ENDOCRINE AGENTS
Endocrine System
Consists of ductless glands that secrete hormones
Hormones chemical substance synthesized
from amino acids and cholesterol
2 categories:
1. proteins or small peptides
2. steroids – adrenal glands and
gonads
Endocrine glands includes?
• Pituitary * Adrenal
• Thyroid * Gonads
• Parathyroid * Pancreas
Pituitary Gland/Hypophysis
• Base of the brain
• 2 lobes:
1. anterior/adenohypophysis – master gland
2. posterior/neurohypophysis – ADH or
vasopressin and oxytocin
Anterior Pituitary hormones
are regulated by negative
feedback: TSH, ACTH, FSH,
LH, GH, PL and MSH
Thyroid-Stimulating Hormone/
Thyrotropic
• Released because of TRH from hypothalamus
• T4 (Thyroxine) and T3 (Triiodothyronine)
• Serum TSH levels should be checked to determine
deficit or excess
Adrenocorticotropic Hormone
* Released because of Corticotropin Releasing
Factor (CRF) from hypothalamus.
• Stimulates the release of glucocorticoids (cortisol),
mineralocorticoids (aldosterone) and androgen.
When the cortisol level is low, ACTH secretion
is stimulated. Elevated serum cortisol inhibits
ACTH and CRF release.
Gonadtropin Hormones
• Regulates hormones from the ovaries and testes
(gonads)
• FSH, LH and prolactin
Growth Hormones/ Somatotropic
Hormones
• acts on all body tissues (bones and skeletal
muscles)
• regulated by Growth Hormone–Releasing Hormone
(GH-RH) and Growth Hormone-Inhibiting Hormone
(GH-IH or somatostatin) from hypothalamus
• Inhibits secretion of GH:
symphatomimetics, serotonin & glucocorticoids
Thyroid Gland
• Secretes: T4 and T3
• controls metabolic rate and activity
• affects cardiac output, oxygen consumption, CHO
use, CHON synthesis and lipolysis
• affects body heat regulation and menstrual cycle
• regulated by negative feedback
• APG secretes TSH—stimulates TG to produce T4 &
T3
Increase TH suppresses the release of TSH and
decrease TH increases the release of TSH
Parathyroid Gland
• secretes PTH or parathormone which regulates Ca
levels in the blood
• Decrease in Ca stimulates the release of PTH.
PTH increases Ca levels by mobilizing calcium from
the bone, promoting calcium absorption from the
intestines and promoting calcium reabsorption from
the renal tubules
Adrenal Gland
• 2 sections:
1. adrenal medulla – cathecolamines epinephrine
and norepinephrine
2. adrenal cortex – glucocorticoids (cortisol)
and mineralocorticoids (aldosterone).
Produces small amount of androgen, estrogen,
and progestin
Pancreas
• Exocrine and endocrine gland
• Exocrine – secretes digestive enzymes into the
duodenum
• Endocrine – has cell clusters:
1. alpha islet cells – produces glucagon
2. beta cells – secretes insulin
PITUITARY/Hypophysis GLAND
Anterior Lobe/ Adenohypophysis/ Master Gland
secretes the following:
1. Growth Hormone (GH) – tissue and bone
2. Thyroid Stimulating Hormone (TSH) – thyroid
gland
3. Adrenocorticotropic Hormone (ACTH) – adrenal
gland
4. Gonadotropins – (FSH and LH) ovaries
Growth Hormone (GH)
no target gland only body tissues and bone
2 Hormones Regulate GH:
1. Growth hormone-releasing hormone (GN-RH)
2. Growth hormone-inhibiting hormone
(GN-IH; somatostatin)
* NOT given orally
given thru SQ or IM
* Can cause DM
Deficiency of GH
somatrem (Protropin)
somatropin (Humatrope) – C/I for pedia patients
with growth deficiency due to Prader Willi
syndrome, severely obese, severe respiratory
impairment
Promotes bone growth at epiphyseal
plates of long bones
Acts on newly forming bone
GH can increase height by a foot
Excess of GH
Gigantism – during childhood
Acromegaly – after puberty
* Due to GH hypersecretion or pituitary tumor
bromocriptine mesylate (Parlodel) – inhibits the
release of GH
octreotide (Sandostatin) – potent synthetic
somatostatin.GI side effects are COMMON
●
Thyroid-Stimulating Hormone (TSH)
Releases thyroxine (T4) and triiodothyronine (T3)
Excess TSH – Hyperthyroidism
Deficit TSH – Hypothyroidism. Maybe caused by
thyroid gland disorder (primary) or
decrease in TSH secretion (secondary)
thyrotropin (Thyropar) – purified extract of TSH
used to diagnose primary and secondary
hypothyroidism
Adrenocorticotropic hormone (ACTH)
Stimulates the release of the ff:
1. glucocorticoids (cortisol) - follows diurnal rythmn
2. mineralocorticoids (aldosterone)
3. androgen
corticotropin (Acthar) given IV or IM
Agent in the diagnosis of adrenal gland disorder
Used in the treatment of adrenal gland
insufficiency
Suppresses inflammatory and immune response
SE: sodium and water retention
Posterior Lobe/ Neurohypophysis
secretes Antidiuretic Hormone/Vasopressin AND
Oxytocin
ADH promotes water reabsorption
ADH deficit leads to Diabetes Insipidus
desmopressin (DDAVP)
vasopressin (Pitressin)
Given intranasally or injection
Nursing interventions:
ADH
Monitor v/s and UO - Increasing HR, decreasing
systolic pressure
ACTH
Observe client’s weight for possible edema
Taper the dose
Electrolyte monitoring
GH
Monitor blood sugar and electrolyte levels
(possible hyperglycemia)
THYROID GLANDS
Thyroid hormones stimulate metabolism and cardiac
function.
