📚🩺 Anatomy and Physiology of the Endocrine System
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ Introduction / Definition
The Endocrine System is a network of glands that produce and secrete hormones directly into the bloodstream to regulate various body functions such as growth, metabolism, reproduction, and homeostasis.
✅ “The endocrine system maintains internal balance and coordinates long-term biological processes through hormone secretion.”
📚🩺 Hypothalamus
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
The Hypothalamus is a vital part of the brain located below the thalamus and above the pituitary gland. It plays a critical role in maintaining homeostasis by controlling the endocrine system, autonomic nervous system, and many physiological functions.
✅ “The hypothalamus acts as a master regulator of endocrine functions, linking the nervous system with the endocrine system via the pituitary gland.”
📖 II. Location and Anatomy
📖 III. Functions of the Hypothalamus
| Function | Description |
| Endocrine Control | Regulates the pituitary gland by secreting releasing and inhibiting hormones. |
| Thermoregulation | Maintains body temperature (Heat loss and heat gain centers). |
| Hunger and Satiety | Controls food intake through the lateral (hunger) and ventromedial (satiety) centers. |
| Water Balance | Regulates thirst and antidiuretic hormone (ADH) secretion. |
| Sleep-Wake Cycle | Controls circadian rhythms via connections with the pineal gland. |
| Emotional Response | Regulates emotions such as fear, pleasure, and anger through the limbic system. |
| Autonomic Control | Regulates heart rate, blood pressure, and digestive activities. |
📖 IV. Hormones Secreted by Hypothalamus
| Hormone | Target Gland | Function |
| CRH (Corticotropin-Releasing Hormone) | Anterior Pituitary | Stimulates ACTH secretion. |
| TRH (Thyrotropin-Releasing Hormone) | Anterior Pituitary | Stimulates TSH secretion. |
| GnRH (Gonadotropin-Releasing Hormone) | Anterior Pituitary | Stimulates LH and FSH secretion. |
| GHRH (Growth Hormone-Releasing Hormone) | Anterior Pituitary | Stimulates GH secretion. |
| Somatostatin (GHIH) | Anterior Pituitary | Inhibits GH and TSH secretion. |
| Dopamine (Prolactin-Inhibiting Hormone) | Anterior Pituitary | Inhibits Prolactin secretion. |
| ADH (Vasopressin) | Posterior Pituitary (Storage) | Controls water balance, increases water reabsorption in kidneys. |
| Oxytocin | Posterior Pituitary (Storage) | Stimulates uterine contractions and milk ejection. |
📖 V. Clinical Significance
| Disorder | Effect |
| Hypothalamic Tumors | Endocrine dysfunction, visual disturbances. |
| Kallmann Syndrome | Deficiency of GnRH leading to delayed puberty. |
| Diabetes Insipidus | ADH deficiency causing polyuria and polydipsia. |
| Obesity | Lesions affecting the satiety center. |
| Sleep Disorders | Disruption in circadian rhythm regulation. |
📖 VI. Nurse’s Role
📚 Golden One-Liners for Quick Revision:
✅ Top 5 MCQs for Practice
Q1. Which hormone from the hypothalamus stimulates the release of ACTH?
🅰️ TRH
🅱️ GnRH
✅ 🅲️ CRH
🅳️ GHRH
Q2. Which part of the hypothalamus controls the hunger center?
🅰️ Ventromedial Nucleus
✅ 🅱️ Lateral Hypothalamus
🅲️ Suprachiasmatic Nucleus
🅳️ Paraventricular Nucleus
Q3. Which hormone secreted by the hypothalamus inhibits prolactin release?
🅰️ GHRH
🅱️ CRH
✅ 🅲️ Dopamine
🅳️ TRH
Q4. Diabetes Insipidus results from a deficiency of which hormone?
🅰️ Insulin
🅱️ Cortisol
✅ 🅲️ ADH (Vasopressin)
🅳️ Oxytocin
Q5. Which function is associated with the suprachiasmatic nucleus of the hypothalamus?
🅰️ Hunger Regulation
🅱️ Emotion Control
✅ 🅲️ Circadian Rhythm Regulation
🅳️ Thirst Regulation
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
The Pituitary Gland, often called the “Master Gland”, is a small, pea-sized endocrine gland responsible for regulating the function of other endocrine glands by releasing various hormones. It plays a central role in maintaining homeostasis, growth, metabolism, and reproduction.
✅ “The pituitary gland controls multiple endocrine functions by secreting stimulating hormones that regulate other glands in the body.”
| Hormone | Target Gland/Organ | Function |
| GH (Growth Hormone) | Bones, Muscles | Stimulates growth and metabolism. |
| TSH (Thyroid-Stimulating Hormone) | Thyroid Gland | Stimulates thyroid hormone production. |
| ACTH (Adrenocorticotropic Hormone) | Adrenal Cortex | Stimulates cortisol production. |
| LH (Luteinizing Hormone) | Gonads | Stimulates ovulation and testosterone production. |
| FSH (Follicle-Stimulating Hormone) | Gonads | Stimulates follicle development and spermatogenesis. |
| PRL (Prolactin) | Mammary Glands | Stimulates milk production. |
| Hormone | Function |
| ADH (Antidiuretic Hormone / Vasopressin) | Regulates water balance by promoting water reabsorption in kidneys. |
| Oxytocin | Stimulates uterine contractions during labor and milk ejection during breastfeeding. |
| Disorder | Effect |
| Hypopituitarism | Decreased secretion of one or more pituitary hormones. |
| Hyperpituitarism | Excessive hormone secretion, often due to pituitary adenomas. |
| Gigantism (Before puberty) | Excess GH → Excessive height and growth. |
| Acromegaly (After puberty) | Excess GH → Enlarged hands, feet, facial features. |
| Diabetes Insipidus | ADH deficiency → Polyuria and polydipsia. |
| Syndrome of Inappropriate ADH (SIADH) | Excess ADH → Fluid retention and hyponatremia. |
Q1. Which hormone is secreted by the anterior pituitary to stimulate the adrenal cortex?
🅰️ TSH
🅱️ FSH
✅ 🅲️ ACTH
🅳️ GH
Q2. What is the primary function of Antidiuretic Hormone (ADH)?
🅰️ Increase blood glucose levels
🅱️ Promote urine excretion
✅ 🅲️ Regulate water balance by reducing urine output
🅳️ Stimulate milk production
Q3. Which disorder is caused by excessive Growth Hormone secretion in adults?
🅰️ Gigantism
🅱️ Dwarfism
✅ 🅲️ Acromegaly
🅳️ Addison’s Disease
Q4. Which surgery is commonly performed for pituitary tumors?
🅰️ Craniotomy
✅ 🅱️ Transsphenoidal Hypophysectomy
🅲️ Thyroidectomy
🅳️ Parathyroidectomy
Q5. Which hormone is responsible for stimulating milk ejection during breastfeeding?
🅰️ Prolactin
🅱️ GH
🅲️ ADH
✅ 🅳️ Oxytocin
📚🩺 Thyroid Gland
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
The Thyroid Gland is a butterfly-shaped endocrine gland located in the front of the neck, responsible for producing hormones that regulate metabolism, growth, and development. It plays a crucial role in maintaining body temperature, heart rate, and energy levels.
✅ “The thyroid gland controls the body’s metabolic rate through the secretion of thyroid hormones (T3 and T4).”
📖 II. Location and Anatomy
📖 III. Hormones Secreted by the Thyroid Gland
| Hormone | Function |
| T3 (Triiodothyronine) | Regulates metabolism, increases oxygen consumption and energy production. |
| T4 (Thyroxine) | Converted to T3 in peripheral tissues; regulates metabolism. |
| Calcitonin | Lowers blood calcium levels by inhibiting bone resorption. |
📖 IV. Regulation of Thyroid Hormone Secretion
📖 V. Functions of the Thyroid Gland
| Body System | Effects |
| Metabolism | Increases basal metabolic rate, energy production. |
| Cardiovascular | Increases heart rate and cardiac output. |
| Growth and Development | Essential for physical and mental growth, especially in children. |
| Thermoregulation | Maintains body temperature. |
| Calcium Homeostasis | Calcitonin regulates calcium levels by inhibiting bone resorption. |
📖 VI. Clinical Significance
| Disorder | Description |
| Goiter | Enlargement of the thyroid gland. |
| Hypothyroidism | Decreased thyroid hormone production (e.g., Hashimoto’s Thyroiditis). |
| Hyperthyroidism | Excess thyroid hormone production (e.g., Graves’ Disease). |
| Thyroid Nodules | Lumps in the thyroid; may be benign or malignant. |
| Thyroid Cancer | Malignancy of the thyroid gland. |
📖 VII. Diagnostic Evaluation
| Test | Purpose |
| Serum TSH | Primary screening test. |
| Free T3 and T4 Levels | Assess thyroid hormone levels. |
| Thyroid Antibodies | Check for autoimmune thyroid disorders. |
| Ultrasound of Thyroid | Detects nodules and enlargement. |
| Thyroid Scan (Radioactive Iodine Uptake Test) | Assesses functional activity of the gland. |
| Fine Needle Aspiration Biopsy (FNAB) | For evaluating thyroid nodules. |
📖 VIII. Nurse’s Role
📚 Golden One-Liners for Quick Revision:
✅ Top 5 MCQs for Practice
Q1. Which hormone regulates the production of thyroid hormones?
🅰️ ACTH
🅱️ GH
✅ 🅲️ TSH
🅳️ FSH
Q2. Which mineral is essential for thyroid hormone synthesis?
🅰️ Calcium
🅱️ Magnesium
🅲️ Iron
✅ 🅳️ Iodine
Q3. What is the most common cause of hyperthyroidism?
🅰️ Hashimoto’s Thyroiditis
🅱️ Thyroid Cancer
✅ 🅲️ Graves’ Disease
🅳️ Iodine Deficiency
Q4. Which hormone lowers blood calcium levels?
🅰️ Parathyroid Hormone
🅱️ Calcitonin
🅲️ Aldosterone
🅳️ Cortisol
Q5. Which test is used to assess the functional activity of the thyroid gland?
🅰️ Ultrasound
🅱️ ECG
✅ 🅲️ Radioactive Iodine Uptake Test
🅳️ Chest X-ray
📚🩺 Parathyroid Gland
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
The Parathyroid Glands are small, pea-shaped endocrine glands located on the posterior surface of the thyroid gland. Their primary function is to regulate calcium and phosphorus balance in the body by secreting Parathyroid Hormone (PTH).
✅ “The parathyroid glands maintain calcium homeostasis by regulating calcium and phosphate levels in the blood through the action of parathyroid hormone (PTH).”
