Chapter 27: Endocrine

Question 1

What is GHD?

Answer 1

A disorder where the pituitary produces insufficient growth hormone, often due to hypothalamic dysfunction.

Question 2

Clinical manifestations of GHD?

Answer 2

Normal birth size, growth <5 cm/year, below 3rd percentile by age 1. May also have hypoglycemic seizures, micropenis, undescended testes, jaundice, pale optic discs.

Question 3

Causes of GHD?

Answer 3

Sickle cell infarcts, brain tumors, trauma, chemotherapy.

Question 4

How is GHD diagnosed?

Answer 4

Radioimmunoassay of GH levels, hand x-ray (bone age), family/growth history, endocrine labs.

Question 5

Treatment for GHD?

Answer 5

Daily bedtime injections of biosynthetic GH. May also need other hormone replacements.

Question 6

Special considerations for GHD?

Answer 6

Prepare family for daily injections, cost concerns, monitor growth, teach injection technique, support body image concerns.

Question 7

What labs indicate hypothyroidism vs hyperthyroidism?

Answer 7

Hypothyroid: ↑ TSH, ↓ T3/T4; Hyperthyroid: ↓ TSH, ↑ T3/T4.

Question 8

Symptoms of hypothyroidism in infants?

Answer 8

Thick tongue, hypotonia, umbilical hernia, large fontanelle, jaundice, constipation.

Question 9

Symptoms of hypothyroidism in children?

Answer 9

Dry/cool skin, hair loss, bradycardia, constipation, fatigue, goiter.

Question 10

Why screen newborns for hypothyroidism?

Answer 10

Untreated congenital hypothyroidism can cause intellectual disability and growth failure.

Question 11

Treatment for hypothyroidism?

Answer 11

Lifelong levothyroxine (15 mcg/kg/day), increase as child grows, monitor labs regularly.

Question 12

What is precocious puberty?

Answer 12

Early sexual development: before age 8 in girls, 9 in boys.

Question 13

Symptoms of precocious puberty?

Answer 13

Advanced bone age, early height spurt, early Tanner stage development.

Question 14

Causes of precocious puberty?

Answer 14

Often idiopathic, but may be caused by adrenal/gonadal tumors or early GnRH stimulation.

Question 15

Treatment for precocious puberty?

Answer 15

GnRH analog (e.g., Lupron) to suppress puberty until appropriate age.

Question 16

Concerns with precocious puberty?

Answer 16

Body image, psychosocial development mismatch, premature epiphyseal plate closure affecting adult height.

Question 17

Family education points for precocious puberty?

Answer 17

Explain physical changes are normal but early, reassure growth and development will normalize, teach med administration.

Question 18

Difference between Type 1 and Type 2 diabetes in kids?

Answer 18

Type 1: Autoimmune destruction of beta cells; presents in younger children; abrupt onset. Type 2: Often due to insulin resistance; presents in obese teens; gradual onset.

Question 19

Common ages for Type 1 onset?

Answer 19

Bimodal peaks at 4–6 and 10–14 years old.

Question 20

Symptoms of Type 1 diabetes?

Answer 20

Polyuria, polydipsia, polyphagia, weight loss, fatigue, irritability, DKA symptoms.

Question 21

Treatment for Type 1 diabetes?

Answer 21

Insulin, blood sugar monitoring, carb counting, lifestyle education.

Question 22

Types of insulin used in children?

Answer 22

Rapid (meal-time), long-acting (basal). Intermediate not used often. Mixed avoided. All are U-100.

Question 23

Common injection sites for insulin?

Answer 23

Abdomen (fastest), arms, legs (slowest). Rotate sites.

Question 24

What is the insulin-to-carb ratio (I:C)?

Answer 24

Number of carbs covered by 1 unit of insulin. Ex: 45g carbs, I:C 1:15 → 3 units insulin.

Question 25

Correction factor (CF) calculation?

Answer 25

(Current BG – target BG) ÷ CF = correction dose. Ex: (300–150)/50 = 3 units.

Question 26

Special considerations in young children regarding insulin?

Answer 26

Don’t give rapid insulin until meal is confirmed eaten (risk of hypoglycemia). Monitor growth, educate caregivers.

Question 27

Definition of DKA?

Answer 27

BG >200, ketonemia/ketonuria, pH <7.3, HCO₃ <15.

Question 28

Why is DKA dangerous?

Answer 28

Can lead to severe dehydration, acidosis, electrolyte imbalance, coma, death.

Question 29

How do we treat DKA?

Answer 29

IV fluids, insulin drip, electrolyte monitoring (esp. potassium), manage acidosis.

Question 30

Nursing responsibilities in DKA?

Answer 30

Frequent VS, neuro checks, BG/ketone monitoring, watch for cerebral edema.

Question 31

Major complication of DKA?

Answer 31

Cerebral edema.

Question 32

What to consider with multiple DKA admissions?

Answer 32

Social work consult, assess family support, education gaps, possible insulin access issues.

Question 33

What is Addison’s disease?

Answer 33

Adrenal insufficiency → low cortisol and aldosterone.

Question 34

How is Addison’s diagnosed?

Answer 34

Cortisol & ACTH levels, stimulation testing.

Question 35

Nursing considerations for Addison’s?

Answer 35

Hydration, cortisol replacement, monitor for adrenal crisis (low BP, fatigue, vomiting).

Question 36

What is Cushing’s disease?

Answer 36

Excessive cortisol, often from a pituitary tumor.

Question 37

How is Cushing’s diagnosed?

Answer 37

24-hour urine cortisol, dexamethasone suppression test, ACTH levels.

Question 38

Nursing considerations for Cushing’s?

Answer 38

Monitor for infection, skin fragility, growth suppression, mood swings. Educate on tapering steroids if used.

Question 39

What is Turner syndrome?

Answer 39

Female with a missing or incomplete X chromosome (45,X).

Question 40

Turner syndrome symptoms?

Answer 40

Short stature, webbed neck, infertility, heart/kidney issues, no secondary sex characteristics.

Question 41

What is Klinefelter syndrome?

Answer 41

Male with extra X chromosome (47,XXY).

Question 42

Klinefelter syndrome symptoms?

Answer 42

Tall stature, small testes, gynecomastia, delayed puberty, learning difficulties.