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Chapter 46 Terms: Caring for the Patient with Glandular and Hormonal Disorders
Acromegaly: a disorder of growth hormone excess that has an onset after puberty.
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Interventions:
o Assess the pituitary gland for adenomas.
o Assess for changes in physical features such as non-fitting hats, gloves, rings, or shoes.
o Provide therapeutic support for patient r/t disturbed body image.
Acropathy – clubbing of hands and toes
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Interventions:
o Recognize that this would be a sign of hyperthyroidism.
Adrenal crisis: acute adrenocortical insufficiency that is a life threatening complication.
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Interventions:
o Recognize that is characterized by dehydration, fever, hyponatremia, hyperkalemia,
vascular collapse, and possible death,
o Usually occurs in patients with chronic adrenocortical insufficiency that is worsened by
other stressors such as trauma or infection.
Amiodarone-induced thyrotoxicosis: thyroiditis that may result from treatment with amiodarone
which exposes the patient to excessive iodine.
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Interventions:
o Nurse should determine if amiodarone treatment is too much and puts the patient at
risk of excessive iodine exposure.
o Nurse should continually monitor T3, T4, and TSH levels for detection of
hyperthyroidism or thyroiditis.
Apathetic thyrotoxicosis: a condition of hyperthyroid that occurs in older patients only
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Interventions:
o Only fatigue, weight loss, apathy, and depression is presented in older patients with
hyperthyroidism as opposed to the hyperkinesis and mental alertness with young
thyrotoxic patients.
Congenital hypothyroidism: condition of thyroid hormone deficiency present at birth.
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Interventions:
o Nurse should assess for the cause of the congenital hypothyroidism if it is a defect in the
anatomy or structure of the thyroid or if the thyroid is underdeveloped.
o Nurse should have pregnant patient go through screening to monitor if maternal
thyrotropin-blocking antibodies are acting on the fetus.
Cretinism: severe form of hypothyroidism in children characterized by mental and growth retardation
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Interventions:
o Nurse should monitor the iodine levels because severe iodine deficiency is the cause of
cretinism
Cushing syndrome: clinical syndrome that results from chronic exposure to excessive circulating levels
of cortisol.
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Interventions:
o Recognize that along with Cushing, patients will usually have varying degrees of
hyperaldosteronism and adrenal androgens.
o Recognize s/s of Cushing’s:
 Obesity, truncal obesity, thin arms and legs, moon face, buffalo hump, acne,
striae, hirsutism, hypertension, severe fatigue and muscle weakness,
hyperglycemia, easy bruising.
o Administer proper medication (Mitotane) which decreases the size of adrenal tumors
and reduces symptoms.
o Extensive corticosteroids therapy can result in Cushing syndrome, patient must be
weaned off of corticosteroids or else adrenal crisis may occur if abrupt stop.
Dermopathy: skin disorder also referred to as pretibial myexedema,
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Interventions:
o Recognize that this is a sign of hyperthyroidism which would look like an inflamed
indurated plaque with deep pin or purple color, and orange skin appearance.
Diabetes insipidus (DI): inability of the kidneys to concentrate urine, resulting from an absolute or
relative lack of circulating ADH.
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Interventions:
o Provide adequate fluid to prevent dehydration and shock.
o Provide therapeutic comfort for patient who may have anxiety and fear.
o Monitor I/O regularly and record and as patient about their thirst.
o Provide proper medications such as ADH therapy.
Euthyroid: having normal thyroid function
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Interventions:
o Although patient has normal thyroid function, still need to be aware of s/s of
hypothyroidism.
o Nurse should be aware of the s/s of hypothyroidism: dry, skin, delayed wound healing,
cold extremities, hair loss, bradycardia, tiredness, menstrual abnormalities, weakness,
hoarse voice, and carpal tunnel syndrome.
Gigantism: growth hormone excess disorder that occurs mostly in children.
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Interventions:
o Recognize that gigantism is diagnosed mostly in childhood and before adolescence.
o Do a family history to determine if any other family members have a similar condition to
assess if there is a familial predisposition.
Goiter: enlargement of the thyroid gland
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Interventions:
o Nurse should recognize that goiters occur due to hypersecretion of TSH which can be
caused in hypothyroidism (compensatory to thyroid hormone deficiency) or
hyperthyroidism.