📖 II. Location and Anatomy
📖 III. Hormone Secreted by Parathyroid Gland
| Hormone | Function |
| Parathyroid Hormone (PTH) |
📖 IV. Regulation of PTH Secretion
📖 V. Functions of Parathyroid Gland
| System | Effect |
| Skeletal System | Regulates calcium release from bones. |
| Renal System | Enhances calcium reabsorption and promotes phosphate excretion. |
| Gastrointestinal | Increases intestinal calcium absorption by activating Vitamin D. |
| Overall Effect | Maintains normal blood calcium levels essential for nerve transmission, muscle contraction, and blood clotting. |
📖 VI. Clinical Significance
| Disorder | Description |
| Hyperparathyroidism | Excess PTH secretion → Hypercalcemia, bone demineralization, kidney stones. |
| Hypoparathyroidism | Deficient PTH secretion → Hypocalcemia, muscle cramps, tetany. |
| Parathyroid Adenoma | Common cause of primary hyperparathyroidism. |
| Pseudohypoparathyroidism | Tissue resistance to PTH despite normal or high levels of hormone. |
📖 VII. Diagnostic Evaluation
| Test | Findings |
| Serum Calcium | Elevated in hyperparathyroidism, low in hypoparathyroidism. |
| Serum PTH Levels | Elevated in hyperparathyroidism, low in hypoparathyroidism. |
| Serum Phosphate | Low in hyperparathyroidism, high in hypoparathyroidism. |
| Bone Density Scan (DEXA) | Detects bone loss in hyperparathyroidism. |
| Ultrasound/CT Scan | Identifies parathyroid adenomas. |
📖 VIII. Nurse’s Role
📚 Golden One-Liners for Quick Revision:
✅ Top 5 MCQs for Practice
Q1. Which hormone is secreted by the parathyroid gland?
🅰️ Calcitonin
✅ 🅱️ Parathyroid Hormone (PTH)
🅲️ Thyroxine
🅳️ Insulin
Q2. What is the primary action of Parathyroid Hormone?
🅰️ Lowers blood calcium levels.
✅ 🅱️ Increases blood calcium levels.
🅲️ Increases phosphate levels.
🅳️ Lowers potassium levels.
Q3. Which clinical sign indicates hypocalcemia?
🅰️ Babinski’s Sign
🅱️ Hoffman’s Sign
✅ 🅲️ Chvostek’s and Trousseau’s Signs
🅳️ Romberg’s Sign
Q4. What is the most common cause of primary hyperparathyroidism?
🅰️ Thyroid Tumor
✅ 🅱️ Parathyroid Adenoma
🅲️ Hypocalcemia
🅳️ Pituitary Adenoma
Q5. Which vitamin’s activation is influenced by PTH to promote calcium absorption?
🅰️ Vitamin A
🅱️ Vitamin C
✅ 🅲️ Vitamin D
🅳️ Vitamin K
📚🩺 Pancreas
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
The Pancreas is a dual-function gland, acting as both an endocrine and exocrine organ. Its endocrine function is critical for maintaining blood glucose levels through the secretion of hormones.
✅ “The pancreas regulates blood glucose homeostasis through endocrine hormone secretion from the Islets of Langerhans.”
📖 II. Location and Anatomy
📖 III. Hormones Secreted by the Endocrine Pancreas
| Hormone | Cell Type | Primary Function |
| Insulin | Beta Cells | Lowers blood glucose by promoting cellular uptake of glucose; stimulates glycogenesis. |
| Glucagon | Alpha Cells | Increases blood glucose by stimulating glycogenolysis and gluconeogenesis. |
| Somatostatin | Delta Cells | Inhibits secretion of insulin, glucagon, and other digestive hormones; regulates the endocrine system. |
| Pancreatic Polypeptide | PP Cells | Regulates pancreatic secretions and gastrointestinal motility. |
📖 IV. Regulation of Hormone Secretion
📖 V. Functions of Endocrine Pancreas
| Hormone | Effect on Glucose Metabolism |
| Insulin | Promotes glucose storage as glycogen, facilitates cellular uptake of glucose, promotes fat and protein synthesis. |
| Glucagon | Stimulates the liver to break down glycogen into glucose, increases blood glucose during fasting or hypoglycemia. |
| Somatostatin | Balances the secretion of insulin and glucagon, prevents excessive hormone release. |
📖 VI. Clinical Significance
| Disorder | Description |
| Diabetes Mellitus Type 1 | Autoimmune destruction of β-cells → Absolute insulin deficiency. |
| Diabetes Mellitus Type 2 | Insulin resistance with relative insulin deficiency. |
| Hyperinsulinism | Excess insulin → Hypoglycemia. |
| Pancreatic Tumors (Insulinoma, Glucagonoma) | Tumors affecting hormone secretion. |
📖 VII. Diagnostic Evaluation
| Test | Purpose |
| Fasting Blood Sugar (FBS) | Evaluates baseline glucose levels. |
| Random Blood Sugar (RBS) | Checks glucose at any time. |
| Oral Glucose Tolerance Test (OGTT) | Assesses glucose metabolism. |
| HbA1c (Glycated Hemoglobin) | Assesses long-term glucose control. |
| Serum Insulin and C-Peptide Levels | Assess insulin production. |
📖 VIII. Nurse’s Role
📚 Golden One-Liners for Quick Revision:
✅ Top 5 MCQs for Practice
Q1. Which hormone is responsible for lowering blood glucose levels?
🅰️ Glucagon
🅱️ Cortisol
✅ 🅲️ Insulin
🅳️ Epinephrine
Q2. Which cells of the pancreas secrete insulin?
🅰️ Alpha Cells
✅ 🅱️ Beta Cells
🅲️ Delta Cells
🅳️ PP Cells
Q3. What is the main function of glucagon?
🅰️ Decrease blood glucose levels.
✅ 🅱️ Increase blood glucose levels.
🅲️ Promote glycogenesis.
🅳️ Stimulate insulin secretion.
Q4. Which test assesses long-term blood glucose control?
🅰️ Fasting Blood Sugar
🅱️ Random Blood Sugar
🅲️ OGTT
✅ 🅳️ HbA1c
Q5. Which hormone inhibits the release of both insulin and glucagon?
🅰️ Insulin
🅱️ Glucagon
✅ 🅲️ Somatostatin
🅳️ Cortisol
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
The Adrenal Glands are small, triangular endocrine glands located on the top of each kidney. They play a vital role in regulating metabolism, blood pressure, stress response, fluid-electrolyte balance, and sexual function through the secretion of essential hormones.
✅ “The adrenal glands secrete life-sustaining hormones that help the body respond to stress, maintain blood pressure, and regulate metabolism and electrolyte balance.”
Divided into three zones:
| Zone | Hormones | Function |
| Zona Glomerulosa | Aldosterone | Regulates sodium and water balance; increases blood pressure (RAAS system). |
| Zona Fasciculata | Cortisol (Glucocorticoid) | Controls metabolism, suppresses inflammation, and manages stress response. |
| Zona Reticularis | Androgens (Sex hormones) | Contribute to secondary sex characteristics. |
| Hormones | Function |
| Epinephrine (Adrenaline) | Activates fight or flight response; increases heart rate, blood pressure, and energy levels. |
| Norepinephrine (Noradrenaline) | Vasoconstriction; increases blood pressure. |
| Hormone | Regulatory Mechanism |
| Cortisol | Controlled by the Hypothalamic-Pituitary-Adrenal (HPA) Axis via ACTH. |
| Aldosterone | Controlled by the Renin-Angiotensin-Aldosterone System (RAAS). |
| Catecholamines | Controlled by the Sympathetic Nervous System during stress. |
| System | Function |
| Metabolism | Cortisol regulates glucose metabolism and energy production. |
| Cardiovascular | Aldosterone maintains blood pressure through sodium and water retention. |
| Immune System | Cortisol suppresses inflammation and immune responses. |
| Stress Response | Epinephrine and norepinephrine prepare the body for “fight or flight”. |
| Electrolyte Balance | Aldosterone regulates sodium and potassium levels. |
| Disorder | Description |
| Addison’s Disease | Cortisol and aldosterone deficiency (Primary Adrenal Insufficiency). |
| Cushing’s Syndrome | Excess cortisol production. |
| Hyperaldosteronism (Conn’s Syndrome) | Excess aldosterone causing hypertension and hypokalemia. |
| Pheochromocytoma | Tumor of the adrenal medulla leading to excessive catecholamine secretion. |
| Adrenal Crisis | Acute life-threatening adrenal insufficiency. |
| Test | Purpose |
| Serum Cortisol & ACTH | Assess adrenal cortex function. |
| Aldosterone and Renin Levels | Evaluate RAAS function. |
| 24-Hour Urinary Catecholamines (VMA, Metanephrines) | Diagnose Pheochromocytoma. |
| Dexamethasone Suppression Test | Diagnose Cushing’s Syndrome. |
| Imaging (CT/MRI Abdomen) | Detect adrenal tumors or hyperplasia. |
Q1. Which hormone is produced by the adrenal medulla?
🅰️ Cortisol
🅱️ Aldosterone
✅ 🅲️ Epinephrine
🅳️ Androgens
Q2. Which hormone helps regulate sodium and potassium balance?
🅰️ Cortisol
🅱️ Epinephrine
✅ 🅲️ Aldosterone
🅳️ Insulin
Q3. Which of the following is a primary function of cortisol?
🅰️ Decrease blood glucose levels
🅱️ Stimulate milk production
✅ 🅲️ Increase blood glucose levels and suppress inflammation
🅳️ Promote sodium excretion
Q4. Which disorder is characterized by excessive secretion of catecholamines?
🅰️ Addison’s Disease
🅱️ Cushing’s Syndrome
✅ 🅲️ Pheochromocytoma
🅳️ Conn’s Syndrome
Q5. Which test is used to diagnose Cushing’s Syndrome?
🅰️ ACTH Stimulation Test
✅ 🅱️ Dexamethasone Suppression Test
🅲️ Renin-Aldosterone Test
🅳️ Water Deprivation Test
📚🩺 Diagnostic Tests of the Endocrine System
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
Endocrine Diagnostic Tests are specialized investigations used to assess the function of various endocrine glands by evaluating hormone levels, glandular structure, and feedback mechanisms.
✅ “These tests help diagnose hormonal imbalances, glandular dysfunctions, and endocrine tumors by measuring hormone concentrations and imaging gland structures.”
