes breakdown of lipids and release of fatty acids from cells; decreases carbohydrate metabolism; promotes glycogen synthesis and increased blood glucose levels; increased somatomedin production

Giantism

Acromegaly

Dwarfism

-A condition of abnormally increased height that usually results from excessive cartilage and bone formation at the epiphyseal plates of long bones. Pituitary giantism is a result of excessive production of the GH.-Management: Dopamine agonists, surgery to remove pituitary tumor or radiotherapy

-Caused by excess GH secretion in adults and is usually developed late in life-Surgery: transsphenoidal surgery-Medications: somatostatin analogues (SSA), growth hormone receptor antagonists (GHRAs) and dopamine agonists-Radiation: conventional radiation therapy and stereotactic radiosurgery

-A condition in which a person is abnormally short. Pituitary dwarfism results when abnormally low levels of GH affect the whole body. Achondroplasia is a condition in which a person with a nearly normal-sized trunk and head has limbs that are shorter than normal.-Surgeries: Limb-lengthening surgery; Inserting metal staples into the ends of long bones (epiphyseal plates) in order to correct the direction in which bones are growing; Dividing a limb bone, straightening it and inserting metal plates to hold it in place; Inserting rods or staples to help correct the shape of the spine; Increasing the size of the opening in the vertebrae to alleviate pressure on the spinal cord-Therapy: Hormone therapy

Adrenocorticotropic Hormone (ACTH)

Stimulates synthesis and secretion of adrenal cortical (glucocorticoid) hormones

Cushing’s disease

Addison’s disease (hypocotisolism)

-It is caused by a tumor or excess growth (hyperplasia) of the pituitary gland due to too much ACTH-Management: Surgical removal of the tumor and cortisol replacement treatments

-This occurs when the anterior pituitary gland does not produce enough cortisol, and in some cases, aldosterone-Medications: hydrocortisone and fludrocortisone acetate

Posterior Pituitary

Antidiuretic Hormone (ADH)

Oxytocin

Increases water reabsorption by kidney

Stimulates contraction of pregnant uterus; milk ejection from breasts after childbirth; unclear function in males

Benign prostatic hyperplasia

Prevention of milk ejection reflex

Autism and autism spectrum disorders

-Prostate enlargement often related to high levels of oxytocin-Medications: alpha blockers and 5α-reductase inhibitors finasteride-Therapies: super-selective intra-prostatic androgen deprivation (SPAD) therapy, transurethral microwave thermotherapy (TUMT) and transurethral needle ablation (TUNA)-Surgery: transurethral resection of the prostate(TURP) -Related to low levels of oxytocin-Treatment: synthetic oxytocin-Management: Apply warm, moist compresses; nipple stimulation; rubs and massages

-Related to low levels of oxytocin-Management: SpEd programs, behavioural therapies and speech therapies

Hypothalamus

Gonadotropin-releasing hormone (GnRH)

Prolactin-inhibiting hormone (PIH)

Prolactin-Releasing Hormone (PRH)

Increase secretion of luteinizing hormone and follicle-stimulating hormone

Decrease prolactin secretion

1. Central Hypogonadism--reduction or absence of hormone secretions from the sex glands (gonads)-Central hypogonadism- the centers of the brain responsible for control of the gonads (the hypothalamus and pituitary) do not function properly.-S/SX:In men symptoms include muscle loss, sexual dysfunction such as a decreased libido, impotence and decreased volume of ejaculate, low serum testosterone levels, weakness, fatigue, breast enlargement, decreased beard and body hair. Females have delayed breast development, scant pubic and axillary hair, and primary amenorrhea.1. Prolactinoma--benign pituitary tumor that produces prolactin-this results to

-Mgt:Treatment will depend on the causes of the problem. Tumors can be treated with surgery and radiotherapy.Infection will required antibiotic therapyNutritional causes require cause specific treatments.Men may require hormonal medication to replace testosterone by patch or injection. Injections of pituitary hormone may be required for men to produce sperm.

-Mgt:Medications: bromocriptine (a dopamine agonist)Bromocriptine may cause tumour shrinkage.

Increase prolatin secretionhyperprolactinemia-S/SX:(Women) Galactorrhea, Breast tenderness, Decreased libido, Headache, Infertility, Stopping of menstruation not related to menopause, or irregular menstruation, Vision changes(Men) Decreased libido, Gynecomastia, Headache, Impotence, Infertility, Vision changes

The medical treatment may be only partially successful. In such cases, the medications may be combined with surgery or radiation therapy.Surgery is indicated in patients with visual field abnormalities or neurologic symptoms. Trans-sphenoidal microsurgery is the procedure of choice.

