Care of the Child with Endocrine Problems Elizabeth Allen RN, MSN

Learning Objectives Describe thyroid and growth hormone disorders of childhood Explain aspects of diabetes care unique to pediatrics

Endocrine System Releases Hormones For Proper Growth and Maturation Hormones affect cellular activity Cell response: quantity plus timing of hormone Responsible for Fetal Development Regulate Central Nervous System Responsible for Maturation of Reproductive Organs Maintain Homeostasis For Proper Growth and Maturation Growth (metabolic process) Thyroid (G/D metabolizing nutrients and energy) Adrenal (glucocorticoids and androgens) Gonadal (androgens-males & progesterone-females) For Proper Metabolic Function Antidiuretic hormone (ADH) Parathyroid Insulin This is FYI Only

Endocrine System Problems Diabetes Mellitus Type 1 Juvenile Diabetes Autoimmune destruction of beta cells in pancreas Inherited susceptibility to the disease Caucasians more often affected Type 2 Cystic Fibrosis-related Diabetes Pancreas scarred, doesn’t produce enough insulin Develop Insulin Resistance

Endocrine System Problems Diabetes Mellitus Support Psychosocial support Peers with diabetes Education entire family and patient Teaching Pathophysiology of insulin insufficiency Glucose monitoring Insulin injection Diet modification Complication prevention and response Peak incidence of juvenile diabetes is between 7- 15 years.

Endocrine Problems Diabetes Mellitus Initial diagnosis often in DKA (diabetic ketoacidosis) DKA Symptoms Elevated Blood sugar Polydipsia Polyuria Headache, fatigue, lethargy Dark circles under eyes Fruity odor to breath

Endocrine Problems Diabetes Mellitus Treatment of DKA/Hyperglycemia Slowly correct blood sugar Hydration!! (NS Boluses) Education Insulin Regimen

Endocrine Problems Diabetes Mellitus Carbohydrate Counting http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/carbohydrate-counting.html Sick day rules http://www.diabetes.org/living-with-diabetes/parents-and-kids/everyday-life/sick-days.html Carbohydrate counting is used for blood sugar management with insulin. It is often used in combination with a correction equation to keep blood sugars within a “normal” range. Please review so you understand this process Sick day rules require more frequent blood sugar testing as the child’s body is under increased stress with infection. Even if child is not eating, increased stress of infection will drive blood sugars abnormally high.

Endocrine Problems Diabetes Mellitus Insulin Pump Psychosocial Support Adolescents! Present oriented

Endocrine Problems Growth Hormone Deficiency Hypopituitarism Hypothalamus Pituitary Gland GH GH – Growth, bone density, glucose uptake Infarction Tumors Trauma Genetic disorders Growth Hormone Level challenge/stimulation testing Bone age Growth hormone replacement? (SQ qday? For several years) Focus on appropriate developmental age Growth hormone secreted by the pituitary gland. Deficiency due to hypopituitarianism Often referred due to short stature. Both children “falling off the growth curve” or height is significantly below the mean height for age. Growth hormone stimulation testing uses medications to stimulate release of GH and is used to diagnose GH deficiency. Treatment is stopped when height achieved or bone age greater than 14 in girls and 16 in boys.

Endocrine Problems Hypothyroidism Congenital (1 in 3000) Causes mental retardation (cretinism) Big tongue, dull appearance, hypotonia Bradycardia, constipation, cool Newborn screening – T4 with Increased TSH Levothyroxine (Synthroid) Maybe Acquired- autoimmune process 2X more common in females Acquired can be idiopathic or Hashimoto thyroiditis, late onset thyroid dysfunction TSH deficiency due to pituitary or hypothalamic dysfunction or due to certain drugs