📖 II. Common Blood Tests
| Test Name | Purpose |
| Serum TSH | Evaluates thyroid function. |
| Free T3 and T4 | Assesses active thyroid hormones. |
| Serum Cortisol | Checks adrenal cortex function. |
| ACTH Levels | Assesses pituitary-adrenal axis. |
| Serum Insulin & C-Peptide | Evaluates pancreatic beta-cell function. |
| Plasma Catecholamines (Epinephrine, Norepinephrine) | Assesses adrenal medulla function (Pheochromocytoma). |
| Parathyroid Hormone (PTH) | Evaluates calcium and phosphate balance. |
| Sex Hormones (Estrogen, Progesterone, Testosterone) | Assesses gonadal function. |
| Growth Hormone (GH) & IGF-1 | Evaluates growth hormone activity. |
📖 III. Urine Tests
| Test Name | Purpose |
| 24-Hour Urinary Free Cortisol | Confirms Cushing’s Syndrome. |
| 24-Hour Urinary Catecholamines & Metanephrines (VMA, HVA) | Diagnoses Pheochromocytoma and Neuroblastoma. |
| Urinary 5-HIAA | Screens for carcinoid tumors. |
📖 IV. Hormonal Suppression and Stimulation Tests
| Test Name | Purpose |
| Dexamethasone Suppression Test | Diagnoses Cushing’s Syndrome. |
| ACTH Stimulation Test | Diagnoses Addison’s Disease. |
| TRH Stimulation Test | Evaluates pituitary response in thyroid disorders. |
| GnRH Stimulation Test | Evaluates pituitary function for LH and FSH release. |
| Glucose Tolerance Test (OGTT) | Assesses insulin response and diabetes mellitus. |
📖 V. Imaging Studies
| Test Name | Purpose |
| Ultrasound (Thyroid/Parathyroid) | Detects gland enlargement, nodules, or cysts. |
| CT/MRI of Adrenal/Pituitary Glands | Evaluates tumors or structural abnormalities. |
| MIBG Scintigraphy | Detects Pheochromocytoma and Neuroblastoma. |
| PET Scan | Detects malignant endocrine tumors. |
| DEXA Scan | Measures bone density, evaluates osteoporosis (related to endocrine disorders like hyperparathyroidism). |
📖 VI. Special Investigations
| Test Name | Purpose |
| Fine Needle Aspiration Biopsy (FNAB) | Diagnoses thyroid nodules and malignancy. |
| Water Deprivation Test | Confirms Diabetes Insipidus. |
| Radioactive Iodine Uptake (RAIU) Test | Evaluates thyroid function and differentiates hyperthyroidism causes. |
📖 VII. Nurse’s Role in Endocrine Diagnostic Tests
📚 Golden One-Liners for Quick Revision:
✅ Top 5 MCQs for Practice
Q1. Which test is used to evaluate long-term glucose control?
🅰️ Fasting Blood Sugar
🅱️ Random Blood Sugar
✅ 🅲️ HbA1c
🅳️ OGTT
Q2. What is the confirmatory test for Addison’s Disease?
🅰️ Dexamethasone Suppression Test
✅ 🅱️ ACTH Stimulation Test
🅲️ Water Deprivation Test
🅳️ TRH Stimulation Test
Q3. Which imaging study is commonly used to detect adrenal tumors?
🅰️ Ultrasound
🅱️ X-ray
✅ 🅲️ CT/MRI
🅳️ ECG
Q4. Which test helps differentiate causes of hyperthyroidism?
🅰️ ACTH Stimulation Test
🅱️ OGTT
✅ 🅲️ Radioactive Iodine Uptake Test
🅳️ DEXA Scan
Q5. Which test is used to confirm Diabetes Insipidus?
🅰️ OGTT
✅ 🅱️ Water Deprivation Test
🅲️ Dexamethasone Suppression Test
🅳️ ACTH Stimulation Test
📚🩺 Disorders of Endocrine System
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ Introduction / Definition
The Endocrine System comprises glands that produce and secrete hormones regulating metabolism, growth, reproduction, mood, and homeostasis. Endocrine disorders occur due to overproduction (hyperfunction), underproduction (hypofunction), or improper functioning of hormones.
✅ “Endocrine disorders are dysfunctions of hormone-producing glands, leading to hormonal imbalances affecting body systems.”
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
Hyperpituitarism is a condition characterized by excessive secretion of one or more hormones from the anterior pituitary gland, usually due to a pituitary adenoma (benign tumor). This hormonal overproduction leads to a range of systemic effects depending on which hormone is elevated.
✅ “Hyperpituitarism results from overactivity of the anterior pituitary, causing excessive hormone production and systemic manifestations.”
| Type | Excess Hormone | Associated Condition |
| Somatotroph Adenoma | Growth Hormone (GH) | Acromegaly (Adults), Gigantism (Children). |
| Corticotroph Adenoma | ACTH | Cushing’s Disease. |
| Lactotroph Adenoma | Prolactin | Hyperprolactinemia (Galactorrhea, Amenorrhea). |
| Thyrotroph Adenoma | TSH | Secondary Hyperthyroidism. |
| Hormone Excess | Signs & Symptoms |
| GH (Acromegaly) | Enlarged hands, feet, facial bones, coarsened features, joint pain, diabetes. |
| ACTH (Cushing’s Disease) | Moon face, buffalo hump, central obesity, muscle weakness, hypertension, hyperglycemia. |
| Prolactin | Galactorrhea, Amenorrhea, Infertility, Erectile Dysfunction. |
| TSH | Symptoms of Hyperthyroidism (Weight loss, Tachycardia, Heat Intolerance). |
| Test | Purpose |
| Hormone Level Tests | GH, ACTH, Prolactin, TSH. |
| Glucose Suppression Test | GH suppression failure confirms Acromegaly. |
| MRI of Pituitary | Detects pituitary adenomas. |
| Visual Field Test | Check for optic chiasm compression by tumors. |
Q1. Which hormone is overproduced in Acromegaly?
🅰️ Prolactin
🅱️ TSH
✅ 🅲️ Growth Hormone (GH)
🅳️ ACTH
Q2. What is the preferred surgical approach for pituitary adenomas?
🅰️ Craniotomy
✅ 🅱️ Transsphenoidal Hypophysectomy
🅲️ Laparotomy
🅳️ Burr Hole Surgery
Q3. Which drug is commonly used to treat prolactin-secreting tumors?
🅰️ Octreotide
✅ 🅱️ Bromocriptine
🅲️ Prednisolone
🅳️ Insulin
Q4. Which of the following is a clinical feature of Cushing’s Disease?
🅰️ Hypoglycemia
🅱️ Hypotension
✅ 🅲️ Buffalo Hump and Moon Face
🅳️ Weight Loss
Q5. Failure of GH suppression during the glucose suppression test indicates:
🅰️ Hypopituitarism
✅ 🅱️ Acromegaly
🅲️ Addison’s Disease
🅳️ Hyperthyroidism
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
Gigantism is a rare endocrine disorder characterized by excessive growth and abnormally increased height and size due to overproduction of Growth Hormone (GH) before the closure of epiphyseal growth plates (in children and adolescents).
✅ “Gigantism results from hypersecretion of Growth Hormone during childhood, leading to abnormal linear growth.”
| Type | Description |
| Pituitary Gigantism | Caused by pituitary adenoma (most common). |
| Genetic Gigantism | Due to genetic mutations (e.g., Sotos syndrome). |
| Idiopathic Gigantism | Cause remains unknown. |
| Test | Purpose |
| Serum GH Levels | Elevated GH indicates hypersecretion. |
| IGF-1 Levels | Elevated levels confirm excessive GH activity. |
| Glucose Suppression Test | GH does not suppress after glucose load (Diagnostic of GH excess). |
| MRI of Pituitary Gland | To detect pituitary tumors. |
| Visual Field Examination | To assess optic nerve compression. |
Q1. Gigantism is caused by excessive secretion of which hormone?
🅰️ Prolactin
🅱️ TSH
✅ 🅲️ Growth Hormone
🅳️ ACTH
Q2. What is the most common cause of Gigantism?
🅰️ Hypothyroidism
🅱️ Genetic Mutation
✅ 🅲️ Pituitary Adenoma
🅳️ Adrenal Hyperplasia
Q3. Which medication is used to suppress Growth Hormone in Gigantism?
🅰️ Levothyroxine
🅱️ Hydrocortisone
✅ 🅲️ Octreotide
🅳️ Insulin
Q4. What is the preferred surgical procedure for pituitary adenoma removal?
🅰️ Craniotomy
🅱️ Burr Hole Surgery
✅ 🅲️ Transsphenoidal Hypophysectomy
🅳️ Laminectomy
Q5. Which of the following is a complication of untreated Gigantism?
🅰️ Hypoglycemia
🅱️ Visual Impairment
🅲️ Short Stature
✅ 🅳️ Both B and D (Visual Impairment and Heart Failure)
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
Acromegaly is a chronic endocrine disorder caused by excessive secretion of Growth Hormone (GH) after the closure of epiphyseal growth plates in adulthood, leading to abnormal enlargement of soft tissues, bones of the hands, feet, and facial features.
✅ “Acromegaly is characterized by progressive somatic disfigurement, organomegaly, and metabolic disturbances due to GH hypersecretion in adults.”
| Type | Cause |
| Primary Acromegaly | Pituitary Adenoma (Most Common). |
| Secondary Acromegaly | Hypothalamic disorders increasing GHRH. |
| Ectopic Acromegaly | GH or GHRH-secreting tumors outside pituitary (Rare). |
| Feature | Symptoms |
| Musculoskeletal | Enlarged hands, feet, coarsened facial features, prognathism (enlarged jaw), arthralgia. |
| Cardiovascular | Hypertension, Cardiomegaly, Heart Failure. |
| Metabolic | Insulin Resistance, Diabetes Mellitus. |
| Neurological | Headache, Visual Field Defects (Bitemporal Hemianopia). |
| Respiratory | Sleep Apnea due to soft tissue overgrowth. |
| Reproductive | Menstrual Irregularities, Decreased Libido, Erectile Dysfunction. |
| Test | Purpose |
| Serum IGF-1 Levels | Elevated in acromegaly. |
| Oral Glucose Tolerance Test (OGTT) | Failure of GH suppression after glucose confirms diagnosis. |
| MRI of Pituitary | Detects pituitary adenoma. |
| Visual Field Testing | Checks for optic chiasm compression. |
Q1. What is the most common cause of Acromegaly?
🅰️ Hypothalamic Tumor
✅ 🅱️ Pituitary Adenoma
🅲️ Thyroid Tumor
🅳️ Adrenal Hyperplasia
Q2. Which drug is primarily used to suppress GH secretion in Acromegaly?
🅰️ Bromocriptine
🅱️ Hydrocortisone
✅ 🅲️ Octreotide
🅳️ Insulin
Q3. Which diagnostic test is most reliable for confirming Acromegaly?
🅰️ Fasting Blood Sugar
🅱️ Serum Calcium
✅ 🅲️ Oral Glucose Tolerance Test (OGTT)
🅳️ ECG
Q4. What is a common complication of untreated Acromegaly?
🅰️ Hypoglycemia
🅱️ Weight Loss
✅ 🅲️ Cardiomegaly and Heart Failure
🅳️ Hypercalcemia
Q5. Which surgical approach is preferred for pituitary adenoma removal in Acromegaly?
🅰️ Craniotomy
🅱️ Burr Hole Surgery
✅ 🅲️ Transsphenoidal Hypophysectomy
🅳️ Laminectomy
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
Hypopituitarism is a clinical condition characterized by deficiency of one or more hormones produced by the anterior or posterior pituitary gland. It may be partial or complete and can affect various endocrine glands leading to multi-system disorders.
