Question | Answer |
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. |