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2010-11-01 01:09:43
Peds endocrine

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  1. Hypopituitarism
    • Diminished/deficient secretion of pituitary hormones. Can lead to gonadotropin deficiency with absence or regression of sex characteristics, GH deficiency, TSH deficiency
    • -Most common organic cause is tumors in pituitary or hypothalamic region
    • -Clinical manifestations: short stature, appear well nourished, relatively inactive, eruption of permanent teeth delayed, overcrowded teeth, sexual development usually delayed but normal.
  2. Diagnostic evaluation of hypopituitarism:
    • Aimed at isolating organic causes in addition to GH deficiency, may include hypothyroidism, oversecretion of cortisol, gonadal aplasia, chronic illness, nutritional inadequacy...
    • Complete diagnostic eval: history, history of growth patterns and previous health status, physical exam, psychosocial eval, radiographic surveys, and endocrine studies.
    • *Definitive diagnosis is based on absent or subnormal reserves of pituitary GH
  3. Therapeutic management of hypopituitarism
    Treatment of GH deficiency is directed towards correction of underlying disease process. **Definitive treatment is replacement of GH, which is 80% successfull.
  4. Nursing care management of hypopituitarism
    *identifying children with growth problems, establish diagnosis, provide education for pt self management (best when GH is given at bedtime)
  5. Pituitary hyperfunction
    • Excess GH before closure of epiphyseal shafts results in proprotional overgrowth of the long bones until the individual reaches 8 feet or more.
    • -Vertical growth is followed with rapid and increased development of muscles and viscera, weight is proportional to height
    • -If oversecretion of GH occurs after closure of epiphyseal plate, growth is in the transverse direction (acromegaly): big head, lips, nose tongue, jaw, increased facial hair,deeply creased skin, and tendency toward diabetesM.
  6. Pituitary Hyperfunction: diagnosis
    Based on history of excessive growth during childhood and evidence of increased levels of GH. radiographic studies may reveal tumor, enlarged bones, evidence of joint changes...