 Hypersecretion of TSH leads to thyroid hypertrophy and hypervascularity.
o Nurse should assess for the s/s of a goiter such as hoarseness, frequent coughing, and
feeling of tightness in the throat.
Goitrogens: foods and drugs that cause suppression of thyroid production
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Interventions:
o Nurse should assess the patient’s diet and medication history to identify if they are risk
of developing hypothyroidism.
o Nurse should be aware of the s/s of hypothyroidism: dry, skin, delayed wound healing,
cold extremities, hair loss, bradycardia, tiredness, menstrual abnormalities, weakness,
hoarse voice, and carpal tunnel syndrome.
Graves’ disease: autoimmune disease that is the most common cause of thyroxicosis.
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Interventions:
o Nurse should understand that Graves’ disease is an autoimmune disease so
immunosuppressants may temporarily be used.
o Nurse should pay close attention to s/s of higher metabolic activity such as nervousness,
the inability to sit still for any length of time, a short attention span, and fine hand
tremors
Hashimoto thyroiditis: genetic immunological disease characterized by development of
autoantibodies toward thyroglobulin.
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Nurse should monitor T3 and T4 levels and the development of hypothyroidism.
Nurse can administer proper thyroid medications.
Nurse should recognize that Hashimito is a congenital so should follow up with patient about
family history and other family members who have hypothyroidism and who is at risk of
developing it.
Hyperthyroidism: condition in which there is excess production of thyroid hormone.
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Interventions:
o Nurse should monitor for s/s of hyperthyroidism:
 Tachycardia and atrial fibrillation, Tremors, Goiter, Warm, moist skin, Hair loss,
Irritability, Heat intolerance, Hyperactivity, Unexplained weight loss, Diarrhea.
o Nurse should monitor for increased T3, T4, decreased TSH which can be indicative of
hyperthyroidism.
o Nurse should administer anti-Thyroid meds, tapazole, PTU, beta adrenergic blockers, or
radioactive iodine as ordered.
 If patient opts for iodine treatment, nurse should educate patient that
hypothyroidism may occur and education on recognizing the s/s of
hypothyroidism.
o If patient opts for surgery, nurse should assess the patient’s airway because hemorrhage
and swelling may compromise the patient’s respiratory status.
Hypoparathyroidism: combination of symptoms that result from inadequate parathyroid hormone
production.
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Interventions:
o Identify cause which is more commonly due to damage or removal of the parathyroid
glands.
o Nurse can treat patient with hormone replacement, symptom management,
management of potential complications and risk for injury, as well as support of patientcare.
Hypothyroidism: condition where the thyroid gland does not make enough thyroid hormone.
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Interventions:
o Nurse should be able to identify the cause of the thyroid hormone deficiency whether it
is primary or secondary.
 Primary: autoimmune (hashimoto), congenital, hyperthyroid treatment
(iatrogenic), iodine deficiency, medications, infiltrative disorders.
 Secondary: hypopituitarism (tumor, surgery), isolated TSH deficiency
o Assessment for hypothermia or temperature intolerance.
o Nurse should be aware of the s/s of hypothyroidism: dry, skin, delayed wound healing,
cold extremities, hair loss, bradycardia, tiredness, menstrual abnormalities, weakness,
hoarse voice, and carpal tunnel syndrome.
o Nurse should monitor the decreased T3, T4 levels, and iodine.
 In iodine deficiency, TSH levels will be increased due to compensation attempts.
 Secondary hypothyroidism: TSH (hormone that controls release of other
hormones) may cause goiter.
Hypopituitarism: a cause of secondary hypothyroidism
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Interventions:
o Recognize that hypopituitarism may occur as a result of damage to the thyroid gland by:
 Tumors, pituitary surgery or radiation
Multinodular goiters: multiple growths leading to enlargement of the total thyroid gland.
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Interventions:
o Nurse should assess and monitor if one of the nodules becomes autonomous from TSH
regulation and beings to excrete excessive T3 and T4.
Myxedema: condition where the thyroid gland does not make enough thyroid hormone.
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Interventions:
o Nurse should be able to identify the cause of the thyroid hormone deficiency whether it
is primary or secondary.
