Endocrine Flashcards
What is hypopituitarism?
Which hormones?
Not enough hormones from the pituitary
GH - main one
Gonadotropin
TSH
Corticotropin
In hypopituitarism, what are GH levels at first?
If GH is low, will this affect their growth?
Normal. They drop around 1 yr or at the growth curve.
- But they still are having this hormone. Just not enough
Yes - duh.
In hypopituitarism, what can occur if Gonadotropin levels are low?
What type of issues can arise with low TSH & corticotropin?
Delayed sexual development
- difficulty reproducing
Developmental issues as well.
What will the bone age be in someone with a low GH level?
Bone age will be delayed
- growth plates will not be developed like they should be for age
When a child isn’t growing like expected & we think it is GH - how do we diagnosis this?
- Check family history to see how other members grew. Combination between parents is typical.
- Check for tumors that interfere with production
- X rays to look at the bone age
If GH is low - what things can stimulate GH production?
Explain the last one
Arginine, L-dopa, and Insulin (hypoglycemia will stimulate it).
Percent of GH cases that are successfully treated when the GH is replaced?
Type of injection used to replace GH?
What is a reason to stop administering the GH?
80% of GH cases
- this means they get “closer” to expected growth
SQ for 6-7 days a week
Stop GH if the bone plates are closing bc it is the maximum
- they will monitor for this
Why do we test kids who have GH deficiency for other hormones?
Just incase they have other deficiencies & to get them those supplements.
- TSH, Gonadotropin especially
Why is family support so important with GH therapy?
It is expensive. Need to make sure the family has the resources.
- help with insurance
Also, children can go through personality changes that the family may not be expecting.
Also help child feel accepted in society.
What is Diabetes Insipidus?
And what does this cause?
Undersecretion of Antidiuretic Hormone (ADH)
- ADH will decrease if there is an excess of fluid and it will increase when there’s too little fluid.
- Just think of the name.
Diabetes Insipidus. Since we don’t have enough ADH, you will have excessive urination and thus dehydrate yourself.
- and restricting fluid won’t help
How to diagnose Diabetes insipidus (or too little ADH = dehydration)?
What can cause DI? How does this affect treatment?
Clinical manifestation of excessive urination
Tumor of or near the pituitary.
Trauma or infection.
- If one of these things are the cause, then we need to treat this first.
What can vasopressin do for Diabetes insipidus?
What route is it given?
If vasopressin is given in then the urine excretion will stop.
It is sort of a definite sign or test that Diabetes insipidus is the problem in the first place.
- vasopressin is actually a synthetic ADH
Give vasopressin IV, orally, nasally
- DDAVP
What if the cause of Diabetes Insipidus isn’t due to a tumor/infection that can be fixed? How will they be treated?
They’ll be given long term therapy for ADH replacement.
- maybe vasopressin long term?
What is Syndrome of Inappropriate Antidiuretic Hormone?
What electrolyte is affected?
What happens to urine osmolality?
SIADH is just an overproduction of ADH.
- meaning you won’t pee & you will retain fluid
Sodium (Na) will dilutionally decrease
Urine osmolality increases.
Since SIADH causes a decrease in sodium, what can that cause?
How to manage this?
Can cause Neurological changes due to cerebral edema (can cause brain damage due to pressure restricting bloodflow)
- the more sodium decreases, more CNS issues arise
Fluid restriction to make sure it doesn’t make it worse.
Do electrolyte replacement to replace or even draw Na back in.
What is hypoparathyroidism?
Which hormones?
Deficiency in hormones from parathyroid.
Parathyroid hormone (PTH) which help regulate serum calcium -PTH, calcitonin, VIT D will
What can cause hypoparathyroidism?
What is the PTH, Ca, phosphorus relationship
Congenital
Post thyroidectomy (for hypothyroidism or nodules) due to close proximity anatomy - leading to short term impact on PTH
Transient PTH deficiency from mom to neonate
- tremors & seizures due to low calcium
If not enough PTH - will see a decrease in serum Ca and increase in phosphorus
- just regulate and return these to norms
Calcium Levels
Newborn
24-48 hrs old
4-7 yrs old
Child
Ionized
Newborn
24-48 hrs old
Thereafter
Calcium Levels
Newborn 9-10.6
24-48 hrs old. 7-12.0
4-7 yrs old. 9-10.9
Child 8.8-10.8
Ionized.
