PEDI | Endocrine
Episode notes
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