 Primary: autoimmune (hashimoto), congenital, hyperthyroid treatment
(iatrogenic), iodine deficiency, medications, infiltrative disorders.
 Secondary: hypopituitarism (tumor, surgery), isolated TSH deficiency
o Assessment for hypothermia or temperature intolerance.
o Nurse should be aware of the s/s of hypothyroidism: dry, skin, delayed wound healing,
cold extremities, hair loss, bradycardia, tiredness, menstrual abnormalities, weakness,
hoarse voice, and carpal tunnel syndrome.
o Nurse should monitor the decreased T3, T4 levels, and iodine.
 In iodine deficiency, TSH levels will be increased due to compensation attempts.
 Secondary hypothyroidism: TSH (hormone that controls release of other
hormones) may cause goiter.
Myxedema coma/crisis: manifestation of severe hypothyroidism.
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Intervention:
o Nurse should recognize this as a medical emergency and report the physical for facial
edema, thick tongue, mental confusion, significant hypothermia (91-95), slowed pulse
and respirations, decreased BP, neuromuscular weakness, and anemia.
Nephrogenic diabetes insipidus: defect in ADH receptor which results in decreased sensitivity to ADH.

Interventions:
o Provide adequate fluid to prevent dehydration and shock.
o Provide therapeutic comfort for patient who may have anxiety and fear.
o Monitor I/O regularly and record and as patient about their thirst.
o Provide proper medications such as ADH therapy.
Opthalmopathy: a presentation of Graves’ disease characterized by eye changes such as: lid lag,
retraction, periorbital edema, exophthalmos, diplopia.
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Interventions
o Nurse should discuss with patient about any concerns about disturbed body image r/t
opthalmopathy.
o Nurse should understand that Graves’ disease is an autoimmune disease so
immunosuppressants may temporarily be used.
o Nurse should pay close attention to s/s of higher metabolic activity such as nervousness,
the inability to sit still for any length of time, a short attention span, and fine hand
tremors
Parathyroid hormone (PTH): most important mediator in the complex feedback loop with PTH and
calcitonin.
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Interventions:
o Nurse should monitor lab values of calcium and phosphate for imbalances which may
indicate PTH dysfunction.
o Nurse assess the intestinal mucosa, kidneys, and bone to note for any abnormalities
which can be indicative of changes on the PTH secretion.
Parathyroid hyperplasia
Pheochromocytomas: tumors arising from cells erived from sympathetic pregangia of the adrenal
medulla.
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Interventions:
o Know the s/s of pheochromocytomas:
 Headaches. Diaphoresis, palpitations, tachycardia, sustained or paroxysmal
hypertension, anxiety, and panic attacks.
o Monitor BP and POC glucose.
o Provide pre-op and post-op care
 Hypotension and hypoglycemia postop expected due to body still needing to
adjust.
Pretibial myxedema: thickening of the skin commonly over the anterior and lateral aspects of the
lower legs.
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Interventions
o Nurse should continually assess skin for any changes, keep skin from becoming too dry
by applying lotion or moisturizers.
Primary adrenal insufficiency: caused by dysfunction of the adrenal cortex resulting in adrenocortical
hormone deficiency.
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Interventions:
o Know s/s:
 Decreased glucocorticoids, mineralcorticoids, and androgens.
 Fatigue, weakness, weight loss, anorexia, n/v, hyperkalemia, pigmentation
changes such as freckling, hypotension
Primary hyperaldosteronism (PH): cause of excess aldosterone production that resides within the
adrenal cortex.
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Interventions:
o Assess pt for essential HTN due to primary hyperaldosteronsim’s prevalence to cause it.
o Post-op care: vitals, LOC, Sao2, wounds and drains, I/O, assess pain, etc.
Secondary adrenal insufficiency: caused by dysfunction of the anterior pituitary leading to loss of
ACTH production result in deficiency of adrenocortical hormones.
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Interventions:
o Know the s/s of secondary adrenal insufficiency:
 Similar to primary adrenal insufficiency EXCEPT:
 No hypokalemia, less prominent hypotension, and no pigmentation
changes.
