Endocrine Disorders Quiz
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Questions and Answers

Which hormone deficiency in hypopituitarism leads to stunted somatic growth in children?

  • Adrenocorticotropic hormone (ACTH) deficiency
  • Gonadotropin deficiency
  • Growth hormone (GH) deficiency (correct)
  • Thyroid-stimulating hormone (TSH) deficiency

    • What is the most common organic cause of pituitary undersecretion?

  • Genetic predisposition
  • Congenital hypopituitarism
  • Idiopathic hypopituitarism
  • Craniopharyngiomas (correct)

    • What is the definition of growth failure in the context of hypopituitarism?

  • An absolute height of less than -1 standard deviation (SD) for age
  • An absolute height of less than -2 standard deviations (SD) for age (correct)
  • A linear growth velocity consistently less than -2 standard deviations (SD) for age
  • A linear growth velocity consistently less than -1 standard deviation (SD) for age

    • What are the symptoms often manifested in infants with congenital hypopituitarism?

    <p>Apnea, cyanosis, severe hypoglycemia</p> Signup and view all the answers

    What is the initial symptom of diabetes insipidus (DI) in infants?

    <p>Irritability relieved with water but not milk</p> Signup and view all the answers

    Why is dehydration usually not a serious issue in older children with DI?

    <p>They are able to drink larger quantities of water</p> Signup and view all the answers

    What is the simplest test used to diagnose DI?

    <p>Restriction of oral fluids and observation of consequent changes in urine volume and concentration</p> Signup and view all the answers

    What does a positive result in the test for DI indicate?

    <p>Fluid restriction has little or no effect on urine formation but causes weight loss from dehydration</p> Signup and view all the answers

    What is the usual treatment for DI?

    <p>Intranasal, oral, or parenteral desmopressin (DDAVP)</p> Signup and view all the answers

    What is an important diagnostic consideration in children with DI?

    <p>To differentiate DI from other causes of polyuria and polydipsia, especially diabetes mellitus (DM)</p> Signup and view all the answers

    What is the initial objective of nursing care for a child with DI?

    <p>Identification of the disorder</p> Signup and view all the answers

    Why should children with DI wear a medical alert identifier?

    <p>For emergency purposes</p> Signup and view all the answers

    What should school personnel be aware of regarding a child with DI?

    <p>So they can grant children unrestricted use of the lavatory</p> Signup and view all the answers

    What is the indication for further investigation in a child with DI?

    <p>All of the above</p> Signup and view all the answers

    What should parents realize about the treatment of DI?

    <p>Treatment is lifelong</p> Signup and view all the answers

    What is the advantage of the injectable form of DDAVP?

    <p>It lasts 48 to 72 hours</p> Signup and view all the answers

    What is the typical interval for blood sample collection during testing for children?

    <p>Every 30 minutes over a 3-hour period</p> Signup and view all the answers

    What are the potential risks associated with children receiving glucagon?

    <p>Nausea and vomiting</p> Signup and view all the answers

    What is essential for children undergoing hormone replacement therapy?

    <p>Support and focus on patient self-management</p> Signup and view all the answers

    How is GH administration facilitated for younger children?

    <p>Establishing family routines and using tools like calendars and colorful stickers</p> Signup and view all the answers

    What may children undergoing hormone replacement therapy achieve at a slower rate than their peers?

    <p>Their adult height</p> Signup and view all the answers

    What results from excess GH before closure of the epiphyseal shafts?

    <p>Proportional overgrowth of long bones</p> Signup and view all the answers

    What are typical signs of acromegaly?

    <p>Overgrowth of facial features, thickened skin, and increased tendency toward hyperglycemia and diabetes mellitus</p> Signup and view all the answers

    How is the diagnosis of acromegaly confirmed?

    <p>Increased levels of GH, often confirmed through MRI and endocrine studies</p> Signup and view all the answers

    What may therapeutic management of acromegaly involve?

    <p>Surgical treatment, external irradiation, radioactive implants, and pharmacological agents in combination with other therapies</p> Signup and view all the answers

    Why is early identification of children with excessive growth rates crucial?

