2 Endocrine System

What is the main function of the endocrine system?

Controls and regulates metabolic processes in the body.

Why is the endocrine system called the “powerhouse” of the body?

Because it regulates key processes that keep the body functioning properly

Which endocrine gland produces thyroid hormones?

Thyroid gland

What is another name for the pituitary gland?

Hypophysis

What is the main role of the pituitary gland?

Regulates other endocrine glands in the body.

How many lobes does the pituitary gland have

Two lobes—anterior and posterior

Which lobe of the pituitary is called the “master gland”?

Anterior pituitary

What controls the anterior pituitary gland?

The hypothalamus

What is hypopituitarism (GH deficiency)?

pituitary gland doesn’t produce enough growth hormone → inhibiting growth in all cells of the body.

What is the primary site of dysfunction in GH deficiency?

The hypothalamus

How is GH deficiency diagnosed in children?

1. evaluating child, parental, and familial growth patterns

2. checking pituitary GH reserves

3. skeletal surveys (<3 yrs)

4. hand–wrist x-rays for ossification centers

What is the main treatments for GH deficiency?

• MAIN - Biosynthetic growth hormone (injections) 

• Other hormone replacements as needed

  • Thyroid extract

  • Cortisone

  • Testosterone or estrogens and progesterone

What are key nursing considerations for children with GH deficiency?

1. Identify growth problems early

2. support the family

3. address body image concerns

4. prepare the child for daily injections

5. consider cost and insurance coverage

What happens in pituitary hyperfunction before epiphyseal closure?

Excess GH → overgrowth of long bones

Physical characteristics in children with pituitary hyperfunction?

1. Very tall (up to 8 ft)

2. rapid vertical growth

3. increased muscle development

Head changes in pituitary hyperfunction?

• Enlarged head circumference

• delayed fontanel closure

When does acromegaly occur?

Excess GH after epiphyseal closure

Typical facial features of acromegaly

1. Enlarged head, lips, nose, tongue, jaw

2. enlarged paranasal & mastoid sinuses

3. facial disproportion to skull

4. separation and malocclusion of teeth

5. Thickened, deeply creased skin

6. increased facial hair

Diagnostic Evaluation of Acromegaly

• Radiologic studies

  • X rays

• Endocrine studies

Therapeutic Management Acromegaly

• Surgical treatment to remove the tumor

• Irradiation and radioactive implants

• Hormone replacement therapy after surgery in some cases

Why might hormone replacement be needed after surgery?

Removing the tumor can lead to hypopituitarism (decreased hormone production).

Nursing Management Acromegaly

• Early identification of children with excessive growth rates

  • Use plot chart

• Early treatment for improved outcomes

• Emotional support

• Body image concerns

What is Precocious Puberty

Defined as sexual development

• before age 9 years in boys

• before age 7 years in Caucasian girl

• before 6 years in African-American girls

Three types of Precocious Puberty

• Central precocious puberty (CPP) (80%)

• Peripheral precocious puberty (PPP)

• Incomplete precocious puberty (IPP)

Central Precocious Puberty (CPP)

• Brain starts puberty too early (HPG axis turned on early).

• Everything develops in normal order, just too soon.

• Most common type (80%).
  🧠 Think: “Central = brain’s fault.”

Peripheral Precocious Puberty (PPP)

• Hormones come from somewhere else (like ovaries, testes, or adrenal glands).

• Brain NOT involved.

• Caused by tumors, cysts, or adrenal problems.
  💥 Think: “Peripheral = problem outside the brain

Incomplete Precocious Puberty (IPP)

• Only one sign of puberty shows up early (like breast buds or pubic hair).

• Doesn’t keep progressing.

• Usually benign and just monitored.
  🌱 Think: “Incomplete = starts but doesn’t finish.”

What is the main goal of treating precocious puberty?

To slow early sexual development and help growth return to normal rates.

What medication is used to treat central precocious puberty?

Leuprolide acetate (Lupron Depot).

