Peds Endocrine Dysfunction Flashcards
Hypopituitarism causes what hormone deficiency
growth hormone deficiency
Hypopituitarism
*Deficient secretion of pituitary hormones
*Inhibits somatic growth and development of secondary sex characteristics
Clinical Manifestations of hypopituitarism
*Normal growth during first year
*Slowed growth curve after first year
*Appear overweight due to stunted height
*Delayed sexual development
definitive diagnosis of Growth Hormone Deficiency is
based on absent or subnormal reserves of pituitary GH.
-Poor linear growth, delayed bone age, and abnormal GH stimulation tests are considered GH deficient.
Therapeutic Management of Growth Hormone Deficiency
*Replacement with GH is successful in 80% of affected children
when is GH therapy ended in children
*when growth rates are less than 1 inch/year
*Girls: At 14 years of age
*Boys: At 16 years of age
when do we give growth hormone
give medication before bed as it mirrors physiological release of GH during first 45 to 90 minutes after onset of sleep
what route is GH given
SQ
Pituitary Hyperfunction results in
excess GH
Pituitary Hyperfunction
*Excess GH BEFORE closure of epiphyseal shafts results in overgrowth of long bones
clinical manifestations of Pituitary Hyperfunction
*Patients can reach heights of 8 feet or more
*Vertical growth is accompanied by increased muscle
*Weight is generally in proportion to height
-Delayed closure of fontanels
Acromegaly
Excess GH AFTER epiphyseal closure
what facial features undergo overgrowth in acromegaly
*Head
*Lips, tongue, jaw, nose
*Paranasal, mastoid sinuses
*Separation and malocclusion of the teeth
patients are at increased risk for what with acromegaly
DM
Therapeutic Management of Pituitary Hyperfunction
*Surgical treatment to remove tumor
*Radiation and radioactive implants
*Hormone replacement therapy after surgery in some cases
*Thyroid extract
*Cortisone
*Sex hormones
s/s of tumor
headache
what additional support is needed for children with pituitary hyperfunction
*Emotional support
*Addressing body image concerns
Precocious Puberty
*Defined as sexual development before age 9 years in boys or before age 8 years in girls
Evaluation for pathologic cause: Required in white girls younger than
7 years
Evaluation for pathologic cause: Required in African-American girls younger than
6 years
Therapeutic Management of Precocious Puberty
*May be treated with leuprolide (Lupron)
*Psychologic support for child and family
*Dress and activities need to be appropriate for child’s chronological age
leuprolide (Lupron)
*Slows prepubertal growth to normal rates
when is treatment with leuprolide (Lupron) stopped
*Treatment is discontinued at age when normal pubertal changes are expected to resume
dosage for leuprolide (Lupron)
once every 4 to 12 weeks depending on the preparation
Diabetes Insipidus
antidiuretic hormone is NOT secreted adequately producing uncontrolled diuresis
cardinal signs of diabetes insipidus
Polyuria and polydipsia
clinical manifestation of an infant with diabetes insipidus
*Irritability relieved with feedings of water but not milk; dehydration often occurs
diagnosis for DI is done by
reducing fluid intake with little or no effect on urine output
Therapeutic Management of Diabetes Insipidus
*Instruct parents in difference between diabetes insipidus and diabetes mellitus
*Daily hormone replacement
*Drug of choice: Vasopressin (DDAVP)
Clinical Manifestations ofJuvenile Hypothyroidism
*Mental decline - if left untreated
*Constipation
*Sleepiness
*Myxedematous skin changes:
*Dry skin
*Sparse hair
*Puffiness around eyes
Therapeutic Management of Juvenile Hypothyroidism
*Oral thyroid hormone replacement (levothyroxine)
*Prompt treatment needed for brain growth in infant
*May administer in increasing amounts over 4 to 8 weeks to avoid symptoms of hyperthyroidism
*Compliance with medication regimen: Crucial
*Children to take responsibility for medication regimen as soon as they are able
Lymphocytic Thyroiditis is also known as
“Hashimoto’s disease” or “autoimmune thyroiditis”
Hashimoto’s disease
autoimmune hypothyroidism; accounts for largest percentage of juvenile hypothyroidism
Clinical Manifestations of Lymphocytic Thyroiditis
*Enlarged thyroid gland
*Usually symmetric
*Firm, nontender
*Freely moveable
*Tracheal compression
*Sense of fullness
*Hoarseness, dysphagia
Therapeutic Management of Lymphocytic Thyroiditis
*Goiter may be transient, asymptomatic
*Goiter may resolve spontaneously within 1 to 2 years
*Oral thyroid hormone administration often decreases the goiter significantly
*Surgery is contraindicated in this disorder
clinical manifestations os Hyperthyroidism (Graves’ Disease)
*enlarged thyroid gland and exophthalmos
Therapeutic Management of Graves’ Disease
*Antithyroid drugs
*Subtotal thyroidectomy
*Ablation with radioiodine
Thyrotoxicosis
*Thyroid “crisis” or “storm”
*May occur from sudden release of thyroid hormone
Care Management of Hyperthyroidism
*Be alert for signs and symptoms