    <p>For restricting further growth and determining adult height</p> Signup and view all the answers

    What should nurses do when identifying children with excessive growth rates?

    <p>Refer such children for medical evaluation and provide emotional support</p> Signup and view all the answers

    What is the cause of short stature in some children?

    <p>Abnormality of the GH–insulin-like growth factor (IGF-I) axis</p> Signup and view all the answers

    What growth curve percentile indicates slowed growth in children with GH deficiency?

    <p>Below the third percentile</p> Signup and view all the answers

    What is recommended for children with low serum IGF-I and IGFBP3 levels and poor growth?

    <p>GH stimulation testing</p> Signup and view all the answers

    What is the success rate of GH replacement in children with GH deficiency?

    <p>80%</p> Signup and view all the answers

    What criteria are used to stop GH therapy in children?

    <p>Growth rates of less than 2.5 cm/year</p> Signup and view all the answers

    What is used for the definitive diagnosis of GH deficiency?

    <p>Absent or subnormal reserves of pituitary GH</p> Signup and view all the answers

    What is recommended for the treatment of GH deficiency caused by organic lesions?

    <p>Correction of the underlying disease process</p> Signup and view all the answers

    What is used as part of the diagnostic evaluation for growth issues?

    <p>Family history</p> Signup and view all the answers

    What is administered subcutaneously on a daily basis for GH replacement?

    <p>GH</p> Signup and view all the answers

    What do children diagnosed with GH deficiency need periodic evaluation of?

    <p>Thyroid and adrenal function</p> Signup and view all the answers

    What do children with other hormone deficiencies require for correction of the specific disorders?

    <p>Replacement therapy</p> Signup and view all the answers

    What may result from GH deficiency in children?

    <p>Delayed sexual development and underdeveloped jaw</p> Signup and view all the answers

    What is the recommended age for evaluation of pathological causes of precocious puberty in White girls?

    <p>Under 7</p> Signup and view all the answers

    What stimulates Leydig’s cells of the testes to secrete testosterone in boys?

    <p>Interstitial cell–stimulating hormone</p> Signup and view all the answers

    What percentage of children with precocious puberty have central precocious puberty (CPP)?

    <p>Approximately 80%</p> Signup and view all the answers

    What is the usual gender distribution of central precocious puberty (CPP)?

    <p>More frequent in girls</p> Signup and view all the answers

    What is the main disorder resulting from undersecretion of antidiuretic hormone (ADH)?

    <p>Diabetes insipidus (DI)</p> Signup and view all the answers

    What are the cardinal signs of diabetes insipidus (DI)?

    <p>Polyuria and polydipsia</p> Signup and view all the answers

    What stimulates the ovarian follicles to secrete estrogens in girls?

    <p>Follicle-stimulating hormone (FSH) and luteinizing hormone (LH)</p> Signup and view all the answers

    What is the result of undersecretion of antidiuretic hormone (ADH)?

    <p>Uncontrolled diuresis</p> Signup and view all the answers

    What is the main cause of central precocious puberty (CPP) in 90% of cases?

    <p>Idiopathic</p> Signup and view all the answers

    What may result in neurogenic diabetes insipidus (DI)?

    <p>Trauma</p> Signup and view all the answers

    In what percentage of cases does pubertal development regress without treatment?

    <p>50%</p> Signup and view all the answers

    What may increase the risk of future breast cancer?

    <p>Early menarche</p> Signup and view all the answers

    Which life-threatening thyroid crisis can occur in children with hyperthyroidism?

    <p>Thyrotoxicosis</p> Signup and view all the answers

    What is the main method for confirming the diagnosis of hyperthyroidism in children?

    <p>Measurement of thyroid-stimulating immunoglobulins</p> Signup and view all the answers

    What is the recommended therapy duration for thyrotoxicosis in children?

    <p>2 to 3 weeks</p> Signup and view all the answers

    What may be the only presenting sign of hyperthyroidism in children?

    <p>Exophthalmos</p> Signup and view all the answers

    What is a key nursing consideration for children with hyperthyroidism?