✅ “Hypopituitarism results from impaired pituitary hormone production, affecting growth, metabolism, reproduction, and homeostasis.”
| Type | Description |
| Partial Hypopituitarism | Deficiency of one or few hormones. |
| Panhypopituitarism | Complete loss of pituitary hormone production. |
| Based on Hormone Deficiency |
| GH Deficiency – Affects growth and metabolism.
| ACTH Deficiency – Affects adrenal cortex (Secondary Adrenal Insufficiency).
| TSH Deficiency – Leads to Secondary Hypothyroidism.
| Gonadotropin Deficiency (LH, FSH) – Infertility, delayed puberty.
| ADH Deficiency – Diabetes Insipidus.
| Category | Examples |
| Congenital | Genetic mutations, Pituitary Hypoplasia. |
| Acquired | Pituitary Tumors (Adenomas), Trauma, Surgery, Radiation. |
| Infections | Meningitis, Tuberculosis. |
| Vascular | Sheehan’s Syndrome (Postpartum pituitary necrosis). |
| Autoimmune | Lymphocytic Hypophysitis. |
| Hormone Deficiency | Signs & Symptoms |
| GH Deficiency | Short stature in children, Fatigue, Poor muscle mass in adults. |
| ACTH Deficiency | Hypotension, Weakness, Hypoglycemia. |
| TSH Deficiency | Weight gain, Cold intolerance, Constipation. |
| LH/FSH Deficiency | Amenorrhea, Infertility, Loss of libido. |
| ADH Deficiency | Polyuria, Polydipsia (Diabetes Insipidus). |
| Test | Purpose |
| Hormonal Assays | Measure levels of GH, ACTH, TSH, LH, FSH, ADH. |
| Stimulation Tests | Insulin Tolerance Test (for GH, ACTH). |
| MRI of Pituitary | Detects tumors or structural defects. |
| Visual Field Tests | Assess optic chiasm compression by pituitary mass. |
| Hormone Replacement Therapy | Medications |
| Cortisol Replacement | Hydrocortisone, Prednisolone. |
| Thyroid Hormone Replacement | Levothyroxine. |
| Sex Hormone Replacement | Estrogen, Progesterone, Testosterone. |
| GH Therapy (Children) | Recombinant GH Injections. |
| Desmopressin (DDAVP) | For ADH Deficiency (Diabetes Insipidus). |
Q1. What is the most common cause of acquired hypopituitarism?
🅰️ Genetic Mutation
✅ 🅱️ Pituitary Tumors
🅲️ Autoimmune Disorders
🅳️ Headache
Q2. Which of the following is a sign of GH deficiency in children?
🅰️ Gigantism
✅ 🅱️ Dwarfism
🅲️ Acromegaly
🅳️ Precocious Puberty
Q3. Sheehan’s Syndrome is associated with which condition?
🅰️ Hyperpituitarism
🅱️ Diabetes Insipidus
✅ 🅲️ Postpartum Hypopituitarism
🅳️ Hyperthyroidism
Q4. Which hormone replacement is essential to prevent adrenal crisis in hypopituitarism?
🅰️ Levothyroxine
✅ 🅱️ Hydrocortisone
🅲️ Desmopressin
🅳️ Growth Hormone
Q5. Which drug is used for managing Diabetes Insipidus in hypopituitarism?
🅰️ Hydrocortisone
🅱️ Levothyroxine
✅ 🅲️ Desmopressin (DDAVP)
🅳️ Bromocriptine
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
Diabetes Insipidus (DI) is a disorder characterized by excessive thirst (polydipsia) and the excretion of large volumes of dilute urine (polyuria) due to deficiency of Antidiuretic Hormone (ADH) or renal insensitivity to ADH.
✅ “Diabetes Insipidus is a water balance disorder resulting from inadequate ADH action, leading to polyuria and polydipsia without hyperglycemia.”
| Type | Cause |
| Central (Neurogenic) DI | ADH deficiency due to pituitary or hypothalamic damage. |
| Nephrogenic DI | Renal tubules unresponsive to ADH. |
| Dipsogenic DI | Excessive fluid intake due to mental health disorders. |
| Gestational DI | Increased metabolism of ADH during pregnancy. |
| Type | Common Causes |
| Central DI | Head Injury, Brain Tumors, Pituitary Surgery, Meningitis, Sheehan’s Syndrome. |
| Nephrogenic DI | Genetic Disorders, Chronic Kidney Disease, Lithium Toxicity, Hypercalcemia. |
| Gestational DI | Placental enzymes degrading ADH. |
| Dipsogenic DI | Psychogenic polydipsia. |
| Symptoms | Features |
| Urinary Symptoms | Polyuria (3-20 liters/day), Nocturia. |
| Thirst | Extreme Polydipsia (Prefers cold water). |
| Dehydration Signs | Dry mucous membranes, Hypotension, Tachycardia. |
| Neurological | Lethargy, Confusion, Seizures (if severe hypernatremia). |
| Test | Purpose |
| Water Deprivation Test | Differentiates between types of DI. |
| Desmopressin (DDAVP) Test | Response confirms Central DI. |
| Serum Electrolytes | Elevated Sodium (Hypernatremia). |
| Urine Specific Gravity | Low (<1.005), Indicates dilute urine. |
| MRI Brain | Identifies pituitary or hypothalamic lesions. |
| Type of DI | Treatment |
| Central DI | Desmopressin (DDAVP) – Nasal, Oral, or IV. |
| Nephrogenic DI | Thiazide Diuretics, Low Sodium Diet, NSAIDs (Indomethacin). |
| Gestational DI | Desmopressin (Safe in Pregnancy). |
Q1. Which hormone deficiency leads to Diabetes Insipidus?
🅰️ Insulin
🅱️ Aldosterone
✅ 🅲️ Antidiuretic Hormone (ADH)
🅳️ Cortisol
Q2. Which drug is used in the treatment of Central Diabetes Insipidus?
🅰️ Furosemide
🅱️ Prednisolone
✅ 🅲️ Desmopressin (DDAVP)
🅳️ Bromocriptine
Q3. Which of the following is a typical sign of Diabetes Insipidus?
🅰️ Oliguria
🅱️ Hyperkalemia
✅ 🅲️ Polyuria and Polydipsia
🅳️ Weight Gain
Q4. What is the expected urine specific gravity in a patient with DI?
🅰️ 1.025
🅱️ 1.015
✅ 🅲️ <1.005
🅳️ >1.030
Q5. Which electrolyte disturbance is commonly seen in untreated Diabetes Insipidus?
🅰️ Hyponatremia
🅱️ Hypokalemia
✅ 🅲️ Hypernatremia
🅳️ Hypocalcemia
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
SIADH is a disorder characterized by excessive release of Antidiuretic Hormone (ADH) despite normal or low plasma osmolality, leading to water retention, dilutional hyponatremia, and concentrated urine output.
✅ “SIADH results in water intoxication and hyponatremia due to inappropriate ADH secretion causing fluid retention and electrolyte imbalance.”
| Classification | Cause |
| Acute SIADH | Post-surgery, Head injury, Stress response. |
| Chronic SIADH | Malignancies, Chronic pulmonary and CNS disorders. |
| Category | Common Causes |
| CNS Disorders | Head injury, Meningitis, Stroke, Brain tumors. |
| Pulmonary Disorders | Pneumonia, Tuberculosis, Acute Respiratory Failure. |
| Malignancies | Small Cell Lung Carcinoma (Most common cancer-related cause). |
| Medications | SSRIs, Carbamazepine, Vincristine, Cyclophosphamide. |
| Hormonal Disorders | Hypothyroidism, Adrenal Insufficiency. |
| Severity | Symptoms |
| Mild Hyponatremia (Na+ 130-135 mEq/L) | Nausea, Vomiting, Headache. |
| Moderate (Na+ 125-129 mEq/L) | Muscle cramps, Weakness, Confusion. |
| Severe (Na+ <125 mEq/L) | Seizures, Altered LOC, Coma, Respiratory Arrest. |
| Test | Findings |
| Serum Sodium | Decreased (<135 mEq/L). |
| Serum Osmolality | Decreased (<275 mOsm/kg). |
| Urine Osmolality | Inappropriately high (>100 mOsm/kg). |
| Urine Sodium | Elevated (>20 mEq/L). |
| Chest X-Ray / CT Brain | To identify underlying cause (Tumor, CNS lesions). |
Q1. Which electrolyte imbalance is commonly seen in SIADH?
🅰️ Hypernatremia
🅱️ Hyperkalemia
✅ 🅲️ Hyponatremia
🅳️ Hypokalemia
Q2. Which malignancy is most commonly associated with SIADH?
🅰️ Breast Cancer
🅱️ Colon Cancer
✅ 🅲️ Small Cell Lung Carcinoma
🅳️ Prostate Cancer
Q3. Which is the first-line management in mild SIADH cases?
🅰️ Administer IV Fluids
✅ 🅱️ Fluid Restriction
🅲️ Administer Potassium Supplements
🅳️ Corticosteroids
Q4. Which of the following is a complication of rapid sodium correction in SIADH?
🅰️ Hyperkalemia
🅱️ Heart Failure
✅ 🅲️ Central Pontine Myelinolysis
🅳️ Diabetes Insipidus
Q5. Which class of drugs directly blocks the action of ADH?
🅰️ Diuretics
🅱️ ACE Inhibitors
✅ 🅲️ Vasopressin Receptor Antagonists (e.g., Tolvaptan)
🅳️ Beta-Blockers
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
Goiter refers to the enlargement of the thyroid gland, which may or may not be associated with changes in thyroid hormone levels. It can present as a visible swelling at the front of the neck and may cause compressive symptoms or be purely cosmetic.
✅ “Goiter is an abnormal enlargement of the thyroid gland due to various causes such as iodine deficiency, autoimmune diseases, or hormonal imbalances.”
| Type | Description |
| Simple (Non-toxic) Goiter | Enlarged gland without hormone imbalance. |
| Toxic Goiter | Enlarged gland with hyperthyroidism (e.g., Graves’ Disease). |
| Endemic Goiter | Due to iodine deficiency, common in specific geographic areas. |
| Nodular Goiter | Presence of nodules within the thyroid gland. |
| Diffuse Goiter | Uniform enlargement of the gland without nodules. |
| Category | Common Causes |
| Nutritional | Iodine Deficiency (Most common worldwide). |
| Autoimmune | Graves’ Disease, Hashimoto’s Thyroiditis. |
| Hormonal | Elevated TSH stimulation due to hypothyroidism. |
| Neoplastic | Benign or malignant thyroid nodules. |
| Drugs | Lithium, Amiodarone. |
| Genetic Factors | Familial tendencies. |
| Feature | Symptoms |
| Neck Swelling | Visible or palpable mass in the neck. |
| Compressive Symptoms | Difficulty swallowing (dysphagia), Hoarseness, Dyspnea. |
| Hyperthyroid Symptoms (Toxic Goiter) | Palpitations, Weight Loss, Heat Intolerance, Tremors. |
| Hypothyroid Symptoms (Hypofunctional Goiter) | Weight Gain, Cold Intolerance, Fatigue, Dry Skin. |
| Test | Purpose |
| Thyroid Function Tests | TSH, T3, T4 levels. |
| Ultrasound of Thyroid | Evaluate size and nodules. |
| Thyroid Scan (Radioactive Iodine Uptake Test) | Differentiates between hot (active) and cold (inactive) nodules. |
| Fine Needle Aspiration Cytology (FNAC) | Rule out malignancy. |
| Serum Iodine Levels | In cases of endemic goiter. |
Q1. Which is the most common cause of goiter worldwide?
