A basic understanding of the endocrine system is helpful in assessing and monitoring patients for common side effects of cancer and its treatments, Marianne Davies, DNP, ACNP, FAAN, from Yale Comprehensive Cancer Center, said during a session held at the ONS BridgeTM virtual conference on September 16, 2021. She provided attendees with a complete overview and associated disorders, emphasizing the need for nurses to be vigilant in watching for signs and symptoms in their patients.
As the body’s communication network, the endocrine system orchestrates metabolic equilibrium among the body’s organs. When the body overproduces or underproduces various hormones, results can range from uncomfortable to fatal.
The pituitary, thyroid, parathyroid, adrenals, pancreas, and gonads comprise the endocrine system, Davies explained. The pituitary gland is considered the master gland and is located at base of brain. Pituitary gland dysfunction may be caused by disease or its treatments and includes:
- Syndrome of inappropriate antidiuretic hormone secretion (SIADH), which is treated with fluid restriction, salt tablets, IV hypertonic saline, diuretics, and demeclocycline
- Diabetes insipidus, which is characterized by extreme thirst, dehydration, and excessive urination
- Hypopituitarism, which refers to a deficiency of one or more pituitary hormones
- Acromegaly, which produces hand and feet swelling, degenerative arthritis, and organ enlargement
- Pituitary tumors
- Hypophysitis, which is associated with altered mental state and decreased cardiac output; patients are managed with fluids
The thyroid gland is the largest endocrine gland and affects almost all organs. Thyroid dysfunction includes these diagnoses:
- Hyperthyroidism manifests as sweating, hyperpigmentation, pruritis and hives, vitiligo, and hair thinning, as well as eye enlargement and cardiac symptoms. Patients also can experience goiters, weight loss, insomnia, dyspnea, and neuropsychiatric symptoms.
- Hypothyroidism is associated with periorbital edema, fatigue and sluggishness, muscle weakness, weight gain, constipation, and hypertension. In patients with end-stage hypothyroidism, tissue metabolism may be reduced by half and patients are extremely lethargic and mentally sluggish, experiencing hypothermia, hypoventilation, stupor, or coma.
- Cretinism begins in children and results in severely stunted physical and mental growth.
- Thyroid cancer is often caused by external radiation.
- Hypoparathyroidism is associated with thyroid or other head and neck surgeries and manifests with seizures, constipation, muscle cramps, hyperreflexia, and other symptoms. Patients are counseled to eat a high-calcium, low-phosphate diet.
- Hyperparathyroidism is often asymptomatic and may present with weakness and constipation, abdominal pain, and depression. It can lead to renal failure. Patients should stay hydrated and eat a low-calcium and high-phosphate diet.
The adrenal gland secretes cortex and medulla hormones. With Cushing syndrome, patients have high levels of cortisol in the blood. Symptoms include central obesity, moon face, hyperhidrosis, growth of fat pads along the collarbone and back of neck, and purple or red striae on the trunk, buttocks, arms, legs, or breast. Patients can experience adrenal insufficiency, aldosteronism, and hypersecretion of catecholamine.
“Adrenal insufficiency that is unmanaged may lead to adrenal crisis. This is a life-threatening emergency,” Davies said.
The pancreas is associated with diabetes mellitus, hypoglycemia, pancreatitis, and pancreatic cancer. Symptoms of pancreatic cancer include pain in the upper abdomen, loss of appetite, weight loss, and painless jaundice.
Many endocrine disorders can affect patients with cancer either as a result of the cancer or its treatments or, in some cases, unrelated issues. Being watchful for symptoms and knowing when to raise concern is critical for oncology nurses caring for these patients.