    <p>Ensuring a quiet, unstimulating environment</p> Signup and view all the answers

    What can lead to severe symptoms and even death in children with hyperthyroidism?

    <p>Thyroid storm</p> Signup and view all the answers

    What is an important aspect of school consultation for children with hyperthyroidism?

    <p>Addressing academic performance impact</p> Signup and view all the answers

    What is a common sign of hyperthyroidism in children?

    <p>Tachycardia</p> Signup and view all the answers

    What is a potential long-term effect of hyperthyroidism in children?

    <p>Stunted growth</p> Signup and view all the answers

    What is a therapeutic management option for hyperthyroidism in children?

    <p>Radioiodine ablation</p> Signup and view all the answers

    What is the most appropriate time to give medication to maintain the normal diurnal pattern of cortisol secretion?

    <p>Early in the day</p> Signup and view all the answers

    What is the reason for gradually withdrawing exogenous cortisol supply?

    <p>To allow the anterior pituitary to secrete increasing amounts of ACTH</p> Signup and view all the answers

    What may result from increased cortisol levels in children?

    <p>Cushing syndrome</p> Signup and view all the answers

    What is a potential consequence of physiological disturbances caused by cortisol?

    <p>Life-threatening consequences</p> Signup and view all the answers

    What is an important consideration before performing a bilateral adrenalectomy?

    <p>Informing parents of the operative benefits and disadvantages</p> Signup and view all the answers

    What is a common symptom experienced post-bilateral adrenalectomy?

    <p>Anorexia, nausea, and vomiting</p> Signup and view all the answers

    What is a potential long-term effect of hyperthyroidism in children?

    <p>Psychological depression</p> Signup and view all the answers

    What is the primary objective of nursing care related to the treatment regimen for an organic cause of Cushing syndrome?

    <p>Allow the anterior pituitary an opportunity to maintain more normal control mechanisms</p> Signup and view all the answers

    What is the potential consequence of inhibiting the action of GH by cortisol in children?

    <p>Short stature</p> Signup and view all the answers

    What should parents be aware of regarding the physiological symptoms of children post-adrenalectomy?

    <p>To be supportive of the child</p> Signup and view all the answers

    What is the diagnostic criteria for diabetes mellitus (DM) in children?

    <p>All of the above</p> Signup and view all the answers

    What is the characteristic blood glucose level in diabetic ketoacidosis (DKA)?

    <p>Blood glucose level ≥14mmol/dL</p> Signup and view all the answers

    What is the primary cause of microvascular complications in diabetes?

    <p>Nephropathy</p> Signup and view all the answers

    What is the effect of intensive insulin therapy on diabetes complications in children?

    <p>It delays the onset and slows the progression of retinopathy, nephropathy, and neuropathy</p> Signup and view all the answers

    What is a potential indicator for the diagnostic evaluation of diabetes in children?

    <p>Repeated urinary tract infections</p> Signup and view all the answers

    What is the characteristic feature of diabetic ketoacidosis (DKA)?

    <p>Relative insulin insufficiency</p> Signup and view all the answers

    What is the timing of microvascular disease development in diabetes?

    <p>Within the first 30 years of diagnosis</p> Signup and view all the answers

    What is the role of serum insulin levels in the onset of diabetes?

    <p>They may be normal or moderately elevated</p> Signup and view all the answers

    What is the primary cause of diabetic ketoacidosis (DKA)?

    <p>Hyperglycemia</p> Signup and view all the answers

    What is the effect of good glycemic control on vascular changes in diabetes?

    <p>It postpones vascular changes for 20 or more years</p> Signup and view all the answers

    What is the prevalence of type 1 diabetes in children in Canada?

    <p>1 in 300 children</p> Signup and view all the answers

    What is the characteristic feature of type 1 diabetes?

    <p>Destruction of pancreatic beta cells</p> Signup and view all the answers

    What is the fastest growing sector of the population with type 1 diabetes?

    <p>Children younger than 5 years and early school-aged children</p> Signup and view all the answers

    Which of the following is NOT a recommended method for diagnosing diabetes mellitus (DM) in children?

