Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Triclocarban wikipedia , lookup
Adrenal gland wikipedia , lookup
Breast development wikipedia , lookup
Glycemic index wikipedia , lookup
Hyperandrogenism wikipedia , lookup
Neuroendocrine tumor wikipedia , lookup
Endocrine disruptor wikipedia , lookup
Xenoestrogen wikipedia , lookup
Hypothalamus wikipedia , lookup
Growth hormone therapy wikipedia , lookup
Endocrine Dysfunction Nursing 355 Maria Rubolino-Gallego Endocrine System Hormones – make up the endocrine system, stimulate and regulate the action of other tissues, exert a physiological effect on other cells Endocrine system and the autonomic nervous system function together to regulate 3 items: growth, metabolism and reproduction Sympathetic and parasympathetic release: Hypothalamus secretes hormones Negative feedback effect At birth the endocrine system is the least developed Hormonal control minimal until months of age Glands and Hormones Hypothalamus and pituitary -Ant. Pit. – secretes hormones, ACTH, TSH, Pit. – stores and secretes antidiuretic hormone and oxytocin Thyroid Gland -Thyroxine, Triiodothyronine, and calcitonin -Post Adrenal Gland -Cortisol, Aldosterone, Androgen, Norepinephrine Ovary -secretes hormones: Estrogen and progesterone Islet of Langerhans -secretes hormones: Insulin Epinephrine, Testes -Testosterone Diagnosis and Treatment Dx of Endocrine Dysfunction -Lab tests -Normal hormone levels are related to patients age and stage of puberty -May need to do peak and trough levels to determine accurate interpretation -X-ray for bone growth -MRI or CT scan for tumors or cysts Accurate height and weight measurements Tanner staging Milestones School performance Treatment Long-term and ongoing Usually through pharmacotherapy Congenital Hypothyroidism Thyroid gland does not produce sufficient thyroid hormone Present at birth 1 in 4,000 live births Usually unknown cause Mother taking PTU during pregnancy can cause transient hypothyroidism Sxs: prolonged jaundice, skin mottling, large fontanel, large tongue, hypotonia, distended abdomen Dx: mandatory newborn testing, Goal for newborn screening: no sooner than 48 hours after delivery Tx: lifelong hormone replacement therapy, monitor growth and development Hashimoto’s Thyroiditis acquired hypothyroidism Thyroid gland produces an inadequate amount of thyroid hormone Autoimmune hypothyroidism Usually in families with a hx of thyroid disease Sxs: goiter, dry, thick skin, coarse, dull hair, fatigue Dx:labs, TSH, T4 Tx: thyroxine Hyperthyroidism (Grave’s Disease) Excessive thyroid hormones are produced by an enlarged thyroid gland Most common cause of hyperthyroidism in children Grave’s accounts for 5-10% of thyroid disorders in children Female to male (4:1), with a familial tendency Sxs: nervousness, diarrhea, increased perspiration, heart rate changes, exophthalmos, poor attention span, school problems Dx: TSH Tx: PTU or methimazole, radioactive iodine, or surgery Comparing Hypo vs. Hyperthyroidism Energy Bowels Intolerance to heat vs. cold Weight Skin muscles Energy Bowels Intolerance to heat vs. cold Weight Skin Heart rate Blood pressure muscles Phenylketonuria (PKU) Genetic metabolic disorder resulting in CNS damage from toxic levels of phenylalanine Autosomal recessive disorder 1 in 10,000 to 25,000 live births in the US Signs may not be present until 3 months old Sxs:vomiting, musty odor to urine, eczema, hypertonia, hyperactive behavior Mental retardation is long term consequence PKU DX: routine neonatal screening Goal: Tx: special diets that restricts phenylalanine intake Precocious Puberty Early onset puberty Prior to 8 y.o. in girls and 9 y.o. in boys Premature appearance of secondary sexual characteristics, accelerated growth rate, advanced bone maturation Rapid bone growth leads to early