Endocrine/Metabolism Disorders

When is growth hormone primarily released?

Largest amounts at night before bedtime

What are clinical manifestations of growth hormone deficiency?

Short stature, delayed growth, increased weight to height ratio

What are the primary causes of growth hormone deficiency?

Anterior pituitary or hypothalamus issues due to tumors, infections, trauma, etc.

What are secondary causes of growth hormone deficiency?

Conditions that interfere with normal GH production or growth such as malnutrition or chronic illnesses

What is the treatment for growth hormone deficiency?

Somatropin or tumor removal

What are the nursing considerations for Somatropin?

Give at night; 1st year should gain 3-5 inches (best growth during 1st year)

What are the side effects of Somatropin?

HA, rapid weight gain, increased thirst/urination, hip or knee pain

What is Central Precocious Puberty (gonadotropin-dependent)?

Puberty triggered by premature secretion of GnRH → release of LH and FSH → gonads produce estrogen or testosterone

What is Peripheral Precocious Puberty (gonadotropin-independent)?

Puberty triggered by androgen and estrogen produced by other parts of the body; no early release of GnRH, LH, or FSH

What is the treatment for central precocious puberty?

Suppress LH and LSH release using continuous GnRH therapy (initially stimulates GnRH, then suppresses it long-term)

What is the treatment for peripheral precocious puberty?

Treat source of excess sex hormones (remove tumor, block estrogen/androgen)

What is diabetes insipidus?

Disorder involving ADH, causing kidneys to lose excessive amounts of water

What is central DI (arginine vasopressin deficiency)?

Diabetes insipidus caused by a posterior pituitary gland disorder

What is nephrogenic DI (arginine vasopressin resistance)?

Diabetes insipidus caused by ADH resistance in kidneys; body still produces ADH normally

What are risk factors for diabetes insipidus?

Brain postop complication, trauma to brain, congenital CNS disorders or tumor

What are clinical manifestations of diabetes insipidus?

Polyuria, polydipsia, irritability, dehydration

What should normal values for UOP and urine specific gravity be like?

>1-2 mL/kg/day AND >1.010

What medications are used to treat diabetes insipidus?

Desmopressin (DDAVP) and vasopressin replace ADH

What are the side effects of ADH replacement medications in diabetes insipidus?

HA, HTN, hyponatremia, water intoxication, nasal irritation

What are the functions of thyroid hormones?

Normal metabolism, physical growth, and CNS development

Why is a neonatal screening required?

Congenital hypothyroidism is asymptomatic early, so if not caught it can cause permanent intellectual disability and growth failure

What are five clinical manifestations of congenital hypothyroidism?

Lethargy, poor feeding, jaundice, constipation, floppy

What medication is given for congenital hypothyroidism?

Levothyroxine (Synthroid)

What are the nursing considerations for levothyroxine?

Given lifelong orally, crushed in water, non-soy formula, or breast milk; beware for over treatment (labs)

What interferes with levothyroxine absorption?

Soy-based formulas, fiber, and iron preparations

What is hyperthyroidism?

Excess production of thyroid hormones (t3 and t4) by the thyroid gland; low TSH

What is thyrotoxicosis?

Excess circulating thyroid hormones

What is thyroid storm?

Condition that occurs due to excessive thyroid hormone levels

What is Graves Disease?

Autoimmune disorder where thyroid-stimulating immunoglobulins (TSI) stimulate the thyroid; acts as TSH

What are the metabolic manifestations of Graves Disease?

Weight loss despite normal appetite, heat intolerance, diaphoresis, tachycardia, palpitations

What are the physical and behavioral changes of Graves Disease?

Hyperactivity, poor school performance, anxiety, exophthalmos, goiter

What are the clinical manifestations of thyroid storm?

Sudden onset of restlessness and irritability, fever, diaphoresis, and severe tachycardia

What medication is given for hyperthyroidism?

Methimazole (Tapazole) and betablockers

What is the MOA for methimazole?

Inhibits thyroid hormone synthesis, decreasing production of t3 and t4; takes 2-3 weeks to work to use previously stored/produced hormones

What are four nursing considerations for methimazole?

Do not discontinue abruptly, take at same time each day with meal, check pulse and BP before dose, beware of overtreatment (hypothyroid symptoms)

What are the side effects of methimazole?

Edema, leukopenia, thrombocytosis, agranulocytosis; it suppresses bone marrow activity (WBCs)

What education should patient report when taking methimazole?

