The endocrine system uses hormones to regulate countless body functions. When hormone levels are too high or too low, medications are used to restore balance. These are often lifelong therapies requiring careful management.

This lesson covers key medications for common endocrine disorders, focusing on their use and essential nursing considerations.

1. Medications for Diabetes Mellitus (Blood Sugar Control)

Diabetes involves problems with insulin, leading to high blood sugar. Medications aim to lower glucose.

• Insulin: (Various types) Replaces or supplements the body’s insulin.

  • Uses: Essential for Type 1 DM, often needed for Type 2 DM.

  • Nursing Focus:

    • Administration: Subcutaneous injection (or pump). Teach proper technique, site rotation.

    • Monitoring: Monitor blood glucose levels frequently. Watch for signs/symptoms of hypoglycemia (low blood sugar – shakiness, sweating, confusion) and hyperglycemia (high blood sugar – increased thirst/urination, fatigue).

    • Education: Injection technique, timing with meals, monitoring blood sugar, managing hypo/hyperglycemia (sick day rules), lifestyle (diet, exercise).

• Oral & Injectable Non-Insulin Medications: (e.g., Metformin, Sulfonylureas, GLP-1 agonists) Improve insulin action or secretion, reduce glucose production/absorption.

  • Uses: Primarily Type 2 DM.

  • Nursing Focus:

    • Administration: Oral or subcutaneous injection. Timing with meals varies by drug.

    • Monitoring: Monitor blood glucose. Watch for side effects (GI upset with Metformin, hypoglycemia with Sulfonylureas).

    • Education: Purpose, dose, timing, side effects, monitoring, lifestyle.

2. Medications for Thyroid Disorders

Treat problems with thyroid hormone (metabolism regulator) being too low (hypothyroidism) or too high (hyperthyroidism).

• Hypothyroidism (Too Little Hormone):

  • Medication: Levothyroxine (synthetic T4).

  • Uses: Lifelong replacement therapy.

  • Nursing Focus:

    • Administration: Once daily, on an empty stomach (at least 30-60 min before food/other meds, especially calcium/iron).

    • Monitoring: Monitor for therapeutic effect (improved energy, weight stabilization, reduced constipation/cold intolerance). Monitor for signs of hyperthyroidism (palpitations, weight loss, nervousness) if dose is too high. Monitor TSH and Free T4 levels regularly.

    • Education: Lifelong therapy. Consistent timing is crucial. Importance of follow-up and lab tests.

• Hyperthyroidism (Too Much Hormone):

  • Medications: Antithyroid drugs (e.g., Methimazole, PTU), Radioactive Iodine (RAI), Beta-blockers (for symptom control).

  • Uses: Reduce hormone production (antithyroid), destroy thyroid cells (RAI), manage symptoms (beta-blockers).

  • Nursing Focus:

    • Administration: Antithyroid drugs (oral), RAI (oral), Beta-blockers (oral).

    • Monitoring: Monitor for reduced hyperthyroid symptoms. Monitor for signs of hypothyroidism (if treatment is too effective or after RAI). Monitor thyroid function tests. Antithyroid drugs: Monitor for liver problems, agranulocytosis (fever, sore throat – rare but serious). RAI: Monitor for signs of hypothyroidism, educate on radiation safety.

    • Education: Antithyroid: Report fever/sore throat. RAI: Radiation precautions. All: Importance of follow-up.

3. Medications for Adrenal Gland Disorders

Treat problems with corticosteroids (like cortisol) being too low (Addison’s disease) or too high (Cushing’s syndrome).

• Addison’s Disease (Too Little Cortisol):

  • Medications: Corticosteroid replacement (e.g., Hydrocortisone, Prednisone), Mineralocorticoid replacement (e.g., Fludrocortisone).

  • Uses: Lifelong replacement therapy.

  • Nursing Focus:

    • Administration: Oral (daily), IV for crisis. Often divided doses.

    • Monitoring: Monitor for effectiveness (improved energy, BP). Monitor for signs of excess hormone if dose too high. Fludrocortisone: Monitor BP, weight, potassium (risk of hypokalemia).

    • Education: Lifelong therapy. Importance of increasing dose during stress (illness, surgery) to prevent adrenal crisis. Do not stop abruptly. Medical alert bracelet.

• Cushing’s Syndrome (Too Much Cortisol):

  • Medications: Drugs that reduce cortisol production (e.g., Ketoconazole).

  • Uses: Manage symptoms when surgery isn’t an option.

  • Nursing Focus:

    • Monitoring: Monitor for reduced Cushing’s symptoms. Monitor for side effects (GI, liver).

    • Education: Purpose, side effects.

4. Medications Affecting the Pituitary Gland

Treat disorders of hormones produced by the pituitary (growth hormone, ADH, etc.).

• Growth Hormone Problems:

  • Medication: Somatropin (Growth Hormone replacement).

  • Uses: Treat growth hormone deficiency.

  • Nursing Focus:

    • Administration: Subcutaneous injection.

    • Monitoring: Monitor growth (children), IGF-1 levels. Watch for side effects (hyperglycemia).

    • Education: Injection technique.

• Diabetes Insipidus (ADH Problem):

  • Medication: Desmopressin (synthetic ADH).

  • Uses: Treat ADH deficiency (central DI) or kidney resistance to ADH (nephrogenic DI). Reduces excessive urination/thirst.

  • Nursing Focus:

    • Administration: Nasal, oral, or injectable.

    • Monitoring: Monitor fluid intake/output, serum sodium. Watch for fluid retention, hyponatremia (low sodium – headache, confusion).

    • Education: Purpose, administration, monitor for fluid overload/hyponatremia.

5. Medications Affecting Sex Hormones

Treat hormone deficiencies, contraception, hormone-sensitive cancers.

• Estrogens & Progestins:

  • Uses: Menopausal symptoms (HRT), contraception, certain cancers.

  • Nursing Focus:

    • Monitoring: Assess risk factors for blood clots. Watch for side effects (blood clots, stroke, heart attack risk with estrogen; mood changes with progestins).

    • Education: Potential side effects, signs of blood clots, importance of screenings.

• Androgens (Testosterone):

  • Uses: Treat testosterone deficiency in men.

  • Nursing Focus:

    • Administration: Various forms (injection, gel). Teach technique.

    • Monitoring: Monitor testosterone levels, hematocrit, PSA. Watch for side effects (acne, prostate changes, mood).

    • Education: Proper administration.

Key Nursing Responsibilities

• Assessment: Assess for signs/symptoms of hormone imbalance, vital signs, weight, fluid status, relevant labs.

• Administration: Correct dose, timing, route, specific instructions (empty stomach for Levothyroxine, injection technique for insulin/GH).

• Monitoring: Watch for therapeutic effect, signs of hormone excess/deficiency (dose too high/low), specific drug side effects, relevant lab tests.

• Patient Education: Critical: Purpose, dose, schedule, side effects, importance of adherence, regular follow-up/labs. Sick day rules (corticosteroids, diabetes). Lifestyle.

• Lifelong Therapy: Many are lifelong. Emphasize not stopping without provider.

• Medical Alert: Advise for certain conditions (Addison’s, insulin-dependent diabetes).