🅰️ Hyperthyroidism
✅ 🅱️ Iodine Deficiency
🅲️ Autoimmune Diseases
🅳️ Thyroid Cancer
Q2. What is the drug of choice for treating a toxic goiter?
🅰️ Levothyroxine
🅱️ Iodine Supplementation
✅ 🅲️ Methimazole
🅳️ Hydrocortisone
Q3. Which investigation is used to differentiate between functional and non-functional thyroid nodules?
🅰️ Thyroid Ultrasound
🅱️ Serum TSH Levels
✅ 🅲️ Radioactive Iodine Uptake Test
🅳️ Serum Iodine Levels
Q4. After thyroid surgery, which complication should the nurse immediately monitor for?
🅰️ Hyperglycemia
🅱️ Hypokalemia
✅ 🅲️ Airway Obstruction
🅳️ Hypertension
Q5. Which of the following is a rich source of dietary iodine?
🅰️ Spinach
🅱️ Rice
✅ 🅲️ Seafood
🅳️ Potatoes
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
Hypothyroidism is a common endocrine disorder characterized by decreased production of thyroid hormones (T3 and T4), leading to a generalized slowing of metabolic processes.
✅ “Hypothyroidism is a state of thyroid hormone deficiency causing reduced metabolism, weight gain, cold intolerance, and fatigue.”
| Type | Cause |
| Primary Hypothyroidism | Disorder in the thyroid gland itself (Most Common). |
| Secondary Hypothyroidism | Pituitary gland failure to produce TSH. |
| Tertiary Hypothyroidism | Hypothalamic failure to produce TRH. |
| Congenital Hypothyroidism | Present at birth; causes cretinism. |
| Type | Common Causes |
| Primary | Hashimoto’s Thyroiditis (Autoimmune), Iodine Deficiency, Post-thyroidectomy, Radioactive Iodine Therapy, Thyroiditis. |
| Secondary | Pituitary Tumors, Sheehan’s Syndrome. |
| Tertiary | Hypothalamic Dysfunction. |
| Congenital | Agenesis of thyroid gland, Iodine deficiency in pregnancy. |
| System | Symptoms |
| General | Fatigue, Weight Gain, Cold Intolerance, Lethargy. |
| Skin | Dry Skin, Hair Loss, Puffy Face. |
| Cardiovascular | Bradycardia, Hypotension. |
| Gastrointestinal | Constipation. |
| Reproductive | Menstrual Irregularities, Infertility, Decreased Libido. |
| Neurological | Depression, Slow Speech, Memory Loss. |
| Severe Form | Myxedema (Non-pitting edema, life-threatening coma). |
| Test | Findings |
| Serum TSH | Elevated in Primary Hypothyroidism. |
| Free T3 & T4 | Decreased. |
| Anti-thyroid Antibodies | Positive in Hashimoto’s Thyroiditis. |
| Lipid Profile | Elevated Cholesterol and Triglycerides. |
| ECG | Bradycardia. |
Q1. Which hormone is deficient in hypothyroidism?
🅰️ Insulin
✅ 🅱️ Thyroxine (T4)
🅲️ Cortisol
🅳️ Growth Hormone
Q2. What is the most common cause of primary hypothyroidism?
🅰️ Iodine Excess
🅱️ Thyroid Cancer
✅ 🅲️ Hashimoto’s Thyroiditis
🅳️ Pituitary Tumor
Q3. What is the drug of choice for the treatment of hypothyroidism?
🅰️ Propylthiouracil
🅱️ Methimazole
✅ 🅲️ Levothyroxine
🅳️ Hydrocortisone
Q4. Which complication is considered life-threatening in hypothyroidism?
🅰️ Addisonian Crisis
🅱️ Thyroid Storm
✅ 🅲️ Myxedema Coma
🅳️ Cushing’s Crisis
Q5. Which of the following is a common symptom of hypothyroidism?
🅰️ Weight Loss
🅱️ Heat Intolerance
✅ 🅲️ Cold Intolerance
🅳️ Tachycardia
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
Hyperthyroidism is an endocrine disorder characterized by excessive production of thyroid hormones (T3 and T4) by the thyroid gland, leading to a hypermetabolic state affecting multiple body systems.
✅ “Hyperthyroidism results from overactivity of the thyroid gland, causing an increase in metabolic rate and systemic excitability.”
| Type | Description |
| Primary Hyperthyroidism | Problem within the thyroid gland (e.g., Graves’ Disease, Toxic Nodular Goiter). |
| Secondary Hyperthyroidism | Excess TSH production from the pituitary gland (Rare). |
| Subclinical Hyperthyroidism | Low TSH with normal T3 and T4 levels, often asymptomatic. |
| Common Causes |
| Graves’ Disease (Most Common – Autoimmune). |
| Toxic Multinodular Goiter. |
| Thyroid Adenoma. |
| Excessive Iodine Intake (Jod-Basedow Phenomenon). |
| Pituitary Adenoma (Secondary). |
| Excessive Thyroid Hormone Medication. |
| System | Symptoms |
| General | Weight Loss despite increased appetite. |
| Cardiovascular | Palpitations, Tachycardia, Hypertension. |
| Gastrointestinal | Diarrhea, Increased Appetite. |
| Nervous System | Anxiety, Tremors, Irritability, Insomnia. |
| Reproductive | Menstrual Irregularities, Decreased Fertility. |
| Eyes | Exophthalmos (Bulging Eyes in Graves’ Disease). |
| Skin | Warm, Moist Skin, Heat Intolerance. |
| Severe Case | Thyroid Storm (Life-threatening crisis). |
| Test | Findings |
| Serum TSH | Decreased (Primary Hyperthyroidism). |
| Free T3 & T4 | Elevated. |
| Thyroid Antibodies | Positive in Graves’ Disease (TSI, Anti-TSH receptor antibodies). |
| Radioactive Iodine Uptake (RAIU) | High uptake in Graves’ Disease. |
| Thyroid Ultrasound | To detect nodules or enlargement. |
| Medications | Purpose |
| Antithyroid Drugs | Methimazole, Propylthiouracil (PTU) – Inhibit hormone synthesis. |
| Beta-Blockers | Propranolol – Control symptoms like palpitations and tremors. |
| Iodine Therapy | Lugol’s Iodine – Temporarily inhibits hormone release. |
| Radioactive Iodine Therapy | Destroys overactive thyroid tissue (Definitive treatment in some cases). |
| Procedure | Indications |
| Subtotal or Total Thyroidectomy | Large goiters, non-responsive to medical therapy, malignancy suspicion. |
Q1. Which is the most common cause of hyperthyroidism?
🅰️ Thyroid Cancer
🅱️ Thyroid Adenoma
✅ 🅲️ Graves’ Disease
🅳️ Hashimoto’s Thyroiditis
Q2. What is the drug of choice for managing hyperthyroidism?
🅰️ Levothyroxine
✅ 🅱️ Methimazole
🅲️ Hydrocortisone
🅳️ Amiodarone
Q3. Which symptom is most characteristic of Graves’ Disease?
🅰️ Bradycardia
🅱️ Weight Gain
✅ 🅲️ Exophthalmos (Bulging Eyes)
🅳️ Cold Intolerance
Q4. What is the most serious life-threatening complication of untreated hyperthyroidism?
🅰️ Hypoglycemia
🅱️ Addisonian Crisis
✅ 🅲️ Thyroid Storm
🅳️ Myxedema Coma
Q5. Which of the following is a supportive drug used to control symptoms of hyperthyroidism?
🅰️ Insulin
🅱️ Levothyroxine
✅ 🅲️ Propranolol
🅳️ Prednisolone
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
Thyroiditis is an inflammatory disorder of the thyroid gland, which can cause either temporary or permanent changes in thyroid hormone production, leading to hypothyroidism or hyperthyroidism, depending on the stage and type of inflammation.
✅ “Thyroiditis is the inflammation of the thyroid gland, often resulting in altered thyroid hormone levels and glandular dysfunction.”
| Type | Description |
| Hashimoto’s Thyroiditis | Autoimmune, most common cause of hypothyroidism. |
| Subacute (De Quervain’s) Thyroiditis | Viral infection-related, painful thyroid gland. |
| Postpartum Thyroiditis | Occurs after childbirth. |
| Silent (Painless) Thyroiditis | Autoimmune, transient thyrotoxicosis followed by hypothyroidism. |
| Acute Suppurative Thyroiditis | Bacterial infection; rare but serious. |
| Riedel’s Thyroiditis | Chronic fibrosis of the thyroid, rare. |
| Type | Common Causes |
| Autoimmune | Hashimoto’s, Silent Thyroiditis. |
| Infectious | Viral (Subacute), Bacterial (Acute Suppurative). |
| Postpartum | Immune system rebound after pregnancy. |
| Drugs | Amiodarone, Lithium, Interferon. |
| Radiation | Following radiotherapy. |
| Phase | Symptoms |
| Hyperthyroid Phase (if present) | Palpitations, Weight Loss, Heat Intolerance, Anxiety. |
| Hypothyroid Phase | Fatigue, Weight Gain, Cold Intolerance, Constipation. |
| Painful Thyroid (Subacute) | Neck Pain Radiating to Jaw/Ears. |
| Painless Swelling | Seen in Hashimoto’s and Silent Thyroiditis. |
| Fever and Redness | Seen in Acute Suppurative Thyroiditis. |
| Test | Findings |
| Thyroid Function Tests (TSH, T3, T4) | May show hyperthyroid or hypothyroid phases. |
| Anti-Thyroid Antibodies (Anti-TPO, Anti-TG) | Elevated in Hashimoto’s Thyroiditis. |
| Erythrocyte Sedimentation Rate (ESR) | Elevated in Subacute Thyroiditis. |
| Thyroid Ultrasound | Detects glandular swelling, nodules. |
| Radioactive Iodine Uptake Test (RAIU) | Low uptake in Thyroiditis (Differentiates from Graves’ Disease). |
| FNAC | Done if malignancy is suspected. |
| Condition | Treatment |
| Pain Management | NSAIDs, Corticosteroids (For Subacute Thyroiditis). |
| Hyperthyroid Phase | Beta-Blockers (Propranolol) for symptom relief. |
| Hypothyroid Phase | Levothyroxine Replacement Therapy. |
| Acute Bacterial Thyroiditis | Antibiotics and Drainage if abscess forms. |
Q1. Which is the most common cause of hypothyroidism globally?
🅰️ Graves’ Disease
✅ 🅱️ Hashimoto’s Thyroiditis
🅲️ Iodine Excess
🅳️ Thyroid Cancer
Q2. Which antibody is most commonly elevated in Hashimoto’s Thyroiditis?
🅰️ Anti-TSH Receptor
✅ 🅱️ Anti-Thyroid Peroxidase (Anti-TPO)
🅲️ Anti-Insulin
🅳️ Anti-Rheumatoid Factor
Q3. What is the typical finding in the Radioactive Iodine Uptake (RAIU) test in Thyroiditis?
🅰️ Increased Uptake
✅ 🅱️ Decreased Uptake
🅲️ Normal Uptake
🅳️ Uptake Only in Nodules
Q4. Which drug class is used for symptomatic relief during the hyperthyroid phase of thyroiditis?
