Chapter 18 | Endocrine Disorders 427
● Somatostatin inhibits glucagon release. ● Pancreatic polypeptide assists with exocrine pancreatic enzyme secretion and gallbladder contraction ● Ghrelin induces gastric emptying and acid secretion and assists in appetite regulation. Sex Glands (Gonads) The sex glands include the testes and the ovaries. These glands are responsible for the regulation of puberty and fertility. The ovaries are located on each side of the uterus (females), and the testes are located in the scrotum (males). The ovaries induce female sexual characteristics such as breast development, body fat around the hips and thighs, and the growth spurt that occurs during puberty. The testes induce the male sexual characteristics such as the development of muscles, increase in facial and body hair, and the growth spurt that occurs during puberty. In girls, the ovaries secrete hormones that regulate the menstrual cycle (Ilie, 2020). Testes The testes produce androgens, mainly testosterone, in Leydig cells of the testicle when stimulated by FSH and LH. Testos- terone produces secondary sex characteristics in males, sperm formation, and sex drive. Ovaries and Uterus The ovaries produce estrogen and follicle cells. ● Estrogen produces secondary sex characteristics in females and mammary development. ● Follicle cells produce corpus luteum (meaning “yellow body”), which makes the hormone progesterone after the egg leaves the follicle. ● Progesterone maintains pregnancy by relaxing the uterus and stimulates milk production in the mammary glands. When a woman is pregnant: ● The ovaries and uterus produce relaxin, a hormone that re- laxes the cervix, vagina, and ligaments around the birth canal in preparation for delivery of a fetus (Vogazianou, 2019).
Thyroid Gland ● Two lobes in anterior neck region below the larynx ● Produce T3 and T4 in response to TSH from the pituitary gland ● T3—tri-iodothyronine (active form of hormone): Respon- sible for synthesis of protein and cholesterol, glucose me- tabolism, heat production, growth and development, and metabolism ● T4—thyroxine (inactive form of hormone) ● Calcitonin—stimulates bone construction, thereby inhibit- ing calcium release from the bones and decreasing calcium blood levels. It also inhibits the reabsorption of phosphate by the kidneys and promotes calcium excretion (Ilie, 2020). Parathyroid Glands These four glands, two on each side of the thyroid gland, pro- duce parathyroid hormone (PTH) (Ilie, 2020): ● Parathyroid hormone increases calcium concentration in the bloodstream by stimulating the osteoclasts in the bone to re- lease calcium. It also increases absorption of calcium from the gastrointestinal (GI) tract and increases calcium reabsorption and promotes phosphate excretion in the kidneys. Adrenal Glands ● Located on top of the kidneys. The adrenal glands consist of two parts, the cortex and medulla (Ilie, 2020): ● The adrenal cortex produces steroids, hormones made from cholesterol ● Glucocorticoids—mainly cortisone, which increases blood sugar, decreases inflammation, and aids in stress reduction ● Mineralocorticoids (aldosterone)—secreted in response to renin-angiotensin to conserve water and to retain sodium ● Androgens ● Estrogen (in small amounts) ● The adrenal medulla ● Epinephrine—fight-or-flight response; increases heart rate, respiratory rate; dilates pupils; increases use of glu- cose; suppresses digestion and immune system ● Norepinephrine—fight-or-flight response (same as noted earlier) ● Dopamine (in small amounts)—increases blood pressure Pancreas ● Has both exocrine (with ducts) and endocrine functions. The endocrine functions will be discussed further. The different cells from the islet of Langerhans are responsible for produc- ing five different hormones (Ilie, 2020): ● Insulin from the beta cells . Insulin is released in response to elevated blood glucose levels. It forces glucose into the cells and stimulates glycogen formation; independent of pitui- tary control; stimulated by the ingestion of glucose. ● Glucagon from the alpha cells. Glucagon works in the oppo- site manner as insulin; it breaks down glycogen in the liver to increase blood sugar.
ASSESSMENT
A comprehensive endocrine-focused assessment includes general history, review of systems, and physical examination. Referral to a pediatric endocrinologist is warranted for children with an endocrine disorder. This section provides a systematic review of a complete endocrine assessment. General History The nurse should gather and assess the following aspects of the client’s history.
Prenatal/Birth History ● Prenatal care ● Type of delivery
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