PEDIATRIC ENDOCRINE FUNCTION AND DYSFUNCTION

Question 1

FUNCTIONS

Answer 1

• regulates body metabolism through release of hormones
• maintain optimal hormone levels
• maintain homeostasis

Question 2

A AND P DIFFERENCES

Answer 2

• endocrine system responsible for sexual differentiation during fetal development
• hormones regulate growth and development
• stimulates reproductive system and regulates puberty

Question 3

NEGATIVE FEEDBACK

Answer 3

• hypothalamus -pituitary axis produce releasing and inhibiting hormones
• hypothalamus synthesizes release of hormones when needed
• secretion inhibited when target cells have received adequate hormone
• secretion resumes when levels of hormone are low

Question 4

assessment of endocrine system

Answer 4

• growth
• BP
• facial characteristics
• neck
• muscles
• genitalia
• body odor
• skin
• family history

Question 5

PUBERTY

Answer 5

-hypothalamus stimulates pituitary to release hormones LH and FSH

Girls

• LH and FSH = ova maturation and ovulation
• mean onset girls before boys and blacks before whites

Boys

• LH = testosterone production
• FSH= sperm production
• mean onset 11.5yrs

Question 6

PUBERTY IN GIRLS

Answer 6

• Therlarche - presence of breast buds in girls (1st sign of puberty in girls )
• adrenarche- growth of pubic hair
• menarche- initial presence of menses

Question 7

AMENORRHEA

Answer 7

primary- absence of menarche by age 16 years
-due to hormonal imbalance , structural defect

Secondary- skip 3 menstrual periods in a row
-due to pregnancy , extreme exercise without eating

Question 8

AMENNOHREA

Answer 8

-history: weight gain or loss, sports training Birth control pills, drugs
exam: vaginal to determine patency
labs: pregnancy test, estrogen, LH , FSH, prolactin
Bone age x ray

Question 9

TREATMENT

Answer 9

• depends on cause
• birth control pills with estrogen and progesterone
• balanced meals, high calorie for athletes

Question 10

PUBERTY IN BOYS

Answer 10

• enlargement of testses
• scrotal changes
• pubertal delay considered if no changes by 13-14yrs

Question 11

GYNECOMASTIA

Answer 11

• breast enlargement in boys during puberty
• common and benign : self limiting
• ratio of estrogen to testosterone is greater than usual

-adolescents concerned with body image

Question 12

TANNER STAGES

Answer 12

• used to classify stage of puberty
• stages 1-5

stage 1: no secondary sex characteistics
stage 2: first signs of puberty
stage 3 and 4: progressive puberty
stage 5: puberty complete

Question 13

NORMAL GROWTH PATTERNS IN PUBERTY

Answer 13

• final 20-25% of height attained during puberty
• Girls: growth spurt age 10-14 years yrs
• Boys growth spurt 11-16 yrs
• growth ceases age 16-20 yrs
• seem to grow from feet up. first shoes, slacks, then shirts get too small

Question 14

CONSTITUTIONAL GROWTH DELAY

Answer 14

• delayed linear growth
• sexual and skeletal maturation behind peers
• may have family history of late bloomers
• delayed bone age
• experience puberty and growth spurt later
• achieve normal height without treatment
• different from familial short stature - short due to genetic potential

Question 15

PRECOCIOUS PUBERTY (PP)

Answer 15

secondary sexual characteristics

• 7 years(white)
• 6 (black)
• 9 (boys)
• central or true PP occurs when hypothalamus is activated to secrete GNGH
• may start out tall for their age, have advanced bone age
• growth stops early as hormones stimulate closure of epiphyseal plate

Question 16

PRECOCIOUS PUBERTY

Answer 16

• labs: LH,FSH , testosterone or estradiol
• bone age xray
• provocative testing confirms diagnosis
• CNS tumors: surgery , chemo, or radiation
• GnRH analogue given to stop puberty
• Lupron IM monthly or synarel intranasal BID
• treatment stops at normal age of puberty

some children may only have careful growth monitoring

Question 17

NURSING MANAGEMENT

Answer 17

• teaching , emotional support, medications
• kids want to hear they are normal
• dress in age- appropriate clothes
• may have mood swings

