Endocrine Disorder

Question 1

What is the endocrine system composed of?

Answer 1

glands, tissues, or clusters of cells that produce and release hormones

Question 2

What is the gold standard for making the diagnosis of GH excess?

Answer 2

Failure to suppress serum GH levels after an oral glucose challenge test

Question 3

Lab/Diagnostic Studies for Diabetes Insipidus

Answer 3

• Radiographic studies
• Urinalysis
• Serum Osmolarity
• Serum Sodium
• Fluid Deprivation

Question 4

What are the two types of pituitary disorders?

Answer 4

Anterior and Posterior

Question 5

Anterior Pituitary Disorders

Answer 5

• Growth Hormone Deficiency
• Hyperpituitarism
• Precocious Puberty

Question 6

Posterior Pituitary Disorders

Answer 6

• Diabetes Insipidus

- Syndrome of Inappropriate Antidiuretic Hormone Secretion

Question 7

When is Growth Hormone typically released?

Answer 7

-throughout the day, mostly secreted during sleep

Question 8

What is growth hormone deficiency usually a result of?

Answer 8

Failure of the anterior pituitary or hypothalamic stimulation on the pituitary to produce sufficient GH

Question 9

GH Deficiency is also known as what?

Answer 9

Hypopituitarism or Dwarfism

Question 10

What is GH Deficiency characterized by?

Answer 10

poor growth and short stature

Question 11

Complications for GH Deficiency Include?

Answer 11

unable to metabolize protein, fat, and carbohydrates effectively

Question 12

What is the primary cause of GH Deficiency?

Answer 12

Injury to pituitary gland or hypothalamus

Question 13

What may cause injury to the pituitary gland or hypothalamus resulting in GHD?

Answer 13

• tumor
• infection/infarction
• CNS irradiation
• abnormal formation in utero
• birth trauma
• Genetics (Prader-Willi or Turner)
• Psychosocial

Question 14

Therapeutic Management for GHD

Answer 14

• supplement GH
• removal of tumors
• continue treatment until near final height
• physical exam

Question 15

What would you see on a Physical Exam for a child w/ GHD?

Answer 15

• height at or < 3rd percentile
• higher weight to height ratio
• prominent abdominal fat
• large forehead
• high pitched voice
• delayed sexual maturity, dentition, skeletal maturation
• decreased muscle mass

Question 16

Teaching Plan for GHD

Answer 16

• promoting growth
• enhancing the child’s self esteem
• providing appropriate education on disorder

Question 17

When does treatment stop for GHD?

Answer 17

With fusion of growth plates

Question 18

How often should you measure a child’s height w/ GHD?

Answer 18

q 3-6 months

Question 19

What should the child notify the physician about during treatment?

Answer 19

• headaches
• rapid weight gain
• increased thirst/urination
• joint pain

Question 20

Complications of GHD

Answer 20

• altered carbohydrate, protein, fat metabolism
• hypoglycemia
• glucose intolerance/diabetes
• slipped capital femoral epiphysis
• pseudotumor cerebri
• leukemia
• recurrence of CNS tumors
• Infection at injection site
• edema and sodium retention

Question 21

Precocious Puberty

Answer 21

Development of sexual characteristics before the usual age of pubertal onset

Question 22

When does Precocious Puberty begin for boys and girls?

Answer 22

Younger than 8 for girls and 9 for boys

Question 23

What is the most common form of Precocious Puberty?

Answer 23

Central Precocious Puberty

Question 24

Central Precocious Puberty develops as a result of what?

Answer 24

Increase in hormones w/ development of sexual characteristics, increased growth, and reproductive capability

Question 25

What happens if Precocious Puberty is left untreated?

Answer 25

The child may become fertile

Question 26

S/S of Precocious Puberty?

