1. Endocrinology

2. Sections
 Anatomy and Physiology
 Endocrine Disorders and
Emergencies

3. 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).

4. 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.

5. Posterior Pituitary
 Diabetes Insipidus
 Oxytocin and Pregnancy

6. Anterior Pituitary

7. Thyroid Gland
 Hyperthyroidism & Hypothyroidism

8. Parathyroid Gland

9. Thymus Gland

10. Pancreas
 Combination
Organ
 Exocrine tissues
called acini secrete
digestive enzymes
into the small
intestine.
 Endocrine tissues
secrete hormones.
 Glycogenolysis.
 Gluconeogenesis.

11. Pancreas

12. 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.

13. Adrenal Gland

14. Gonads
 Female
 Ovaries
 Male
 Testes

15. Pineal Gland
 Located in the roof of the thalamus.
 Related to the body’s “biological clock.”
 Implicated in Seasonal Affective Disorder.

16. Other Organs with
Endocrine Activity
 Placenta
 Releases hCG throughout gestation
 Digestive Tract
 Gastrin and secretin
 Heart
 ANH
 Kidneys
 Renin

17. Endocrine Disorders
and Emergencies
 Disorders of the Pancreas
 Disorders of the Thyroid Gland
 Disorders of the Adrenal Glands

18. Disorders of the
Pancreas
 Diabetes Mellitus
 Glucose Metabolism
 Metabolism
• Anabolism & catabolism

19. 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

20. 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.

21. 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.

22. Diabetic Emergencies

23. Diabetic Emergencies

24. Blood Glucose Determination
Choose a vein, and prep the site.

25. Blood Glucose Determination
Perform the venipuncture.

26. Blood Glucose Determination
Place a drop of blood on the reagent strip. Activate the timer.

27. Blood Glucose Determination
Wait until the timer sounds.

28. Blood Glucose Determination
Wipe the reagent strip.

29. Blood Glucose Determination
Place the reagent strip in the glucometer.

30. Blood Glucose Determination
Read the blood glucose level.

31. Blood Glucose Determination
Administer 50% dextrose intravenously, if
the blood glucose level is less than 80 mg.

32. Diabetic Emergencies
 Diabetic Ketoacidosis
 Pathophysiology
 Results from the body’s change to fat metabolism.
 Continuous buildup of ketones produces significant
acidosis.
 Signs and Symptoms
 Extended period of onset (12–24 hours).
 Sweet, fruity breath odor.
 Potassium-related cardiac dysrhythmias.
 Kussmaul’s respiration.
 Decline in mental status and coma.

33. 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.

34. 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.

35. 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.

36. 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 body’s stores have been used.
 Diabetics with kidney failure are predisposed to
hypoglycemia.

37. 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.

38. Diabetic Emergencies
 Management
• Maintain airway and support breathing as indicated.
• Determine blood glucose level and obtain blood sample.
• Establish IV access.
• If blood glucose <60mg/dL or is unknown, administer 25–
50g of 50% Dextrose IV.
• If IV cannot be established, administer 0.5–1.0mg
glucagon intramuscularly.
• Monitor cardiac rhythm and vital signs.
• Expedite transport.

39. Disorders of the
Thyroid Gland
 Grave’s 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.

40. 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.

41. 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.

42. 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.

43. 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

44. 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.

45. Disorders of the
Adrenal Gland
 Hyperadrenalism
(Cushing’s 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

46. 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

47. Disorders of the
Adrenal Gland
 Assessment & Management
 Support ABCs.
 Use caution when establishing IV access.
 Report any observations indicative of Cushing’s
Syndrome to the receiving facility.
 Adrenal Insufficiency (Addison’s
Disease)
 Pathophysiology
 Due to destruction of the adrenal cortex.
 Often related to heredity.
 Stress may trigger Addisonian crisis.

48. 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

49. 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.

50. Summary
 Anatomy & Physiology
 Endocrine Disorders and
Emergencies