PINEAL BODY

Melatonin Allows the entrainment of the circadian rhythms or the sleep-wake cycle. It also decreases the secretion of GnRH.

Insomnia - reported sleeping difficulties. It may be due to an alteration to a person’s sleep-wake cycle, which is controlled by melatonin.

Promote relaxation therapyEliminate daytime napssleeping tablets and other sedativessedatives such as benzodiazepinesDiphenhydramine intake as prescribed.Alcohol is often used as a form of self-treatment of insomnia to induce sleep.

Posterior Pituitary Gland

Antidiuretic hormone (ADH)

It is the major control of osmolality (concentration) and body water volume.It increases water reabsorption int he collecting ducts of the kidneys.

1. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

2. Diabetes Insipidus (DI)

- hypersecretion of ADH-characterized by excessive retention of water by the renal tubules-causes include trauma, stroke, medications and stress-S/SX:Edema, wt. gain, hypertension, dilutional hyponatremia-Mgt:Administer diuretics and Demeclocyline (Declomycin) as prescribed.Restrict fluid intake as prescribed.Monitor VS, cardiac and neurologic status.Monitor I & O, daily wt. and electrolyte levels.

-hyposecretion of ADH-characterized by inability of the renal tubules to retain water (water loss)-S/SX:Polyuria (as much as 20L of urine/day), urine is dilute-with low specific gravity, polydipsia, dehydration constipation, retarded growth in children-Diagnostic test:Water Deprivation Test-Mgt:Antidiuretic hormones likeDesmopressin acetateVasopressinChlorpropramide and thiazide diuretics potentiate the action of vasopressin.

Thymus Gland

Thymosin -plays an important role in the development and maturation of the immune system

DiGeorge Syndrome -hyposecretion of thymosin or absence of thymus gland-occurs in children born without a thymus gland.  As a result, there is a lack of thymosin production.  Thymosin is needed to stimulate the differentiation of T lymphocytes.-S/SX: Little or no immune response.2.  Inability to resist bacterial, viral or fungal infections.3.  A lack of cancer cell surveillance.4.  Inability to reject foreign tissues.-Mgt:

DiGeorge syndrome can't be cured, but treatment of problems such as low calcium, surgery for heart problems and thymus cell transplants to restore the

immune system can reduce complications. Educational support and help for the family is vital.

Antenatal diagnosis, usually using CVS or amniocentesis, is possible especially when there's a family history or abnormalities on ultrasound scanning. Postnatal diagnosis

Thymoma

and counselling is also available for those at risk of passing on the condition.

-a tumor originating from the epithelial cells of the thymus. found in 15% of patients with myasthenia gravis

-S/SX

superior vena cava syndrome, dysphagia, cough, or chest pain caused by compression of the surrounding organs by an expansive mass

-Mgt:Surgery

Chemotherapy,radiotherapy

HYPOTHALAMUS Growth hormone – releasing hormone (GHRH)

Somatostatin (Growth

hormone – inhibiting hormone)

Thyrotropin – releasing

hormone (TRH)

Corticotropin – releasing hormone

(CRH)

Gonadotropin – releasing hormone (GnRH)

Controls the release of pituitary hormones.

Stimulates the release of TSH (thyroid-stimulating hormone) and prolactin from the anterior pituitary.

Stimulates the pituitary synthesis of Adrenocorticotropic Hormone

(ACTH).

Responsible for the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from

the anterior pituitary.

It also triggers the release of pituitary hormones causing the onset of puberty with resulting

sexual development and fertility

Hypogonadotropic hypogonadism - there is an impaired secretion of gonadotropins, including follicle-stimulating hormone (FSH) and luteinizing hormone (LH), and in turn decreased gonadotropin levels and a resultant lack of sex

- Administration of either a GnRH agonist or a gonadotropin formulation.

- Hormone replacement therapy with androgens and estrogens in males and females, respectively.

steroid production. It is manifested by delayed, reduced, or absent puberty, low libido, and infertility.

Hypothalamic Amenorrhea – A condition wherein an event that the hypothalamus stops producing GnRH, which in turn, will reduce the amount of other hormones produced (FSH, LH, and estrogen). Ovulation and menstruation stop, which will result in infertility.

Kallmann Syndrome - genetic condition which results in the failure or non-completion of puberty. It is characterised by hypogonadism and by a total lack of sense of smell (anosmia) or a heavily reduced sense of smell (hyposmia).

