EndocrinologyEndocrinology

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Anatomy and Physiology Endocrine Disorders and

Emergencies

Anatomy and Physiology Endocrine Disorders and

Emergencies

Anatomy & Anatomy & PhysiologyPhysiology Endocrine Glands

Have systemic effects. Act on specific target

tissues in specific ways.

May have single or multiple targets.

Disorders Disorders result

from over- or underproduction of hormone(s).

Endocrine Glands Have systemic effects. Act on specific target

tissues in specific ways.

May have single or multiple targets.

Disorders Disorders result

from over- or underproduction of hormone(s).

HypothalmusHypothalmus Located deep within the cerebrum.

Some cells relay messages from the autonomic nervous system to the central nervous system.

Other cells respond as gland cells to release hormones.

Located deep within the cerebrum. Some cells relay messages from the autonomic nervous system

to the central nervous system. Other cells respond as gland cells to release hormones.

Posterior PituitaryPosterior Pituitary

Diabetes Insipidus Oxytocin and Pregnancy

Diabetes Insipidus Oxytocin and Pregnancy

Anterior PituitaryAnterior Pituitary

Thyroid GlandThyroid Gland

Hyperthyroidism & Hypothyroidism Hyperthyroidism & Hypothyroidism

Parathyroid GlandParathyroid Gland

Thymus GlandThymus Gland

PancreasPancreas Combination

Organ Exocrine tissues

called acini secrete digestive enzymes into the small intestine.

Endocrine tissues secrete hormones.

Glycogenolysis. Gluconeogenesis.

Combination Organ Exocrine tissues

called acini secrete digestive enzymes into the small intestine.

Endocrine tissues secrete hormones.

Glycogenolysis. Gluconeogenesis.

PancreasPancreas

Adrenal GlandAdrenal Gland Adrenal Medulla

Inner segment of adrenal gland. Closely tied to autonomic nervous system.

Adrenal Cortex Outer layers of endocrine tissue, which secrete

steroidal hormones.

Adrenal Medulla Inner segment of adrenal gland. Closely tied to autonomic nervous system.

Adrenal Cortex Outer layers of endocrine tissue, which secrete

steroidal hormones.

Adrenal GlandAdrenal Gland

GonadsGonads Female

Ovaries

Male Testes

Female Ovaries

Male Testes

Pineal GlandPineal Gland Located in the roof of the thalamus.

Related to the body’s “biological clock.” Implicated in Seasonal Affective Disorder.

Located in the roof of the thalamus. Related to the body’s “biological clock.” Implicated in Seasonal Affective Disorder.

Placenta Releases hCG throughout gestation

Digestive Tract Gastrin and secretin

Heart ANH

Kidneys Renin

Placenta Releases hCG throughout gestation

Digestive Tract Gastrin and secretin

Heart ANH

Kidneys Renin

Other Organs withOther Organs withEndocrine ActivityEndocrine Activity

Disorders of the Pancreas Disorders of the Thyroid Gland Disorders of the Adrenal Glands

Disorders of the Pancreas Disorders of the Thyroid Gland Disorders of the Adrenal Glands

Endocrine Disorders Endocrine Disorders and Emergenciesand Emergencies

Disorders of the Disorders of the PancreasPancreas

Diabetes Mellitus Glucose Metabolism

Metabolism• Anabolism & catabolism

Diabetes Mellitus Glucose Metabolism

Metabolism• Anabolism & catabolism

Disorders of the Disorders of the PancreasPancreas

Insulin is required for glucose metabolism• Presence of enough insulin to meet cellular needs.• Ability to bind in a manner to stimulate the cells

adequately. When unable to obtain energy from glucose, the

body begins to use fatty stores.• Ketones and ketosis.

