7.3 General Endocrine System Assessment

When evaluating a client for possible disorders of the endocrine system, the nurse assesses individual and population risk factors, cultural influences, and socioeconomic factors that may impact health. Client health history, physical examination findings, and diagnostic test results also play an important role in endocrine system assessment.

Risk Factors

Understanding the risk factors associated with endocrine system alterations is important for identifying potential endocrine disorders facing many individuals. Risk factors can be diverse and vary depending on the specific endocrine disorder or condition.

Common risk factors for endocrine system alterations include the following:

• Age: Many endocrine disorders, such as diabetes and thyroid disorders, are more common in certain age groups.^[1] For example, type 1 diabetes is often diagnosed in childhood, while type 2 diabetes is more common in adults. Thyroid disorders are also more prevalent with age.
• Genetics: A family history can increase an individual’s risk. Many endocrine conditions, such as diabetes, have a genetic component.^[2]
• Autoimmune Conditions: Autoimmune diseases, where the immune system mistakenly attacks the body’s own tissues, can affect the endocrine system. Conditions like Hashimoto’s thyroiditis and Addison’s disease are autoimmune disorders that impact the thyroid and adrenal glands, respectively.^[3]
• Obesity: Obesity is a significant risk factor for type 2 diabetes. It can also lead to insulin resistance, a condition where the body’s cells don’t respond effectively to insulin.^[4]
• Environmental Factors: Exposure to environmental toxins, such as certain chemicals or radiation, can increase the risk of endocrine disorders. For example, exposure to radiation can increase the risk of thyroid cancer.^[5]
• Diet and Lifestyle: Poor dietary habits and sedentary lifestyles can contribute to endocrine disorders. Unhealthy eating habits and lack of physical activity can lead to conditions like obesity, which is a risk factor for diabetes.^[6]
• Stress: Chronic stress can disrupt the endocrine system, particularly the hypothalamic-pituitary-adrenal (HPA) loop. This disruption can lead to conditions like adrenal fatigue and alterations in cortisol levels.^[7]
• Medications: Some medications, such as corticosteroids, can affect the functioning of the endocrine system. Long-term use of these drugs can lead to conditions like Cushing’s syndrome.^[8]
• Pregnancy: Pregnancy can lead to temporary alterations in the endocrine system, such as gestational diabetes or thyroid dysfunction. Some women may develop permanent endocrine disorders following pregnancy.^[9]
• Underlying Health Conditions: Some preexisting health conditions, such as polycystic ovary syndrome (PCOS) or pituitary tumors, can affect the endocrine system directly or indirectly.^[10]

Cultural Factors

Cultural risk factors refer to aspects of a person’s culture or lifestyle that can contribute to an increased risk of endocrine-related health issues. Cultural dietary practices can have a significant impact on endocrine health. For example, high consumption of sugary foods and processed carbohydrates can increase the risk of obesity and type 2 diabetes. In contrast, diets rich in fruits, vegetables, and whole grains can have a protective effect. Some cultures also have dietary restrictions or fasting practices as part of their religious or cultural traditions. These practices can impact blood sugar regulation and management.^[11]

Norms regarding alcohol and substance use can vary significantly across cultural groups. For example, some cultural groups abstain from alcohol and drug use, whereas other cultural groups may commonly use alcohol and other substances. Excessive alcohol consumption and substance use can harm the endocrine system, leading to conditions like liver damage or hormone imbalances. Additionally, some cultures may rely heavily on traditional medicines and healing practices, which is important to consider as the treatment plan is developed.^[12] Nurses must consider cultural factors when developing a nursing care plan.

Socioeconomic Factors

Socioeconomic status can affect access to health care, nutrition, and education. Lower socioeconomic status is associated with a higher risk of endocrine-related conditions, such as obesity, diabetes, and cardiovascular diseases. People with lower incomes or inadequate health insurance may delay seeking medical attention, miss regular check-ups, or forgo preventive care. This can result in undiagnosed or poorly managed endocrine disorders. Additionally, many endocrine disorders require lifelong medication management. The cost of medications can be a barrier for those with limited financial resources. Skipping or rationing medication due to cost concerns can lead to poor disease control and complications.^[13]

Individuals with low-income levels may have limited access to nutritious foods, which can contribute to obesity and diet-related endocrine disorders like type 2 diabetes. Food insecurity can also lead to irregular meal patterns and unhealthy eating habits. Additionally, socioeconomic factors can impact opportunities for physical activity. People in lower-income communities may have limited access to safe recreational spaces, gym facilities, or affordable sports activities. A sedentary lifestyle is also a risk factor for endocrine disorders.^[14]