🅰️ Levothyroxine
🅱️ Corticosteroids
✅ 🅲️ Beta-Blockers
🅳️ Antibiotics
Q5. Subacute thyroiditis is most commonly associated with which cause?
🅰️ Autoimmune Reaction
✅ 🅱️ Viral Infection
🅲️ Bacterial Infection
🅳️ Malignancy
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
Hyperparathyroidism is an endocrine disorder characterized by excessive secretion of parathyroid hormone (PTH) from the parathyroid glands, resulting in hypercalcemia and hypophosphatemia, which affect bone metabolism, renal function, and neuromuscular activity.
✅ “Hyperparathyroidism is a condition where increased PTH levels disturb calcium and phosphate metabolism, leading to bone demineralization and hypercalcemia.”
| Type | Cause |
| Primary Hyperparathyroidism | Overactivity of the parathyroid glands (e.g., adenoma). |
| Secondary Hyperparathyroidism | Compensatory PTH secretion due to chronic hypocalcemia (e.g., in chronic kidney disease). |
| Tertiary Hyperparathyroidism | Persistent hypersecretion of PTH after correction of secondary causes, often seen in renal transplant patients. |
| Type | Common Causes |
| Primary | Parathyroid Adenoma (Most common), Parathyroid Hyperplasia, Parathyroid Carcinoma. |
| Secondary | Chronic Kidney Disease, Vitamin D Deficiency, Malabsorption. |
| Tertiary | Long-standing Secondary Hyperparathyroidism leading to autonomous PTH secretion. |
| System | Symptoms |
| General | Fatigue, Muscle Weakness. |
| Skeletal | Bone Pain, Pathological Fractures, Osteoporosis. |
| Renal | Kidney Stones (Nephrolithiasis), Polyuria. |
| Gastrointestinal | Nausea, Vomiting, Constipation, Abdominal Pain. |
| Neurological | Depression, Confusion, Memory Loss. |
| Cardiovascular | Hypertension, Arrhythmias. |
| Test | Findings |
| Serum Calcium | Increased (>10.5 mg/dL). |
| Serum Phosphate | Decreased. |
| Serum PTH Levels | Elevated. |
| Vitamin D Levels | May be low in secondary hyperparathyroidism. |
| Bone Density Scan (DEXA) | Shows decreased bone density (Osteoporosis). |
| Neck Ultrasound / Sestamibi Scan | Detects parathyroid adenoma or hyperplasia. |
| Approach | Treatment |
| Hydration Therapy | IV Normal Saline to dilute calcium levels. |
| Bisphosphonates | Alendronate, Pamidronate – Reduce bone resorption. |
| Calcimimetics | Cinacalcet – Decrease PTH secretion. |
| Vitamin D Supplements | In secondary hyperparathyroidism. |
| Procedure | Indications |
| Parathyroidectomy | Indicated for primary hyperparathyroidism with severe hypercalcemia, bone disease, or kidney stones. |
Q1. Which electrolyte imbalance is seen in hyperparathyroidism?
🅰️ Hypocalcemia
✅ 🅱️ Hypercalcemia
🅲️ Hyperphosphatemia
🅳️ Hyponatremia
Q2. What is the most common cause of primary hyperparathyroidism?
🅰️ Vitamin D Deficiency
🅱️ Chronic Kidney Disease
✅ 🅲️ Parathyroid Adenoma
🅳️ Thyroid Tumor
Q3. Which drug is used to reduce parathyroid hormone secretion?
🅰️ Levothyroxine
🅱️ Furosemide
✅ 🅲️ Cinacalcet
🅳️ Hydrocortisone
Q4. What is a common complication of untreated hyperparathyroidism?
🅰️ Hypoglycemia
🅱️ Hypocalcemia
✅ 🅲️ Kidney Stones
🅳️ Hypokalemia
Q5. Which clinical sign indicates hypocalcemia after parathyroid surgery?
🅰️ Chvostek’s Sign
🅱️ Trousseau’s Sign
✅ 🅲️ Both A and B
🅳️ None
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
Hypoparathyroidism is a rare endocrine disorder characterized by insufficient secretion of parathyroid hormone (PTH), leading to hypocalcemia and hyperphosphatemia, affecting neuromuscular function and bone metabolism.
✅ “Hypoparathyroidism results from low PTH levels, causing decreased blood calcium and increased phosphate levels, leading to neuromuscular irritability and tetany.”
| Type | Description |
| Primary Hypoparathyroidism | Due to direct damage or disease of the parathyroid glands. |
| Secondary Hypoparathyroidism | Suppression of PTH due to other factors (e.g., severe hypomagnesemia). |
| Pseudohypoparathyroidism | Genetic disorder where tissues are resistant to PTH despite normal/high levels of hormone. |
| Category | Common Causes |
| Surgical | Accidental removal or damage of parathyroid glands during thyroidectomy or neck surgery (Most Common Cause). |
| Autoimmune | Autoimmune destruction of parathyroid glands. |
| Genetic | DiGeorge Syndrome, Pseudohypoparathyroidism. |
| Metabolic | Hypomagnesemia (Magnesium is essential for PTH secretion). |
| Radiation Therapy | Neck or head radiation causing gland damage. |
| System | Symptoms |
| Neuromuscular | Muscle cramps, Tingling (Perioral, Hands, Feet), Tetany, Seizures. |
| Cardiovascular | Hypotension, Arrhythmias, Prolonged QT Interval. |
| Respiratory | Laryngospasm, Bronchospasm (Life-threatening). |
| Skin | Dry, Coarse Skin, Brittle Nails, Hair Loss. |
| Classic Signs | Chvostek’s Sign (Facial twitching), Trousseau’s Sign (Carpal spasm with BP cuff). |
| Test | Findings |
| Serum Calcium | Decreased (<8.5 mg/dL). |
| Serum Phosphate | Increased. |
| Serum PTH | Low in Primary Hypoparathyroidism. |
| Serum Magnesium | Check for hypomagnesemia. |
| ECG | Prolonged QT Interval, Risk of Arrhythmias. |
| Therapy | Purpose |
| Calcium Supplements | Oral or IV Calcium Gluconate in acute cases. |
| Vitamin D Supplements | Calcitriol to enhance calcium absorption. |
| Magnesium Replacement | If hypomagnesemia is present. |
| Recombinant PTH (Natpara) | Used in chronic, severe cases. |
Q1. Which electrolyte imbalance is seen in hypoparathyroidism?
🅰️ Hypercalcemia
🅱️ Hypophosphatemia
✅ 🅲️ Hypocalcemia
🅳️ Hypernatremia
Q2. What is the most common cause of hypoparathyroidism?
🅰️ Autoimmune Destruction
✅ 🅱️ Accidental Removal During Thyroid Surgery
🅲️ Radiation Therapy
🅳️ Vitamin D Deficiency
Q3. Which clinical sign is seen in hypocalcemia?
🅰️ Babinski’s Sign
🅱️ Hoffman’s Sign
✅ 🅲️ Chvostek’s and Trousseau’s Signs
🅳️ Romberg’s Sign
Q4. What is the immediate treatment for severe tetany in hypoparathyroidism?
🅰️ Oral Calcium Tablets
🅱️ Vitamin D Injections
✅ 🅲️ IV Calcium Gluconate
🅳️ High Protein Diet
Q5. Which vitamin is essential for calcium absorption in hypoparathyroidism?
🅰️ Vitamin C
🅱️ Vitamin E
✅ 🅲️ Vitamin D
🅳️ Vitamin K
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
Diabetes Mellitus (DM) is a chronic metabolic disorder characterized by hyperglycemia due to either deficiency of insulin secretion, insulin resistance, or both, leading to disturbances in carbohydrate, fat, and protein metabolism.
✅ “Diabetes Mellitus is a disorder of glucose metabolism resulting in elevated blood glucose levels, affecting multiple organ systems if left uncontrolled.”
| Type | Description |
| Type 1 DM | Autoimmune destruction of pancreatic β-cells → Absolute insulin deficiency. Common in children and young adults. |
| Type 2 DM | Insulin resistance with relative insulin deficiency. Common in adults; associated with obesity. |
| Gestational DM | Diabetes first diagnosed during pregnancy. |
| Secondary DM | Due to other conditions (e.g., Cushing’s Syndrome, Pancreatitis, Drug-Induced). |
| Type | Common Causes |
| Type 1 DM | Autoimmune factors, Genetic predisposition, Viral infections (Coxsackievirus). |
| Type 2 DM | Obesity, Sedentary lifestyle, Genetic factors, Hypertension, Dyslipidemia. |
| Gestational DM | Hormonal changes during pregnancy, Obesity. |
| Secondary DM | Cushing’s Syndrome, Pancreatic Disorders, Drugs (e.g., Steroids). |
| Type | Mechanism |
| Type 1 DM | Autoimmune destruction of β-cells → No insulin production → Hyperglycemia. |
| Type 2 DM | Insulin resistance → Decreased cellular glucose uptake → Hyperglycemia. |
| Both Types | Prolonged hyperglycemia leads to microvascular (retinopathy, nephropathy, neuropathy) and macrovascular (CAD, stroke) complications. |
| Common Symptoms (3 P’s) | Other Symptoms |
| Polyuria (Frequent urination) | Fatigue, Weakness. |
| Polydipsia (Excessive thirst) | Blurred Vision. |
| Polyphagia (Increased hunger) | Weight Loss (Type 1), Weight Gain (Type 2). |
| Delayed Wound Healing, Recurrent Infections, Numbness or Tingling (Peripheral Neuropathy). |
| Test | Diagnostic Criteria |
| Fasting Blood Sugar (FBS) | ≥126 mg/dL (after 8 hrs fasting). |
| Random Blood Sugar (RBS) | ≥200 mg/dL with classic symptoms. |
| HbA1c (Glycated Hemoglobin) | ≥6.5% (Reflects 3-month glucose control). |
| Oral Glucose Tolerance Test (OGTT) | ≥200 mg/dL at 2 hours post-glucose load. |
| Urine Test | Presence of glucose and ketones (in Type 1 DM). |
| Type 1 DM | Type 2 DM |
| Insulin Therapy: |
| Acute | Chronic |
| Diabetic Ketoacidosis (DKA – Common in Type 1). | |
| Hyperosmolar Hyperglycemic State (HHS – Type 2). | |
| Hypoglycemia (due to insulin or medication overdose). | |
| Retinopathy, Nephropathy, Neuropathy. | |
| Coronary Artery Disease (CAD), Stroke. | |
| Diabetic Foot Ulcers, Gangrene. |
Q1. Which hormone is deficient in Type 1 Diabetes Mellitus?
🅰️ Glucagon
🅱️ Cortisol
✅ 🅲️ Insulin
🅳️ Growth Hormone
Q2. Which is the first-line drug for managing Type 2 Diabetes Mellitus?
🅰️ Sulfonylureas
✅ 🅱️ Metformin
🅲️ Insulin
🅳️ DPP-4 Inhibitors
Q3. What is the normal value of HbA1c to diagnose Diabetes Mellitus?
🅰️ ≥5%
🅱️ ≥6%
✅ 🅲️ ≥6.5%
🅳️ ≥7%
Q4. Which of the following is an acute complication of Diabetes Mellitus?