Regulation of Blood Glucose Hypoglycemia and hyperglycemia Role of pancreas, liver, and kidneys Osmotic diuresis and glycosuria

Insulin is required for glucose metabolism• Presence of enough insulin to meet cellular needs.• Ability to bind in a manner to stimulate the cells

adequately. When unable to obtain energy from glucose, the

body begins to use fatty stores.• Ketones and ketosis.

Regulation of Blood Glucose Hypoglycemia and hyperglycemia Role of pancreas, liver, and kidneys Osmotic diuresis and glycosuria

Diabetes MellitusDiabetes Mellitus Type I Diabetes Mellitus

Also called juvenile or insulin-dependent diabetes mellitus (IDDM).

Characterized by low production of insulin.• Closely related to heredity.

Results in pronounced hyperglycemia.• Symptoms of untreated Type I DM include polydipsia,

polyuria, polyphagia, weight loss, and weakness.

• Untreated or noncompliant patients may progress to ketosis and diabetic ketoacidosis.

Type I Diabetes Mellitus Also called juvenile or insulin-dependent diabetes

mellitus (IDDM). Characterized by low production of insulin.

• Closely related to heredity.

Results in pronounced hyperglycemia.• Symptoms of untreated Type I DM include polydipsia,

polyuria, polyphagia, weight loss, and weakness.

• Untreated or noncompliant patients may progress to ketosis and diabetic ketoacidosis.

Diabetes MellitusDiabetes Mellitus Type II Diabetes Mellitus

Also called adult-onset or non-insulin-dependent diabetes mellitus (NIDDM).

Results from decreased binding of insulin to cells.• Related to heredity and obesity.• Accounts for 90% of all diagnosed diabetes patients.• Less risk of fat-based metabolism.

Results in less-pronounced hyperglycemia.• Hyperglycemic hyperosmolar nonketotic acidosis.• Managed with dietary changes and oral drugs to stimulate

insulin production and increase receptor effectiveness.

Type II Diabetes Mellitus Also called adult-onset or non-insulin-dependent

diabetes mellitus (NIDDM). Results from decreased binding of insulin to cells.

• Related to heredity and obesity.• Accounts for 90% of all diagnosed diabetes patients.• Less risk of fat-based metabolism.

Results in less-pronounced hyperglycemia.• Hyperglycemic hyperosmolar nonketotic acidosis.• Managed with dietary changes and oral drugs to stimulate

insulin production and increase receptor effectiveness.

Diabetic Diabetic EmergenciesEmergencies

Diabetic Diabetic EmergenciesEmergencies

Blood Glucose Blood Glucose DeterminationDetermination

Choose a vein, and prep the site.Choose a vein, and prep the site.

Blood Glucose Blood Glucose DeterminationDetermination

Perform the venipuncture.Perform the venipuncture.

Blood Glucose Blood Glucose DeterminationDetermination

Place a drop of blood on the reagent strip. Activate the timer.Place a drop of blood on the reagent strip. Activate the timer.

Blood Glucose Blood Glucose DeterminationDetermination

Wait until the timer sounds.Wait until the timer sounds.

Blood Glucose Blood Glucose DeterminationDetermination

Wipe the reagent strip.Wipe the reagent strip.

Blood Glucose Blood Glucose DeterminationDetermination

Place the reagent strip in the glucometer.Place the reagent strip in the glucometer.

Blood Glucose Blood Glucose DeterminationDetermination

Read the blood glucose level.Read the blood glucose level.

Blood Glucose Blood Glucose DeterminationDetermination

Administer 50% dextrose intravenously, if the blood glucose level is less than 80 mg.

Administer 50% dextrose intravenously, if the blood glucose level is less than 80 mg.

Diabetic Diabetic EmergenciesEmergencies Diabetic Ketoacidosis

Pathophysiology Results from the body’s change to fat metabolism. Continuous buildup of ketones produces significant

acidosis.

Signs and Symptoms Extended period of onset (12–24 hours). Sweet, fruity breath odor. Potassium-related cardiac dysrhythmias. Kussmaul’s respiration. Decline in mental status and coma.

