Endocrinology

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Endocrinology
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Sections

• Anatomy and Physiology
• Endocrine Disorders and Emergencies

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Anatomy Physiology

• 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).

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Hypothalmus

• 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.

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Posterior Pituitary

• Diabetes Insipidus
• Oxytocin and Pregnancy

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Anterior Pituitary
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Thyroid Gland

• Hyperthyroidism Hypothyroidism

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Parathyroid Gland
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Thymus Gland
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Pancreas

• Combination Organ
• Exocrine tissues called acini secrete digestive
  enzymes into the small intestine.
• Endocrine tissues secrete hormones.
• Glycogenolysis.
• Gluconeogenesis.

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Pancreas
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Adrenal 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.

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Adrenal Gland
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Gonads

• Female
• Ovaries
• Male
• Testes

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Pineal Gland

• Located in the roof of the thalamus.
• Related to the bodys biological clock.
• Implicated in Seasonal Affective Disorder.

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Other Organs withEndocrine Activity

• Placenta
• Releases hCG throughout gestation
• Digestive Tract
• Gastrin and secretin
• Heart
• ANH
• Kidneys
• Renin

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Endocrine Disorders and Emergencies

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

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Disorders of the Pancreas

• Diabetes Mellitus
• Glucose Metabolism
• Metabolism
• Anabolism catabolism

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Disorders of the Pancreas

• 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

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Diabetes 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.

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Diabetes 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.

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Diabetic Emergencies
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Diabetic Emergencies
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Blood Glucose Determination

• Choose a vein, and prep the site.

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Blood Glucose Determination

• Perform the venipuncture.

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Blood Glucose Determination

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

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Blood Glucose Determination

• Wait until the timer sounds.

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Blood Glucose Determination

• Wipe the reagent strip.

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Blood Glucose Determination

• Place the reagent strip in the glucometer.

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Blood Glucose Determination

• Read the blood glucose level.

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Blood Glucose Determination

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

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Diabetic Emergencies

• Diabetic Ketoacidosis
• Pathophysiology
• Results from the bodys change to fat metabolism.
• Continuous buildup of ketones produces
  significant acidosis.
• Signs and Symptoms
• Extended period of onset (1224 hours).
• Sweet, fruity breath odor.
• Potassium-related cardiac dysrhythmias.
• Kussmauls respiration.
• Decline in mental status and coma.

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Diabetic Emergencies

• 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.

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Diabetic Emergencies

• 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.

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Diabetic Emergencies

• 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.

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Diabetic Emergencies

• 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 bodys stores have been used.
• Diabetics with kidney failure are predisposed to
  hypoglycemia.

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Diabetic Emergencies

• 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.

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Diabetic Emergencies

• Management
• Maintain airway and support breathing as
  indicated.
• Determine blood glucose level and obtain blood
  sample.
• Establish IV access.
• If blood glucose lt60mg/dL or is unknown,
  administer 2550g of 50 Dextrose IV.
• If IV cannot be established, administer 0.51.0mg
  glucagon intramuscularly.
• Monitor cardiac rhythm and vital signs.
• Expedite transport.

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Disorders of the Thyroid Gland

• Graves 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.

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Disorders of the Thyroid 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.

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Disorders of the Thyroid 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.

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Disorders of the Thyroid 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.

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Disorders of the Thyroid 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

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Disorders of the Thyroid Gland

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

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Disorders of the Adrenal Gland

• Hyperadrenalism
• (Cushings 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

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Disorders of the Thyroid 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

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Disorders of the Adrenal Gland

• Assessment Management
• Support ABCs.
• Use caution when establishing IV access.
• Report any observations indicative of Cushings
  Syndrome to the receiving facility.
• Adrenal Insufficiency (Addisons Disease)
• Pathophysiology
• Due to destruction of the adrenal cortex.
• Often related to heredity.
• Stress may trigger Addisonian crisis.

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Disorders of the Adrenal 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

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Disorders of the Adrenal 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.

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Summary

• Anatomy Physiology
• Endocrine Disorders and Emergencies