🅰️ Nephropathy
🅱️ Retinopathy
✅ 🅲️ Diabetic Ketoacidosis
🅳️ Neuropathy
Q5. Which of the following is the best nursing intervention to prevent diabetic foot ulcers?
🅰️ Use hot water to soak feet daily.
🅱️ Apply tight bandages for foot support.
✅ 🅲️ Encourage daily foot inspection and proper hygiene.
🅳️ Walk barefoot to improve circulation.
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
Diabetic Ketoacidosis (DKA) is a life-threatening acute complication of Type 1 Diabetes Mellitus, characterized by severe hyperglycemia, ketosis, and metabolic acidosis, resulting from absolute or relative insulin deficiency.
✅ “DKA is an acute metabolic crisis caused by insulin deficiency leading to hyperglycemia, ketone body formation, and metabolic acidosis.”
| Common Causes |
| Missed or Inadequate Insulin Dose. |
| Infections (e.g., Urinary Tract Infection, Pneumonia). |
| Acute Illness or Stress (Myocardial Infarction, Stroke). |
| Undiagnosed Type 1 Diabetes Mellitus. |
| Excessive Physical or Emotional Stress. |
| System | Symptoms |
| General | Polyuria, Polydipsia, Polyphagia. |
| Gastrointestinal | Nausea, Vomiting, Abdominal Pain. |
| Respiratory | Kussmaul’s Breathing (Deep, Rapid Respirations), Fruity Odor of Breath (Due to Acetone). |
| Neurological | Drowsiness, Confusion, Coma (If severe). |
| Cardiovascular | Hypotension, Tachycardia, Dehydration Signs. |
| Test | Findings |
| Blood Glucose | >250 mg/dL. |
| Serum Ketones | Positive (Elevated). |
| Arterial Blood Gas (ABG) | pH <7.3 (Metabolic Acidosis), Low HCO₃⁻ (<18 mEq/L). |
| Serum Electrolytes | Low Sodium, Low Potassium (Despite initial high serum K⁺ due to acidosis). |
| Urine Test | Positive for Glucose and Ketones. |
Q1. What is the hallmark blood pH value indicating metabolic acidosis in DKA?
🅰️ >7.35
🅱️ 7.30-7.35
✅ 🅲️ <7.30
🅳️ >7.40
Q2. Which type of insulin is used for initial management of DKA?
🅰️ NPH Insulin
🅱️ Glargine
✅ 🅲️ Regular Insulin (IV)
🅳️ Detemir
Q3. Which respiratory pattern is characteristic of DKA?
🅰️ Cheyne-Stokes
🅱️ Apneustic
✅ 🅲️ Kussmaul’s Breathing
🅳️ Biot’s Breathing
Q4. Which electrolyte imbalance must be corrected first before starting insulin therapy in DKA?
🅰️ Sodium
🅱️ Chloride
✅ 🅲️ Potassium
🅳️ Calcium
Q5. Which of the following is NOT a typical symptom of DKA?
🅰️ Polyuria
🅱️ Polydipsia
✅ 🅲️ Bradycardia
🅳️ Fruity Odor Breath
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
HHNS is a life-threatening, acute complication primarily of Type 2 Diabetes Mellitus, characterized by severe hyperglycemia, hyperosmolarity, profound dehydration, and absence or minimal ketosis.
✅ “HHNS is an acute hyperglycemic crisis with extremely high blood sugar and dehydration without significant ketoacidosis, seen mostly in elderly patients with Type 2 DM.”
| Common Causes |
| Poorly Controlled Type 2 Diabetes. |
| Infections (e.g., Pneumonia, Urinary Tract Infections). |
| Acute Illness (e.g., Myocardial Infarction, Stroke). |
| Certain Medications (e.g., Diuretics, Corticosteroids, Beta-Blockers). |
| Noncompliance with Anti-diabetic Medications. |
| System | Symptoms |
| General | Extreme Thirst, Dry Mucous Membranes. |
| Neurological | Confusion, Lethargy, Seizures, Coma (If severe). |
| Cardiovascular | Hypotension, Tachycardia due to hypovolemia. |
| Renal | Oliguria or Anuria (Late stage). |
| Respiratory | Shallow breathing (No Kussmaul’s respiration). |
| Test | Findings |
| Blood Glucose | >600 mg/dL (Often >1000 mg/dL). |
| Serum Osmolality | >320 mOsm/kg. |
| Arterial Blood Gas (ABG) | pH >7.3 (No significant acidosis). |
| Serum Ketones | Negative or Minimal. |
| Electrolytes | Severe dehydration, Elevated Sodium. |
| Urine Test | High Glucose, Negative or Trace Ketones. |
Q1. Which of the following is the hallmark difference between DKA and HHNS?
🅰️ Presence of Hypoglycemia
🅱️ Severe Acidosis in HHNS
✅ 🅲️ Absence of Significant Ketosis in HHNS
🅳️ Kussmaul’s Breathing in HHNS
Q2. What is the typical blood glucose level seen in HHNS?
🅰️ >250 mg/dL
🅱️ >300 mg/dL
✅ 🅲️ >600 mg/dL
🅳️ >150 mg/dL
Q3. Which fluid is preferred initially for resuscitation in HHNS?
🅰️ Dextrose 5%
✅ 🅱️ Normal Saline (0.9% NaCl)
🅲️ Half Normal Saline
🅳️ Lactated Ringer’s
Q4. Which electrolyte imbalance should be carefully monitored during HHNS treatment?
🅰️ Calcium
🅱️ Magnesium
✅ 🅲️ Potassium
🅳️ Chloride
Q5. Which of the following is NOT typically seen in HHNS?
🅰️ Severe Dehydration
🅱️ Altered Mental Status
🅲️ Kussmaul’s Respiration
✅ 🅳️ Significant Ketosis
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
Addison’s Disease is a chronic endocrine disorder characterized by insufficient production of adrenal cortex hormones, mainly glucocorticoids (Cortisol), mineralocorticoids (Aldosterone), and sometimes androgens, leading to metabolic, electrolyte, and cardiovascular disturbances.
✅ “Addison’s disease is a condition of primary adrenal insufficiency caused by destruction or dysfunction of the adrenal cortex, leading to life-threatening hormonal imbalances.”
| Type | Description |
| Primary Addison’s Disease | Direct destruction or disease of adrenal glands (Most Common). |
| Secondary Adrenal Insufficiency | Due to decreased ACTH from the pituitary. |
| Tertiary Adrenal Insufficiency | Hypothalamic dysfunction affecting CRH production. |
| Type | Common Causes |
| Primary | Autoimmune Adrenalitis (Most common), Tuberculosis of Adrenals, Adrenal Tumors, Fungal Infections, HIV/AIDS. |
| Secondary | Pituitary Tumors, Long-term Steroid Use (Abrupt Withdrawal). |
| Tertiary | Hypothalamic Tumors, Trauma, Infections. |
| General Symptoms | Electrolyte & Hormonal Effects |
| Fatigue, Weakness, Weight Loss. | Hyponatremia, Hyperkalemia. |
| Anorexia, Nausea, Vomiting, Diarrhea. | Hypoglycemia. |
| Hyperpigmentation (Especially in skin creases and mucous membranes). | |
| Hypotension, Dizziness (Orthostatic Hypotension). | |
| Salt Craving, Depression, Irritability. |
| Test | Findings |
| Serum Cortisol | Low. |
| Plasma ACTH | Elevated in Primary Addison’s Disease. |
| Serum Electrolytes | Low Sodium, High Potassium, Hypoglycemia. |
| ACTH Stimulation Test (Cosyntropin Test) | Confirms diagnosis if cortisol fails to rise. |
| CT/MRI Abdomen | Detects adrenal gland abnormalities or tumors. |
| Therapy | Purpose |
| Glucocorticoid Replacement | Hydrocortisone, Prednisolone – To replace cortisol. |
| Mineralocorticoid Replacement | Fludrocortisone – To replace aldosterone. |
| Salt Replacement | Especially in cases of severe hyponatremia. |
| Manage Hypoglycemia | IV Dextrose if required. |
Q1. Which hormone is deficient in Addison’s Disease?
🅰️ Insulin
🅱️ Thyroxine
✅ 🅲️ Cortisol
🅳️ Growth Hormone
Q2. Which skin manifestation is typically seen in Addison’s Disease?
🅰️ Vitiligo
🅱️ Jaundice
✅ 🅲️ Hyperpigmentation
🅳️ Cyanosis
Q3. Which electrolyte imbalance is commonly found in Addison’s Disease?
🅰️ Hypernatremia
🅱️ Hypokalemia
✅ 🅲️ Hyponatremia and Hyperkalemia
🅳️ Hypercalcemia
Q4. Which drug is used for long-term mineralocorticoid replacement in Addison’s Disease?
🅰️ Hydrocortisone
✅ 🅱️ Fludrocortisone
🅲️ Prednisolone
🅳️ Dexamethasone
Q5. What is the immediate management of Addisonian Crisis?
🅰️ Oral Steroids
🅱️ Beta-Blockers
✅ 🅲️ IV Hydrocortisone and Fluids
🅳️ Oral Salt Tablets
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
Cushing’s Disease is a form of Cushing’s Syndrome caused by excessive secretion of Adrenocorticotropic Hormone (ACTH) from a pituitary adenoma, leading to overproduction of cortisol by the adrenal glands.
✅ “Cushing’s Disease is a specific cause of Cushing’s Syndrome resulting from ACTH-secreting pituitary tumors, leading to chronic hypercortisolism.”
| Type | Cause |
| Cushing’s Disease | ACTH-secreting pituitary adenoma (Common cause). |
| Cushing’s Syndrome | Any cause of excess cortisol (e.g., adrenal tumors, ectopic ACTH production, long-term corticosteroid therapy). |
| Primary Cause (Cushing’s Disease) | Pituitary adenoma secreting excess ACTH.
| Other Causes (Cushing’s Syndrome) | Adrenal tumors, Ectopic ACTH-producing tumors (e.g., Small Cell Lung Carcinoma), Prolonged corticosteroid therapy.
| General Features | Specific Signs |
| Weight Gain (Central Obesity). | Moon Face, Buffalo Hump (Fat deposition on back of neck). |
| Muscle Weakness, Thin Extremities. | Purple Striae (Stretch Marks on Abdomen, Thighs). |
| Hyperglycemia, Hypertension. | Easy Bruising, Poor Wound Healing. |
| Osteoporosis, Back Pain. | Hirsutism (Excess Hair in Women), Menstrual Irregularities. |
| Mood Changes, Depression, Irritability. |
| Test | Findings |
| Serum Cortisol | Elevated. |
| 24-Hour Urinary Free Cortisol | Elevated cortisol levels. |
| Low-Dose Dexamethasone Suppression Test | No suppression of cortisol (Confirms Cushing’s Syndrome). |
| High-Dose Dexamethasone Test | Suppression indicates pituitary cause (Cushing’s Disease); No suppression suggests ectopic ACTH. |
| Serum ACTH Levels | Elevated in Cushing’s Disease. |
| MRI of Pituitary Gland | Detects pituitary adenoma. |
| Drug Therapy | Purpose |
| Ketoconazole, Metyrapone | Inhibit cortisol synthesis. |
| Pasireotide | Controls ACTH secretion. |
| Procedure | Indication |
| Transsphenoidal Hypophysectomy | Preferred for pituitary adenoma removal. |
| Adrenalectomy | If adrenal tumors are present or pituitary surgery fails. |
Q1. What is the most common cause of Cushing’s Disease?
