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What is negative feedback?
Increasing the levels of a specific hormone to inhibit the system responsible for releasing that hormone
Fill in: Hormonal control of many body functions are not fully developed until ___ months of age. This will cause fluid imbalance, amino acids and glucose too.
This term uses a scale that defines physical measurements of development based on external primary and secondary sex characteristics, such as the size of the breasts, genitals, testicular volume and development of pubic hair.
Which foods are needed to avoid with someone who has PKU (Phenylketonuria)?
- Soybeans and Beans
- Chicken, beef, pork, fish
This is a disorder of the adrenal glands where there is a lack of enzymes to make the hormones, CORTISOL and ALDOSTERONE. What are the physical findings in boys? Girls?
- Congenital Adrenal Hyperplasia (CAH)
- Boys: early development of male characteristics, growth problems
- Girls: ambiguous genitalia, failure to to menstruate, growth problems
What serum levels will you look for with CAH and other tests?
What is the treatment?
(CAH: disorders of adrenal glands where there is a lack of enzymes to make the hormone cortisol and aldosterone)
- Serum renin ad cortisol levels
- X-rays (bone age) and newborn screen
- Tx: Hormone replacement
- - Glucocorticoid (hydrocortisone acetate, cortisone acetate)
- - Mineralcorticoid (Fludrocortsone acetate: FLORINEF)
Most common for of CAH, manifests around this time of life, __a__.
With CAH, the low mineralcorticoid production can result in __b__.
- a. early weeks of life
- b. renal salt wasting
Renal salt wasting can be caused by what disorder?
What three things can result from renal salt wasting?
Can be caused by CAH (Congental Adrenal Hyperplasia)
- 1. Hypovolemia - hypotensive crisis/shock
- 2. Hyponatremia - risk for seizures
- 3. Hyperkalemia - risk for cardiac dysrhythmias
List treatment methods for CAH (congenital Adrenal hyperplasia)
- 1. Prompt fluid/electrolyte management
- 2. Oral glucocorticoid and mineralocorticoid replacement
- 3. FLORINEF for replacement therapy
- 4. Hydrocortisone if vomiting
With Diabetes Insidipus, will production of ADH increase or decease if serum osmolarity is low? What will this cause?
- Low serum osmolarity = Decreased ADH
- - Causes increased urine output
With Diabetes insipidus, will ADH production increase or decrease when serum osmolarity is high? What can this cause?
- High Osmolarity = increased ADH
- - This can cause increased water retention and decreased urine output
1. ADH deficiency
2. Kidneys insensitive to normal ADH levels
a. Central DI
b. Nephrogenic DI
What is central DI and what are its causes?
- Central diabetes insipidus is a form of DI that occurs when the body has a lower than normal amount of antidiuretic hormone (ADH).
- It involves extreme thirst and excessive urination.
- - Causes: Head trauma, tumor, infection of brain, brain surgery
What is Nephrogenic DI?
In nephrogenic diabetes insipidus, the kidneys produce a large volume of dilute urine because the kidney tubules fail to respond to vasopressin (antidiuretic hormone) and are unable to reabsorb filtered water back into the body.
This condition is when ADH is oveproduced, causing water retention (further causing hyponatremia d/t diluted serum levels)
SIADH (Syndrome of Inappropriate Antidiuretic Hormone)
List causes of SIADH
tx of DI, head trauma, CNS infection, tumors, generalized seizures
Children who have had surgery involving the hypothalamus or pituitary will first exhibit a transient __a__, followed by a permanent DI.
T or F: SIADH can be transient and will resolve on its own
What is the tx for SIADH
- Correcting lytes, mainly the diluted serum sodium
- - fluid restrictions
- - Possible NaCl infusion
State whether these are DI s/s or SIADH
1. Decreased urination
2. Increased urination
3. Fluid loss
4. Fluid retention
- 1. SIADH (decreased urination)
- 2. DI
- 3. DI (fluid loss)
- 4. SIADH
- 5. SIADH (HYPOnatremia)
- 6. DI
State whether this is s/s of DI or SIADH
1. Increased serum osmolality
2. Decreased serum osmolality
3. Decreased urine osmolality
4. Increased urine osmolality
This drug is a man-made form of a hormone that occurs naturally in the pituitary gland. This hormone is important for many functions including blood flow, blood pressure, kidney function, and regulating how the body uses water.