Sore throat, mouth lesions, unusual bleeding or bruising; indicates infection or blood-cell abnormality

Why are betablockers given for hyperthyroidism?

Treats the symptoms by decreasing tachycardia, tremors, restlessness; does not stop thyroid hormone production

What surgical procedure is done if meds can’t treat hyperthyroidism?

Subtotal thyroidectomy

What are the functions of glucocorticoids (cortisol)?

Regulates blood glucose, metabolism, and body’s response to stress

What does the adrenal medulla produce?

Catecholamines (epinephrine, norepinephrine, dopamine)

What are two causes of adrenal insufficiency?

Addison disease and congenital adrenal hyperplasia (CAH)

What are five clinical manifestations of aldosterone insufficiency?

Hyponatremia, hyperkalemia, dehydration, hypotension, syncope

What are three clinical manifestations of cortisol insufficiency?

Hypoglycemia, muscle weakness/fatigue, weight loss

What are skin and GI manifestations of adrenal insufficiency?

NVD and hyperpigmentation (increased ACTH)

What should be assessed in adrenal insufficiency?

Vitals r/t dehydration, electrolytes, weights (I/Os), and neuro status

What medication is given to replace glucocorticoid in adrenal insufficiency?

Hydrocortisone; may be adjusted during illness, injury, or surgery (stresses)

What medication is given to replace mineralocorticoid in adrenal insufficiency?

Fludrocortisone; promotes sodium and water retention, potassium excretion

What is Addisonian crisis?

Acute, severe deficiency of adrenal hormones that causes circulatory instability and can progress to shock

What are some triggers for Add crisis?

Infection, injury, surgery, N/V, abrupt discontinuation of steroids

What are seven clinical manifestations of addisonian crisis?

Persistent vomiting, severe dehydration, hypotension, tachycardia, shock, electrolyte imbalances, hypoglycemia

What is the nursing management for addisonian crisis?

Recognize symptoms early and notify provider, administer IV hydrocortisone and IV fluid resuscitation with D5N5

What is Cushing syndrome?

Condition caused by excessive circulating corticosteroids, most commonly excess cortisol

What are five clinical manifestations of Cushing syndrome?

Rapid weight gain, muscle fatigue, frequent infections, sleep disturbances, poor wound healing

What is the normal hemoglobin A1c range for children less than 19 years old?

<7.0

What range is considered hypoglycemia?

<70 mg/dL; occurs when insulin exceeds glucose

What are clinical manifestations of hypoglycemia?

Irritability, shakiness, hunger, pallor, sweating, dizziness, shallow respirations

What are clinical manifestations of hyperglycemia?

3 P’s, fatigue, dry mouth, weight loss, slow wound healing

What is the nursing management for hypoglycemia?

15-15 rule, children should carry snack/glucose source, give glucagon/sugar gel if unconscious

What is diabetic ketoacidosis (DKA)?

Life-threatening complication caused by severe insulin deficiency, resulting in hyperglycemia, dehydration, ketone accumulation, and metabolic acidosis

What is the pathophysiology for DKA?

Insulin insufficiency → glucose can’t enter cells → fat breakdown for energy → ketones released (acidic)

Why is potassium low in DKA?

Insulin deficiency and acidosis shifts potassium out of cells, excreted in urine, then remaining potassium pulled into cells with insulin

What are five clinical manifestations of DKA?

Hyperglycemia (>250-300 mg/dL), 3 P’s, fruity breath, Kussmaul respirations, AMS/lethargy

What are Kussmaul respirations?

Deep, rapid breathing as body attempts to eliminate CO2 to compensate for metabolic acidosis

What are diagnostic findings of DKA?

Blood sugar >250-300, pH <7.2, bicarbonates <15 mEq/l

What is the nursing management for DKA?

Admit to ICU, IV fluids, IV insulin, glucose electrolyte and neuro monitoring

What medication is given for type 2 DM and what is its MOA?

Metformin = decreases glucose production and improves insulin sensitivity (not produce)

What are the side effects of metformin?

NVD, abdominal bloating, flatulence

What is the nursing management for metformin?

Give twice daily with meals to prevent GI upset and monitor blood glucose

What nursing intervention should be done when DKA patient now has blood glucose <240 mg/dL?

Add dextrose to IV fluids to prevent rapid osmolality shifts and cerebral edema