Endocrine Flashcards
Hypopituitarism Sx
-Short (< 3% on chart)
-Delayed tooth eruption
-“Baby face”
-Delayed sexual development
-No intelligence issues
-Low IGF-1
Hypopituitarism Dx
-Evaluate any child 2-3 SD below mean height or who is falling off the growth chart
-XR, MRI, growth hormone testing
Hypopituitarism Tx
-Growth hormone replacement (SQ)
-Expensive (social support)
-Monitor for SE
-Foster independence
-Emotional support
Hyperpituitarism Sx
-Child’s predicted height exceeds parental height
-Acromegaly
-High IGF-1
Hyperpituitarism Tx
-Surgical removal of tumor/pituitary gland
-Radiation therapy
-High doses of sex steroids
-Make sure there’s no tumor of hypothalamus
Diabetes Insipidus Sx
-Posterior pituitary gland
-Low ADH
-Tubules do not reabsorb water
-3P’s
-Increased serum Na, Osmolality
-Dehydrated
-Low vasopressin/anti-diuretic hormone
-Irritable
-Failure to thrive
-Lethargic
-N/V
-Constipation
-Caused by brain or kidneys
Diabetes Insipidus Tx
-DDAVP (oral desmopressin acetate) results in reduced UOP, decreased thirst and nocturia
-Kidneys: thiazide diuretics
-Monitor Na and K levels
-Monitor I/Os
-Replace fluids (oral or IV)
-Educate for monitoring Sx, medication use, diet, daily weight
SIADH
-Water intoxication
-Low Na
-Cellular edema
-Hypertension
-Distended JV
-Lung crackles
-Weight gain w/o edema
-High urine osmolality, urine specific gravity
-Low BUN
SIADH Tx
-Restrict fluids
-Diuretics
-Demeclocycline blocks action of ADH at renal collecting tubules
-Hypertonic fluids
-Seizure risk due to hyponatremia
-Monitor Na, LOC, I/Os, labs
Precocious Puberty Sx
-early puberty (8F, 9M)
-premature hormone secretion
-Short stature in adulthood
-Dx: LH, FSH, Testosterone
Precocious Puberty Tx
-Support for the child concerning body image and sexuality
-Can be treated with surgery, radiation, chemo or medications
-Medication therapy
-Luteinizing releasing factor to slow down the progression of puberty
Hypothyroidism Sx
-Screening 2-6d after birth
-T4 < 3
-TSH > 40
-Jaundice
-Constipation
-Feeding problems
-Cold skin
-Decreased crying
-Hypotonia (spazzed out arms)
-Large fontanel
-Thick tongue
Hypothyroidism Tx
-Monitor growth and development
-Education on medications
-Infant stimulation programs
-Teach parents to take a pulse
-Vitamin D
-Levothyroxine 10-15mcg/kg/day (Synthroid)
-Sx of OD: irritability, rapid pulse, dyspnea, sweating, fever
Hyperthyroidism Sx
-Causes: Grave’s disease
-High T3, T4
-Low TSH
-Tachycardia
-Tremor
-Excessive perspiration
-Irritability
-Weight loss
-Diarrhea
-Increased appetite
-Muscle weakness
-Fatigue
-Exophthalmos
-Non tender, big thyroid gland
Hyperthyroidism Tx
-Monitor Sx
-Methimazole (Tapazole)
-PTU
-TID
-Propranolol
-Rest
-Diet
-Cool environment
-Radiation or surgery
Hyperparathyroidism Sx
-Fatigue
-Exhaustion
-Lethargy
-Constipation
-High Ca, PTH
Hyperparathyroidism Tx
-Resection of parathyroid
-Hypercalcemia prevention
-F/E monitoring and replacement
-Monitor Ca, P
-Educate signs of hypocalcemia
Hypoparathyroidism Sx
-Low Ca
-High P
-Hyperirritability
-Muscle rigidity
-Seizures
-N/V
-ABD distention
-Dental/enamel hypoplasia
-Chvostek sign
Hypoparathyroidism Tx
-High Ca foods
-Low P foods
Cushing Syndrome Sx
-Causes: tumor
-Weight gain
-Moon face
-Buffalo hump
-Red striae on skin
-HTN
-Acne
-Deep voice
-High cortisol
Cushing Syndrome Tx
-Radiation
-Drug therapy
-Surgery
Congenital Adrenal Hyperplasia
-Causes: ambiguous genitalia
