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M6 13-005

Exam 12: Peds Endocrine System

Early signs of an inborn error of metabolism in the newborn (1) Lethargy. (2) Failure to thrive. (3) Vomiting.
What are the two major systems that control and monitor the functions of the body? The nervous system and the endocrine system.
Hypopituitarism : a primary disorder associated with deficient secretion of GH (somatotropin).
Hypopituitarism may be the result of a variety of conditions Developmental defects. Destructive lesions from tumors on the pituitary, birth trauma (head injury) or vascular abnormalities (aneurysms). Hereditary disorders. Functional disorders such as anorexia nervosa or psychosocial dwarfism.
Endocrine studies are done to detect evidence of other abnormalities such as: Hypothyroidism. Hypersecretion of cortisol. (Cushing Syndrome). Gonadal aplasia.
Diabetes Insipidus (DI) occurs as a result of the hyposecretion of the antidiuretic hormone or vasopressin which produces a state of uncontrolled diuresis.
Primary causes of DI Familial. Idiopathic.
Secondary Causes of DI Trauma. Tumors. Granulomatous disease. Infections. Vascular anomalies.
DI Manifestations Polyuria. Polydipsia. The first sign usually is enuresis. With infants: the initial symptoms include irritability that is relieved with feedings of water, not milk.
vasopressin (Pitressin) alleviate the polyuria and polydipsia
The usual treatment requires daily replacement of vasopressin using desmopressin acetate (DDAVP), which is a synthetic form of vasopressin
DDAVP: Signs of overdose Water intoxication. Anorexia. Nausea. Stomach cramps. Irritability. Changes in personality. Seizures. Changes in level of consciousness.
Treatment for DI is Lifelong
syndrome of inappropriate antidiuretic hormone secretion (SIADH). Hypersecretion of vasopressin
SIADH is commonly caused by (1) Infections. (2) Tumors. (3) Trauma of the central nervous system.
SIADH manifestations Increased fluid volume. Low sodium levels. Anorexia. Nausea. Stomach cramps. Irritability. Personality changes. Changes in level of consciousness. Seizures.
Hypothyroidism Hypothyroidism occurs when there is a deficiency in the secretions of the thyroid gland. May be congenital or acquired. It is one of the most common disorders of the endocrine system in children.
The thyroid gland controls the rate of metabolism in the body by producing thyroxine (T4) and triiodothyronine (T3)
Hypothyroidism Manifestations Infant is sluggish and sleeps a lot. Tongue becomes enlarged, causing noisy respiration. Skin is dry. Hands and feet are cold. Infant feels floppy when handled. Hypotonic bowels. Hair dry and brittle. irreversible mental retardation. If untreated.
Children with Hypothyroidism may experience with treatment. synthetic hormone sodium levothyroxine (Synthroid or Levothroid). Reversible Hair loss. Insomnia. Aggressiveness. Schoolwork may decline during first few months of therapy.
Synthetic hormone sodium levothyroxine (Synthroid or Levothroid) signs of overdose. 1) Rapid pulse. 2) Dyspnea. 3) Irritability. 4) Fever. 5) Sweating. 6) Weight loss.
Synthetic hormone sodium levothyroxine (Synthroid or Levothroid) signs of inadequate medication Fatigue. Sleepiness. Decreased Appetite. Constipation.
Hyperthyroidism. Graves disease is associated with an enlarged thyroid gland and exophthalmos. It is thought to be caused by a serum thyroid-stimulating immunoglobulin, but no specific etiology has been identified.
hyperthyroidism manifestations Emotional Liability. Physical restlessness. Voracious appetite with weight loss. Tachycardia, HTN and widened pulse pressure. Dyspnea on exertion. Exopthalmos. Goiter. Heat intolerance. Systolic Murmurs. Acute Thyroid storm.
Thyroid Storm Severe irritability and restlessness. Vomiting and diarrhea. Hyperthermia. HTN and severe tachycardia.
Therapy is directed toward retarding the rate of hormone secretion. There are three ways to do this (a) Antithyroid drugs. (b) Subtotal thyroidectomy. (c) Ablation with radioiodine.
Chvostek’s sign facial muscle spasms elicited by tapping the facial nerve.
Trousseau sign carpal spasm elicited by pressure applied to nerves of the upper arm.
Tetany involuntary contraction of muscles
Diabetes Mellitus a chronic metabolic condition in which the body is unable to use carbohydrates properly because of a total or partial deficiency of insulin.
Type I DM: most common endocrine disorder of children. characterized by destruction of the pancreatic beta cells which produce insulin. This leads to absolute insulin deficiency.
Type II Dm: usually arises because of insulin resistance, where the body fails to use insulin properly in addition to an insulin deficiency. This occurs primarily in adults.
Diabetes Mellitus Genetic Factors 1) Type I DM is not inherited, but heredity has a role in its etiology. 2) Type II DM has a strong correlation to heredity with a 90 to 100% concordance.
Diabetes Mellitus Autoimmune Mechanisms 1) An autoimmune process is involved in persons who develop type I DM. 2) There is also a strong association between type I DM and other autoimmune endocrine disorders such as thyroiditis and Addison’s disease.
Ketoacidosis: When insulin is absent, glucose is unavailable for cellular metabolism and the body chooses other sources of energy, mainly fat.
DM Diagnostic Evaluation Fasting blood glucose. Glucose Tolerance Test.
Management of DKA 1) Rapid assessment. 2) Adequate insulin to reduce the elevated blood glucose levels. 3) Fluids to overcome the dehydration. 4) Electrolyte replacement.
Created by: jtzuetrong