Pediatric Endocrine Disorders

The Endocrine System is…

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

• Influences all physiological effects:

  • Growth and development

  • Metabolic processes related to fluid and electrolyte balance and energy production

  • Sexual maturation and reproduction

  • The body’s response to stress

Anterior Pituitary Disorders

Growth Hormone Deficiency:

• Physical Signs:

  • Poor growth

  • Short stature

• Complications:

  • Altered carbohydrate, protein, and fat metabolism

  • Hypoglycemia

  • Glucose intolerance

• Treatment:

  • Supplemental growth hormone

    • Regular visits to an endocrinologist for growth hormone injections until puberty.

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Precocious Puberty:

• Physical Signs:

  • Development of sexual characteristics before the usual age of puberty

  • Breast buds, pubic hair

  • More common in females and children with high adipose levels

• Concerns:

  • Once a child enters puberty, especially females (menstruation), growth slows, leading to concerns about height velocity, bone, and organ maturation.

• Treatment:

  • Education

  • Medications to slow secondary sexual development (may or may not be used depending on the child’s proximity to normal puberty)

  • Promote psychosocial well-being

Posterior Pituitary Disorders

Diabetes Insipidus (DI):

• Deficiency of ADH—losing more water.

• Causes:

  • Tumor, genetics, or idiopathic

• Pathophysiology:

  • Kidneys lose high amounts of water and retain sodium in the serum.

• Physical Signs:

  • Polydipsia

  • Polyuria

• Diagnostic Findings:

  • Specific gravity < 1.005

  • Elevated serum sodium

• Treatment:

  • Low sodium/protein diet

  • Desmopressin Acetate (DDAVP)

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Syndrome of Inappropriate Antidiuretic Hormone (SIADH):

• Excess ADH—holding onto more water.

• Physical Signs:

  • Decreased urine output

  • Weight gain

• Diagnostic Findings:

  • Specific gravity > 1.030

  • Decreased serum sodium

• Complications:

  • May have neurological symptoms as sodium levels decrease.

  • Risk for fluid overload.

• Treatment:

  • Correct underlying disorder

  • Fluid restriction

  • Sodium chloride IV

Diabetes Insipidus vs SIADH (comparison)

Diabetes Insipidus (DI):

• "High and dry"

• Increased urination

• Hypernatremia

• Serum osmolality > 300 mOsm/kg

• Urine specific gravity < 1.005

• Decreased urine osmolality

• Dehydration, thirst

VS

Syndrome of Inappropriate Antidiuretic Hormone (SIADH):

• "Low and wet"

• Decreased urination

• Hyponatremia

• Serum osmolality < 280 mOsm/kg

• Urine specific gravity > 1.030

• Increased urine osmolality

• Fluid retention, weight gain, hypertension

Thyroid Disorders

Hyperthyroidism:

• Hyperfunction of the thyroid gland (elevated T3 and T4).

• Peaks during adolescence due to Graves’ disease.

• Symptoms:

  • Nervousness/anxiety

  • Diarrhea

  • Heat intolerance

  • Weight loss

  • Smooth, velvety skin

• Complications:

  • Thyroid storm

• Treatment:

  • Antithyroid medications

  • Radioactive iodine therapy

  • Thyroidectomy

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Hypothyroidism:

• Malfunction of the thyroid gland.

• Insufficient production of thyroid hormone (low T3 and T4).

• Symptoms:

  • Tiredness/fatigue

  • Constipation

  • Weight gain

  • Dry, thick skin; edema of face, eyes, and hands

  • Decreased growth

• Complications:

  • Intellectual disability

  • Short stature

  • Growth failure

  • Delayed physical maturation.

• Treatment:

  • Thyroid replacement therapy (e.g., Synthroid)

Types of Diabetes Mellitus

Impaired carbohydrate, protein, and lipid metabolism.

Type 1 Diabetes:

• Caused by a deficiency of insulin secretion due to pancreatic beta-cell damage.

Type 2 Diabetes:

• A consequence of insulin resistance that occurs at the level of skeletal muscle, liver, and adipose tissue, with varying degrees of beta-cell impairment.

Gestational Diabetes:

• Diabetes that develops during pregnancy.

Secondary Diabetes:

• Occurs as a result of certain conditions such as:

  • Cystic fibrosis

  • Glucocorticoid use (e.g., Cushing syndrome)

  • Infections

  • Autoimmune syndromes

  • Genetic syndromes (e.g., Down syndrome, Klinefelter syndrome, Turner syndrome)

Type 1 Diabetes

Deficiency of insulin secretion due to pancreatic β-cell damage.

• Autoimmune in nature.

• Onset usually in younger children.

• DKA (Diabetic Ketoacidosis) is more likely in Type 1.

• Sometimes has a genetic predisposition.

• Affects all ethnic groups.