growth-plate fusions leads to short stature Precocious Puberty Idiopathic or by CNS tumors More in girls than boys Dx: Hx, labs Tx: administration of GnRH agonist Once therapy is discontinued, puberty resumes Diabetes Insipidus Inability to concentrate urine because of a deficiency of vasopressin (AKA antidiurectic hormone) Causes: commonly from head trauma, tumors, infection in the area of the hypothalamus Sxs: polyuria, polydipsia, nocturia, dehydration Dx: hypernatremia, low urine specific gravity, water deprivation test Tx: Maintain fluid balance and (synthetic vasopressin) DDAVP Growth Hormone Deficiency Inadequate production or secretion of GH Sxs: immature face, decreased muscle mass, micropenis, hypoglycemia, short stature Causes: hypopituitarism, brain tumors, cranial radiation Dx: careful measurements over time (Ht), TSH, BUN/Creatnine, CBC, electrolytes Tx: Synthetic GH, sq inj. 6-7 times/wk at HS or a time release sq inj., until growth plates close Galactosemia Deficiency of galactose-1-phosphate Prevents the conversion of galactose to glucose Cannot properly digest milk or sugar 1 in 60,000 to 80,000 live births Infants can exhibit: hypoglycemia, liver damage, cataracts, infections Tx: lifelong lactose-restricted diet Maple Syrup Urine Disease 1 in 250,000 to 300,000 live births Affects metabolism of certain amino acids Build up of acids causes ketoacidosis Sxs: lethargy, poor feeding, vomiting, weight loss, seizures, loss of reflexes Urine smells like maple syrup Tx: lifelong low protein, limited amino acid diet Tay-Sachs Disease Affects primarily infants in the Ashkenazi Jewish population Abnormal build-up of gangliosides in the neurons After a 6 month normal development, the infant has developmental delays and neurologic deterioration Sxs: macrocephaly, seizures, blindness, deafness, death Tx: symptomatic and supportive care Neonatal Hypoglycemia Low level of glucose in the serum Less than Risk Factors: Respiratory Distress Asphyxia Prematurity SGA (less than 2500 grams) Maternal Toxemia Infant with Rh incompatability Infant of diabetic mother Neonatal Hypoglycemia 2-10 in 1000 live births Many infants are asymptomatic If symptoms occur: Jitteriness Poor feeding Lethargy Seizures Apnea Hypotonia High-pitched cry Bradycardia cyanosis Neonatal Hypoglycemia Glucose concentrations reach their lowest level at hours posnatal age Treatment: D5W, formula via nipple or gavage Type 1 DM Pancreas is unable to produce or secrete insulin Causes: genetic, autoimmune process Tx: insulin therapy, may experience a honeymoon phase characterized by hypoglycemia Type 2 DM Production of excess insulin, but the cells are not able to utilize it properly Youth tend to be obese Peak incidence occurs with onset of puberty Incidence is on the rise (5 y.o. have been diagnosed) Higher in certain ethnicities DM Sxs: 3 P’s Wt. loss Fatigue Blurred vision Recurrent vaginal infections Typically overweight Acanthosis nigricans If untreated can lead to ketoacidosis Tx with insulin and IV NS, lower blood sugars. Swith to oral agents Blood glucose monitoring If not managed well: retinopathy, nephropathy, neuropathy Dx: random glucose elevated, FBS elevated, elevated HbA1c Tx: check blood sugars, exercise, insulin injections, meal planning Goals: Normal growth and development, absence of complications, normal HbA1c Diabetic Ketoacidosis DKA Absolute insulin defecit Sxs: Abdominal and chest pain N/V Fruity breath Decreased LOC Kussmau respirations DKA Dx: Blood glucose Arterial pH Urine ketones Serum ketones Serum potassium Serum phosphorus WBCs Hypocalcemia Inadequate stores of calcium Neonatal hypocalcemia serum level of less than 7/0mg/dl Occurs typically in infant of diabetic mothers Sxs: twitching, tremors, irritability, jitteriness, ECG changes Tx: formula feedings or IV supplement