- Limitation of strenuous exercise.- Avoid excessive weight gain.- Hormone or fertility medications.

- Hormone replacement therapy- Fertility treatments

 Male Gonads/Testis

TestosteroneIt is made by the interstitial cells of the testes, causes the development of the adult male sex characteristics. It promotes the growth and maturation of the reproductive system organs to prepare the young man for reproduction. It also causes the development of the male’s secondary sex characteristics(growth beard, development of heavy bones and muscles, and lowering of the voice) as well as stimulating the male sex drive. In adulthood, testosterone is necessary for continuous production of sperm. In cases of hyposecretion, the man becomes sterile, such cases are usual treated by testosterone injection. Both the endocrine and exocrine functions of the testes begin at puberty under the influence of the anterior pituitary gonadotropic hormones. Testosterone production is specifically stimulated by LH.

Testosterone Deficiency- 1. Erectile dysfunction (sometimes called impotence) refers to the inability to achieve or maintain an erection sufficient to complete sexual intercourse. It can be organic in origin, meaning it is caused by disease, medication, or environmental factors2. infertility 3. low sex drive4. priapism- refers to an abnormal and persistent penile erection without sexual stimulation. It is extremely painful and may last several hours or even days. The client must seek immediate medical attention.5. Peyronie’s disease is an accumulation of plaques or scar tissue along the corpora cavernosa, causing a painful curvature of the penis when erect. This plaque or scar tissue formation is idiopathic and benign. 

Management: 1. Oral Medications. Oral medications include sildenafil citrate (Viagra) and tadalafil (Cialis). These medications are vasodilators taken in pill form that help the penis to fill with blood. 2. Vasoactive Intracorporeal Pharmacotherapy. Medications, such as papaverine, alprostadil, or prostaglandin Ej. (Caverject, Edex), can be used to induce an erection. The client self-injects a vasodilating medication into the penis.3. Mechanical Devices. Mechanical devices, such as vacuum erection devices or vacuum constriction devices, are noninvasive. They create an erection by mechanically pulling blood into the penis.4. Penile Implants. Several types of devices can be implanted in the penis to help the client achieve and maintain an erection. 5. Priapism can be difficult to treat, and sometimes treatment may be unsuccessful. The goal is to improve the venous drainage of the corpora cavernosa while preventing ischemia that may result in impotence. Injection of a solution of phenylephrine into the corpora cavernosa may reverse priapism. Cavernostomy with a butterfly needle (to allow drainage) and irrigation may be used, or surgery may be required. 6. Treatment for peyronie’s disease includes oral medications: aminobenzoate potassium (Potaba), vitamin E, and nonsteroidal anti-inflammatory drugs (NSAIDs). The plaque or scar tissue may be removed by surgery.

 Female Gonads/

Estrogen primarily estrone and estradiol, produce by the Graafian follicles of the

1. Osteoporosis: Osteoporosis is commonly

Estrogen replacement therapy during menopause protects bone mass and helps

Ovaries

Progesterone

ovaries, stimulate the development of the secondary sex characteristics in females(primarily growth and maturation of the reproductive organs and the appearance of hair in the pubic and axillary regions). In addition, the estrogens work with progesterone to prepare the uterus to receive a fertilized egg. This results in cyclic changes in the uterine lining which is called the menstrual cycle. Estrogens also help maintain pregnancy and prepare the breasts to produce milk (lactation). However, the placenta and not the ovaries is the source of the estrogens at this time.

acts with estrogen to bring about the menstrual cycle. During pregnancy, it quiets the muscles of the uterus and so that an implanted embryo will not be aborted and helps prepares breast tissue for lactation. Progesterone is produced by another grandular structure of the ovaries, the corpus luteum.

associated with menopause, just like mood swings and hot flashes.Menopause is marked by the rapid loss of estrogen. The role estrogen play in bone loss can best be described in terms of a battle between osteoclasts(bone absorbing cells) and osteoblasts (bone producing cells). Estrogen is on the side of the osteoblasts, but as the estrogens diminish, the osteoblasts are discouraged from producing more bone. As such, the osteoclasts win by absorbing more bone than is being produced by the osteoblasts.2. Ovarian Cancer: Ovarian cancer is an extremely serious, but rare, disease. Its symptoms usually don’t become apparent until the cancer has progressed into the later stages.Symptoms of ovarian cancer include: persistent abdominal pain, indigestion, bloating, abnormal uterine bleeding,

