Endocrinology+Round+2

The adrenal glands - inner cortex, outer medulla
 * Disorders of the Adrenal Gland: **

Cortex - hormones called steroids > Glucocorticoids  (cortisol metabolizes glucose, proteins, fats, involved in stress reactions and inhibition of inflamation) Mineralocorticoids  (Aldosterone maintains extracellular fluid volume, and blood pressure by conserving sodium, chloride, water, excretion of potassium)

Medulla - secretes catecholamines epinephrine and norepinephrine

***These hormones are produced by the sympathetic nervous system so when the adrenal gland is not working properly it is life threatening***

Deficiency in enzyme needed for synthesis of cortisol and sometimes aldosterone Most common 21-hydroxylase (21-OH) 95% of all cases
 * Congenital adrenal hyperplasia (CAH): **

Pathophysiology: Cortisol synthesis blocked > this increases the production of ACTH (adrenocorticotrophic hormone) by the anterior pituitary. Too much ACTH causes hyperthrophy of the adrenal glands and excess androgen production

Clinical Manifestations: <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">The enzyme deficiency causes the fetus to be exposed to excess androgens. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;"> In males no effect, virilizes the female infants - <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Ambiguous genitalia, pseudohermaphrodism, ovaries, fallopian tubes, uterus normal. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">75% have salt wasting defect since cannot synthesize aldosterone <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Leads to life threatening adrenal crisis by day 10-14 > hyponatremia, hyperkalemia, hypovolemia

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Atypical 21-OH later toddler or preschool > premature adrenarche (pubic hair development) with accelerated growth, acne, Hirsutism (masculine body hair distribution) <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Prenatal diagnosis possible <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">In newborn testing in 42 states (detect before adrenal crisis and wrong sex assignment) <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Confirmation through repeated blood tests, electrolyte levels and physical exam performed immediately

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 160%;">Treatment: <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Supression of adrenal secretion of androgens <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Prevention of progressive virilization <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Replacement of the steroids the adrenal gland cannot produce <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Glucocorticoid hydrocortisone and mineralocorticoid fludrocortisone (Florinef) <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Normal replacement has no symptoms <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Too much = hypertension, acne, growth impairment <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Most difficult is female with ambiguous genitalia and surgery considerations

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 160%;">Nursing management/ Family teaching: <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Newborn maintain homeostasis with fluids, cortisone <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Monitor electrolytes, vital signs <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Safe environment for caregivers to ask questions <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Your baby, your child, **not** he, she, it <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Genitals, sex organs **not** penis or clitoris <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Cortisone necessary to maintain life oral or IM <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Illness, stress or surgery cortisol will be increased (stressors typically increase cotisol levels) <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Sex assignment

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 150%;">Congenital Adrenal Hyperplasia

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<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 170%;">Cushing Disease (Adenocortical Hyperfunction) <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 170%;">Cushing's Disease is adding a cushion of glucocorticords, cushions are fluffy and provide excess weight <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Excess glucocorticoids (especially cortisol) in the bloodstream <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Caused by a malignant carcinoma or hyperplasia of the adrenal glands or a benign tumor <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Mnemonic trick - Cushings = Cushion, excess weight

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Clinical Manifestations/Symptoms include: <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Reduced linear growth <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Mental or behavioral problems <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Cushingoid appearance - moon face, fat pads on the shoulders and back <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">( most of the time the appearance is due to consumption of steroids for other reasons) <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Muscle, capillary weakness, fatigue due to catabolism of protein <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Demineralization of bones, osteoporosis due to decreased absorption of calcium <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Excessive weight gain due to increased appetite <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Increased blood pressure and blood volume due to salt retention

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Nursing Measures: <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Monitor vital signs <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Monitor electrolytes (calcium), fluid volume, and weight <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Monitor muscle strength <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Cluster care, provide rest periods <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Teach family to monitor blood pressure <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Nutritional counseling <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Medic alert bracelet <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Teach parents to recognize an adrenal crisis and or insufficiency after corticosteroids are withdrawn

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">***If child has had the adrenal glands removed and is on hydrocortisone (Solu-Cortef, Cortisone acetate) be sure that they understand administration pattern best mimics the body to administer early in the morning. If the child is vomiting and cannot take the medication orally give injection or could lead to severe illness or Cardiovascular collapse.**


 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">While Sharmyn is not a child her story typifies the struggles with Cushing's disease. **

