PEDI | Endocrine [Primer]
Notas del episodio
This material focuses on the endocrine system's role in regulating metabolism, growth, and development through hormones. Disorders generally stem from hypofunction (deficiency) or hyperfunction (excess) of specific glands.
General Nursing Framework
• Assessment: Critical reliance on growth charts (height/weight velocity) and developmental milestones. Physical exams focus on dysmorphic features, skin changes, and sexual maturity ratings.
• Interventions: Priorities include medication adherence (often lifelong), managing fluid/nutrition, and supporting psychosocial needs like body image and self-esteem.
Key Pituitary Disorders
• Growth Hormone (GH) Deficiency: Manifests as short stature and delayed bone age. Treated with daily subcutaneous somatropin injections. Success is measured by improved growth rates before epiphyseal plates fuse.
• Precocious Puberty: Sexual development before age 8 (girls) or 9 (boys). If untreated, it leads to rapid bone aging and short adult stature. Treated with GnRH agonists to halt puberty.
• Diabetes Insipidus (AVP-D): Deficiency of ADH (Vasopressin) leading to massive water loss. Symptoms: Polyuria, polydipsia, hypernatremia ("High and Dry"). Treated with Desmopressin (DDAVP).
• SIADH: Excess ADH causing fluid retention and dilutional hyponatremia ("Low and Wet"). Management involves strict fluid restriction and seizure precautions.
Thyroid Disorders
• Congenital Hypothyroidism: A medical emergency for brain development. Untreated infants risk severe intellectual disability. Symptoms include lethargy, large tongue, and hypotonia. Treated immediately with Levothyroxine.
• Hyperthyroidism (Graves Disease): Autoimmune excess of thyroid hormone. Signs include weight loss, tachycardia, goiter, and exophthalmos. Risk of thyroid storm (fever, severe tachycardia). Treated with antithyroid meds (methimazole), radiation, or surgery.
Adrenal Disorders
• Congenital Adrenal Hyperplasia (CAH): Genetic cortisol deficiency and androgen excess. Females may present with ambiguous genitalia. Treatment requires lifelong steroids (hydrocortisone/fludrocortisone).
◦ Critical Alert: Patients are at risk for Adrenal Crisis (shock, dehydration, hyperkalemia) during illness/stress and require "stress dosing" of steroids.
Pancreatic Disorders (Diabetes Mellitus)
• Type 1 DM: Autoimmune destruction of beta cells leading to absolute insulin deficiency. Management requires insulin therapy, glucose monitoring, and balancing diet/exercise.
• Diabetic Ketoacidosis (DKA): A life-threatening complication (hyperglycemia, ketones, acidosis). Signs include Kussmaul respirations and fruity breath. Requires ICU care for fluid and insulin management.
• Type 2 DM: Insulin resistance often linked to obesity. Managed with lifestyle changes and metformin.
Parathyroid Disorders
• Hypoparathyroidism: leads to hypocalcemia. Monitor for tetany (Chvostek sign) and seizures. Treat with Calcium and Vitamin D