Levothyroxine (both congenital & noncongenital) HYPERthyroidism (Graves Disease) →Decreased TSH, increased T4, increased T3 Enlarged thyroid gland Think autoimmune response to the TSH receptors but no etiology has been identified Most often between 6-15 y/o 5x more likely in girls S/S →See picture below Thyrotoxicosis (Thyroid Storm or Thyroid Crisis) →happens with a sudden release in TH Unusual in children but can be life threatening S/S→severe irritability and restlessness, n/v, diarrhea, HYPERthermia, HTN, tachycardia Treatment of Hyperthyroidism Anti-thyroid medications →Methimazole Can induce remission and then stop medications, although a relapse can occur Thyroidectomy →surgical removal of thyroid; used when other methods are not effective Ablation with radioiodine →Response may be slower; concerns about link to thyroid cancer
-They said there will be questions regarding these two charts Parathyroid Disorders - Know the inverse relationships HYPOparathyroidism Decrease in serum calcium and an increase in phosphorus S/S—SEE TB BOX 29-8 HYPERparathyroidism →rare in children Treatment →Give calcium and VitD; want to maintain normal range of Ca2+ and mineralization of the bones Adrenal Gland Disorders Adrenal Cortex →secretes three types of hormones/steroids Glucocorticoids – mainly hydrocortisone Blood sugar regulation, response to stress Mineralocorticoids – mainly aldosterone Regulates water in cells Sex steroids – androgens Overproduction = masculinization Adrenal Medulla →Catecholamines = epinephrine and norepinephrine Cushing Syndrome →excessive Cortisol May be due to an adrenal tumor Requires surgical removal May be due to excessive steroid therapy Uncommon in children Congenital Adrenal Hyperplasia (CAH) Deficiency in 21-hydroxylase →enzyme needed for cortisol production Types: Salt wasting →decreased hydrocortisone, decreased aldosterone S/S = vomiting, poor weight gain, poor feedings, drowsiness, dehydration, LBP Ambiguous genitalia of female Non Salt-wasting →decreased hydrocortisone
Aldosterone = WNL so less problems with Na+ regulation External female genitalia may appear male-like Late onset →can cause precocious puberty Treatment—no cure; cortisol replacement, fluorine (for salt wasters), surgery **Important to 2x or 3x baseline cortisol at times of stress ** (fever, vomiting, injury, surgery) Pheochromocytoma →Adrenal Medulla Tumor (nonmalignant) Secretes excessive adrenaline and noradrenaline (increased catecholamines) Persistent elevated BP Treatment—surgery; may need lifelong glucocorticoid and mineralocorticoid therapy High risk during surgery r/t excessive release of catecholamine then catecholamine withdrawal/shock Turner Syndrome – absence of one of the X chromosomes Often diagnosed in preschool children because of growth delay; more common in girls Treatment – female hormone therapy and counseling/support for child and family S/S—short stature, webbed neck, low set ears, delayed sexual development, amenorrhea
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- Spring '14