what does the endocrine system do
- releases hormones that…
- affects cellular activity
- cell response depends on quantity and timing of hormone
major organs/glands of endocrine
- pineal in hypothalamus
- pituitary in hypothalamus
- parathyroid glands in thyroid
- medulla and cortex in adrenal
- pancreas (islets of langerhans)
- ovary and testes
the endocrine system is responsible for what in kids
- sexual differentiation in fetal development
- stimulating growth and development
pediatric differences in endocrine system
- childhood, production of sex hormones is low
- puberty occurs when gonads secrete increased amounts of sex hormones
- menstruation onset: 11-13 yrs (signals sexual maturity)
hormone functions in kids
- responsible for fetal development
- regulate CNS
- responsible for maturation of reproductive organs
- maintain homeostasis
important childhood hormones for growth and maturation
- growth
- thyroid
- adrenal
- gonadal
important childhood hormones for metabolic function
- ADH
- parathyroid
- insulin
endocrine diagnostic tests
-ACTH stimulation
-ACTH suppression
-bone age
-CT
-fluid deprivation
-karyotype
-MRI
RAIU scan
lab tests done for endocrine
-fasting plasam glucose
-hemoglobin A1C
-hormone levels
-ICF-1 and IGFBP-3
-newborn metabolic screen
provocative GH testing
-thyroid antibodies
endocrine disorder signs: changes in..
- growth rate
- cognitive development
- sexual development
- metabolic regulation (fluids, electrolytes, glucose)
what are the hormones of the anterior pituitary
growth hormone, TSH, ACTH, FSH, LH, MSH
what are the hormones of the posterior pituitary
ADH, oxytocin, beta endorphins
what are the hormones of they thyroid
T4 and T3, thyrocalcitonin
hormone of the parathyroid
parathyroid
hormones of the adrenal gland
aldosterone, cortisol, epi, androgens
hormones of pancreas
insulin, glucagon, somatostatin
hormones of ovaries
progesterone and estrogen
hormone of testes
testosterone
describe diabetes mellitus
- most common metabolic disease in children
- disorder of pancreatic function
- disorder of hyperglycemia d/t defects in insulin secretion, action or both
- leads to abnormalities in carbohydrates, protein, fat metabolism
most oral meds are used to treat which type of diabetes
type 2 BUT NOT FDA approved for children
when are you at risk for diabetes complications
until 5 yrs or more after diagnosis and onset of puberty
describe type 1 diabetes
- peak incidence is 7-15 yrs
- higher incidence in Caucasian
- genetic predisposition followed by autoimmune response
- pancreatic beta cell destruction results in absolute insulin deficiency
- abrupt onset, Ketosis (prone)
manifestations of type 1 (classic signs)
- polyuria (excessive urination)
- polydipsia (excessive thirst)
- polyphagia (excessive appetite with significant wt loss)
other signs of type 1 (not the classic 3)
- unexplained fatigue/lethargy
- headaches
- stomachaches
focus of clinical therapy of type 1
-glycemic control by combining insulin, nutritional management to support growth
clinical therapy of type 1
- maintain blood glucose at near normal levels
- exercise regimen
- psychological support
- multiprofessional approach (endocrinologist, diabetic educator, nutritionist)
mechanisms of type 1
destruction of alpha and beta cells in the islets of langerhans produces multiple metabolic changes
diagnostic tests of type 1
- presence of classic signs
- hemoglobin AIC > 6.5% and one of the following:
- fasting plasma glucose >126 mg/dL, no caloric intake for at least 8 hrs
- 2 hr plasma glucose >200 mg/dL during oral glucose tolerance test
- random plasma glucose concentration > 200 mg/dL
what is important to rememeber about basal insulin
- *cannot be mixed with other insulin
- basal bolus has increased glycemic control in pediatric diabetic pop
- basal administered once a day using long acting
describe short duration insulin (rapid acting)
- Lispro, Aspart
- onset: 10-30 min
- peak: 0.5-2.5 hrs
- duration: 3-6 hrs
describe short duration insulin (slower acting)
- regular-acting
- onset: 30-60 min
- peak: 1-5 hrs
- duration: 6-10 hrs
describe intermediate duration insulin
- NPH
- onset: 60-120 min
- peak: 6-14 hrs
- duration: 16-24 hrs
describe long duration insulin
- ultralente
- onset: 240-360 min
- peak: 14-24 hrs
- duration: 24-36 hrs
describe basal duration insulin
- Lantus (glargine) & Levemir (detemir)
- onset: 60-120 min
- peak: none
- duration: 24 hr
- ***do NOT mix with other insulins