Endocrine

Question 1

Pediatric Differences

Answer 1

• Sexual differentiation during fetal development ( wk 7-8 will determine gender )
• Hormone low throughout childhood
• Puberty
  -Age 9 female -> breast development -> pubic hair -> menarche (start period)
• Age 11 male -> adrenarche -> testicular enlargement -> pubic hair -> sperm present -> facial hair -> voice change

Nursing: Assess growth and development

Question 2

What is the role of the pituitary gland

Answer 2

Stimulate or inhibits the release of hormones

Question 3

Hormones in the anterior pituitary gland

Answer 3

1. thyroid stim
2. Adrenocorticotropic
3. Luteinizing
4. Follicle stim
5. growth hormone
6. Prolcatin

Question 4

Hormone in the posterior pituitary gland

Answer 4

1. Antidiuretic
2. Oxytocin

Question 5

Growth Hormone deficiency ( Hypopituitarism )

Answer 5

S/SX: short stature, growth delay, high pitched voice, decreased muscle mass, “CHERUBIC”- angel face,
- Delayed dentition, skeletal maturation, sexual characteristics

DX: screening, provacative GH testing, bone aging XR

TX: replacement, SOMATOTROPINM SubQ (stopped when growth slows to <1in a year )

Nursing: education about injections, compliance, body image concerns, expensive tx, monitor growth pattern

Question 6

Growth Hormone Excess ( Acromegaly or Hyperpituitarism )

Answer 6

patho: increased growth rate

S/SX: 7-8 ft tall, large hands, feet, long extremities, protruding brow, lower jaw

DX: bone aging XR

TX: OCTREOTIDE ( slows down the growth but has a lot of side effects ), remove causative agents- tumor?

Nursing: education and emotional support

Question 7

Diabetes Insipidus ( Arginine Vasopressin Disorder )

Answer 7

Patho: decreased secretion of antidiuretic hormone = kidneys cant concentrate urine

Cause: idiopathic, tumors, brain trauma, infection, neurosurgery

S/SX: Polyuria (excessive urination), Polydipsia ( excessive thirst ), Enuresis ( bed wetting ) w/ insatiable thirst , Dehydration ( hypernatremia )

TX: DESMOPRESSIN ( decreases urinary output )
- can give PO or intranasal

Nursing: avoid food that causes diuresis( increases urinary output )

Question 8

Precocious Puberty

Answer 8

Patho: appearance of secondary sex characteristics before 8 ( more common in females )

Cause: Gonadatropin releasing hormone cause growth plate to close

TX: LEUPROLIDE (decreases growth rate )
- tx cause if known

Nursing: psychologic support

Question 9

DM Type 1

Answer 9

Patho: PANCREASE DOESNT PRODUCE ANY INSULIN
( blood glucose increases but no insulin to transport into cells)

S/Sx: polyuria, polydipsia, polyphagia , urine glucose and ketones, leaner body types

DX: fasting blood sugar, Hemoglobin A1C <7

TX: insulin - SubQ or pump

Nursing: Education- hyperglycemia, hypoglycemia, meal planning, glucose needs change as child grows, long term complications
- Sickness= higher risk of complication, monitor urine ketones at home, hydrate, call doctor when unable to take fluids

Question 10

DM Type 2

Answer 10

Patho: insulin resistance

Cause: obesity, sedentary, race and family hx

S/SX: polyuria, polydipsia, polyphagia, urine glucose +ketones, dyslipidemia and HTN

DX: fasting glucose, HGB A1C

Question 11

Diabetic Ketoacidosis (DKA)

Answer 11

Patho: increase glucose but dont have insulin for cells to use glucose –> liver breaks down fat –> production of ketones ( which is an acid )
- Kidneys try to excrete glucose –> dehydration ( water follow glucose )
- rising ketone + dehydration = METABOLLIC ACIDOSIS

S/SX: Polyuria, polydipsia, ketonuria, dehydration, electrolyte imbalance, N/V, tachycardia, hypotension, ( loss of 40% of volume )
- KUSSMAL RESPIRATIONS ( long + slow breathing - trying to get rid of acid )
- Altered level of consciousness, coma, death, ( b/c cells cant use glucose )

TX: IV hydration, regular insulin ( monitor for hypokalemia and cerebral edema - water follow glucose )

Nursing: educate

Question 12

Hypoglycemia

Answer 12

Patho: blood glucose less than 70

Cause: rapid growth rates, activity level, eating habits

S/SX: pallor, sweating, tremors, dizzy, confusion, seizures, death

TX: admin PO glucose (tabs, paste) if alert, Glucose IV or glucagon IM if unable to take PO

Nursing: give extra snacks to prevent when active ( complex carbs, protein)
- Hyperglycemia: s/sx= dry mouth, thirst, weakness, HA, blurred vision, polyuria

Question 13

Gynecomastia

Answer 13

Patho: growth of breast tissue in males (imbalance of hormones )

Cause: Klinefelter, testicular issues

TX: surgery or TAMOXIFEN

Nursing: body image concerns

Question 14

Amenorrhea

Answer 14

Patho: absence of menarche (period ) with or w/o secondary sex characteristics

Cause: turners, tumors, PCOS, thyroid issues

Nursing: rule out pregnancy,
At risk b/c of lack of body fat (athletes, anorexia nervosa )

Question 15

Dysmenorrhea

Answer 15

Patho: painful menstration (PMS,PMDD)

TX: NSAIDS, oral contraceptives

Nursing: r/o pelvic abnormality (endometreosis, uterine fibroids, pelvic inflammatory disease, STI’s, cysts, IUD )

Question 16

Turner Syndrome

Answer 16

Patho: sex chromosome abnormality in females ( missing all or part of one X chromosome )

S/SX: infertility, low hairline, small jaw, short, webbed neck and broad chest, heart + kidney defects

Question 17

Klinefelter Syndrome

Answer 17

Patho: extra x chromosomes in males

S/SX: androgen deficiency, infertile, delayed puberty, small testicles, gynecomastia, less hair, learning disabilities

TX: testosterone replacement therapy

Question 18

Phenylketonuria (PKU)

Answer 18

Patho: can utilize protein, leads to brain damage –> disability if left untreated ( autosomal recessive inherited )

S/SX: musty urine and body odor, irritability, hypertonic (tense), seizures

DX: newborn screening at 24 hrs old

TX: diet restrictions - life long