ENDOCRINE SYSTEM
C. Signs and Symptoms (Table 6.8)
3. C. Treatment of cerebral edema should begin at recognition: administering hypertonic saline or
mannitol, elevating the head of the bed, and per
forming an emergent CT scan of the brain to evaluate degree of edema. Fluid administration should be decreased. If the Glascow Coma Scale score is less than 9, support of respiratory and neurologic status is necessary. Risk factors for cerebral edema include first presentation, high serum blood urea nitrogen (BUN) and CO2 ( reflective of the degree of dehydra
tion and acidosis), administration of insulin bolus doses, bicarbonate administration, rapid glucose correction, aggressive fluid administration, and younger age at diagnosis.
Case Study 6.4
1. B. Hypothyroidism in the neonate is characterized by poor feeding, hypotonia, constipation, weight loss and decreased activity with weak cry. Lab results seen in hypothyroidism will reveal an ele
vated TSH and low free T4. Treatment with levothy
roxine should be initiated in conjunction with pediatric endocrinology as lack of treatment can lead to significant cognitive impairment.
REFERENCES
American Diabetes Association. (2016). Children and adolescents.
Diabetes Care, 39(Suppl. 1), S86–S93. doi:10.2337/dc16S014 Babler, E., Betts, K., Courtney, J., Flores, B., Flynn, C., Laerson, M.,
. . . Wroley, D. (2013). Clinical handbook of pediatric endocrinol- ogy (2nd ed.). St Louis, MO: Quality Medical Publishing.
Brashers, V., Jones, R., & Huether, K. (2014). Mechanisms of hormonal regulation. In K. McCance & S. Huether (Eds.), Pathophysiology: The biologic basis for disease in adults and chil- dren (7th ed., pp. 689–716). St. Louis, MO: Mosby/Elsevier.
Buzby, M. (2012). Endocrine disorders: Physiology and diagnos
tics. In K. ReuterRice & B. Bolick (Eds.), Pediatric acute care:
A guide for interprofessional practice (pp. 369–376). Burlington, MA: Jones & Bartlett.
Carcillo, J., & Fields, A. (2002). Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Critical Care Medicine, 30, 1365–1378. Retrieved from https://journals.lww.com/ccmjournal/Abstract/2002/
06000/Clinical_practice_parameters_for_hemodynamic.40 .aspx
Chameides, L., Samson, R., Schexnayder, S., & Hazinski, M. (2011).
Pediatric advanced life support provider manual. Dallas, TX:
American Heart Association.
Chan, M., Chan, M., Mengshol, J., Fish, D., & Chan, E. (2013).
Octreotide: A drug often used in the critical care setting but not well understood. Chest, 144(6), 1937–1945. doi:10.1378/
chest.130382
Chantra, M., Limsuwan, A., & Mahachoklertwattana, P. (2016).
Low cardiac output thyroid storm in a girl with grave’s dis
ease. Pediatrics International, 58(10), 1080–1083. doi:10.1111/
ped.13102
Chung, C., & Zimmerman, D. (2009). Hypernatremia and hypo
natremia: Current understanding and management. Clinical Pediatric Emergency Medicine, 10(4), 272–278. doi:10.1016/j .cpem.2009.11.002
Clark, L., Preissig, C., Rigby, M., & Bowyer, F. (2008). Endocrine issues in the pediatric intensive care unit. Pediatric Clinics of North America, 55, 805–833. doi:10.1016/j.pcl.2008.03.001 Clayton, M., & McCance, K. (2014). Stress and disease. In K.
McCance & S. Huether (Eds.), Pathophysiology: The biologic basis for disease in adults and children (7th ed., pp. 338–362).
St. Louis, MO: Mosby/Elsevier.
Dattani, M., & Gevers, E. (2016). Endocrinology of fetal develop
ment. In S. Melmed, K. S. Polonsky, P. R. Larsen, & H. M.
Kronenberg (Eds.), Williams textbook of endocrinology (13th ed., pp. 849–892). Philadelphia, PA: Elsevier.
Davis, A., Carcillo, J., Aneja, R., Deymann, A., Lin, J., Nguyen, T., . . . Zuckerberg, A. (2017). American College of Critical Care Medicine clinical practice parameters for hemodynamic
support of pediatric and neonatal septic shock. Critical Care Medicine, 45(6), 1061–1093. doi:10.1097/CCM.0000000000002425 De León, D., Thornton, P., Stanley, C., & Sperling, M. (2014).
