Pediatrics 335 > Endocrine Function > Flashcards

Endocrine Function Flashcards

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1
Q

Endocrine system functions

A

-sexual differentiation during fetal development
-stimulation and growth
-produce sex hormones
-start and regulate menarche in females

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2
Q

Endocrine diseases lead to what hormone problems

A

-hormone excess
-hormone deficiency
-hormone resistance

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3
Q

what is hypopituitarism?

A

decreased activity of the pituitary gland that leads to inhibition of somatic growth

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4
Q

primary site of dysfunction in hypopituitarism

A

hypothalamus

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5
Q

what percentile are hypopituitarism patients on the growth chart?

what are they at birth?

A

below the third percentile

normal birth weight and lengths

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6
Q

possible causes of hypopituitarism

A

-sickle cell infarct
-tumor (hypothalamus or pituitary)
-brain trauma
-chemotherapy

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7
Q

signs and symptoms of hypopituitarism

A

-hypoglycemic seizures
-hyponatremia
-neonatal jaundice
-pale optic discs
-micropenis and undescended testicles

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8
Q

diagnostic evaluation of hypopituitarism:
-what are we looking at in the family

A

-does stature represent their parents/siblings

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9
Q

diagnostic evaluation of hypopituitarism:
-what are we looking at with X-rays

A

-growth potential vs ossification
-are their growth plates closed

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10
Q

management of hypopituitarism

A

biosynthetic growth hormone injections

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11
Q

when giving GH replacement, how does it affect their growth rate

A

growth doubles in a year compared to prior to tx

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12
Q

when would we give GH to patients

A

-at night

-this is when our bodies naturally release GH

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13
Q

education for patients with hypopituitarism

A

-keep serial height and weight records
-make sure family can give injections (daily)
-best to give injections at night
-support body image
-cost of medications & testing

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14
Q

what is precocious puberty

A

sexual development before age 9 in boys or before age 8 in girls

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15
Q

who is precocious puberty more common in

A

girls

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16
Q

s/s of precocious puberty

A

-appear tall for their age
-advanced bone age
-have higher tanner staging than expected

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17
Q

assessment tools for precocious puberty

A

-tanner staging
-height/weight

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18
Q

causes of precocious puberty

A

-no causative factor in 80-90% of girls
-no causative factor in 50% of boys

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19
Q

how does precocious puberty occur

A

when the hypothalamus is activated to secrete gonadotropin-releasing hormones (GnRH)

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20
Q

treatment if we know specific cause for precocious puberty

A

treat underlying issue
-remove tumor
-discontinuation of steroid

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21
Q

medical treatment for precocious puberty

A

Lupron

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22
Q

how does Lupron work

A

-slows pubertal growth to normal rates
-tx discontinues at age for normal pubertal changes to resume (kind of like a pause button)

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23
Q

failure to treat precocious puberty may result in what?
why?

A

stunted growth
-because they have advanced bone age (growth plates close too soon)

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24
Q

what do we need to try to promote in precocious puberty?

A

a positive body image!