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 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Chanelle's Cushing's story **

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<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Chanelle was the first to notice something different with her body. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">What did she notice? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">What other symptoms did she notice? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">What was her treatment? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">What would be important nursing considerations for her.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Deficiency of glucocorticoids, mineralocorticords (aldosterone) and adrenal androgens <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">This affects the bodies ability to handle stress <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Caused by autoimmune reponse, metabolic disease, infection or malignancy <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Develops slowly <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Early signs - weakness, fatigue, emotional lability, anorexia, salt craving, poor weight gain <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Hyperpigmentation <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Abdominal pain, nausea, vomiting, diarrhea, hypoglycemia <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">After a stressful event adrenal crisis may occur
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 170%;">Addison's Disease (Adrenal Insufficiency) **
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 170%;">Remember 'Add'ison's Disease is really a subtraction problem! Minus adequate gluco and mineralocorticords! **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Diagnostic tests: <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Cortisol and urinary 17-hydroxycorticoid measured in am <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">ATCH stimulation test

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Treatment and Nursing Management: <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Replacement of hormones <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Parental education <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Management of an adrenal crisis

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<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Type 1 diabetes mellitus and type 2 diabetes mellitus
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">Diabetes **<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 19.5px;"> -

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 23.399999618530273px;">Type 1 Diabetes <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 23.399999618530273px;">media type="youtube" key="_OOWhuC_9Lw?version=3" height="361" width="485" align="left"

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Idiopathic or autoimmune destruction of pancreatic beta cells <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Genetic predisposition and environmental factors may contribute <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">By the time symptoms appear 90% of beta cells have been destroyed <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">peaks at age 2, 4-6, and again at 10-14 <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Equal among boys and girls <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">More prevalent in caucasians
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Incidence/etiology - **

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">Pathophysiology: Type 1 <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">autoimmune destruction results in inadequate insulin secretion <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">10-20% of normal produces symptoms <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Insulin is not able to help transport glucose across the cell membrane = hyperglycemia <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Low insulin = hepatic glucose increase, hyperlipidemia, ketones <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Growth hormone, cortisone, glucagon increase, which promote insulin resistence <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Glycogenesis - glycogen from non-carbohydrate sources <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Proteolysis - protein breakdown <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Lipolysis - fat breakdown

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Blood glucose levels > 150-180mg/dl filtered out of blood and into urine <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Polyuria - glucose in urine creates a shift with additional water excreted <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Polydipsia - Fluid loss creates thirst <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Polyphagia - less glucose used for energy production <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Ketones are acid bodies buffered by bicarbonate, as bicarb is depleted metabolic acidosis increases <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Kussmaul breathing slow deep breathing with acetone breath odor

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 21px;">Clinical Manifestations Type 1: <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Polyuria <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Polyphagia <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Polydipsia <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">weight loss <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Dehydration <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Occasionally, abdominal pain, vomiting <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Irritability/fatigue <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Diabetic ketoacidosis (DKA)

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 19.5px;">Diagnosis: <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Presentation characteristics often enough, may present with 3 P's and glucose >200 mg/dl <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Or in diabetic ketoacidosis (DKA) <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Oral glucose tolerance test (OGTT) <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Fasting serum glucose <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Fasting plasma glucose preferred <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">A1c not recommended for diagnosis

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Nursing interventions/management <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">If in DKA <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Labs for diagnosis <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Monitor vital signs, neurological status <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Stabilize with fluids, insulin <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Strict I&O <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Monitor labs <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Teach glucose monitoring, insulin administration, diet, exercise, S&S of hypo and hyperglycemia <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Medic alert band

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<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 23px;">Type 2 Diabetes <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Prevalent among children now <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">contributing factors food consumption patterns <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">lack of exercise <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">obesity <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Higher in AA, Hispanic, Asian or American Indian descent <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">90% have acanthosis skin condition with hyperpigmented patches in creases

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Pathophysiology Type 2 diabetes <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Social, environmental, behavioral contributors <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Initially insulin resistence then beta cell failure

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">Clinical Manifestations: <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">Type 2:
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Body mass index over 95% **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Fatigue **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Frequent infections **


 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 25.350000381469727px;">Diagnosis <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;"> for type 2 = Fasting glucose >126 or random glocose >200 mg/dl **


 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 20.799999237060547px;">Treatment: **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Education and prevention **