How does leuprolide acetate work?

suppresses gonadotropin release, slowing puberty progression to a normal rate

When is treatment for precocious puberty discontinued?

When the child reaches the normal age for puberty to begin.

What do thyroid hormones regulate?

The basal metabolic rate (BMR) — how fast the body uses energy.

What two main hormones are secreted by the thyroid gland?

• T3 (Triiodothyronine) and T4 (Thyroxine)

• calcitonin

Which thyroid hormone is more potent?

T3 is stronger, but there’s more T4 in circulation

What hormone controls thyroid hormone release?

TSH (Thyroid-Stimulating Hormone) from the pituitary gland

What does calcitonin do?

Lowers blood calcium by storing calcium in bones

What happens in hypothyroidism?

Thyroid is underactive → low metabolism, fatigue, weight gain, cold intolerance, constipation 

What happens in hyperthyroidism?

Thyroid is overactive → high metabolism, weight loss, heat intolerance, anxiety, tachycardia

What might cause thyroid hormone imbalance?

Either too much or too little TSH or direct thyroid dysfunction

Lab pattern in Graves disease (hyperthyroidism)?

• ↑ T3 + ↑ T4 + ↓ TSH

• (thyroid is overactive, pituitary slows TSH release).

What are the two main types of juvenile hypothyroidism?

• Congenital 

• Acquired

Congenital Juvenile Hypothyroidism

• Congenital hypoplastic thyroid gland

• Born with it and there's a problem with the thyroid gland

• Underactive hypothroid

Acquired Juvenile Hypothyroidism

• Partial or complete thyroidectomy for cancer or thyrotoxicosis

• Following irradiation for Hodgkin disease or other malignant disease

• Obtained accidentally maybe from getting cut from a tumor

Can dietary iodine deficiency cause juvenile hypothyroidism in the U.S.?

Rarely — it’s uncommon because most foods are iodized

Clinical Manifestations of Juvenile Hypothyroidism

1. Decelerated growth

2. Myxedematous skin changes

   • Dry skin

   • Sparse hair

   • Periorbital edema

3. Constipation

4. Sleepiness

5. Mental decline

What is a goiter?

Hypertrophy (enlargement) of the thyroid gland → making it swollen

Congenital Goiter 

Usually results from maternal ingestion of antithyroid drugs during pregnancy

Acquired Goiter

Result of

• neoplasm

• inflammatory disease

• dietary deficiency (but rarely in children)

• increased secretion of pituitary TSH

Why is thyroid enlargement at birth a concern?

may compromise the newborn’s airway

How can goiters present in newborns?

• Large goiters are obvious

• smaller nodules may only be felt on palpation

How is hypothyroidism with thyroid enlargement treated?

Thyroid hormone (TH) replacement

What is lymphocytic thyroiditis also called?

Hashimoto disease or chronic autoimmune thyroiditis

Who is most affected by lymphocytic thyroiditis

Children and adolescents, usually after age 6

How does lymphocytic thyroiditis present?

Often as a goiter, which may be transient and asymptomatic

How long might lymphocytic thyroiditis take to resolve spontaneously?

1 to 2 years.

What treatment can decrease goiter size in lymphocytic thyroiditis

Oral thyroid hormone (TH) replacement.

Is surgery recommended for lymphocytic thyroiditis?

No, surgery is contraindicated.

What is the most common cause of hyperthyroidism in children?

Graves disease AKA diffuse toxic goiter

What causes Graves disease?

Autoimmune response to TSH receptors (exact cause unknown)

Typical signs of Graves disease in children?

Enlarged thyroid (goiter) and exophthalmos

Peak age for Graves disease onset in children?

12–14 years, but it can occur at birth

How is Graves disease diagnosed?

High T4 and T3 levels, with suppressed TSH.

What is the goal of therapy for Graves disease?

Slow hormone secretion to reduce hyperthyroidism symptoms

Treatments for Graves disease in children?

• Antithyroid drugs: propylthiouracil (PTU) or methimazole (give with food).

• Subtotal thyroidectomy.

• Radioactive iodine ablation

What is thyrotoxicosis?

