Ch. 17 - endocrine.docx - Chapter 17 Endocrine Disorders...

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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