What is it used to treat?
DDAVP (desmopressin): treats bed-wetting, central cranial DI, increased thirst and urination
Fill in: Too much DDAVP when treating DI can lead to ____.
List DI tx in lecture slide
- Maintain fluid balance
- Administer vasopressin (DDAVP nasal spray)
What deficiency are these diagnosis indicate?
- Ht <5th percentile
- diminished growth rate
- Cherubic facies
- delayed puberty
Growth Hormone deficiency
What can these s/s indicate?
- Large fontanel
- Large tongue
- slow reflexes
- Prolonged jaundice
- feeding problems
- skin mottling
- dry/thick skin
- coarse/dull hair
- intolerance, constipation, weight gain
Congenital Hypothyroidism: thyroid gland does not produce sufficient thyroid hormones to meet the body's metabolic needs
State whether these two tests for Hypothyroidism will be high or low.
2. Free T4
What is the tx for hypothyroidism?
- 1. High
- 2. Low
- Thyroid hormone replacement
State whether these two tests for HYPERthyroidism will be high or low
2. Free T4
A pt. with goiter, increased appetite, weight loss, and tremors might have this
What is this term: Premature appearance of secondary sex characteristics, accelerated growth rate, and advanced bone maturation (Before 8 in girls, and 9 in boys)
Precocious Puberty occurs before ___ y/o in girls, and ___ y/o in boys.
Premature closure of epiphyseal plates can limit adult height. At what age for girls and boys is premature?
T or F: Children with precocious puberty often appear older than their chronological age.
True: they are treated so with unrealistic developmental expectations
Fill in: Elevated LSH and FSH in young adolescents may indicate this ___.
- Precocious Puberty in girls
- - Increased Testosterone in boys
What is med tx for Precocious Puberty?
GnRH agonist/blocker (central)
List the glucose goals for each of these types of children:
1. Non-diabetic children
2. Children with T1 DM
3. Infants and toddlers with T1 DM
- 1. 70-110
- 2. 90-180
- 3. 100-180
When mixing two different type of insulin in the same syringe, and after injecting air, will you withdraw from the short-acting (clear) insulin first, or the intermediate-acting (cloudy) insulin first?
List these sites from most rapid absorption rate to least rapid
Abdomen -> Arms -> Hips -> Thighs
- Increased urine
- fluid loss
- Increased SO
- Decreased Urine osmo
T or F: You may see goiter with both hypo and hyperthyroidism
List s/s, tests, and tx for hyperthyroid (graves)
Will TSH and T4 be high or low?
- s/s: goiter, increased appetite, weight loss, nervous, tremor, increased HR, behavior
- Tests: low TSH, high free t3
- Tx: antithyroid drug therapy (methimazole) radioactive iodine, or surgery (remove thyroid)
List cause (which is the main cause), tests, labs, tx and interventions for Precocious puberty
- cause: central (hypothalamus); idiopathic, CNS tumor, head trauma, radiation, CAH **main cause is malignant tumor**
- tests: tanner, xray (bone age), ct, mri, US
- Labs: elevated LSH, FSH, testosterone, estrogen
- tx: GnRH agonist
List the onset of each insulin:
- Lispro (rapid) 5-15 mins
- Reg 30-60 mins
- NPH 2-4 hr **Duration 10-16 hrs
- Lantus 2-4 hr **Duration 20-24 hr
Explain how to mix insulin in one syringe
- 1. Inject air into vials
- 2. Withdraw from short acting (clear) first
- 3. Withdraw from intermediate acting (cloudy) insulin second
What will labs look like with DKA?
- >300 glucose
- Positive ketones in urine and blood
- pH <7.25
List s/s of acquired hypothyroidism, s/s, and tests
- s/s: goiter, dry thick skin, always tired, cold, constipation, weight gain, edema
- tests: high TSH, low free T4
- Tx: thyroid hormone replacement
Select all that correlate with Hyperthyroidism:
Edema of face
- Weight gain
- Weight loss
- Dry skin
- Smooth skin
- Edema of face
- Decreased growth/puberty
- Accelerated growth
- Decreased activity
- Decreased HR
- Increased HR
What is the difference between DM and DI?
DI is the body