EXAM 3: ENDOCRINE Flashcards
Describe hypopituitarism
Growth Hormone Deficiency
Deficient secretion of pituitary hormones
Inhibits somatic growth and development of secondary sex characteristics
Normal growth the first
Slowed growth after infancy
Delayed sexual development
Replacement with GH is successful in 80% of affected children
Therapy is ended when growth rates are less than 1 inch per year
Girls: at 14 years of age
Boys: at 16 years of age
Describe Pituitary Hyperfunction
Excess GH before closure of epiphyseal shafts results in overgrowth of long bones
Patients can reach heights of 8 feet or more
Vertical growth is accompanied by increased muscle
Weight is generally in proportion to height
Excess GH after epiphyseal closure is called “acromegaly”
Typically, several facial features undergo overgrowth
to fix, get rid of tumor and Hormone replacement therapy after surgery in some cases
Thyroid extract
Cortisone
Sex hormones
Describe Precocious Puberty
Defined as sexual development before age 9 years in boys or before age 8 years in girls
May be treated with leuprolide (Lupron)
Slows prepubertal growth to normal rates
Treatment is discontinued at age when normal pubertal changes are expected to resume
What are the 2 Types of Precocious Puberty
Central precocious puberty (CPP)
80% of cases of precocious puberty
Early maturation and development of gonads and secondary sex characteristics
Peripheral precocious puberty
Premature development of breasts, pubic and axillary hair, and menses
Describe Diabetes Insipidus
Pit gland produces insufficient ADH, which makes thee kidneys make a lot more urine.
First sign is often enuresis (involuntary urination: wetting self)
Infants: irritability relieved with feedings of water but not milk; dehydration often occurs
Diagnosed by reducing fluid intake with little or no effect on urine output
Daily hormone replacement
Drug of choice: vasopressin (DDAVP)
Nasal spray or intravenous administration
Subcutaneous or intramuscular injection
Treatment required for life
Describe Syndrome of Inappropriate Antidiuretic hormone (SIADH)
LOW URINE output
concentrated urine
EDEMA, muscle twitching, confusion, lethargy
Fluid retention and hypotonicity
Kidneys unable to reabsorb water
Manifestations
Anorexia, nausea/vomiting, irritability, personality changes
Fluid retention and hypotonicity
Symptoms alleviated when ADH is decreased
Tx: ADH Antagonist
Nursing management of SIADH
Accurate measurements of intake and output
Observation for signs of fluid overload
Seizure precautions
ADH-antagonizing medications
Describe Goiter
Hypertrophy of the thyroid gland
Congenital
Usually results from maternal ingestion of antithyroid drugs during pregnancy
Acquired
Result of neoplasm, inflammatory disease, dietary deficiency (but rarely in children), or increased secretion of pituitary thyrotropic hormone
Goiters may become noticeable during periods of rapid growth
Large goiters may be obvious; smaller nodules may be evident only on palpation
Thyroid hormone replacement is necessary for treatment of hypothyroidism
Immediate surgery may be life-saving in infants born with goiter
Describe Lymphocytic Thyroiditis
Also known as “Hashimoto disease”
Most common cause of thyroid disease in children and teenagers
Accounts for largest percentage of juvenile hypothyroidism
Occurs most frequently after age 6 years, peaks during adolescence
Enlarged thyroid gland
Usually symmetric
Firm, nontender
Freely moveable
Tracheal compression
Sense of fullness
Hoarseness, dysphagia
Hyperthyroidism possible
Antithyroid antibodies are present
Oral thyroid hormone administration often decreases the goiter significantly
Surgery is contraindicated in this disorder
Describe Hyperthyroidism
(Graves Disease)
Big eyes, big thyroid
It is believed to be caused by autoimmune response to TSH receptors
Treatments
Antithyroid drugs (propylthiouracil and methimazole)
Subtotal thyroidectomy
Ablation with radioiodine
Child needs quiet environment, rest periods. Higher calorie diet
Function of PTH:
maintain serum calcium level by
Clinical Manifestations of Hypoparathyroidism
Dry, scaly skin with eruptions
Brittle hair, thin nails with transverse grooves
Tetany, paresthesias, tingling, laryngeal stridor, spasms, or a combination of these
Headache, seizures, emotional lability, depression, confusion, memory loss
Chvostek’s Sign Trousseau’s Sign
Both due to hypocalcemia
Goal is to maintain calcium and phosphate levels
Tetany immediately corrected (with Ca, Vit D, and Mg)
Monitor renal function, blood pressure, serum vitamin D levels
Maintain seizure and safety precautions
Monitor for laryngospasm
T/F: Adrenal crisis is life threatening
True, without Tx you’ll die
low BG, back pain, hair loss, confusion, fever, fatigue, LOC, vomiting, joint pain, hypotension
Therapeutic management
Replace cortisol
IVFs HYDROCORTISONE
Nursing- monitor electrolytes, s/s of dec K+
Describe Chronic Adrenocortical Insufficiency
(Addison Disease)
rare in children, only have sx late stage
Therapeutic management
Replacement of cortisol and aldosterone
Should be taken qd-qod (AM) with food
Describe Cushing Syndrome
TOO MUCH CORTISOL:
May be caused by excessive or prolonged steroid therapy
Condition: reversible once steroids are discontinued
Abrupt withdrawal of steroids: may precipitate acute adrenal insufficiency
turn into a fat red pimply goblin with a buffalo hump and brittle bones
