endocrine system

growth hormone deficiency

congenital or acquired (brain injury, chemo), damage to pituitary gland

genetic mutations, MEN1 or FIPA (higher chance of pituitary tumor), stroke

most common pituitary hormone deficiency

growth hormone deficiency risks

family hx, cleft plate/lip, childhood cancers

growth hormone deficiency clinical presentation

shorter than expected, decreased height velocity over time

may exp cognitive impairments and poor performance in school

growth hormone deficiency diagnostics

focus on growth pattern, xrays (bone age), blood tests, GH stim testing, MRI

growth hormone deficiency treatments

daily injections of synthetic human GH, sequential height measurements and bone age

joint pain from rapid growth ^

precocious puberty and delayed puberty

imbalance of hormonal regulation of the hypothalamic-pituitary-gonadal-axis which helps regulate hormones and control puberty, reproductive function, and sex hormone production

precocious puberty and delayed puberty risks/causes

chronic illnesses, nutritional deficiency

precocious puberty and delayed puberty clinical presentation

puberty onset before 8F or 9M, breast enlargement, pubic hair, menstruation, testicular enlargement followed penis and scrotum growth

13-16 no development (females, delayed), 14 no enlargement of testes (males, delayed)

precocious puberty and delayed puberty treatments

GNRH - agonists to postpone puberty (before 10 best)

low dose of estrogen and testosterone

hypopituitarism/hyper

hypo - acquired or congenital; injury, tumor, or gene mutation, radiation, infection, autoimmune

hyper - growth or tumor

hypopituitarism/hyper clinical presentation

neonates/hypo - micropenis, hypoglycemia, jaundice, growth failure, delayed tooth development, delay in puberty

hyper (rare) - gigantism or acromegaly, delay in puberty, accumulation of fat and facial hair, bruise easily

hypopituitarism/hyper treatment

hypo - fix underlying cause; replacement of ACTH, TSH, LH, and FSH hormone

hyper - surgery, radiation therapy

argine vasopressin disorder/diabetes inspidus

result of dysfunction of ADH synthesis, release, or renal response

diabetes inspidus cause

unknown; tumor putting pressure on pituitary gland, hereditary

diabetes inspidus clinical presentation

drinking a lot but still looking dehydrated, voids 100mL/hr++ (2yo) or 50mL/hr++, fever, weak thready pulse, poor skin turgor, low BP, nocturia, dizziness, failure to thrive, muscle twitching (hyperNa+)

diabetes inspidus treatment

symptoms due to ADH deficiency or resistance

desmopressin (defciency), thiazide diuretics (resistance), indomethacin + low solute diet (resistance)

hypothyroidism

low t4/t3 levels causing a hypometabolic state

thyroid issue = increased TSH, pituitary/hypothalamus issue = decreased or normal TSH

hypothyroidism cause

congenital - agenesis, dysplasia, or ectopy of thyroid (poor development)

acquired - body attacks own thyroid; iatrogenic (thyroid medically destroyed), central (pitituary no signal for TSH)

hypothyroidism risks

family hx, twin births, multiple births, pregnancy 35 yo+, preterm, autoimmune disease

hypothyroidism clinical presentation

congenital - elevated birth weight, delayed stooling, poor feeding, noisy respirations, hoarse cry, jaundice

acquired - increased weight, goiter, slow growth, delayed bone maturation, dry skin, obstructive sleep apnea, galactorrhea, sexual pseudo precocity

both - constipation, lethargy, hypothermia

hypothyroidism treatments

before 2 wks; levothyroxine

hyperthyroidism

due to low or suppressed TSH with elevated t3/4 resulting in a hypermetabolic state → graves disease + goiter

autoimmune disorder

hyperthyroidism cause

maternal graves disease, graves disease, thyroiditis

hyperthyroidism risks

toxic multifocal goiter, trisomy 21, acute thyroiditis, immunocompromised

hyperthyroidism clinical presentation

infant - craniosynostosis (premature fusion of cranial sutures), impaired cognitive abilities, growth failure, short stature

irritability, poor feeding, htn, tachycardia, exophthalmos, goiter, microcephaly, sleep disturbances, hyperactivity, heat intolerance, weight loss, increased bowel movmenets, tremors

hyperthyroidism treatments

methimazole (antithyroid), beta-blockers (manage manifestations)

radioactive iodine or surgery

type 1 diabetes

autoimmune destruction of pancreatic beta cells and absolute insulin deficiency causing an inability to uptake glucose

type 1 diabetes cause

genetics, environment

type 1 diabetes risks

family hx, predisposition of autoimmune disorders, male,

type 1 diabetes clinical presentation

hyper - polyuria, polydipsia, polyphagia, weight loss, dehydration, altered mental status, smell of ketones (fruity); DKA

hypo - pallor, sweating, headache, tachycardia, fatigue, irritability, dizziness

diabetic ketoacidosis (DKA)

occurs if insulin levels are too low, glucose 200+, pH less than 7.3

type 1 diabetes lab and diagnostics

a1c meaure 2-3 mo, continuous glucose monitoring, screenings for thyroid and GI disorders

type 1 diabetes treatments

rapid-acting (lispro): 15-30 mins

short-acting (regular): 30 min-hr

intermediate-acting (NPH): 1-2 hr

long-acting (glargine): 2-4 hr

ultra-long (degludec): 1hr

type 2 diabetes

insulin resistance causing an increase in insulin production, sometimes not enough

type 2 diabetes risks

ethnicity, family hx, genetic predisposition, obesity, physical activity level, dietary habits

type 2 diabetes clinical presentation

polyuria, polyphagia, polydipsia, weight loss

vomiting, lethargy, altered LOC, dehydration

hyperosmolar hypoglycemic state (HHS)

type 2 diabetes lab/diagnostics

hemoglobin a1c greater than 6.5%, fasting bg of 126+

type 2 diabetes treatments

lifestyle modifications, metformin (increase body response to insulin), insulin if random bg 250+ or a1c 9%+