Education levels are closely tied to socioeconomic status. Individuals with lower levels of education may have less health literacy and awareness about endocrine disorders, preventive measures, and effective management of these conditions. Lower health literacy levels can lead to misunderstandings about endocrine alterations and the importance of adherence to treatment plans.^[15]

General Endocrine System Assessment

A comprehensive evaluation of overall health status is important for identifying potential alterations within the endocrine system. The endocrine system controls many different body functions so signs and symptoms of potential disorders can be seen in many different areas. Endocrine dysfunction can result in improper hormone regulation, which subsequently can impede growth, metabolism, mood, and other imbalances within the body.

Health History

Several health history factors can significantly impact endocrine function. Examination of current symptoms, family history, medications and allergies, as well as past medical history, including surgeries and radiation therapy, may help identify undiagnosed endocrine disorders.

The health history should begin by assessing current symptoms. Common endocrine symptoms, such as unexplained weight changes; fatigue; mood swings; and changes in appetite, thirst, or urine output, can provide valuable clues to potential endocrine disorders. Additionally, menstrual irregularities and reproductive disorders can indicate endocrine abnormalities. It is important to also note the client’s current and past medications, especially those affecting hormones (e.g., steroids, birth control pills), that can influence endocrine function. Finally, exposure to substances that can disrupt normal endocrine function should be examined. Examples of endocrine disruptors include occupational exposure to chemicals or pesticides, fabrics treated with flame retardants, and ingestion of soy-based products containing phytoestrogens.^[16]

Physical Assessment

Conducting a thorough examination of each body system provides the nurse with cues regarding potential endocrine disorders. Early identification of abnormal findings and notification of the health care provider can lead to prompt intervention. Table 7.3 summarizes abnormal findings in each body system that can potentially be related to the endocrine system.

Table 7.3. Abnormal Findings by Body System Potentially Related to the Endocrine System^[17],[18]

Life Span Considerations

Nurses consider characteristics of pediatric clients and older adults when performing an assessment.^[19],[20]

Pediatric Considerations

• Pediatric clients are at higher risk for some endocrine disorders, such as congenital hypothyroidism, congenital adrenal hyperplasia, growth disorders, and type 1 diabetes mellitus.
• Dynamic changes occur during pediatric growth and development. Growth hormone, insulin-like growth factor 1, and thyroid hormones are vital during childhood and adolescence.
• Sex hormones (gonadotropins, estrogen, testosterone) are integral during adolescence to develop secondary sexual characteristics.
• During infancy and adolescence, growth hormone secretion supports rapid growth with responsive hormone fluctuation.
• Childhood obesity challenges insulin and glucose regulation, which can result in type 2 diabetes mellitus.
• Neonates, infants, and children have increased glucose requirements with poor glycogen stores and can rapidly develop hypoglycemia and muscle fatigue.

Older Adult Considerations

• Hypothyroidism should be considered when older adults present with lethargy, slow thought processes, and lack of enthusiasm, and not simply attributed to dementia.
• The development of diabetes mellitus is more likely in older adults due to alterations in glucose metabolism and insulin secretion.
• Older adults are prone to hypoglycemia and are likely to experience dramatic symptoms of hypoglycemia.
• “Tight” glycemic control may not be an appropriate goal for older adults because severe hypoglycemia may precipitate myocardial infarction, angina, stroke or seizures.
• Physical limitations may impact exercising by older adults with diabetes mellitus. Nurses should stress safe alternatives like walking, swimming, or stationary bicycle riding to assist with blood sugar control.
• Overall metabolic activity decreases in older adults due to decline in thyroxin and triiodothyronine secretion.
• Older women experience menopause, along with an increased risk of cardiovascular disease, loss of bone mass, and atrophy of estrogen-responsive tissue.

Diagnostic Testing

The aim of diagnostic testing is to identify abnormalities or dysfunction related to endocrine gland functioning and the release of hormones. Health care providers order diagnostic tests based on signs and symptoms exhibited that reflect potential endocrine disorders.

Laboratory Studies

One of the most definitive signs of an endocrine dysfunction is an abnormal hormone level in blood tests. Read more about specific hormone blood tests under each endocrine system alteration discussed later in this chapter.

Imaging Studies

Imaging studies such as an ultrasound, CT scan, MRI, and nuclear medicine scan may be used to visualize the endocrine glands and identify structural abnormalities or tumors.