Topic 6 The Child Endocrine Dysfunction P1

• What is the master gland of the endocrine system?

  Anterior pituitary.
• What is hypopituitarism?


  Growth hormone deficiency.
• What happens with hypopituitarism?

  GH deficiency which causes stunted somatic growth. TSH deficiency which causes hypothyroidism. ACTH deficiency which causes adrenal hypofunction.
• What kind of hypopituitarism is related to growth hormone deficiency?

  Idiopathic hypopituitarism.
• What are clinical manifestations of hypopituitarism?

  Normal growth in first year that slows down, appears overweight due to stunted height, delayed sexual development.
• How is a definitive diagnosis reached for hypopituitarism?

  Absent or subnormal reserves of pituitary GH.
• What is the definitive treatment for hypopituitarism?

  Growth hormone replacement.
• When is GH replacement stopped?

  When growth rates are less than 1 inch/year. Girls at 14 years old. Boys at 16 years old.
• What is acromegaly?

  When GH excretion is excess after epiphyseal closure.
• What kinds of medications can treat acromegaly?

  Somatostatin receptor ligands, dopamine agonists, GH receptor agonists.
• What is precocious puberty for boys?

  Sexual development before 9 years old.
• What is precocious puberty for caucasian girls?

  Before 7 years old.
• What is precocious puberty for African American girls?

  Before 6 years old.
• What can be given to treat precocious puberty?

  Monthly injections Leuprolide (Lupron).
• When is Lupron discontinued?

  At the age of normal pubertal changes are expected to resume.
• What are the cardinal signs of DI?

  Polyuria and polydipsia.
• What are signs of DI in infants?

  Irritability relieved with water but not milk; dehydration often occurs.
• How is DI diagnosed?

  Reducing fluid intake with little or no effect on urine output.
• What is the drug of choice for DI patients?

  Desmopressin (DDAVP).
• How can Desmopressin be administered?

  Nasal spray, oral, parenterally.
• What should parents know about Desmopressin?

  It is a lifelong medication.
• What is the most common endocrine problem in childhood?

  Hypothyroidism.
• What can happen if hypothyroidism is left untreated in children?

  Mental decline.
• Why is hypothyroid treatment important for children?

  To ensure proper brain development.
• When does Hashimoto's disease commonly occur?

  After 6 years old and peaks during adolescence.
• What are clinical manifestations of Hashimoto's?

  Enlarged thyroid gland that is symmetric, firm and non-tender, freely movable.
• What are signs of tracheal compression with Hashimoto's?

  Sense of fullness, hoarseness, dysphagia.
• What procedure is contraindicated for hypothyroidism?

  Surgery.
• When does hyperthyroidism peak in children?

  Between 12 - 14 years but it may be present at birth.
• What problems can happen with antithyroid therapy?

  Agranulocytosis, rash, liver toxicity.
• How long is antithyroid and beta blocker therapy done for thyroid storm?

  2 - 3 weeks.