Answer 26

- headaches - vision probs - behavior changes/mood swings - acne, body odor - accelerated growth - bone age is advanced - size of uterus increased

Question 27

Goals of Nursing Management of Precocious Puberty

Answer 27

- educating about physical changes - teaching on meds - self esteem issues - promoting age appropriate physical dev and pubertal progression

Question 28

Delayed Puberty for Girls

Answer 28

- breasts not developed by 12 - pubic hair not produced by 14 - menarche not occurred by 15

Question 29

Delayed Puberty for Boys

Answer 29

- no testicular enlargement or scrotal changes by 14 | - no pubic hair by 15

Question 30

What is the most common cause of Delayed Puberty?

Answer 30

Constitutional Delay-"Late Bloomer"

Question 31

What are the 2 types of Diabetes Insipidus?

Answer 31

Nephrogenic and Central

Question 32

How does Nephrogenic occur?

Answer 32

- transmitted genetically | - acquired from renal disease, hypercalcemia, hypokalemia, drugs-lithium, rifampin

Question 33

Therapeutic Management for Nephrogenic DI

Answer 33

- diuretics - high fluid intake - restricted sodium - high-protein diet

Question 34

What is the most common form of Diabetes Insipidus?

Answer 34

Central

Question 35

Central DI is a disorder of what?

Answer 35

the pituitary gland

Question 36

Central DI is characterized by what?

Answer 36

Polydipsia and polyuria

Question 37

When does SIADH occur?

Answer 37

when the feedback mechanism that regulates ADH does not function properly

Question 38

Diabetes Insipidus

Answer 38

- "high and dry" - increased urination - Hypernatremia - serum osmolarity > 300 - decreased urine osmolarity - dehydration, thirst

Question 39

Syndrome of Inappropriate ADH

Answer 39

- "low and wet" - decreased urination - hyponatremia - serum osmolarity <280 - increased urine osmolarity - fluid retention - weight gain - HTN

Question 40

Graves Disease

Answer 40

autoimmune disorder that causes excessive amounts of thyroid hormone to be released in response to human thyroid stimulator immunoglobin

Question 41

Congenital Hypothyroidism

Answer 41

"Cretinism" - failure of the thyroid gland to migrate during fetal development which causes malfunction/malformation of thyroid gland - insufficient production of thyroid hormone

Question 42

What happens if Congenital Hypothyroidism is left untreated?

Answer 42

- intellectual disability - short stature - growth failure - delayed physical maturity

Question 43

What is the most common cause of preventable intellectual disability?

Answer 43

Congenital Hypothyroidism

Question 44

How often should you measure thyroid levels until target is reached on stabilized dose of meds?

Answer 44

q 2-4 weeks

Question 45

Hyperthyroidism

Answer 45

- nervousness/anxiety - diarrhea - heat intolerance - weight loss - smooth, velvety skin

Question 46

Hypothyroidism

Answer 46

- tiredness, fatigue - constipation - cold intolerance - weight gain - dry, thick skin, edema of face, eyes and hands - decreased growth

Question 47

Signs of Thyroid Storm

Answer 47

- sudden onset of severe restlessness and irritability - fever - diaphoresis - severe tachycardia - increased BP, HR, body temp to dangerous levels

Question 48

Thyroid Storm

Answer 48

life-threatening health condition of untreated or undertreated hyperthyroidism

Question 49

Addison's Disease

Answer 49

deficiency in the adrenal steroids, glucocorticoids-cortisol, and mineralcorticoids,-aldosterone

Question 50

S/S of Addison's Disease

Answer 50

- hyponatremia - hyperkalemia - water loss - hypoglycemia - hypotension - hyperpigmentation - adrenal crisis

Question 51

Cushing Syndrome

Answer 51

excess levels of one or all hormones, but most commonly glucocorticoid excess

Question 52

S/S of Cushing Syndrome

Answer 52

- rapid weight game - decreased linear growth - weakness/fatigue - irritability - sleep problems - HTN - missed menstrual period

Question 53

Congenital Adrenal Hyperplasia

Answer 53

autosomal recessive disorder in which there is an inefficient supply of the enzymes required for the synthesis of cortisol and aldosterone

Question 54

What is the most common type of adrenocortical insufficiency?

Answer 54

Congenital Adrenal Hyperplasia

Question 55

What is the obvious sign of Congenital Adrenal Hyperplasia?

Answer 55

Ambiguous genitalia