Endocrine
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| Hypopituitarism refers to GH deficiency and will be a dysfx where? Caused by? | hypothalamus
cause: dev defects, tumors, trauma, surg, hereditary disorders, anorexia nervosa, dwarfism
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| Diagnostic studies include? | fam hx, growth patterns, hand xrays to evaluate growth potential vs ossification, endocrine tests
Diffinitive dx: GH levels in blood
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| Tx for hypopituitarinism | GH injections is tx of choice
May need TH, cortisone, test or estrogen/progesterone
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| what is Prader-Willi Syndrome | uncommon genetic disorder cause poor muscle tone, low levels of sex hormones, constant hunger, so obesity. Infants floppy(poor muscle tone). Boys undescended testicles
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| Late s/s that may appear wtih Prader-Willi Syndrome | short stature, poor motor skills, wt gain, underdev sex organs, mild mental retardation.
No cure
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| Nsg for hypopituitarianism | help fam w/ body image, prepare child for inj and very exp, give inj at bedtime to resemble normal GH release
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| What is consideration of pt getting GH from cadavers that does not occur from biosynthetic GH? | Creutzfeldt-Jakob Disease
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| What do you get with hyper pituitary fx? | Giants, up to 8ft, excess long bone growth if give GH before epiphyseal shafts close
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| After epiphyseal closure and have excess GH, what do you get? | acromegaly, overgrowth of head, lips, nose, tongue, jaw, mastoid sinuses, malocclusion of teeth, incr facial hair, thick, creased skin
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| Tx for hyper pituitary fx? | remove tumor from sella turcica, radiation implants, hormone replacement after
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| What is precocious puberty? | sex dev b4 9y/boys, 8y/girls. Girls w/ higher body fat at 5y more likely. Am then mex-Am, then white
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| two types of precocious puberty | true: premature activation of hypo-pit-gonadal w/ early maturation
pseudopuberty - incomplete: no early secretion of gonadotropin, overproduction of sex hormones caused by tumor
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| tx for precocious puberty | Lupron: luteinizing hormone
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| What is nephrogenic DI? | unresponsiveness of renal tubules to hormone, rare hereditary disorder and will not respond to DDAVP
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| First sign of neruogenic DI? | enuresis, infants are irritable and prefer water to milk.
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| Does SIADH lead to edema? | not necessarily bc edema is excess of water and sodium, this is retention of water.
s/s: FVE (no edema), seizure from low Na
tx: ADH antagonizing meds
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| What is most common endocrine disorder for children? s/s? tx? nsg? | juvenile hypothyroidism
s/s: decelerated growth, constipation, sleepiness, dry skin, sparse hair, periorbital edema
tx: TH replacement, infant need immediate care for brain growth which happens by 2-3y
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| What are some antithyroid or iodide meds? SE of PTU? | MTZ methimazole, PTU propylthiouracil
SE: sore throat, fever, leukopenia, hypothyroidism
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| what is lymphocytic thyroiditis? | Hashimoto disease or juvenile autoimmune thyroiditis. Most common cause of thyroid disease in children/teen
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| what are cardinal s/s of Grave's Disease? | emotional liability, restlessness, poor school performance, voracious appetite w/ wt loss.
Dx: elevated T3 & T4
tx: PTU, thyroidectomy, radioiodine
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| What is tx for thyrotoxicosis or thyroid storm? | antithyroid drugs, propranolol for s/s of hyperthyroidism
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| what is fx of PTH? | incr Ca & Phosphate release bone demineralization
incr absorption of Ca and excretion os phosphate by kidneys
Incr Ca absorption in GI
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| With Pseudohypoparathyroidism what r s/s? | PTH is incr, but end organs are unresponsive to hormone
s/s: short stature, round face, thick neck, stubby fingers/toes, dimpling skin over knuckles, mental retardation
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| s/s? tx for hypoparathyroidism | s/s: muscle cramps(early), numbness, stiffness, tingling in hands/feet, +Chvostek/Trousseau's sign, laryngeal spasms
tx: massive Vit. D
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| Early s/s of acute adrenocortical insufficiency? Shocklike state s/s? In infants? | early: irritable, HA, abd pain, weak, N/V/D
shock: weak, rapid pulse, decr BP, shallow resp, cold/clammy skin, cyanosis, cirulatory collapse
Inf: hyperpyrexia, tachypnea, cyanosis, seizures, palpable gland
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| what is Waterhouse-Friderichsen Syndrome? | generalized cerebrospinal meningitis with fever, nuchal rigidity, seizures, stupor, coma
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| tx for acute adrenocortical indufficiency Nsg? | cortisol, fluids for dehydration/hypovolemia, glucose for hypoglycemia, antibiotics if inf.
Nsg: monitor for hypokalemia(weak, paralysis, hyporeflexia, ileus, arrhythmias)
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| Addison's disease is chronic adrenocortical insufficiency and is rare in children, what are s/s? | Neuro: muscle weak, mental fatigue, irritable, listless
Pigment: palmar creases, dark over elbows/knees/waist
GI: dehydration, anorexia, wt loss
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| more s/s of Addison's dis | circulatory: hypotension, sm heart size, dizzy, fainting
Hypoglycemic: HA, hunger, weak, tremble
other: crave salt, acute abd pain, electrolyte imbalance
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| tx for Addison's Disease | cortisol, aldosterone
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| s/s of Cushing's dx tests? tx? | excessive hair growth, red cheeks, moon face, pendulous abd with red stiae, poor wound healing, ecchymosis
dx: fasting blood glucose, serum electrolytes, 24h urine
tx: surgery, GH, ADH, TH, donadotropins, steroid replacement.
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| Nsg for cushings | If steroid cause, give early morn or every other day.
if surgery, watch for shocklike state, like hypotension adn hyperpyrexia
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| Waht does hyperaldosteronism casue? nsg? tx? | htn, K imbalances, polyuria that fails to respond to ADH
tx: spironolactone
nsg: s/s of hypo/hyperkalemia
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| what is congenital adrenogenital hyperplasia? | decr enzyme activity req for cortisol production in adrenal cortex, 21-hydroxylase insufficiency so masculination of female fetus.
Can't assign sex to female
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| tx for congenital adrenogenital hyperplasia | give cortisone to suppress high ACTH, reconstructive surgery.
Nsg: can be reason for ambiguous genitalia in newborns.
Salt losing type, will tell parents need lifelong meds of aldosterone
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| What is nsg considerations for pheochromocytoma? | Can mimic hyperthyroidism and DM
Do not palpate mass bc release catecholamines.
monitor for hyperglycemia, htn, CHF preop and shock postop
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| s/s hypopitutarism | short stature, ht retarded more than wt, inactive,
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| What is ht velocity? How calculate project target ht? | observe child's ht over time, 6mos of observe,
father ht + mother's ht + 13/2 for boys
father + mother -13/2 for girls
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| premature thelarche(breast dev), menarche, pubarche r s/s of | incomplete precocious puberty
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| best test to dx DI | restrict oral fluids and observe changes in urine. Watch for kids drinking from toilet bowl, flower vases, etc.
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| How do you make vasopressin for DI effective? | resuspend in oil under warm water for 10-15m and shake vigorously b4 draw in syringe, want to see brown particles
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| With SIADH, what s/s are severe? | disorientation, confusion, coma, seizures r/t hyponatremia
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| what are s/s or lymphocytic thyroiditis | enlarged thyroid, hoarseness, dysphagia, possible hyperthyroidism
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