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

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

3. 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

4. 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

5. 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 years.

6. 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

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

8. Endocrine Problems Diabetes Mellitus Carbohydrate Counting
Sick day rules
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.

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

10. 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.

11. 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