Diabetic Ketoacidosis Pathophysiology

Results from the body’s change to fat metabolism. Continuous buildup of ketones produces significant

acidosis.

Signs and Symptoms Extended period of onset (12–24 hours). Sweet, fruity breath odor. Potassium-related cardiac dysrhythmias. Kussmaul’s respiration. Decline in mental status and coma.

Diabetic Diabetic EmergenciesEmergencies Assessment and Management

Focused History & Physical Exam• Obtain SAMPLE and OPQRST histories.• Look for medical identification.

Management• Maintain airway and support breathing as indicated.• Determine blood glucose level and obtain blood sample.• If blood glucose unknown, administer 25g 50% dextrose.• Establish IV and administer normal saline per local protocol.• Monitor cardiac rhythm and vital signs.• Expedite transport.

Assessment and Management Focused History & Physical Exam

• Obtain SAMPLE and OPQRST histories.• Look for medical identification.

Management• Maintain airway and support breathing as indicated.• Determine blood glucose level and obtain blood sample.• If blood glucose unknown, administer 25g 50% dextrose.• Establish IV and administer normal saline per local protocol.• Monitor cardiac rhythm and vital signs.• Expedite transport.

Diabetic Diabetic EmergenciesEmergencies Hyperglycemic Hyperosmolar

Nonketotic (HHNK) Coma Pathophysiology

Found in Type II diabetics. Results in blood glucose levels up to 1000mg/dL. Insulin activity prevents buildup of ketones. Sustained hyperglycemia results in marked

dehydration.• Often related to dialysis, infection, and medications.

Very high mortality rate.

Hyperglycemic Hyperosmolar Nonketotic (HHNK) Coma Pathophysiology

Found in Type II diabetics. Results in blood glucose levels up to 1000mg/dL. Insulin activity prevents buildup of ketones. Sustained hyperglycemia results in marked

dehydration.• Often related to dialysis, infection, and medications.

Very high mortality rate.

Diabetic Diabetic EmergenciesEmergencies Signs & Symptoms

Gradual onset over days. Increased urination and thirst, orthostatic

hypotension, and altered mental status.

Assessment & Management Difficult to distinguish from diabetic ketoacidosis in

the prehospital setting. Treatment is identical to diabetic ketoacidosis.

Signs & Symptoms Gradual onset over days. Increased urination and thirst, orthostatic

hypotension, and altered mental status.

Assessment & Management Difficult to distinguish from diabetic ketoacidosis in

the prehospital setting. Treatment is identical to diabetic ketoacidosis.

Diabetic Diabetic EmergenciesEmergencies Hypoglycemia

Pathophysiology True medical emergency resulting from low blood

glucose levels; rarely seen outside diabetics. By the time signs and symptoms develop, most of

the body’s stores have been used. Diabetics with kidney failure are predisposed to

hypoglycemia.

Hypoglycemia Pathophysiology

True medical emergency resulting from low blood glucose levels; rarely seen outside diabetics.

By the time signs and symptoms develop, most of the body’s stores have been used.

Diabetics with kidney failure are predisposed to hypoglycemia.

Diabetic Diabetic EmergenciesEmergencies Signs & Symptoms

Altered mental status with rapid onset• Frequently involves combativeness.

Diaphoresis and tachycardia Hypoglycemic seizure and coma

Assessment and Management Focused History & Physical Exam

• Obtain SAMPLE and OPQRST histories.

• Look for medical identification.

Signs & Symptoms Altered mental status with rapid onset

• Frequently involves combativeness.

Diaphoresis and tachycardia Hypoglycemic seizure and coma

Assessment and Management Focused History & Physical Exam

• Obtain SAMPLE and OPQRST histories.

• Look for medical identification.

Diabetic Diabetic EmergenciesEmergencies Management

• Maintain airway and support breathing as indicated.

• Determine blood glucose level and obtain blood sample.

• Establish IV access.

