Endocrine Flashcards
Growth Hormone Deficiency - Cause
often due to hypothalamic dysfunction and decreased pituitary activity
Growth Hormone Deficiency - Clinical Signs:
Normal birth size but slow growth (<5 cm/year) below 3rd percentile by age 1.
Growth Hormone Deficiency Other Symptoms:
Hypoglycemic seizures, micropenis, undescended testes, neonatal jaundice
Growth Hormone Deficiency Diagnosis:
GH level tests, hand x-rays for bone growth, endocrine studies, family history
Growth Hormone Deficiency Treatment:
GH Injections, possibly other hormone replacements (thyroid, cortisone, sex hormones)
Growth Hormone Deficiency Considerations:
Bedtime injections for better effect, family support for body image and cost concerns.
Hypothyroidism Causes:
Primary (thyroid failure) or central (pituitary/hypothalamic dysfunction).
Hypothyroidism Symptoms in Infants:
Thick tongue, hypotonia, constipation, hoarse cry, large fontanelles
Hypothyroidisms Symptoms in Children:
Dry Skin
hair loss
bradycardia
cold intolerance
goiter
Depressed deep tendon reflexes
decreased appetitie
Hypothyroidism Diagnosis:
Increased TSH
decreased T3/T4.
Hypothyroidism Treatment:
Lifelong levothyroxine with dose adjustments.
Hypothyroidism Newborn Screening:
Prevents intellectual disability and growth delay.
Precocious Puberty Definition:
Early puberty (<9 in boys, <8 in girls).
Precocious Puberty Causes:
Adrenal/gonadal tumors
early activation of GnRH
No known cause 80% of boys, 50% of girls
Precocious Puberty Symptoms:
Tall for age
early secondary sex characteristics
advanced bone age
Precocious Puberty Treatment:
GnRH analogs (Lupron) to slow early puberty. Failure to treat can result in stunted growth as children with this have advanced bone age. Removing tumor
Precocious Puberty Concerns:
Advanced bone age leads to short adult stature if untreated.
Precocious Puberty Family Education:
Emphasize normal emotional development despite early physical changes, promote positive body image, family education
Precocious Puberty Assessment
tanner staging
height/weight
psychosocial - body image
Type 1 DM Cause:
Autoimmune destruction of beta cells. Hyperglycemia resulting from defects in insulin secretion and or action
Type 1 DM Peak Ages:
4-6 years
10-14 years.
Type 1 DM Symptoms:
Polyuria
polydipsia
Weight Loss
Fatigue
Ketoacidosis
Type 1 DM Treatment:
Insulin therapy
glucose monitoring
Diet Control
Type 1 DM Insulin:
Given subcutaneously (abdomen, arms, thighs). Rapid-acting before meals.
Type 1 DM Insulin Dosing I/C Ratio:
Carbs/insulin ratio (e.g., 1:20 means 1 unit insulin per 20g carbs).
Type 1 DM Insulin Dosin Correction Factor (CF)
Correction Factor (CF): Adjusts for high blood sugar (e.g., CF 50 means every 50 mg/dL above target, 1 extra unit of insulin).
Diabetic Ketoacidosis (DKA) Definition:
Blood sugar >200 mg/dL
ketonemia
PH <7.3
Diabetic Ketoacidosis (DKA) Causes:
Missed Insulin
illness
Trauma
Diabetic Ketoacidosis (DKA) Symptoms:
Dehydration
fruity breath
Kussmaul respirations
Diabetic Ketoacidosis (DKA) Treatment:
IV fluids
insulin
Electrolyte replacement
Diabetic Ketoacidosis (DKA) Complications:
Cerebral Edema
Diabetic Ketoacidosis (DKA) Nursing Care:
Teach family about insulin
ketone testing
emergency care
Addison’s Disease (Adrenal Insufficiency) Cause
Deficiency in cortisol and aldosterone.
Addison’s Disease (Adrenal Insufficiency) Symptoms:
Fatigue, hyperpigmentation, low BP, hypoglycemia
Addison’s Disease (Adrenal Insufficiency) Diagnosis:
ACTH stimulation test.
Addison’s Disease (Adrenal Insufficiency) Treatment:
Corticosteroid replacement.
Addison’s Disease (Adrenal Insufficiency) Nursing Considerations:
Monitor for adrenal crisis (severe hypotension, shock).
Cushing’s Disease (Excess Cortisol) Cause:
Pituitary tumor (excess ACTH) or prolonged steroid use
Cushing’s Disease (Excess Cortisol) Symptoms:
Moon face, truncal obesity, muscle wasting, striae.
Cushing’s Disease (Excess Cortisol) Diagnosis:
24-hour urine cortisol, dexamethasone suppression test
Cushing’s Disease (Excess Cortisol) Treatment:
Surgery or medication
Cushing’s Disease (Excess Cortisol) Nursing Considerations:
Monitor for adrenal insufficiency after treatment
Turner Syndrome (45, X) Symptoms
Short stature, webbed neck, heart defects, infertility
Turner Syndrome (45, X) Treatment:
Growth hormone
estrogen replacement.
Klinefelter Syndrome (47, XXY) Symptoms
Tall, infertile, learning difficulties
Klinefelter Syndrome (47, XXY) Treatment
Testosterone replacement
What is considered the master controller?
Hypothalamus
5 Horomones
GH (Growth) - Bones and muscles
ACTH (Adrenocorticotropin) - Adrenal
TSh (Thyroid)
FSH, LH (Gonadotropic) - Testes and ovaries
MSH (Melanocyte) - Skin
Growth Hormone Deficiency (GHD) Prognosis
Successful in 80% treated children - 3 to 4 cm/yr BEFORE treatment and 8 to 9 after
Hypothyroidism Nursing Considerations
Plot growth, education
Euthyroid
Normal TSH/T4
Hyperthyroidism
Low Tsh
High T4
Hypothyroidism
High TSH
LowT4
Type 1 DM - Patho
deficiency of insulin, glucose is unable to enter the cell and remains in blood causing hyperglycemia when glucose exceeds the renal threshold, spills into urine. Cell break down protein and fat for conversion to glucose by liver
Type 1 DM Sick Day Rules
required insulin may need to be adjusted, don’t skip doses, fluids, urine for ketones
Rapid Insulin
Give w/in 15 minutes of a meal - watch small kids who don’t eat full meals
Intermediate insulin
Not used often in children - cloudy
Long Acting Insulin
Most common for type 1 - cant be used with any other insulin in same syringe