    <p>Postprandial blood glucose determinations</p> Signup and view all the answers

    What is the characteristic feature of diabetic ketoacidosis (DKA) in children?

    <p>Ketonemia (strongly positive)</p> Signup and view all the answers

    What is the primary cause of microvascular complications in diabetes?

    <p>Hyperglycemia</p> Signup and view all the answers

    What is the main disorder resulting from undersecretion of antidiuretic hormone (ADH) in children?

    <p>Diabetes insipidus (DI)</p> Signup and view all the answers

    What is the consequence of insulin deficiency in the body?

    <p>Hyperglycemia as glucose cannot enter cells, causing osmotic fluid movement and glycosuria</p> Signup and view all the answers

    What are the long-term complications of diabetes?

    <p>Microvascular (nephropathy, retinopathy, neuropathy) and macrovascular (hypertension, atherosclerosis) issues</p> Signup and view all the answers

    What can intensive insulin therapy do in diabetes management?

    <p>Delay and slow the progression of microvascular complications</p> Signup and view all the answers

    Study Notes

    Precocious Puberty and Diabetes Insipidus

    • The evaluation for pathological causes of precocious puberty is recommended for White girls under 7 and Black girls under 6.
    • There is a concern that early menarche may increase the risk of future breast cancer.
    • No change in the guidelines for evaluation of precocious puberty in boys is recommended.
    • The hypothalamic-releasing factors stimulate secretion of gonadotropic hormones from the anterior pituitary at puberty.
    • In boys, interstitial cell–stimulating hormone stimulates Leydig’s cells of the testes to secrete testosterone; in girls, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) stimulate the ovarian follicles to secrete estrogens.
    • Approximately 80% of children with precocious puberty have central precocious puberty (CPP), which may be the result of congenital anomalies, infectious, neoplastic, or traumatic insults to the central nervous system (CNS), or treatment of long-standing sex hormone exposure.
    • Central precocious puberty (CPP) occurs more frequently in girls and is usually idiopathic, with 90% of cases demonstrating no causative factor.
    • Peripheral precocious puberty includes early puberty resulting from hormone stimulation other than the hypothalamic GnRH–stimulated pituitary gonadotropin release.
    • Treatment of precocious puberty is directed toward the specific cause, and in 50% of cases, pubertal development regresses without treatment.
    • Diabetes insipidus (DI) is a disorder resulting from undersecretion of antidiuretic hormone (ADH), also known as vasopressin, producing uncontrolled diuresis.
    • Neurogenic DI may result from familial or idiopathic causes, trauma, tumors, granulomatous disease, infections, and certain drugs.
    • The cardinal signs of DI are polyuria and polydipsia.

    Pediatric Hyperthyroidism: Diagnosis and Management

    • Hyperthyroidism in children can lead to visual disturbances and difficulty covering the cornea with the lid as the eyeball protrudes.
    • Diagnosis is based on increased levels of T4 and T3, with suppressed TSH levels, and confirmation through measurement of thyroid-stimulating immunoglobulins.
    • Therapeutic management includes antithyroid medications, subtotal thyroidectomy, and radioiodine ablation, each with its own advantages and disadvantages.
    • Children with hyperthyroidism may exhibit signs such as weight loss, tachycardia, and hypertension and require limited activity until thyroid levels normalize.
    • Thyrotoxicosis, a life-threatening thyroid crisis, can occur in children with hyperthyroidism, characterized by severe symptoms such as hyperthermia and hypertension.
    • Treatment for thyrotoxicosis includes antithyroid medications and beta-adrenergic blocking agents, with therapy usually required for 2 to 3 weeks.
    • Nursing care involves early identification of children with hyperthyroidism, as clinical manifestations may appear gradually and be mistaken for behavioral issues.
    • Exophthalmos, protruding eyeballs, may be the only presenting sign of hyperthyroidism and can develop long before other symptoms.
    • Children with hyperthyroidism need a quiet, unstimulating environment, and may experience heat intolerance and mood swings, requiring adjustments in their environment and diet.
    • School consultation is important for providing education and support for children with hyperthyroidism, as it can impact their academic performance and relationships.
    • Clinical manifestations of hyperthyroidism include heat intolerance, emotional lability, weight loss, and other physical signs, while thyroid storm can lead to severe symptoms and even death.
    • Management of hyperthyroidism in children involves a comprehensive approach, including diagnosis, treatment, and nursing care tailored to the unique needs and challenges of pediatric patients.

