Endocrine Disorders
Congenital Hypothyroidism
1. Thyroxine (T4) is produced by thyroid stimulating hormone (TSH) which is produced by anterior
pituitary gland.
2. T4 is require for growth & development. Tissues of body respond to T4 by producing proteins &
enabling cells to utilize O2
3. Patho:
a. Anterior pituitary fails to send TSH to thyroid, or thyroid gland fails to develop in utero = T4
not produced
b. S/S:
i. Large fontanelles
ii. Protruding tongue
iii. Umbilical hernia
iv. Constipation
v. Lethargy
vi. Prolonged jaundice
vii. Untreated cognitive deficits
4. Dx:
a. Suggestive: clinical picture
b. Newborn screening: 24 hours after birth
i. Positive thyroid scan for definitive dx
5. Tx:
a. Daily Synthroid (levothyroxine) based on age & weight for rest of life
6. Nursing considerations:
a. Deficient knowledge/risk for altered family process/anxiety/grieving
i. Educate: administration to Synthroid to prevent s/s of hypothyroidism & potentially
irreversible developmental disabilities, & need for serum testing of T4 levels at each
well – child visit
ii. Dosage of Synthroid will increase as child ages & gains weight
iii. Signs of hypothyroidism: constipation, lethargy, dry skin, weight gain will appear if
med dosage is no longer adequate
iv. Signs of hyperthyroidism: tachycardia, weight loss, & sleeplessness for
overmedication
v. Until correct dosage is found child may have signs of hypo or hyper thyroidism.
Parents should be aware of the signs.
b. Risk for delayed growth & development
Precocious Puberty
1. Girls: begin maturation at 9 y.o. some begin as early as 7 & others late as 11
2. Boys: begin at 9.5 – 15 y.o.
3. Precocious puberty begin physical sexual development earlier
4. Patho:
a. Early signs of puberty:
, i. In girls:
1. Secondary sex characteristics: breast development, pubic & axillary hair
growth, & growth spurt
2. Vaginal changes & early menarche
ii. In boys:
1. Secondary sex characteristics: pubic & axillary hair growth, vocal changes
2. Testicular enlargement, penile growth, & ejaculation
iii. Early bone fusion = short adult stature.
5. Dx:
a. Suggestive: clinical picture
b. Hormonal blood tests (LH, FSH, testosterone, estrogen)
c. X-rays of the wrists to determine bone growth
d. Rule out tumors
6. Tx:
a. Administer leuprolide acetate (eligard, Lupron) to inhibit release of gonadotropin – releasing
hormone from hypothalamus = reduction in pituitary hormone production
7. Nursing considerations:
a. Deficient knowledge
i. Educate: medication regimen including monthly IM injection procedure
b. Risk for disturbed body image/impaired social interaction
Growth Hormone Deficiency (GHD)
1. Multiple causes
a. Malfunctioning pituitary gland
b. Brain tumors
c. Genetic syndromes
2. Patho:
a. Delayed growth pattern
i. Below 5th percentile for height
ii. Slowed growth rate
iii. Delayed puberty w. immature facial appearance, poor muscle mass (but increased
fat deposits) and small penis
iv. Hypoglycemia
3. Dx:
a. Suggestive: clinical picture
b. Laboratory data & x – rays of growth plates of wrist
c. Hormonal studies: thyroid studies & sex hormones
d. Definitive:
i. Growth hormone (GH) levels assessed
1. Stimulating meds: insulin, clonidine hydrochloride (catapres, duraclon)
ii. GH less than 10ng/mL on two occasions = diagnostic
4. Medical management
a. Synthetic GH subQ at bedtime 6 – 7x/week
i. 2cm/yr growth
, ii. Given until desired height is reached
b. Monitor growth closely
5. Nursing considerations:
a. Delayed growth & development/risk for situation low self-esteem/risk for altered
coping/risk for disturbed body image
i. Child may not reach full desired height
b. Deficient knowledge
i. Educate: reconstituting med & injection technique
Type 1 DM
1. Peak ages of dx: 5 – 7 y/o & at puberty
2. Patho:
a. Automimmune inflammatory process = destruction of beta cells = no insulin produced =
cells are unable to utilize glucose resulting in:
i. Excess circulating glucose, eventually spilling in urine
ii. Compensation of lost fuel by catabolism (breaking down) of fats & proteins
1. Ketones are formed = metabolic acidosis
b. S/S:
i. Hyperglycemia
ii. 3 P’s: polyuria (urine), polydipsia (thirst), polyphagia (hunger)
iii. Weight loss
iv. Blurred vision
v. Fatigue
vi. Headache
c. Ketoacidosis (medical emergency), coma, & death if insulin isn’t given.
i. DM often is not suspected until development of ketoacidosis & marked confusion or
coma.
ii. S/S:
1. Glucose >400mg/dL
2. Serum pH less than 7.25
3. Elevated urine ketones
4. N/V
5. Abdominal pain
6. Extreme weakness & fatigue
7. Dry, itchy skin
8. “fruity” breath
9. Kussmaul respirations (deep & labored)
10. Altered sensorium
iii. Intensive care w. fluid replacement, IV insulin, & potassium monitoring &
replacement
iv. DKA: when body is unable to utilize glucose bc of lack of insulin production, body will
go into fat catabolism. A marked rise in circulating ketones & a large UO follow. Child
becomes severely dehydrated, acidotic, & electrolytes shift (esp. potassium).