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25
how do we tx patients with precocious puberty
the age they are and not the age they look
26
teaching to a child with precocious puberty
reassure child that friends will experience the same stages of development eventually
27
normal TSH + normal Free T4
euthyroid function -this is normal -ideal
28
high TSH + low Free T4
Primary hypothyroidism -primary problem in the thyroid
29
normal TSH + low free T4
Central hypothyroidism -CNS problem (hypothalamus or pituitary gland)
30
what is hypothyroidism
disorder in which levels of active thyroid hormones are decreased
31
primary vs central hypothyroidism
primary: failure of thyroid gland central: lack of either pituitary or hypothalamic hormone
32
is hypothyroidism congenital or acquird
it could be either
33
why are thyroid hormones important
-for growth and development -for metabolizing nutrients and energy
34
s/s of hypothyroidism congenital disorder
-thick tongue -hypotonia -umbilical hernia -hoarse cry -dry skin -constipation -large fontanelles
35
hypothyroidism: -congenital newborn screen
positive -increased free T3/T4
36
s/s of hypothyroidism acquired disorder
-decreased appetite -dry/cool skin -thinning hair/loss -depressed deep tendon reflexes -bradycardia -constipation -sensitivity to cold temps -abnormal menses -goiter
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hypothyroidism: -acquired newborn screen
increased TSH decreased T3/T4
38
hypothyroidism medical tx
levothyroxine -tx for congenital
39
how long will a pt take levothyroxine
lifelong -titrate dose as they grow
40
what time of day do we give levothyroxine
-in the morning on empty stomach -45 mins before eating
41
overdose s/s of levothyroxine
-sweating -new facial hair -ptosis -tachycardia (titrate dose)
42
what is the most common endocrinopathy disorder of childhood and adolescents
dibetes mellitus (DM)
43
cause of hyperglycemia
defects in insulin secretion, insulin action, or both
44
DM: is type 1 or type 2 more common is children
type 1
45
type 1 DM
-immune system mistakenly attacks the beta cells in the pancreas that produce insulin -pancreas can no longer produce enough insulin OR cells stop responding to the insulin that is produced
46
type 2 DM
-insulin resistance occurs after prolonged exposure to elevated glucose levels -control w diet and exercise
47
co-morbid conditions with DM type 2
-PCOS -Lipid disorders -HTN
48
what are the two age groups that type 1 DM is common in
4-6 years 10-14 years (age of rapid growth)
49
patho of DM 1
glucose is unable to enter the cell and remains in blood, causing hyperglycemia
50
if there is glucose in urine, what can we expect there blood sugar to be
>250
51
glycosuria
glucose in urine
52
glucogenesis
cells break down protein and fat for conversion to glucose by liver (protein and fat increase acidosis of blood stream)
53
3 P's of DM1
polyuria -increase peeing polydipsia -increase thirst polyphagia -increased hunger
54
clinical presentation of DM1
-polyuria -polydipsia -polyphagia -rapid weight loss -dry skin -irritability -fatigue -abd. discomfort -ketoacidosis
55
what kind of process is DM1 typically
autoimmune -but can be idiopathic
56
treatment for DM1
-no cure -insulin -monitor glucose levels -lifestyle changes (nutrition)
57
why is it hard to treat young children with DM1
-they can't tell you if they are hungry or thirsty -more at risk for complications
58
children with BS >200 should have their urine checked for....
ketones
59
what is an important factor with giving insulin to children
carb counting
60
insulin: 100 units= ?
1 mL
61
rapid acting insulin
-give within 15 minutes of a meal -young children may not eat full meal (difficult because you cant reason with young children) -check glucose close to meal time
62
intermediate insulin
-cloudy -not often used in children -----may help pts who struggle with compliance ("somethings better than nothing)
63
long acting insulin
-common component to manage type 1 DM -can't be mixed with other insulins Lantus -long term management
64
important aspect for insulin administration
-rotate sites -subcutaneous
65
insulin absorption
abdomen is fastest, arm is next, leg is slowest
66
where will you give insulin to pt about to go play a soccer game?
leg
67
when will insurance give patients an insulin pump?
good glycemic control: 6 months to 1 year
68
if a patient comes in to ED with a pump on, what are we going to do first?
ask provider what to do with pump!!!! hypo: remove pump hyper: leave in place until insulin arrives
69
3 step process for Insulin
1. insulin to carb ratio 2. blood glucose correction 3. total dose
70
signs of hypoglycemia
pallor sweating tremors dizzy confusion irritability AMS
71
if BS is <70 and they are conscious, what do we do
give one of the following: -1/2 cup orange juice -3/4 cup of sugar sweetened beverage -1 small box of rasins -3-4 glucose tablets wait 15 minutes and recheck
72
once BS returns to at least 80, what do we give
more substantial snack -cheese -crackers (if meal is more than 30 minutes away)
73
if BS is <70 and child is unconscious, what do we do
-administer IM or SQ glucagon or spread glucose paste on the gums -DO NOT GIVE JUICE
74
Sick day rules
-seek medical attention for fever or other signs of infection -monitor serum glucose more often than routine -required dose of insulin may be increased -do not skin doses of insulin -continue to maintain food and fluid intake -monitor urine for ketones
75
if a patient is throwing up and not eating, will we hold their insulin?
check BS and give insulin accordingly -do not just skip
76
who is most at risk for developing DKA
children who have an illness
77
DKA defining factors
-diabetic: Blood glucose >200 -keto: ketonuria/ketonemia -acidosis: pH <7.3 and serum bicarb < 15
78
causes of DKA
-incorrect or missed insulin doses -incorrect admin of insulin -illness -trauma -surgery
79
DKA: If not reversed, what can occur
dehydration--> electrolyte imbalance--> acidosis--> coma--> death
80
DKA: as acidosis worsens, what happens to the cells
cell death occurs and potassium is released into blood stream and excreted by kidneys -low potassium levels
81
DKA clinical manifestations are related to degree of
-hyperosmolality -volume depletion -acidosis
82
DKA clinical manifestations
-signs of dehydration -flushed ears and cheeks -kussmaul respirations -acetone breath (fruity) -Altered LOC -hypotension
83
in the hospital, what two things will we give a severe hyperglycemic patient so their BS doesnt drop too fast
both insulin and dextrose -confuses parents
84
how long will a patient stay on an insulin drip for
until acidosis is corrected
85
what is the best way to ensure families have mastered diabetes skills
teach back method
86
preschool age DM
autonomy and control: -pick out snacks -pick which finger to stick -help parents gather necessary supplies
87
school age DM
-learn to test BS, administer insulin, and keep records -taught how to select foods and portion sizes -learn s/s of hypo=keep rapidly absorbing sugar product on them
88
adolescents DM
often rebel against daily regimen -desire to be like peers may interfere with treatment regimen
89
turner syndrome
-females have missing or partial absence of one X chromosome -associated with short stature and infertility
90
turner syndrome: s/s in newborn
-edema of hands and feet -webbed neck -high arched palate -small jaw -low set ears -ptosis -low hairline -short forth toe -short fingers -broad chest -widely separated nipples
91
klinefelter syndrome
pts have an extra X chromosome
92
Klinefelter Syndrome: S/S
-tall stature and long limbs -infertility in males -testes small and firm -puberty is delayed -less facial/body hair
93
Addison disease
Adrenal Insufficiency -deficiency of glucocorticoids (cortisone) and mineralocorticoids (aldosterone) -autoimmune -body can't handle stress
94
Addison Disease: S/S
-weakness -fatigue -loss of appetite -weight loss -hypotension -hypoglycemia -salt cravings
95
Addison Disease: TX
removal of tumors supportive care
96
Cushing's Disease
-excess blood levels of corticosteroids (especially cortisol) -children older than 7, pituitary secretes excess ACTH
97
Cushing's Disease: S/S
-obesity -weight gain -moon face w/ prominent cheek
98
Cushing's Disease: Diagnostics
-24 hour urianry levels of free cortisol
Pediatrics 335
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