*Child needs quiet environment, rest periods
*Help family cope with emotional lability
*Dietary requirements are higher to meet child’s increased metabolic rate
Parathyroid glands secrete
*parathormone (PTH)
Function of PTH:
To maintain serum calcium level by:
*Increasing release of calcium and phosphate from bone demineralization
*Increasing absorption of calcium and excretion of phosphate by the kidneys
*Promote calcium absorption in GI tract
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
*Diagnosis based on clinical symptoms
*Low plasma PTH
diagnosis for hypoparathyroidism is based on
clinical manifestations associated with decreased serum calcium and increased serum phosphorus
goal for hypoparathyroidism is to
*maintain calcium and phosphate levels
Therapeutic Management Hypoparathyroidism
*Tetany immediately corrected
*Vitamin D therapy
*Monitor renal function, blood pressure, serum vitamin D levels
*Maintain seizure and safety precautions
*Monitor for laryngospasm
Signs of laryngospasm
stridor, hoarseness, and feeling of tightness in throat
signs of vitamin toxicity
weakness, fatigue, lassitude, headache, nausea, vomiting, and diarrhea
Diabetes mellitus is characterized by a
*total or partial deficiency of the hormone insulin
Type 1 Diabetes Mellitus
*Characterized by destruction of beta cells, usually leading to absolute insulin deficiency
*Onset typically in childhood and adolescence but can occur at any age
*Most childhood cases of diabetes mellitus are type 1
Type 2 Diabetes Mellitus
*Arises because of insulin resistance
*Onset usually after age 45
*Affected people may require insulin injections
Ketoacidosis
*When glucose is unavailable for cellular metabolism, the body breaks down alternative sources of energy; ketones are released, and excess ketones are eliminated in urine (ketonuria) or by the lungs (acetone breath)
Diabetic Ketoacidosis
*Pediatric emergency
*Results from progressive deterioration with dehydration, electrolyte imbalance, acidosis, coma; may cause death
Long-Term Complications of Diabetes Mellitus
*Microvascular complications, especially nephropathy and retinopathy
*Macrovascular disease, neuropathy
*With poor control, vascular changes as early as 2.5 to 3 years after diagnosis
-recurrent vaginal and urinary tract infections , especially Candid albicans
Four different tests to confirm DM
*8-hour fasting blood glucose of 126 mg/dL
*Random blood glucose 200 mg/dL or more
*Oral glucose tolerance test of 200 mg/dL or more in 2-hour sample
*Hemoglobin A1C of 6.5% or more
Therapeutic Management of Diabetes Mellitus
-insulin theapy: mostly for type 1
-monitor BG levels
-nutrition and exercise
-monitor morning hypoglycemia
-illness management
nutrition management for DM
need sufficient calories to balance daily expenditure for energy and to satisfy the requirements for growth and development
-increase dietary fiber to diminish the rise in blood glucose after meals total caloric intake to appetite and activity
Insulin preparations: Dosage
twice-daily insulin regimen of combination of rapid-acting and intermediate-acting insulin drawn up in the same syringe and injected before breakfast and before evening meal
exercise management for DM
-children’s activities are unplanned therefore snack during the prolonged activity
-Activity often results in reduction of insulin requirements
Down Syndrome
*Nonfamilial trisomy 21, Extra chromosome 21
clinical manifestations of downs syndrome
*Square head with upward slant to eyes
*Flat nasal bridge, protruding tongue
*Hypotonia- decreased muscle tone
diagnosis of downs syndrome
*Chromosome analysis
physical problems for downs syndrome
*Congenital heart disease (ASD, VSD)
*Hypothyroidism
*Leukemia
available therapies for downs syndrome
*Surgery to correct congenital anomalies
*Decreased muscle tone compromises respiratory expansion
-Nasal bone is underdeveloped therefore inadequate drainage of mucus
-Protruding tongue = interferes with feeding
-Decreased muscle tone affects gastric motility, predisposed to constipation
*Periodic testing of thyroid function
Care management for downs syndrome
*Supporting child’s family at time of diagnosis
*Preventing of physical problems
*Assist in prenatal diagnosis and genetic counseling
Fragile X Syndrome
a disorder produced by injury to a gene on the X chromosome, producing mild to moderate mental retardation
Fragile X Syndrome: Clinical Manifestations
*Large head circumference
*Long face with a prominent jaw (prognathism)
*Large, protruding ears
*Large testes (postpubertal)
Fragile X Syndrome: Classic Behavioral Features
*Mild-to-severe cognitive impairment
*Delayed speech and language
*Hyperactivity
*Hypersensitivity to taste, sounds, and touch
*Autistic-like behaviors
*Aggressive behaviors
Fragile X Syndrome: Therapeutic Management
*Tegretol/Prozac for behavioral control
*Stimulants for hyperactivity (similar to management of attention deficit/hyperactivity disorder)
*Referral to early intervention program
