Chapter 17: Endocrine Disorders Anatomy and Physiology Glands of the Endocrine System - Hypothalamus: secretes releasing or inhibitory hormones to the pituitary gland which controls the thyroid releasing hormone, corticotropin releasing hormone, luteinizing hormone, growth hormone, somatostatin (stops release of GH) - Pituitary gland: o Anterior = GH. Thyroid stimulating, ACTH, prolactin, follicle stimulating, LH, melanocyte stimulating o Posterior = ADH and oxytocin - Pineal Body: wake-sleep cycle, melatonin secretion - Thymus: atrophies with age, responsible for cellular immunity - Thyroid: metabolism – T3, T4, calcitonin - Parathyroid Glands (4): PTH increased calcium levels in the blood – less in bone - Adrenal Glands: glucocorticoids, aldosterone, epinephrine - Pancreas: ezymes for digestion, insulin from beta cells - Sex Glands/Gonads o Testes produce testosterone when stimulated by FSH and LH o Ovaries have follicle cells which produce corpus luteum/progesterone, HCG, and relaxin Assessment General History - Prenatal care, type of delivery/any complications, gestational age, substance abuse - Hospitalizations, current medications (including OTC and alternative remedies), allergies, immunizations, family history (short stature, endocrine disorders, chronic disesase) - Developmental history - Nutrition (pattern, likes, history, GI distress, fast-food consumption, problems eating) - Activity level Physical Examination - ROS, weight, height (supine up to 24 months), head circumference (up to 36 months), fontanels, vitals, tanner stage of puberty - Mid-parental high/target height …and height velocity (cm/inches of growth per year) - Skin, body odor, neck, muscles, facial characteristics Hypopituitarism/Panhypopituitarism
- One or more pituitary hormones are deficient caused by trauma, tumors, infection of CNS, chemo, radiation, surgery, or congenital syndromes - GH is first to go and is more delicate Growth Hormone Deficiency - Delayed growth of less than 2 inches (3-4 cm) per year - Monitored with serial growth point plots on a chart slow height growth and increased abdominal fat for height - May have delayed anterior fontanel closure, delayed dental eruption, decreased muscle mass, cherub-like appearance, looks younger than age, delayed puberty, and high pitched voice - Congenital hypopituitarism – frequent hypoglycemia, prolonged jaundice, small penis, feeding problems requires GH replacement therapy - Testing o Bone age, growth plots over a 6month-1 year, provocative GH testing, MRI of pituitary gland for abnormalities, karyotyping o Single GH lab measurement not indicative of GHD - Frequent reassessments of response to therapy with endocrinologist - Somatropin is manufactured GH – lack one amino acid compared to human GH Diabetes Insipidus -
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