Cerebral edema is a serious complication.
, 3. Dx:
a. Suggestive: glycosuria w. s/s of diabetes
b. Definitive:
i. Hemoglobin A1C greater than or equal to 6.5%
ii. Fasting blood glucose greater than or equal to 126mg/dL
iii. 2 hr, 75g, oral glucose test 200mg/dL or higher
iv. Incidental BG of 200mg/dL or higher w. s/s of diabetes
4. Tx:
a. Insulin via subQ or insulin pump
i. Only fast acting insulin are used in pumps
ii. Fast acting insulin = child should eat within 5 min of injection
iii. 2 types of insulin to be injected at same time = read if compatible in same syringe
iv. 2 types compatible, regular 1st than intermediate – acting 2nd
v. Injection sites rotated around body rapid to less rapid absorption abdomen,
upper arms, hips, thighs
b. Regular BG testing
i. Before meals
ii. Goals for infants & toddlers are higher bc hypoglycemic episodes are most common
iii. Hemoglobin A1C goal: less than 7.5
c. Regular urine testing
d. Diabetic diet
e. Exercise
f. Hypoglycemia take simple sugar (packet of sugar, hard candy)
i. Unconscious or incoherent emergency injection of glucagon (releases glucose
from liver)
1. Kits prescribed
2. Common side effects:
a. N/V position child on side to prevent aspiration of vomitus
b. Hyperglycemia monitor levels after injection
5. Nursing considerations:
a. Risk for injury from hyperglycemia:
i. Educate everyone: s/s of hyperglycemia, BG testing throughout day, insulin
administration (rotation of sites & types), ways to prevent hyperglycemia episodes
(diet, & exercise)
b. Risk for injury from hypoglycemia
i. Educate everyone:
1. s/s of hypoglycemia: tachycardia, clammy skin, irritability, slurred speech, &
LOC
a. May be mistaken for temper tantrums in young children
2. Uncertain whether hypo or hyper assume hypo give simple sugar or
injection recheck BG level once level is normal consume a protein
source to maintain normal level
c. Imbalanced nutrition: less than body requirements
i. Educate: interaction btw food intake & insulin needs
Congenital Hypothyroidism
1. Thyroxine (T4) is produced by thyroid stimulating hormone (TSH) which is produced by anterior
pituitary gland.
2. T4 is require for growth & development. Tissues of body respond to T4 by producing proteins &
enabling cells to utilize O2
3. Patho:
a. Anterior pituitary fails to send TSH to thyroid, or thyroid gland fails to develop in utero = T4
not produced
b. S/S:
i. Large fontanelles
ii. Protruding tongue
iii. Umbilical hernia
iv. Constipation
v. Lethargy
vi. Prolonged jaundice
vii. Untreated cognitive deficits
4. Dx:
a. Suggestive: clinical picture
b. Newborn screening: 24 hours after birth
i. Positive thyroid scan for definitive dx
5. Tx:
a. Daily Synthroid (levothyroxine) based on age & weight for rest of life
6. Nursing considerations:
a. Deficient knowledge/risk for altered family process/anxiety/grieving
i. Educate: administration to Synthroid to prevent s/s of hypothyroidism & potentially
irreversible developmental disabilities, & need for serum testing of T4 levels at each
well – child visit
ii. Dosage of Synthroid will increase as child ages & gains weight
iii. Signs of hypothyroidism: constipation, lethargy, dry skin, weight gain will appear if
med dosage is no longer adequate
iv. Signs of hyperthyroidism: tachycardia, weight loss, & sleeplessness for
overmedication
v. Until correct dosage is found child may have signs of hypo or hyper thyroidism.
Parents should be aware of the signs.
b. Risk for delayed growth & development
Precocious Puberty
1. Girls: begin maturation at 9 y.o. some begin as early as 7 & others late as 11
2. Boys: begin at 9.5 – 15 y.o.
3. Precocious puberty begin physical sexual development earlier
4. Patho:
a. Early signs of puberty:
, i. In girls:
1. Secondary sex characteristics: breast development, pubic & axillary hair
growth, & growth spurt
2. Vaginal changes & early menarche
ii. In boys:
1. Secondary sex characteristics: pubic & axillary hair growth, vocal changes
2. Testicular enlargement, penile growth, & ejaculation
iii. Early bone fusion = short adult stature.