Secondary hyperaldosteronism (SH): caused by changes outside of the adrenal cortex i.e excess
secretion of renin by the kidneys which stimulate the RAA system.
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Interventions:
o Monitor for kidney perfusion and blood volume due to renal artery stenosis and
hypovolemia being causes of secondary hyperaldosteronism.
o Provide adequate fluid to improve renal blood flow to prevent over stimulation of the
RAA system.
Silent thyroiditis: inflammation of the thyroid gland associated with an infiltrative process in the
thyroid gland.
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Interventions:
o Nurse should assess the patient’s thyroid for inflammation and not if there are any signs
of an infiltrative process and distinguish that an upper respiratory tract infection is not
the cause for inflammation.
 Thyroid gland will be normal or slightly enlarged without tenderness or pain.
Subacute thyroiditis: inflammation of the thyroid gland that may follow an upper respiratory
infection.
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Interventions:
o Nurse should assess the patient’s thyroid when an upper respiratory tract infection is
present to detect for presence of subacute thyroiditis.
 Thyroid will be tender, painful, and minimally enlarged.
Syndrome of inappropriate ADH secretion (SIADH): reduction in urinary output and fluid volume
expansion.
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Interventions:
o Assess VS (high BP)
o Treat for hyponatremia
o Closely monitor I/O
o Neuro assessment to detect for body response to fluid overload and electrolyte
imbalances.
o Other assessment findings: bounding pulse, pulmonary cracles, cramps, vomiting,
decreased BS, no DTR.
Tetany: constellation of symptoms caused by hypocalcemia
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Interventions:
o Recognize s/s of tetany:
 Painful carpal spasms and laryngeal stridor.
o Perform Chvostek’s sign and Trousseau’s sign to detect for presence of tetany.
o Monitor Calcium levels because hypocalcemia causes tetany.
Thyroid storm:
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Interventions:
o May occur at any age, but most common in the elderlies.
o Typically occurs if thyrotoxicosis is not fully treated after a precipitating event such as
surgery, infection, or trauma.
o Nurse should be aware of the s/s of Thyroid storm:
 Temp > 104, diaphoresis, tachycardia, n/v, tremors, atrial fibrillation, delirium.
o Nurse should rely on assessments to recognize the hypermetabolic state of thyroid
storm.
o Nurse provides adequate O2, ventilation, administration of ATDs, administration of
hormones to block thyroid hormone release.
Thyrotoxicosis: clinical syndrome that results when tissues are exposed to high levels of circulating
thyroid hormone.
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Nurse should assess and identify the cause of the thyrotoxicosis, usually it will either be Graves’
disease, multinodular goiters, or amiodarone-induced thyrotoxicosis.
Nurse should recognize that thyrotoxicosis can occur despite normal thyroid functioning.
Nurse should monitor for s/s of hyperthyroidism:
o Tachycardia and atrial fibrillation, Tremors, Goiter, Warm, moist skin, Hair loss,
Irritability, Heat intolerance, Hyperactivity, Unexplained weight loss, Diarrhea.
Thyrotoxicosis factitia: psychoneurotic disorder in which the patient induced thyroiditis from an
overdose of T4 replacement (levothyroxine).
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Nurse should educate patient about alternative methods to losing weight, such as diet and
exercise, or even consulting a dietician.
Thyroxine (t4): one of the two primary hormones that the thyroid releases to regulate body
temperature, metabolism, and heart rate. T3 is the active hormone, t4 converted into t3
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Interventions:
o Nurse should be aware of the s/s of a t4 imbalance by monitoring the body
temperature, heart rate, and amount of metabolic waste products.
 S/s: weakness fatigue, insomnia, increased sensitivity to heat or cold, weight
loss or gain, menstrual irregularity, hair loss, hand tremors, and increased heart
rate.
Triiodothronine (t3): one of the two primary hormones that the thyroid releases to regulate body
temperature, metabolism, and heart rate. T3 is the active hormone, t4 converted into t3

Interventions:
o Nurse should be aware of the s/s of a t4 imbalance by monitoring the body
temperature, heart rate, and amount of metabolic waste products.
 S/s: weakness fatigue, insomnia, increased sensitivity to heat or cold, weight
loss or gain, menstrual irregularity, hair loss, hand tremors, and increased heart
rate.