🅰️ Adrenal Tumor
✅ 🅱️ Pituitary Adenoma
🅲️ Long-term Steroid Use
🅳️ Ectopic ACTH Secretion
Q2. Which classic sign is associated with Cushing’s Disease?
🅰️ Pallor
🅱️ Weight Loss
✅ 🅲️ Buffalo Hump
🅳️ Dehydration
Q3. Which diagnostic test differentiates between Cushing’s Disease and Cushing’s Syndrome?
🅰️ MRI Brain
🅱️ Serum Calcium
✅ 🅲️ High-Dose Dexamethasone Suppression Test
🅳️ ECG
Q4. What is the surgical procedure of choice for Cushing’s Disease?
🅰️ Craniotomy
✅ 🅱️ Transsphenoidal Hypophysectomy
🅲️ Thyroidectomy
🅳️ Adrenalectomy
Q5. Which drug is used to inhibit cortisol synthesis in Cushing’s Disease?
🅰️ Hydrocortisone
✅ 🅱️ Ketoconazole
🅲️ Levothyroxine
🅳️ Insulin
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
Hyperaldosteronism is an endocrine disorder characterized by excessive secretion of aldosterone from the adrenal cortex, leading to sodium retention, potassium excretion, and water retention, causing hypertension and hypokalemia.
✅ “Hyperaldosteronism is a condition marked by elevated aldosterone levels resulting in fluid retention, high blood pressure, and low potassium levels.”
| Type | Cause |
| Primary Hyperaldosteronism (Conn’s Syndrome) | Aldosterone-producing adrenal adenoma or hyperplasia. |
| Secondary Hyperaldosteronism | Increased renin production due to conditions like congestive heart failure, liver cirrhosis, nephrotic syndrome, or renal artery stenosis. |
| Primary (Conn’s Syndrome) | Adrenal adenoma (Most common), Adrenal hyperplasia, Adrenal carcinoma.
| Secondary | Renal artery stenosis, Heart failure, Cirrhosis, Chronic kidney disease.
| Electrolyte & Fluid Effects | Symptoms |
| Hypernatremia | Hypertension, Headache. |
| Hypokalemia | Muscle Weakness, Cramps, Fatigue, Constipation. |
| Metabolic Alkalosis | Numbness, Paresthesia, Tetany (Rare). |
| Cardiovascular | Palpitations, Risk of Arrhythmias. |
| Renal | Polyuria, Polydipsia, Nocturia. |
| Test | Findings |
| Serum Aldosterone Levels | Elevated. |
| Serum Potassium | Low (<3.5 mEq/L). |
| Plasma Renin Activity (PRA) | Low in Primary, High in Secondary. |
| Aldosterone/Renin Ratio (ARR) | Elevated in Primary Hyperaldosteronism. |
| Saline Infusion or Fludrocortisone Suppression Test | Confirms diagnosis. |
| Imaging (CT/MRI) | Detects adrenal adenoma or hyperplasia. |
| Condition | Treatment |
| Primary Hyperaldosteronism | Aldosterone Antagonists (Spironolactone, Eplerenone). |
| Secondary Hyperaldosteronism | Treat underlying cause (e.g., manage CHF, correct renal artery stenosis). |
| Electrolyte Management | Potassium supplements if needed. |
| Procedure | Indication |
| Adrenalectomy | For adrenal adenoma or carcinoma. |
Q1. Which electrolyte imbalance is commonly seen in hyperaldosteronism?
🅰️ Hyperkalemia
🅱️ Hyponatremia
✅ 🅲️ Hypokalemia
🅳️ Hypocalcemia
Q2. What is the most common cause of primary hyperaldosteronism?
🅰️ Renal Artery Stenosis
🅱️ Adrenal Carcinoma
✅ 🅲️ Adrenal Adenoma (Conn’s Syndrome)
🅳️ Pituitary Adenoma
Q3. Which drug is commonly used to manage hyperaldosteronism?
🅰️ Hydrocortisone
✅ 🅱️ Spironolactone
🅲️ Insulin
🅳️ Levothyroxine
Q4. Which test is used to confirm the diagnosis of hyperaldosteronism?
🅰️ Dexamethasone Suppression Test
🅱️ ACTH Stimulation Test
✅ 🅲️ Aldosterone/Renin Ratio (ARR)
🅳️ Water Deprivation Test
Q5. What is the definitive treatment for adrenal adenoma causing hyperaldosteronism?
🅰️ Medication Only
🅱️ Chemotherapy
✅ 🅲️ Adrenalectomy
🅳️ Dialysis
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
Pheochromocytoma is a rare, catecholamine-secreting tumor arising from the chromaffin cells of the adrenal medulla, leading to excessive production of epinephrine and norepinephrine, causing severe hypertension and other sympathetic nervous system manifestations.
✅ “Pheochromocytoma is a neuroendocrine tumor of the adrenal medulla that results in episodic or persistent hypertension due to excessive catecholamine secretion.”
| Type | Location |
| Adrenal Pheochromocytoma | Originates from adrenal medulla (90% cases). |
| Extra-Adrenal Paragangliomas | Located outside adrenal glands (Sympathetic Chain, Bladder, Neck). |
| Causes | Details |
| Idiopathic | Most common; unknown cause. |
| Genetic Syndromes | MEN Type 2 (Multiple Endocrine Neoplasia), Von Hippel-Lindau Disease, Neurofibromatosis Type 1. |
| Familial Predisposition | Autosomal dominant inheritance. |
| Common Symptoms |
| Headache (Severe, pounding). |
| Palpitations (Tachycardia). |
| Excessive Sweating (Diaphoresis). |
| Paroxysmal Hypertension (Sudden episodes). |
| Anxiety, Panic Attacks, Tremors. |
| Weight Loss despite good appetite. |
| Visual Disturbances, Blurred Vision. |
| Test | Findings |
| 24-Hour Urinary Catecholamines and Metanephrines | Elevated. |
| Plasma Free Metanephrines | Highly sensitive test; elevated. |
| Clonidine Suppression Test | Failure to suppress catecholamine levels confirms diagnosis. |
| CT/MRI Abdomen | Detects adrenal mass. |
| MIBG Scintigraphy (Metaiodobenzylguanidine) | Localizes extra-adrenal tumors. |
| Procedure | Indications |
| Adrenalectomy | Definitive treatment for adrenal tumors. |
| Laparoscopic Adrenalectomy | Preferred minimally invasive approach. |
Q1. Which hormone is excessively secreted in Pheochromocytoma?
🅰️ Cortisol
🅱️ Aldosterone
✅ 🅲️ Catecholamines
🅳️ Insulin
Q2. What is the first drug of choice in the management of Pheochromocytoma?
🅰️ Beta-Blocker
✅ 🅱️ Alpha-Blocker (Phenoxybenzamine)
🅲️ Calcium Channel Blocker
🅳️ ACE Inhibitor
Q3. Which test is most sensitive for the diagnosis of Pheochromocytoma?
🅰️ Serum Cortisol
🅱️ Serum Calcium
✅ 🅲️ Plasma Free Metanephrines
🅳️ Blood Glucose
Q4. Which surgical procedure is preferred for treating Pheochromocytoma?
🅰️ Thyroidectomy
🅱️ Laminectomy
✅ 🅲️ Adrenalectomy
🅳️ Parathyroidectomy
Q5. What is the major complication during tumor manipulation in surgery?
🅰️ Hypotension
✅ 🅱️ Hypertensive Crisis
🅲️ Hypoglycemia
🅳️ Bradycardia
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
Neuroblastoma is a highly malignant pediatric tumor arising from the sympathetic nervous system, particularly from neural crest cells. It commonly affects the adrenal medulla but can also occur along the sympathetic chain in the neck, chest, abdomen, and pelvis.
✅ “Neuroblastoma is the most common extracranial solid tumor in children, typically diagnosed before the age of 5 years.”
| Location | Frequency |
| Adrenal Gland | Most Common (~40%). |
| Abdomen (Sympathetic Chain) | ~25%. |
| Thoracic Cavity | ~15%. |
| Cervical & Pelvic Regions | Rare. |
| Factors | Details |
| Genetic Factors | ALK gene mutations, Familial predisposition. |
| Environmental Factors | Unclear; no definitive causes identified. |
| Congenital Syndromes | Associated with Beckwith-Wiedemann Syndrome, Hirschsprung Disease. |
| Primary Tumor Effects | Metastatic Effects |
| Abdominal Mass (Often Painless). | Bone Pain, Limping (Bone Metastasis). |
| Weight Loss, Anorexia. | Hepatomegaly (Liver Metastasis). |
| Hypertension, Tachycardia. | Proptosis, Periorbital Ecchymosis (“Raccoon Eyes”) – Skull Metastasis. |
| Sweating, Flushing, Diarrhea (Catecholamine Effects). | Bluish Nodules on Skin (Skin Metastasis). |
| Test | Findings |
| Urinary Catecholamine Metabolites | Elevated VMA (Vanillylmandelic Acid) and HVA (Homovanillic Acid). |
| Imaging (CT/MRI Abdomen) | Detects primary tumor. |
| MIBG Scintigraphy | Locates metastatic sites. |
| Bone Marrow Biopsy | Evaluates bone marrow involvement. |
| Histopathology | Confirms diagnosis via biopsy. |
| Treatment Modality | Purpose |
| Chemotherapy | Used in high-risk and metastatic cases. |
| Radiation Therapy | For unresectable or residual tumors. |
| Immunotherapy | Anti-GD2 antibody therapy to target neuroblastoma cells. |
| Procedure | Indications |
| Complete Tumor Resection | Preferred if feasible. |
| Debulking Surgery | In large tumors to reduce mass effect. |
Q1. What is the most common site of origin for Neuroblastoma?
🅰️ Brain
✅ 🅱️ Adrenal Gland
🅲️ Thyroid
🅳️ Kidneys
Q2. Which urinary metabolites are elevated in Neuroblastoma?
🅰️ Creatinine and Urea
🅱️ Epinephrine and Norepinephrine
✅ 🅲️ VMA and HVA
🅳️ Dopamine and Serotonin
Q3. What is the typical ocular manifestation of metastatic Neuroblastoma?
🅰️ Cataract
🅱️ Ptosis
✅ 🅲️ Raccoon Eyes
🅳️ Conjunctivitis
Q4. Which imaging modality is most sensitive for detecting Neuroblastoma metastases?
🅰️ Chest X-ray
🅱️ MRI
🅲️ CT Scan
✅ 🅳️ MIBG Scintigraphy
Q5. What is the definitive diagnostic method for Neuroblastoma?
🅰️ Blood Test
🅱️ Urine Test
✅ 🅲️ Histopathological Biopsy
🅳️ ECG