5. Dx:
a. Suggestive: clinical picture
b. Hormonal blood tests (LH, FSH, testosterone, estrogen)
c. X-rays of the wrists to determine bone growth
d. Rule out tumors
6. Tx:
a. Administer leuprolide acetate (eligard, Lupron) to inhibit release of gonadotropin – releasing
hormone from hypothalamus = reduction in pituitary hormone production
7. Nursing considerations:
a. Deficient knowledge
i. Educate: medication regimen including monthly IM injection procedure
b. Risk for disturbed body image/impaired social interaction
Growth Hormone Deficiency (GHD)
1. Multiple causes
a. Malfunctioning pituitary gland
b. Brain tumors
c. Genetic syndromes
2. Patho:
a. Delayed growth pattern
i. Below 5th percentile for height
ii. Slowed growth rate
iii. Delayed puberty w. immature facial appearance, poor muscle mass (but increased
fat deposits) and small penis
iv. Hypoglycemia
3. Dx:
a. Suggestive: clinical picture
b. Laboratory data & x – rays of growth plates of wrist
c. Hormonal studies: thyroid studies & sex hormones
d. Definitive:
i. Growth hormone (GH) levels assessed
1. Stimulating meds: insulin, clonidine hydrochloride (catapres, duraclon)
ii. GH less than 10ng/mL on two occasions = diagnostic
4. Medical management
a. Synthetic GH subQ at bedtime 6 – 7x/week
i. 2cm/yr growth
, ii. Given until desired height is reached
b. Monitor growth closely
5. Nursing considerations:
a. Delayed growth & development/risk for situation low self-esteem/risk for altered
coping/risk for disturbed body image
i. Child may not reach full desired height
b. Deficient knowledge
i. Educate: reconstituting med & injection technique
Type 1 DM
1. Peak ages of dx: 5 – 7 y/o & at puberty
2. Patho:
a. Automimmune inflammatory process = destruction of beta cells = no insulin produced =
cells are unable to utilize glucose resulting in:
i. Excess circulating glucose, eventually spilling in urine
ii. Compensation of lost fuel by catabolism (breaking down) of fats & proteins
1. Ketones are formed = metabolic acidosis
b. S/S:
i. Hyperglycemia
ii. 3 P’s: polyuria (urine), polydipsia (thirst), polyphagia (hunger)
iii. Weight loss
iv. Blurred vision
v. Fatigue
vi. Headache
c. Ketoacidosis (medical emergency), coma, & death if insulin isn’t given.
i. DM often is not suspected until development of ketoacidosis & marked confusion or
coma.
ii. S/S:
1. Glucose >400mg/dL
2. Serum pH less than 7.25
3. Elevated urine ketones
4. N/V
5. Abdominal pain
6. Extreme weakness & fatigue
7. Dry, itchy skin
8. “fruity” breath
9. Kussmaul respirations (deep & labored)
10. Altered sensorium
iii. Intensive care w. fluid replacement, IV insulin, & potassium monitoring &
replacement
iv. DKA: when body is unable to utilize glucose bc of lack of insulin production, body will
go into fat catabolism. A marked rise in circulating ketones & a large UO follow. Child
becomes severely dehydrated, acidotic, & electrolytes shift (esp. potassium).
Cerebral edema is a serious complication.
, 3. Dx:
a. Suggestive: glycosuria w. s/s of diabetes
b. Definitive:
i. Hemoglobin A1C greater than or equal to 6.5%
ii. Fasting blood glucose greater than or equal to 126mg/dL
iii. 2 hr, 75g, oral glucose test 200mg/dL or higher
iv. Incidental BG of 200mg/dL or higher w. s/s of diabetes
4. Tx:
a. Insulin via subQ or insulin pump
i. Only fast acting insulin are used in pumps
ii. Fast acting insulin = child should eat within 5 min of injection
iii. 2 types of insulin to be injected at same time = read if compatible in same syringe
iv. 2 types compatible, regular 1st than intermediate – acting 2nd
v. Injection sites rotated around body rapid to less rapid absorption abdomen,
upper arms, hips, thighs
b. Regular BG testing
i. Before meals
ii. Goals for infants & toddlers are higher bc hypoglycemic episodes are most common
iii. Hemoglobin A1C goal: less than 7.5
c. Regular urine testing
d. Diabetic diet
e. Exercise
f. Hypoglycemia take simple sugar (packet of sugar, hard candy)
i. Unconscious or incoherent emergency injection of glucagon (releases glucose
from liver)
1. Kits prescribed
2. Common side effects:
a. N/V position child on side to prevent aspiration of vomitus
b. Hyperglycemia monitor levels after injection
5. Nursing considerations:
a. Risk for injury from hyperglycemia:
i. Educate everyone: s/s of hyperglycemia, BG testing throughout day, insulin
administration (rotation of sites & types), ways to prevent hyperglycemia episodes
(diet, & exercise)
b. Risk for injury from hypoglycemia
i. Educate everyone:
1. s/s of hypoglycemia: tachycardia, clammy skin, irritability, slurred speech, &
LOC
a. May be mistaken for temper tantrums in young children
2. Uncertain whether hypo or hyper assume hypo give simple sugar or
injection recheck BG level once level is normal consume a protein
source to maintain normal level
c. Imbalanced nutrition: less than body requirements
i. Educate: interaction btw food intake & insulin needs