-Tall then short in adulthood
-Hypoglycemia
-N/V
-dehydration
-low BP
-low Na
-High ACTH
Congenital Adrenal Hyperplasia Tx
-Adrenal secretion suppression
-Support
Addison Disease Sx
-Shock if untreated
-Low cortisol
-Weakness/fatigue
-Emotional lability
-Salt craving
-Hyperpigmentation
-Irritability
-N/V
-Diarrhea
-ABD pain
-Fever
-Anorexia
-Hypoglycemia
Addison Disease Tx
-Replace deficient hormones
-Fluids
Pheochromocytoma Sx
-Adrenal gland tumor
-High NE, E
-HTN
-Tachycardia
-Arrhythmias
-Triad: HTN, DM, HTN crisis
Pheochromocytoma Tx
-Removal of identified tumors
DM Type 1 Sx
-fasting glucose > 120
-3P’s
-fatigue
-confusion
-dry skin
-loss of DTR
-weight loss
-ketonuria
DM Type 1 Tx
-IV fluids to regulate acidosis
-Strick I/Os
-Monitor BG
-Low fat/carb diet
-HgbA1C q3 months
-Normal 4-7%
-High = DM
-Insulin: room temp, discard after 1m, SQ, IV for regular only
DM Type 1 Complications
-Retinopathy
-Heart Disease
-Renal failure
-Peripheral vascular disease
DKA
-Type 1
-BG > 250
-pH < 7.3
-Bicarb < 15
-Ketonuria
-High BUN, Cr, K, Cl
-Low Na, P, Ca, Mg
-3P’s
-Weight loss
-ABD pain
-N/V
-Tachycardia
-Dehydration
-Flushed face
-Kussmaul
-Fruity breath
-AMS
-Hypotension
DKA Tx
-IV insulin
-NS until BG hits 250-300, then D5 1/2 to prevent hypoglycemia
-Replace K
Hypoglycemia Sx
-Causes: too much insulin, missed meals, strenuous exercise w/o nutrition
-BG < 70
-Diaphoresis
-Tremors
-Hunger
-Weakness
-Pallor
-coma
-Seizures
-Death
Hypoglycemia Tx
-Replace glucose
-Juice/soda
-Severe: cake frost, glucagon
DM Type 2
-gradual onset
-fasting glucose > 120
-Acanthosis Nigricans
-Obesity
-no 3P’s
-HTN
Lipid disorders
DM Type 2
-Normalize blood glucose and HbA1c levels (<6.5%)
-Decrease weight
-Increase exercise
-Normalize lipid profile and blood pressure
-Nutrition education, emotional support
-Metformin improves sensitivity of target cells to insulin
-GLP-1 SQ - 10-12+ years old
Gynecomastia Sx
-Enlarged breast tissue in men
-Estrogen > testosterone
-Lasts 1-2 years
-Causes: Klinefelter, drugs that increase circulating concentration of prolactin
Amenorrhea Sx
-Lack of periods
-Primary: no growth/development at 14.5y/o
-Secondary: growth/development at 16y/o
Amenorrhea Tx
-OC
-High caloric diet
-Ca supplement
Turner Syndrome Sx
-Missing X chromosome in women
-oocytes gone by 2y/o
-Peripheral lymphedema
-Webbed neck
-Low hairline
-Short
Turner Syndrome Tx
-Monitor growth
-Growth hormone therapy
-Low dose estrogen and progesterone therapy
Klinefelter Syndrome Sx
-Extra X chromosome in men
-Low androgen
-Sexual dysfunction
-Tall
-Delayed language
-Delayed auditory
-Decreased testicular size
-Gynecomastia
Klinefelter Syndrome Tx
-Testosterone therapy
Phenylketonuria
-High phenylalanine
-Musty body/urine odor
-Irritable
-N/V
-Hyperactivity
-Hypertonia
-increased DTR
-Seizures
-Rash
-Lighter skin tone
-Dx: Guthrie screening
Phenylketonuria Tx
-Low protein diet
-No bread, cheese, eggs, flour, meat, poultry, fish, nuts, milk, legumes, aspartame
-Frequent urine/blood tests
Galactosemia Sx
-low GALT (liver enzyme)
-high galactose in eyes, liver, kidneys, brain
-Failure to gain weight
-Untreated = sepsis, death after 1m
Galactosemia Tx
-Lactose/galactose free formula
-No dairy, food coloring, lactose
Maple Syrup Urine Disease
-poor appetite
-lethargy
-N/V
-variable muscle tone
-irritability
-sweet odor in bodily fluids
Maple Syrup Urine Disease Tx
-Special diet w/ 3 amino acids removed