protect against the risk of osteoporotic fractures.2. For PCOS: a. educate the patient about the use of oral contraceptives to normalize hormone levelsb. healthy diet and exercise to lose weightc. oral insulin-sensitizing drugs such as metformin may be prescribed3. HRT combination therapy

and pain during sexual intercourse. 3. Ovarian Cysts: Ovarian cysts are fluid-filled sacs that affect women of all ages, though mostly women of child-bearing age. Cysts are very common—and they can range in size from a pea to a grapefruit. The majority of cysts are harmless, though larger cysts (those larger than 5 cm in diameter) may need to be surgically removed because large cysts can twist the ovary and disrupt its blood supply.4. Polycystic Ovary Syndrome: Polycystic means “many cysts.” Overproduction of androgens interfere with the development of eggs and their release from the female ovaries. PCOS is a leading cause of infertility.

PANCREAS Glucagon This pancreatic hormone helps to elevate your blood sugar levels. When levels of sugar in your blood declines, your pancreas produces glucagon, which stimulates the liver to produce more glucose. As a result, your blood glucose levels return to normal.

Hyposecretion of glucagon - chronic hypoglycemiaA decreased ability to secrete glucagon from pancreatic alpha cells has been associated with chronic hypoglycemia. Other contributing factors

Glucagon is administered by injection to counteract diabetic hypoglycaemia.

to this condition would be:a. A beta cell tumorb. Defect in the mechanism releasing glucose from the liver.c. Addison's disease - low levels of corticosteroids which enhance glucose production.d. Hyposecretion of growth hormone 2. Cancers of alpha cells (glucagonomas) are one situation known to cause excessive glucagon secretion. 

Insulin Lowers blood glucose by facilitating glucose transport across cell membranes of muscle, liver and adipose tissue

DIABETES MELLITUS

- Hyperglycemia- Glycosuria, polyuria,

dehydration- Diabetic ketoacidosis

(abdominal pain, N/V, hyperventilation, fruity breath odor, altered LOC)

- Continuous subcutaneous insulin infusion, insulin pump

- Control of total caloric intake, blood glucose level, and normalization of lipids and BP

Adrenal Glands

Adrenal Medulla1. Epinephrine

2. Norepinephrine

Adrenal Cortex1. Cortecosteroid

sa. Glucocortic

oids(e.g. cortisol, corticosterone, cortisone)

b. Mineralocorticoids

“fight or flight”Increase RRMetabolic rate decreasesForce of muscular contraction improvesOnset of muscular fatigue delayedReduced blood supply to the bladder and intestines, their muscular walls relax, sphincters contract

Vasoconstriction leading to increase in BPIncrease blood flow through coronary arteries and decreases HRIncrease rate and depth of breathingRelaxation of smooth muscle in the intestinal walls

Utilization of CHO, CHON, FatsNormal response to stressAnti-inflammatory

Regulation of fluid balance

Male sex hormones

PHEOCHROMOCYTOMA

- Benign tumor that originates from chromaffin cells of adrenal medulla

- Cause of high blood pressure

- S/Sx:Headache, vertigo, blurring of visiom, tinnitus, air hunger and dyspnea, ↑BP, ↑HR

ADDISON’S DISEASE- Adrenocortical

insufficiency- Therapeutic use of

cortecosteroids- S/Sx:Muscle

weakness, anorexia, GI symptoms, fatigue, emaciation, dark pigmentation of mucous membranes and skin, ↓BP, ↓blood glucose, ↓serum Na, ↑serum K

- Addisonian crisis

CUSHING’S SYNDROME

- Excessive adrenocortical hormone

- Bed rest with head of bed elevated to promote an orthostatic decrease in BP

- Alpha adrenergic blocking agents, smooth muscle relaxant

- Adrenalectomy

- Place in recumbent position with legs elevated

- Hydrocortisone/IV- Glucocortecoids prevents addisonian

crisis

- Transsphenoidal hypophysectomy- Adrenalectomy- Adrenal enzyme inhibitor

- Adrenalectomy- Spironolactone (Aldactone)

Provide rest periods

(e.g. aldosterone)c. Androgens

- Caused by use of corticosteroid medications

- S/Sx:Oversecretion of glucocorticoids and androgens, central type obesity, “buffalo hump”, thin extremities

PRIMARY ALDOSTERONISM

- Hypersecretion of aldosterone

- Hypokalemia(muscle weakness, fatigue), alkalosis, ↑BP, polyuria, polydipsia