• If blood glucose <60mg/dL or is unknown, administer 25–50g of 50% Dextrose IV.

• If IV cannot be established, administer 0.5–1.0mg glucagon intramuscularly.

• Monitor cardiac rhythm and vital signs.

• Expedite transport.

Management• Maintain airway and support breathing as indicated.

• Determine blood glucose level and obtain blood sample.

• Establish IV access.

• If blood glucose <60mg/dL or is unknown, administer 25–50g of 50% Dextrose IV.

• If IV cannot be established, administer 0.5–1.0mg glucagon intramuscularly.

• Monitor cardiac rhythm and vital signs.

• Expedite transport.

Grave’s Disease Pathophysiology

Probably hereditary in nature. Autoantibodies are generated that stimulate thyroid

tissue to produce excessive hormone.

Signs & Symptoms Agitation, emotional changeability, insomnia, poor heat

tolerance, weight loss, weakness, dyspnea. Tachycardia and new-onset atrial fibrillation. Protrusion of the eyeballs or goiters.

Grave’s Disease Pathophysiology

Probably hereditary in nature. Autoantibodies are generated that stimulate thyroid

tissue to produce excessive hormone.

Signs & Symptoms Agitation, emotional changeability, insomnia, poor heat

tolerance, weight loss, weakness, dyspnea. Tachycardia and new-onset atrial fibrillation. Protrusion of the eyeballs or goiters.

Disorders of the Disorders of the Thyroid GlandThyroid Gland

Assessment & Management Usually arise from cardiovascular signs/symptoms.

• Manage signs and symptoms.

Thyrotoxic Crisis (Thyroid Storm) Pathophysiology

Life-threatening emergency, usually associated with severe physiologic stress or overdose of thyroid hormone.

Results when thyroid hormone moves from bound state to free state within the blood.

Assessment & Management Usually arise from cardiovascular signs/symptoms.

• Manage signs and symptoms.

Thyrotoxic Crisis (Thyroid Storm) Pathophysiology

Life-threatening emergency, usually associated with severe physiologic stress or overdose of thyroid hormone.

Results when thyroid hormone moves from bound state to free state within the blood.

Disorders of the Disorders of the Thyroid GlandThyroid Gland

Signs & Symptoms High fever (106º F or higher) Reflected in increased activity of sympathetic

nervous system.• Irritability, delirium or coma• Tachycardia and hypotension• Vomiting and diarrhea

Assessment and Management Support airway, breathing, and circulation. Monitor closely and expedite transport.

Signs & Symptoms High fever (106º F or higher) Reflected in increased activity of sympathetic

nervous system.• Irritability, delirium or coma• Tachycardia and hypotension• Vomiting and diarrhea

Assessment and Management Support airway, breathing, and circulation. Monitor closely and expedite transport.

Disorders of the Disorders of the Thyroid GlandThyroid Gland

Hypothyroidism and Myxedema Pathophysiology

Can be inherited or acquired. Chronic untreated hypothyroidism creates

myxedema.• Thickening of connective tissue in skin and other tissues.

• Infection, trauma, CNS depressents, or a cold environment can trigger progression to a myxedemic coma.

Hypothyroidism and Myxedema Pathophysiology

Can be inherited or acquired. Chronic untreated hypothyroidism creates

myxedema.• Thickening of connective tissue in skin and other tissues.

• Infection, trauma, CNS depressents, or a cold environment can trigger progression to a myxedemic coma.

Disorders of the Disorders of the Thyroid GlandThyroid Gland

Signs & Symptoms Fatigue, slowed

mental function Cold intolerance,

constipation, lethargy

Absence of emotion, thinning hair, enlarged tongue

Cool, pale doughlike skin

Coma, hypothermia, and bradycardia

Signs & Symptoms Fatigue, slowed

mental function Cold intolerance,

constipation, lethargy

Absence of emotion, thinning hair, enlarged tongue

Cool, pale doughlike skin

Coma, hypothermia, and bradycardia

Disorders of the Thyroid Disorders of the Thyroid GlandGland

Assessment and Management Focus on maintaining ABCs. Closely monitor cardiac and pulmonary status. Establish IV access, but limit fluids. Expedite transport.