Signs & Symptoms:

• Polyuria

• Polydipsia

• Polyphagia

• Weight loss

• Abdominal cramping/nausea/vomiting

• Headache/fatigue/blurred vision

  *School-aged child will present with, sudden night time enuresis (wetting the bed)*

Diagnostics:

• Glucosuria (glucose in the urine)

• Ketonuria (ketones in the urine)

• Hemoglobin A1C (reflects average blood glucose over 3 months)

• Serum Glucose > 200 mg/dL

• Random Glucose > 200 mg/dL accompanied by typical symptoms of diabetes

Honeymoon Phase

• Some people with type 1 diabetes experience a "honeymoon" period where the body produces enough insulin to lower blood glucose levels.

• This phase typically occurs after starting insulin therapy, and you may not need to manage blood glucose as actively.

• The honeymoon phase can last from 1 week to 1 year.

• It does not mean that the diabetes is gone, and the pancreas will eventually be unable to produce enough insulin. Without treatment, symptoms will return.

Diabetic Ketoacidosis (DKA)

• If diabetes (especially type 1) goes unrecognized or inadequately treated, diabetic ketoacidosis (DKA) or fat catabolism can develop.

• This occurs when there is a deficiency or ineffectiveness of insulin, causing the body to use fat instead of glucose for energy.

Signs & Symptoms: MEDICAL EMERGENCY

• Anorexia

• Nausea/vomiting

• Lethargy

• Stupor

• Altered level of consciousness/Confusion

• Decreased skin turgor

• Abdominal pain

• Kussmaul respirations and air hunger

• Fruity (sweet-smelling) or acetone breath odor

• Presence of ketones and glucose in urine and blood

• Tachycardia & Tachypnea

• Metabolic acidosis

• Alterations in potassium (K+)

• Severe insulin deficiency

• Serum glucose > 300 mg/dL (usually 400 to 800 mg/dL)

• If left untreated, coma and death may occur.

Diagnostic Values for DKA:

• Hyperglycemia: Serum glucose > 300 mg/dL (typically 400-800 mg/dL)

• Acidosis: pH <7.3, HCO3- <15 mEq/L

Interventions:

• Fluid Therapy:

  • Initial 20 mL/kg bolus of 0.9% normal saline over 1 to 2 hours.

  • Hypertonic solution to reduce the risk of cerebral edema.

  • Continuous IV fluid replacement.

• EKG Monitoring.

• Frequent V/S and physical assessment. (neuro checks)

• Monitoring Urine Output.

• Frequent blood glucose checks, potassium, and sodium levels.

• Continuous insulin drip (IV Regular insulin).

• Don’t drop blood glucose too quickly to avoid cerebral edema. Blood glucose should not fall more than 100 mg/dL per hour.

Types of Insulin

• Rapid-Acting Insulin

• Long-Acting Insulin

• Intermediate-Acting Insulin

• Insulin Pumps

• Sliding Scales

Diabetes Mellitus: Nursing Assessment

• Regulating Glucose Control and A1C Levels:

  • Target A1C for children should be <7.5%.

• Monitor and Manage Complications:

  • Regular monitoring for potential complications such as diabetic retinopathy, nephropathy, neuropathy, and cardiovascular issues.

• Education:

  • Provide ongoing education about diabetes management, nutrition, insulin administration, and recognizing signs of complications.

• Support the Child and Family:

  • Offer emotional and psychological support to help cope with the challenges of managing diabetes.

Type 2 Diabetes

• Not autoimmune

• Onset usually in adolescents

• DKA less likely but still possible

• Usually linked to a family history

• Affects Disproportionate Ethnic Groups:

  • Native-American

  • African-American

  • Latino

  • Asian/Pacific Islander

Signs & Symptoms:

• Polyuria

• Polydipsia

• Polyphagia

• Obesity

• Hypertension

• Dyslipidemia

Goals for Diabetes Mellitus Management

• Achieve normal growth and development.

• Promote optimal serum glucose control:

  • Near normal A1C.

  • Prevent hypoglycemia.

• Prevent complications:

  • Both in the hospital and long-term.

• Promote adjustment to the disease:

  • Address age-related changes and considerations.

Diabetes Mellitus: Diet & Exercise

• Diet: Low in saturated fats and concentrated carbohydrates.

• Identifying: Carbs, fats, and proteins.

• Carb counting.

• Meal plan: 3 meals per day + snacks for consistency.

• Encourage regular exercise.

• Age-appropriate sports.

Age-Related Considerations of Diabetes Mellitus

Infant:

• Educate the family, watch for extreme fluctuations in serum glucose. (they’re growing fast!)

Toddlers:

• Picky eaters, temper tantrums, emphasize routine.

Preschoolers:

• May begin to participate, increasing awareness of diabetes.

School-Age:

• Socialization, more participation in diabetes management.

Adolescent:

• Body image concerns, independence, peer acceptance, maintain consistency.