Question 18

PHENYLKETONURIA

Answer 18

• autosomal recessive disorder of amino acid metabolism
• enzyme missing to convert phenylalanine to tyrosine
• results in build up of PKU in blood
• leads to mental retardation , seizures, death

Question 19

PKU SCREENING AND TREATMENT

Answer 19

• screening in all 50 states
• after 24 hrs of birth
• positive test needs to be repeated
• 2 positive tests? referral
• treated by diet;
• special formulas
• low protein and low aspartame foods
• elemental medical foods
• low phenylalanine diet for life

Question 20

NURSING MANAGMENT

Answer 20

• mainly supportive
• education of parents
• PKU sources of food
• strict adherence to diet to avoid decline in IQ
• negotiations with insurance companies to pay for medical food
• genetic counseling

Question 21

TYPE 2 DIABETES MELLITUS

Answer 21

• impaired insulin action (insulin resistance)
• visceral fat produces TNF - insulin receptors are desensitized
• impaired insulin secretion
• hyperinsulinemia, eventually decreased insulin release
• leads to hyperglycemia , impaired glucose tolerance , diabetes

Question 22

T2DM

Answer 22

risk factors

• obesity
• low physical activity
• low socioecomonic status
• race
• family H/O of diabetes

Question 23

NURSING MANAGEMENT

Answer 23

• assess child with BMI at 85 percentile or above for signs or insulin resistance
• acanthosis nigricans, HTN, dyslipidemia
• family H/O diabetes in overweight child
• Hgb A1C levels

Question 24

NURSING MANAGMENT

Answer 24

EDUCATION

• disease and lifestyle, BG testing
• weight loss or maintainenece if going through growth spurt
• annual screening for potential complications
• BP, lipids, eye exam , neuro exam of extremities , liver and renal function

Question 25

TYPE 1 DIABETES

Answer 25

- pancreatic islet cells fail to produce insulin - autoimmune, genetic genetic predisposition CLINICAL MANIFESTATIONS -polyuria, polydipsia, polyphagia, weight loss, fatigue, lethargy, candida vaginitis DKA CLINICAL THERAPY -monitor BG, insulin, CHO balancing, exercise

Question 26

NURSING MANAGEMENT

Answer 26

-physiological assessment - Vitals, LOC - hydration status - labd: blood gas, glucose, electrolytes - cardiac intake

Question 27

NURSING MANAGMENT

Answer 27

PSYCHOSOCIAL ASSESSMENT - coping mechanisms - family resources - ability to manage disease - educational needs DEVELOPMENTAL ASSESSMENT - FINE MOTOR SKILLS - COGNITIVE LEVEL

Question 28

DEVELOPMENTAL CONSIDERATIONS

Answer 28

Toddlers -picky eaters , need to consume enough calories PRECHOOLERS - allow choices with food , which finger to test BG School- age - learn to obtain BG and administer insulin - can be taught food management Adolescents - compliance can become an issue - may skip insulin doses - may eat like their peers (candy ) - alcohol

Question 29

NURSING MANGEMENT T1DM TEACHING

Answer 29

SICK DAY GUIDLINES - be seen for fever or infection - monitor BG frequently - test urine for ketones - don't skip insulin - may need more insulin - maintain hydration - drinks with CHOs if eating less

Question 30

NURSING TEACHING

Answer 30

- good foot care - rotate injection sites - medical alert ID - school health plan - carry rapid sugar product - hypoglycemia treatment - vaccinations - balance food and insulin dosage with activity - summer camp- active need more food

Question 31

HYPOGLYCEMIA

Answer 31

- signs: pallor, HA, sweating, tremors, dizziness, altered LOC, irritability - Test BG: if less than or equal to 70 - give 1/2 cup of juice or soda , small box raisins, or 3-4 glucose tabs - wait 15min and retake BS ( repeat juice if 70 or less and repeat BS) - unconscious administer IM glucagon or glucose paste on gums