Assessment and Management Focus on maintaining ABCs. Closely monitor cardiac and pulmonary status. Establish IV access, but limit fluids. Expedite transport.

Disorders of the Disorders of the Thyroid GlandThyroid Gland

Hyperadrenalism (Cushing’s Syndrome) Pathophysiology

Often due to abnormalities in the anterior pituitary or adrenal cortex.

May also be due to steroid therapy for nonendocrine conditions such as COPD or asthma.

Long-term cortisol elevation causes many changes.• Atherosclerosis, diabetes, hypertension• Increased response to catecholamines• Hypokalemia and susceptibility to infection

Hyperadrenalism (Cushing’s Syndrome) Pathophysiology

Often due to abnormalities in the anterior pituitary or adrenal cortex.

May also be due to steroid therapy for nonendocrine conditions such as COPD or asthma.

Long-term cortisol elevation causes many changes.• Atherosclerosis, diabetes, hypertension• Increased response to catecholamines• Hypokalemia and susceptibility to infection

Disorders of the Disorders of the Adrenal GlandAdrenal Gland

Signs & Symptoms Weight gain “Moon-faced”

appearance Fat

accumulation on the upper back

Skin changes and delayed healing of wounds

Mood swings Impaired

memory or concentration

Signs & Symptoms Weight gain “Moon-faced”

appearance Fat

accumulation on the upper back

Skin changes and delayed healing of wounds

Mood swings Impaired

memory or concentration

Disorders of the Thyroid Disorders of the Thyroid GlandGland

Assessment & Management Support ABCs. Use caution when establishing IV access. Report any observations indicative of Cushing’s

Syndrome to the receiving facility.

Adrenal Insufficiency (Addison’s Disease) Pathophysiology

Due to destruction of the adrenal cortex. Often related to heredity. Stress may trigger Addisonian crisis.

Assessment & Management Support ABCs. Use caution when establishing IV access. Report any observations indicative of Cushing’s

Syndrome to the receiving facility.

Adrenal Insufficiency (Addison’s Disease) Pathophysiology

Due to destruction of the adrenal cortex. Often related to heredity. Stress may trigger Addisonian crisis.

Disorders of the Disorders of the Adrenal GlandAdrenal Gland

May be related to steroid therapy.• Sudden withdrawal can trigger Addisonian crisis.

Signs & Symptoms Progressive weakness, fatigue, decreased appetite,

and weight loss Hyperpigmentation of skin and mucous membranes Vomiting or diarrhea Hypokalemia and other electrolyte disturbances Unexplained cardiovascular collapse

May be related to steroid therapy.• Sudden withdrawal can trigger Addisonian crisis.

Signs & Symptoms Progressive weakness, fatigue, decreased appetite,

and weight loss Hyperpigmentation of skin and mucous membranes Vomiting or diarrhea Hypokalemia and other electrolyte disturbances Unexplained cardiovascular collapse

Disorders of the Disorders of the Adrenal GlandAdrenal Gland

Assessment and Management Maintain ABCs. Closely monitor cardiac and pulmonary status. Obtain blood glucose level and treat for

hypoglycemia if present. Establish IV and provide aggressive fluid

resuscitation. Expedite transport.

Assessment and Management Maintain ABCs. Closely monitor cardiac and pulmonary status. Obtain blood glucose level and treat for

hypoglycemia if present. Establish IV and provide aggressive fluid

resuscitation. Expedite transport.

Disorders of the Disorders of the Adrenal GlandAdrenal Gland

SummarySummary

Anatomy & Physiology Endocrine Disorders and

Emergencies

Anatomy & Physiology Endocrine Disorders and

Emergencies