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- growth hormone deficiency due to LOW amounts
of growth hormones (patients will be small & frail)
Patho of HYPOpituitarism - can be caused by congenital defect, trauma that
damages pituitary gland, pituitary tumor, or issue
with hypothalamus
dwarfism, developmental delay, various visual and
neurological symptoms, seizure disorder, congenital
Signs & Symptoms of
malformations, delayed sexual maturation
Hypopituitarism
(amenorrhea, micropenis, undescended testicles),
hypoglycemia, diabetes
Not something that is automatically screened for,
but will be obvious when height & weight is plotted
& there is no progression
Diagnostics for
- hormone stimulation test: administer insulin,
hypopituitarism
argining, glucagon and check the release of growth
hormones
- Bone density tests
- Xrays/CT scans
, Biosynthetic growth hormone injection Somatropin
(Humatrope) - VERY EXPENSIVE and child will only
take until they reach optimal height (what height this
Treatment of is will depend on parents/pediatrician discussion)
hypopituitarism
Other hormone replacements (levothyroxine,
estrogen, testosterone, progesterone, synthroid,
cortisone)
- Patient not growing taller, but growing wider -
body image issues
- Teaching about growth hormone injections - 2cm
Nursing teaching for
from umbilicus or thighs, rotate sites, teach infection
hypothyroidism
control, teach child how to clean and eventually
adminster these injections on their own (so they can
be involved in their own healthcare)
Disorder of gonads, adrenal glands, or
hypothalamic-pituitary-gonadal axis - cause is
usually unknown
patho of precocious
puberty 2 types - central (most common, kids can reproduce
& have somatic growth) & peripheral
(overproduction of gonads, increased sex organ
sensitivity)
S&S of precocious Sexual development before 9 in boys (typically 11-
puberty 14) or before 8 in girls (usually 10-12)
, Can treat the cause if the cause is known
- Surgery, chemo, radiation to remove any tumors
- GnRH analog for central precocious puberty
- Girls: luteinizing hormone releasing hormone
(Lupron): HOT FLASHES is a normal side effect
- Depoprovera shot or Cycrin tables to reduce
Treatment/management
secretion of gonadrotrophins & stop menstruation
of precocious puberty
- Stop medications when child reaches normal
pubertal age
- Parents will need to have "birds and bees"
conversation early with these children - teach them
about body image, periods, etc.
Juvenile hypothyroid can be congenital (genetic
mutation, most common preventable cause of
Patho of hypothyroidism intellectual disability, covered in newborn screening
test) or acquired (such as from a thyroidectomy or
radiation for Hodgkins)
Thyroid enlargement the compromises newborn
airway, decelerated growth, periorbital edema,
delayed mental responsivenessm constipation
S&S of hypothyroidism in
Peds All other symptoms like adults - low and slow body
Babies hard to wake up, round belly from decreased
peristalsis, sparse hair and dry skin
Levothyroxine (Synthroid)
- measure & record growth at regular intervals
Treatment of - Obtain thyroid tests more frequently until
hypothyroidism adolescence (every 3-4 mths, then every 6-12 as
adolescents)
- Provide additional rest periods and extra measures
for thermoregulation