Chapter 28: Endocrine Dysfunction in Children

Endocrine Dysfunction in Children contrasts this with pituitary hyperfunction conditions like gigantism and acromegaly, and precocious puberty, which involves early sexual development often treated with luteinizing hormone-releasing hormone. Disorders of the posterior pituitary are explored, including diabetes insipidus (DI), characterized by undersecretion of antidiuretic hormone (ADH) leading to polyuria and polydipsia manageable with vasopressin (DDAVP), and the syndrome of inappropriate antidiuretic hormone secretion (SIADH), which necessitates fluid restriction to manage fluid retention and hyponatremia. Thyroid function is examined through juvenile hypothyroidism, which can cause neurocognitive dysfunction if untreated, and hyperthyroidism, predominantly Graves disease, which presents with exophthalmos and emotional lability. The chapter also covers lymphocytic thyroiditis (Hashimoto disease) and the critical management of thyroid storm. Parathyroid disorders are discussed in terms of calcium and phosphorus homeostasis, identifying hypoparathyroidism symptoms like tetany and positive Chvostek or Trousseau signs, versus hyperparathyroidism which leads to hypercalcemia and bone pain. Significant attention is given to adrenal function, distinguishing between acute adrenal crisis, a medical emergency requiring immediate fluid and cortisol replacement, and chronic adrenocortical insufficiency (Addison disease). Cushing syndrome is detailed as a condition of excess cortisol often resulting from steroid therapy, presenting with moon face and weight gain. Congenital adrenal hyperplasia (CAH) is thoroughly explained as an inherited 21-hydroxylase deficiency causing ambiguous genitalia in females and potential salt-wasting crises. The chapter concludes with an extensive review of diabetes mellitus (DM), differentiating Type 1 (immune-mediated beta-cell destruction) from Type 2 (insulin resistance). It covers the pathophysiology of hyperglycemia, glycosuria, and diabetic ketoacidosis (DKA), a life-threatening metabolic acidosis requiring intensive fluid, electrolyte, and insulin management. The text emphasizes the nursing role in educating families on insulin administration, pump therapy, blood glucose monitoring, nutrition planning, and recognizing the signs of hypoglycemia versus hyperglycemia to prevent long-term microvascular and macrovascular complications.