• Thyroid “crisis” or “storm”

• sudden, extreme release of thyroid hormones

Is thyrotoxicosis common in children

unusual but can be life-threatening

What can trigger a thyroid storm in kids?

• Infection

• surgery

• stopping antithyroid meds suddenly

Treatment for thyroid storm?

Antithyroid drugs + propranolol

What’s the first step in nursing care for pediatric thyroid disorders?

Identify children with hypothyroidism

How should the environment be for a child with thyroid issues?

Quiet with rest periods

Dietary needs for children with thyroid disorders?

Meet increased metabolic requirements

What should nurses teach about thyroid medications?

Explain medications and their side effects

What does the adrenal cortex secrete?

1. Glucocorticoids

2. mineralocorticoids 

3. sex steroids 

What do glucocorticoids do?

• Regulate metabolism and stress response

• (cortisol, corticosterone)

What do mineralocorticoids do?

• Control sodium and water balance

• (aldosterone).

What do adrenal sex steroids do?

• Influence sexual development and characteristics

• (androgens, estrogens, progestins)

What does the adrenal medulla secrete?

Catecholamines: epinephrine and norepinephrine for energy

What is the main cause of adrenal medulla hyperfunction?

Catecholamine-secreting tumors (e.g., pheochromocytoma)

What happens if the adrenal medulla tumor is present?

Overproduction of catecholamines → hyperactivity, high blood pressure, other symptoms

What is acute adrenocortical insufficiency also called?

Adrenal crisis

What are common causes of adrenal crisis?

1. Trauma with adrenal hemorrhage

2. severe infection

3. abrupt withdrawal of cortisone

4. failure to increase cortisone during stress

What are clinical symptoms of adrenal crisis?

1. Low blood sugar

2. lethargy

3. nausea

4. muscle weakness

5. headache

6. sometimes infection

How is adrenal crisis treated?

Emergency stress dose of corticosteroids (e.g., Solu-Cortef IM)

What is chronic adrenocortical insufficiency in children called?

Addison Disease

What usually causes Addison disease in children?

1. Adrenal neoplasm

2. adrenal lesion

3. idiopathic (unknown) cause.

When do symptoms typically appear?

Gradually, after ~90% of adrenal tissue is nonfunctional

How is Addison disease diagnosed?

1. Blood tests

2. urine tests

3. ACTH stimulation test

4. MRI

5. CT scan

How is Addison disease treated?

Corticosteroid replacement therapy (replace what is missing).

What are key nursing considerations for Addison disease?

1. Chronic illness management

2. patient/family education

3. monitoring for adrenal crisis

What is Cushing Syndrome?

group of symptoms caused by too much circulating cortisol

What are common causes of Cushing Syndrome in children?

1. Adrenal tumor

2. prolonged/excessive steroid therapy

3. pituitary ACTH excess

4. ectopic tumors

5. food-dependent adrenal response (polypeptide)

What can abrupt steroid withdrawal cause in Cushing Syndrome?

Acute adrenal insufficiency

What is a typical “Cushingoid appearance”?

1. Moon face

2. red cheeks

3. weight gain

4. pendulous abdomen with red striae

5. excessive hair

6. poor wound healing

7. ecchymosis

How is Cushing Syndrome diagnosed?

1. Confirm excess cortisol

2. lab tests (glucose, electrolytes, 24-hour urine)

3. X-rays (osteoporosis, sella turcica)

What is the treatment for Cushing Syndrome?

• Surgery if tumor present

• hormone replacement (GH, ADH, TH, gonadotropins, steroids).

Nursing considerations for Cushings Disease

1. Body image support

2. chronic disease management

3. multiple medications

4. monitoring for complications

How do hormones work in children?

Secreted by endocrine glands (pituitary, thyroid, adrenal, ovaries) → travel in blood to organs/tissues to regulate functions

Most common endocrine disorders in children?

1. Diabetes

2. thyroid disorders

3. early/delayed puberty

4. growth hormone deficiency

5. Turner syndrome

6. tumors