    Diabetic Ketoacidosis and Long-Term Complications in Children with Type 1 Diabetes

    • Diabetic ketoacidosis (DKA) can lead to decreased total body potassium and elevated serum potassium levels due to decreased fluid volume.
    • DKA can result in progressive deterioration, leading to dehydration, electrolyte imbalance, acidosis, coma, and death if not promptly treated with insulin therapy and correction of fluid deficiency and electrolyte imbalance.
    • Long-term complications of diabetes in children include microvascular complications (nephropathy, retinopathy, and neuropathy) and macrovascular complications (hypertension and atherosclerotic cardiovascular disease).
    • Microvascular disease in diabetes develops within the first 30 years of diagnosis, with renal involvement appearing 10-15 years after puberty, but good glycemic control can postpone vascular changes for 20 or more years.
    • Intensive insulin therapy can delay the onset and slow the progression of retinopathy, nephropathy, and neuropathy in children with diabetes.
    • Children with type 1 diabetes are at increased risk for classic or atypical celiac disease, thyroid function alterations, primary adrenal insufficiency, and limited mobility of small joints of the hand.
    • Diagnostic evaluation for diabetes in children includes considering glycosuria, polyuria, weight loss, metabolic acidosis, and repeated urinary tract infections as possible indicators.
    • DM in children is diagnosed based on abnormal glucose metabolites, such as fasting blood glucose levels ≥7.0 mmol/L, random blood glucose values >11.1 mmol/L with classic signs of diabetes, or an oral glucose tolerance test finding of ≥11.1 mmol/L in the 2-hour sample.
    • Postprandial blood glucose determinations and traditional OGTTs have low detection rates in children and are not usually necessary for diagnosis.
    • Serum insulin levels may be normal or moderately elevated at the onset of diabetes, and delayed insulin response to glucose indicates impaired glucose tolerance.
    • DKA must be differentiated from other causes of acidosis or coma, including hypoglycemia, uremia, and encephalitis.
    • DKA is characterized by relative insulin insufficiency, hyperglycemia (blood glucose level ≥14mmol/dL), ketonemia, and acidosis.

    Understanding the Role of Insulin in Diabetes

    • Insulin facilitates the entry of carbohydrates, fats, and proteins into cells, aiding in metabolism.
    • Insulin is essential for glucose entry into muscle and fat cells, prevents fat mobilization, and stores glucose as glycogen in liver and muscle cells.
    • Insulin deficiency leads to hyperglycemia as glucose cannot enter cells, causing osmotic fluid movement and glycosuria.
    • Insulin deficiency results in depletion of essential chemicals, including potassium, and breakdown of protein to glucose by the liver.
    • In the absence of insulin, the body enters a state of starvation, depleting fat and protein stores.
    • Insufficient insulin leads to ketoacidosis, as the body uses fat for energy, producing ketone bodies and lowering serum pH.
    • Ketoacidosis causes hyperventilation, potassium depletion, and cardiac complications due to electrolyte imbalance.
    • Long-term complications of diabetes include microvascular (nephropathy, retinopathy, neuropathy) and macrovascular (hypertension, atherosclerosis) issues.
    • Microvascular complications can appear as early as 2-3 years after diagnosis without good diabetic control.
    • Intensive insulin therapy can delay and slow the progression of microvascular complications.
    • Postpubertal duration of type 1 diabetes is a risk factor for microvascular disease development.
    • Children with type 1 diabetes may experience other complications.

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    Test your knowledge of precocious puberty and diabetes insipidus with this informative quiz. Explore the evaluation, causes, and treatment of precocious puberty, as well as the underlying factors and cardinal signs of diabetes insipidus.

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