Chapter 47: Endocrine Disorders in Children

Endocrine Disorders in Children begins with the pituitary gland, detailing the impacts of growth hormone deficiency, which leads to proportional short stature, and the contrasting effects of pituitary hyperfunction, resulting in gigantism or acromegaly depending on whether the epiphyseal shafts have closed. The discussion covers precocious puberty, emphasizing the early development of secondary sex characteristics and the use of synthetic analogs to delay maturation and protect final adult height. Posterior pituitary dysfunction is explored through diabetes insipidus, characterized by massive fluid loss and insatiable thirst due to inadequate antidiuretic hormone, and the syndrome of inappropriate antidiuretic hormone secretion (SIADH), which causes fluid retention and dangerous hyponatremia. Thyroid health is analyzed via juvenile hypothyroidism, where decelerated growth and metabolic slowing occur, and Graves disease (hyperthyroidism), which triggers hypermetabolic states, tremors, and protruding eyeballs (exophthalmos). Autoimmune conditions like Hashimoto thyroiditis are identified as leading causes of goiter and acquired thyroid dysfunction in adolescents. Parathyroid abnormalities are reviewed, highlighting the risk of hypocalcemic tetany and the importance of monitoring for neuromuscular excitability through signs such as the Chvostek or Trousseau reflexes. Adrenal cortex issues include acute insufficiency—a life-threatening medical emergency—and chronic conditions like Addison disease and Cushing syndrome, the latter often resulting from prolonged steroid therapy and presenting with a "moon face" and weight gain. The chapter provides a critical look at congenital adrenal hyperplasia, focusing on the masculinization of external genitalia and potential salt-wasting crises in neonates. Adrenal medulla function is addressed via pheochromocytomas, rare tumors that secrete catecholamines and cause severe hypertension. A significant portion of the text is dedicated to diabetes mellitus, distinguishing between the autoimmune destruction of beta cells in type 1 and the insulin resistance seen in type 2. Detailed nursing protocols for managing diabetic ketoacidosis, calculating insulin dosages, and treating hypoglycemic reactions are provided, alongside strategies for family education, carbohydrate counting, and the use of technology like insulin pumps and continuous glucose monitors. Throughout, the chapter emphasizes the nurse's role in providing psychological support, monitoring growth curves, and teaching self-management to promote healthy development into adulthood.