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 * <span style="color: #9e18cd; font-family: 'Times New Roman',Times,serif; font-size: 18px;">Obesity = BMI > 85% overweight, BMI > 95% obese **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">2002 - 32% of children ages 6-19 were at risk for being overweight **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Higher prevalence in the Hispanic, African American, and American Indian population **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Birth weight is not a future indicator of obesity **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Positive correlation between childhood obesity and parental obesity **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Fewer than 5% shown to be due to an underlying disease process **
 * <span style="color: #9e18cd; font-family: 'Times New Roman',Times,serif; font-size: 18px;">Causes: **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Appetite regulation **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Familial influence **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Physical inactivity - unsafe communities **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Institutional factors - vending machines **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Psychological factors of comfort **
 * <span style="color: #9e18cd; font-family: 'Times New Roman',Times,serif; font-size: 18px;">Can lead to significant health problems: **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">High blood pressure **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Elevated cholesterol, **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Respiratory disorders, **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Orthopedic conditions, **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Gall stones, **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Fatty liver, **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Type 2 diabetes, **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Low self esteem, **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Isolation **
 * <span style="color: #9e18cd; font-family: 'Times New Roman',Times,serif; font-size: 18px;">Therapeutic Management - **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Nutritional counseling **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Behavioral therapy **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Group involvement **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Family involvement **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Prevention **

<span style="color: #cb2020; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Disorders related to sex chromosome abnormalities: **

<span style="color: #cb2020; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Turners Syndrome media type="youtube" key="ldjb-FR-PKo" width="616" height="439"

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">May be diagnosed at birth, preschool or adolescence. <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Occurs in 1/2000 female births <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Missing or partially absent X chromosome

<span style="color: #cb2020; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Characteristics include: <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Lymphedema of hands and feet <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Webbed neck <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Low hair line <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Low set ears <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Small mandibles, resulting in need for orthodontics <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Short stature <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Delayed breast development, lack of spontaneous menstrual cycles <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Infertile need estrogen to stimulate secondary sex characteristics <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Possibly socially ackward, immature <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Possible heart defects (coartation of the aorta) <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Strabismus <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Hip dysplasia, scoliosis

<span style="color: #cb2020; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Nursing Management: <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Monitoring growth rates <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Observing for s/s of cardiac, musculoskeletal disorders, renal, GI or thyroid dysfunction <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Treat child age appropriately, not according to size <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Parental Education

<span style="color: #2031cb; font-family: 'Times New Roman',Times,serif; font-size: 22.100000381469727px;">Klinefelter Syndrome

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<span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Extra x chromosome in males. <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">One of the most common genetic syndromes, 1/500 males <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Infrequent diagnosis before puberty.

<span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; font-size: 18px;">Characteristics: <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Infertile and may have cognitive delays. <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Tall stature, less facial and body hair <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Gynecomastia (breast development) <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Noted when secondary sexual characteristics do not occur. <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">They may have difficulty with learning disabilities in school <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Therapy includes hormone replacement (testosterone) beginning at 11 or 12

<span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; font-size: 18px;">Nursing Considerations include: <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Parental education

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 13pt;">References:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Hockenberry, M. J. (2009). Chapter 29: The child with endocrine dysfunction. In M. J. Hockenberry & D. Wilson (Eds.), Wong's essentials of pediatric nursing (2009 ed., pp. 1023-1059). St. Louis, MO: Mosby Elsevier.

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Videos:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Cares Foundation Congenital Adrenal Hyperplasia http://youtu.be/4oRKwboWezQ

The Magic Foundation Congenital Adrenal Hyperplasia http://youtu.be/qLoc0jrlHyo

Cushing's Disease by Sharmyn 411 http://youtu.be/ib5CGOqujSY

Cushing's Disease by Sousini17 http://youtu.be/QXAHtxis1fM

Addison's Disease by drmdk http://youtu.be/qqgIYDKd75E

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Videos:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Type 1 Diabetes by Clearly Health http://youtu.be/_OOWhuC_9Lw

Children with Diabetes http://youtu.be/yx1t4yZ1nQU

Nick Jonas Diabetes http://youtu.be/hOW7FTLcFkI

Pediatric diabetes by Health Matters http://youtu.be/Vr86FaTdp5E

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Turner syndrome: located at <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">http://youtu.be/ldjb-FR-PKo

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Klinefelters Syndrome https://youtu.be/c9ne4Cwy9T4