Download Ready for Review - Paramedic EMS Zone

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The endocrine system directly or indirectly influences almost every cell, organ,
and function of the body.
Patients with an endocrine disorder often present with a multitude of signs and
symptoms that require a thorough assessment and immediate treatment to
interrupt life-threatening emergencies.
The endocrine system comprises a network of glands that produce and secrete
hormones. The main function of the endocrine system and its hormone
messengers is to maintain homeostasis and promote permanent structural changes.
Hormones travel in the bloodstream to target tissues.
The major components of the endocrine system are the hypothalamus, pituitary,
thyroid, parathyroid, adrenals, and reproductive organs (gonads). The pancreas is
also part of this system; it has a role in hormone production as well as in
digestion.
The pituitary gland is often referred to as the “master gland” because its
secretions control, or regulate, the secretions of other endocrine glands.
The thyroid secretes thyroxine when the body’s metabolic rate decreases.
Thyroxine, the body’s major metabolic hormone, stimulates energy production in
cells, which increases the rate at which cells consume oxygen and use
carbohydrates, fats, and proteins. The thyroid gland also secretes calcitonin,
which helps maintain normal calcium levels in the blood.
The adrenal glands produce hormones that regulate the body’s metabolism, its
balance of salt and water, the immune system, and sexual function. Adrenal
hormones also help the body cope with physical and emotional stress by
increasing the pulse and respiratory rates and the blood pressure.
The pancreas secretes digestive enzymes as well as the hormones glucagon and
insulin, which are responsible for the regulation of blood glucose levels.
The gonads are the main source of sex hormones (Table 29-3). In men, the
gonads, or testes, are located in the scrotum and produce hormones called
androgens. The most important androgen in men is testosterone. Androgens
regulate body changes associated with sexual development (puberty), including
growth spurts, deepening of the voice, growth of facial and pubic hair, and muscle
growth and strength.
In women, the gonads are the ovaries, which release the eggs and secrete the
hormones oestrogen and progesterone.
Diabetes is a metabolic disorder in which the body’s ability to metabolise glucose
is impaired. It is characterised by the passage of large quantities of urine
containing glucose, significant thirst, and deterioration of body function.
In type 1 diabetes, most patients do not produce insulin at all. They require daily
injections of supplemental synthetic insulin throughout their lives to control blood
glucose levels.
The most common form of diabetes is type 2 diabetes [sometimes called adult
(late)-onset diabetes], in which blood glucose levels are elevated.
Hypoglycaemia in the patient with insulin-dependent diabetes is often the result
of having taken too much insulin, too little food, or both. The patient will
experience trembling, a rapid pulse rate, sweating, and a feeling of hunger—a
result of the actions of adrenaline.
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Hyperglycaemia (high blood glucose level) is one of the classic symptoms of
diabetes mellitus. Common early signs include frequent and excessive thirst,
accompanied by frequent and excessive urination.
If left untreated, hyperglycaemia progresses to the life-threatening condition
known as diabetic ketoacidosis (DKA). DKA occurs when certain acids
accumulate in the body because insulin is not available.
Hyperosmolar nonketotic coma (HONK), also called hyperosmolar
hyperglycaemic nonketotic coma (HHNC), is a metabolic derangement that
occurs principally in patients with type 2 diabetes. This condition is characterised
by hyperglycaemia, hyperosmolarity, and an absence of significant ketosis.
Adrenal insufficiency is characterised by underproduction of cortisol and
aldosterone, which leads to weakness, dehydration, and the body’s inability to
maintain adequate blood pressure or to properly respond to stress. Primary adrenal
insufficiency (also known as Addison’s disease) is caused by atrophy or
destruction of both adrenal glands, leading to deficiency of all the steroid
hormones produced by these glands. Secondary adrenal insufficiency is defined as
a lack of ACTH secretion from the pituitary gland.
Acute adrenal insufficiency is referred to as an Addisonian crisis, which may
result from an acute exacerbation of chronic insufficiency, usually brought on by
a period of stress, trauma, surgery, or severe infection.
Cushing’s syndrome is caused by an excess of cortisol production by the adrenal
glands or by excessive use of cortisol or other similar steroid (glucocorticoid)
hormones.
Thyroid hormones are critical for cell metabolism and organ function. If their
supply becomes inadequate, organ tissues don’t grow or mature (due to the
decreased metabolic rate), energy production declines (a cause of the decreased
metabolic rate), and the actions of other hormones are affected.
Symptoms of hypothyroidism include fatigue, feeling cold, weight gain, dry skin,
and sleepiness. Continued decrease of the hormone levels may lead to
myxoedema coma.
Thyrotoxicosis is a toxic condition caused by excessive levels of circulating
thyroid hormone. A thyroid storm is a rare, life-threatening condition that may
occur in patients with thyrotoxicosis.
Assessing patients with endocrine emergencies can be difficult because their
conditions tend to affect many organ systems and the seriousness of their
presentations varies greatly. Don’t take these calls lightly, as poor outcomes can
result very quickly.