Chapter 48: Endocrine & Metabolic Disorders in Children

The chapter first explores the function and pathology of the pituitary gland, which regulates growth through Somatotropin (GH); deficiencies (hypopituitarism) cause short stature treated with recombinant human growth hormone (rhGH), while excesses cause overgrowth or acromegaly,. Pituitary regulation of fluid balance is critical, where deficient Antidiuretic Hormone (ADH) causes Diabetes Insipidus (DI)—marked by excessive thirst (polydipsia) and copious urination (polyuria)—treated with desmopressin (DDAVP),. Conversely, overproduction of ADH causes Syndrome of Inappropriate Antidiuretic Hormone (SIADH) and resulting hyponatremia. Thyroid disorders covered include congenital hypothyroidism, which, if untreated, results in severe cognitive delay and is identified through mandatory newborn blood spot screening, requiring synthetic thyroid hormone replacement (levothyroxine),. Hyperthyroidism, often due to Graves disease, accelerates metabolism, causing weight loss, nervousness, and prominent eye globes (exophthalmia), managed initially with antithyroid medications,. Adrenal disorders include the life-threatening acute adrenocortical insufficiency, and Congenital Adrenal Hyperplasia (CAH), an inherited cortisol deficiency leading to excessive androgen production and precocious masculinization,. Cushing syndrome involves cortisol overproduction, characterized by truncal obesity, a moon face, and hypertension,. The chapter places significant emphasis on pancreatic disorders, particularly Type 1 Diabetes Mellitus (T1D), an autoimmune destruction of insulin-producing cells leading to hyperglycemia, glycosuria, and potential diabetic ketoacidosis (DKA),. T1D management requires careful balancing of insulin dosage, detailed carbohydrate counting, and routine blood glucose monitoring, often utilizing insulin pump therapy (continuous subcutaneous insulin infusion or CSII) for improved control and quality of life,. Hypoglycemia, a major risk, is treated with immediate fast-acting carbohydrates or glucagon,. Type 2 Diabetes (T2D) is presented as a growing pediatric concern linked to obesity, managed primarily with diet, exercise, and oral agents like metformin,. Finally, several Inborn Errors of Metabolism (IEMs) are discussed, such as Phenylketonuria (PKU), requiring a lifelong low-phenylalanine diet to prevent severe cognitive challenges, and Galactosemia, managed with a galactose-free diet,. Throughout the discussion, nurses are tasked with integrating the nursing process to assess growth deviations, support long-term medication adherence, and enhance the child’s self-esteem and coping mechanisms.