Newborn. 4.3-5.1
24-48 hrs old. 4.0 -4.7
Thereafter 4.8-4.92
How to recognize hypocalcemia?
How to treat hypocalcemia?
Tremors, seizures, or any changes in muscle functioning
EKG changes
Treat w calcium replacement IV (later on oral)
As well as replace vitamin D IV to help with calcium absorption
- stay away w scalp veins & monitor their EKGs
Which diabetes is more common in children?
Type 1 since it is an autoimmune process with genetic predisposition.
- However, type 2 is growing since obesity is becoming more common.
For type 1 diabetes to occur in a child, what needs to happen?
What is the patho?
Often need an environmental trigger of some sort like an infection or exposure to chemical. Not really known for sure. We just know its not just genes.
- one time they tried to use immunosuppresants in a study to stop it from happening but it didn’t work
Destruction of beta islet cells in the pancreas
- insulin is produced in these & so then there is a lack of insulin since there’s no cells to make it
- insulin resistance
3 P’s associated with diabetes type 1?
Polyruia - increased urination
PolyDipsia - thirst
Polyphagia - hunger, leading to weight loss
- we often bring someone into the doctors for a prolonged issue like this & they find they have elevated BG and then have diabetes.
- may be DKA too
What is Diabetic Keto acidosis?
How does this happen?
Type 1 diabetics can develop this.
- Changes in breathing
- Fruity smell
- Change of consciousness
Well the 3 P’s kind of set this off due to BG. DKA is often the first finding that causes someone to know they have diabetes type 1.
Can a type 1 diabetes who is already diagnosed and treated develop DKA?
Yes.
Infection/Illness can cause the DKA
Poor diet control and BG climbing & thus burning fat cells (keto)
Stress
Patho of Diabetic Keto Acidosis (DKA)
Glycogen
Glycogenesis
Gluconeogenesis
Explain how they work together
Normal: insulin allows glucose to come on in and feed the cell with energy
- carbs is usually the source of glucose for immediate use
Glycogen: stored carbs in liver in the form of glucose
Glycogenesis: creating the glycogen
Gluconeogenesis: stored proteins and fats as glycogen
Body will usually put carbs in the liver as glycogen. This process if called Glycogenesis. Gluconeogensis is when we put fats & protein into a form of stored glycogen also. (All this means is that we have energy stored away in liver, fat, and muscle. First one to get used up is in the liver)
If we aren’t getting enough glucose in the form of carbs to keep up with energy needs, we burn through all of the stored energy. IF it gets to the point we are using the fats and proteins as energy, our body will give off ketones. Once ketones reach our blood, then we become in a state of acidosis. And we aren’t made to be in an acidotic state & so our body will try to correct it
What are symptoms of DKA…..
Fluids?
Cardiac?
Weight?
Breath?
What may someone mistake them as?
F&E imbalances
Dehydration
- due to wanting to pee out the acid so much
Tachycardia
Hypotension
- trying to compensate for less volume but eventually the tachy stops working to compensate
Kussmauls
- deep respirations trying to blow off CO2 (acid)
Weight loss
- not getting nutrients to cells & the polyphagia
Fruit/acetone breath
- due to ketones
Decreased senses and neuro
- someone might actually think they’re drunk
What can DKA progress to?
Coma & death
- emergency situation
Diabetic Keto Acidosis labs (DKA)
Potassium
Sodium
BUN
Chloride
Phosphurus
Ca & Mg
Co2
Blood sugar
WBC
Triglycerides
DKA
Potassium can be normal or low
- Low due to intracellular changes
Sodium serum level low
- due to diuresis or peeing
BUN increased
- dehydration
Chloride
- normal, low , or high
- saline resuscitation may reason for increased CL
Phosphurus is low
- diuresis
Ca & Mg decrease
- the decrease comes from phosphorus replacement
CO2 will be low now
- due to them trying hard to breath it off
Blood sugar
- elevated
WBC shift left is change is triggered by infection
Triglycerides are elevated
- Very important to monitor these labs DURING treatment. Increased neuro problems with shifting fluid - even if intentional.
Why and when do we want to monitor DKA labs so closely?
We want to monitor labs during treatment especially. This is because our treatment may include fluid shifts - and if this happens too fast, we can have some neuro issues due to cerebral edema. Even if it is intentional, the shift cannot be all of a sudden. It takes time.