Essential for normal growth and development of the
nervous and musculoskeletal systems.
Hypothyroidism is the abnormally
decreased secretion of thyroid
hormone.
Caused by:
Primary cause (thyroid gland disorder – decreased
T4 and elevated TSH)
Secondary cause (lack of TSH secretion)
Cretinism is hypothyroidism in
infants.
Infant will be short in stature and
delayed in mental and physical
development.
Myxedema is hypothyroidism in adults.
Manifestations:
bradycardia, cold and dry skin, brittle hair, low
body temperature, fatigue, cold intolerance, flat
affect, slowed cognition, and weight gain
Drug Therapy:
levothyroxine (Synthroid, Levothroid) commonly
used, increases T3 and T4. Drug of choice. With
longer half-life and highly protein bound drugs.
Excreted in the bile and feces.
liothyronine (Cytomel), synthetic T3, useful as initial
treatment for Myxedema. Shorter half-life
liotrix (Euthroid, Thyrolar)
Mixture of levothyroxine and liothyronine
Antithyroid Agents
Hyperthyroidism is the abnormal
increase secretion of thyroid hormone
Manifestations:
tachycardia, dysrhythmias,
palpitations, excessive perspiration, heat intolerance,
nervousness, irritability, exopthalmos, weight loss
*can be treated by surgery (Subtotal Thyroidectomy)
* propanolol (Inderal) is usually given to control
cardiac symptoms
Drug Therapy:
Thiourea derivatives (Thioamides) – drug of choice.
Blocks thyroid hormone. No effect with thyroid tissue
2 thioamides:
propylthiouracil (PTU) - Inhibit peripheral
conversion of T4 to T3. Used to treat thyrotoxic
crisis and in preparation for subtotal thyroidectomy
methimazole (Tapazole) – 10 times more potent,
with longer half-life
Iodide preparations have been used to suppress
thyroid function for those who have undergone
subtotal thyroidectomy.
strong iodine solution (Lugol’s solution,
Potassium iodide solution)
SE: teeth discoloration
*** Thyroid drugs increases
the effect of anticoagulants
and decreases insulin
effects
Client health teaching:
For hypothyroidism
-Take drug same time each day, pre-breakfast
-To report signs of hyperthyroidism
-Avoid foods that can inhibit thyroid
secretions(strawberry, peach, pear, cabbage,
cauliflower, radish, peas)
For hyperthyroidism
-Taken with meals
-Avoid iodine and iodine-containing food, OTC
cough meds
- To report signs of hypothyroidism
-Avoid the drugs if pregnant or breastfeeding
Parathyroid Glands
Parathyroid hormone (PTH) regulates calcium levels
in the blood.
Decrease in serum calcium stimulates the
release of PTH
PTH agents treat hypoparathyroidism
Hypocalcemia can be caused by PTH deficiency, vit
D deficiency, renal impairment, diuretic therapy
PTH Agents
• Promotes calcium absorption from the GI tract
• Promote reabsorption of calcium from renal tubules
• Activates Vitamin D
Hypoparathyroidism and Hypocalcemia Agents
calcitriol (Rocaltrol) – Vitamin D analogue.
Increases serum calcium with long onset, peak &
duration of action
calcifediol (Calderol) – bone disease and
hypocalcemia associated with chronic renal disease
and dialysis
Hyperthyroidism is caused by malignancies of the
parathyroid glands or ectopic PTH secretion from
lung cancer, hyperthyroidism or prolonged
immobility
Hyperparathyroidism and Hypercalcemia Agents
calcitonin (human) (Cibacalcin) – Paget’s disease
calcitonin (salmon) (Calcimar) – more potent
Etidronate (Didronel)
PAGET’S DISEASE
Body absorbs old bone and forms
abnormal new bone
Client teaching: HYPOPARATHYROIDISM
• Report symptoms of tetany
Client teaching: HYPERPARATHYROIDISM
• Report signs: bone pain, anorexia, NV, thirst,
constipation, lethargy, bradycardia and polyuria
• Check OTC drugs for calcium content (vitamins and
antacid)
Adrenal Glands
Adrenal cortex produces two hormones or
corticosteroids: glucocorticoids (cortisol) and
mineralocorticoids (aldosterone)
It affects carbohydrate, protein and fat metabolism;
Na and water reabsorption; K excretion; have
antinflammatory, antiallergic, and anti-stress
effects
Addison’s disease- decrease in corticosteroid
Cushing’s syndrome - increase in corticosteroid
Addison’s disease: weight loss, fatigue,
hyperpigmentation, muscle
weakness, low blood pressure
1. Glucocorticoids/ Cortisone drugs
Short-acting
cortisone acetate (Cortone Acetate)
hydrocortisone (Cortef)
Intermediate-acting
methylprednisolone (Medrol, Solu-Medrol)
prednisolone (Hydeltrasol)
prednisone (Deltasone) – “inexpensive”
Long-acting
betamethasone (Celestone)
dexamethasone (Decadron) – potent glucocorticoid
Interventions:
* Check BP, Na and water retention
* Record weight (5lbs in several days)
* Check electrolytes and blood sugar level
* Check s/Sx of increased Osteoporosis
2. Glucocorticoid Inhibitors
Used in treating clients with Cushing’s syndrome
ketoconazole (Nizoral) – adjunct to surgery or
radiation
aminoglutethimide (Cytadren) – used as temporary
treatment
Mitotane (Lysodren) – ANTINEOPLASTIC hormone
antagonist
3. Mineralocorticoids (aldosterone)
Given with a glucocorticoid
Secrete aldosterone that maintain fluid balance by
promoting the reabsorption of Na from the renal
tubules
fludrocortisone (Florinef) – oral mineralocorticoid,
given with glucocorticoid