Hypoglycemia in the newborn and infant. In M. Sperling (Ed.), Pediatric endocrinology (4th ed., pp. 157–183).
Philadelphia, PA: Elsevier.
Doig, A., & Huether, S. (2014). Structure and function of the digestive system. In K. McCance & S. Huether (Eds.), Pathophysiology:
The biologic basis for disease in adults and children (7th ed., pp. 1393–1422). St. Louis, MO: Mosby/Elsevier.
Engorn, B., & Flerlage, J. (Eds.). (2015). The Harriet Lane handbook (20th ed.). Philadelphia, PA: Elsevier/Saunders.
Ganeson, R., Kazmi, Y., & Levy, R. (2012). Endocrine disorders:
Thyroid and parathyroid disorders. In K. ReuterRice &
B. Bolick (Eds.), Pediatric acute care: A guide for interprofessional practice (pp. 394–399). Burlington, MA: Jones & Bartlett.
Goel, P., & Choudhury, S. (2012). Persistent hyperinsulinemic hypoglycemia of infancy: An overview of current concepts.
Journal of Indian Association of Pediatric Surgeons, 17(3), 99–103.
doi:10.4103/09719261.98119
Gunnala, V., Guo, R., Minutti, C., DurazoArvizu, R., Laporte, C., Matthews, H., . . . Bhatia, R. (2015). Measurement of salivary cortisol level for the diagnosis of critical illness related cor
ticosteroid insufficiency in children. Pediatrics Critical Care Medicine, 16(4), e101–e106. doi:10.1097/pcc.0000000000000361 Hall, J. (2016). Guyton and Hall textbook of medical physiology.
(13th ed.). Philadelphia, PA: Elsevier.
Hazinski, M., Mondozzi, M., & Uridales Baker, R. (2014). Shock, multiple organ dysfunction syndrome, and burns in children.
In K. McCance & S. Huether (Eds.), Pathophysiology: The bio- logic basis for disease in adults and children (7th ed., pp. 1699–
1727). St. Louis, MO: Mosby/Elsevier.
Hockenberry, M. J., & Wilson, D. (Eds.). (2015). Wong’s nursing care of infants and children (10th ed.). St. Louis, MO: Elsevier.
Jones, R., Brashers, V., & Huether, S. (2010) Alterations of hormonal regulation. In K. McCance & S. Huether (Eds.), Pathophysiology:
The biologic basis for disease in adults and children (6th ed., pp. 737–780). Maryland Heights, MO: Mosby/Elsevier.
Kaiser, U., & Ho, K. K. Y. (2016). Pituitary physiology and diagnos
tic evaluation. In S. Melmed, K. S. Polonsky, P. R. Larsen, &
H. M. Kronenberg (Eds.), Williams textbook of endocrinology (13th ed., pp. 176–231). Philadelphia, PA: Elsevier.
Klein, M., Sathasivam, A., Novoa, Y., & Rapaport, R. (2011). Recent consensus statements in pediatric endocrinology: A selec
tive review. Pediatric Clinics of North America, 58, 1301–1315.
doi:10.1016/j.pcl.2011.07.014
KlineTilford, A. (2016). Pheochromocytomas. In A. KlineTilford,
& C. Haut (Eds.), Lippincott certification review: Pediatric acute care nurse practitioner. Philadelphia, PA: Wolters Kluwer.
Kwon, Y., Suh, G., Jeon, K., Park, S., Lim, S., Koh, W., . . . Kwon, O. (2010). Serum cytokines and critical illnessrelated corti
costeroid insufficiency. Intensive Care Medicine, 36, 1845–1851.
doi:10.1007/s0013401019719
LevyShraga, Y., & PinhasHamiel, O. (2013). Critical illness
related corticosteroid insufficiency in children. Hormone Research Paediatrics, 80, 309–317. doi:10.1159/000354759 Ly, T. T., Maahs, D. M., Rewers, A., Dunger, D., Oduwole, A., &
Jones, T. W. (2014). ISPAD clinical practice consensus guidelines—Hypoglycemia: Assessment and management of hypoglycemia in children and adolescents with diabe
tes. Pediatric Diabetes, 15(Suppl. 20), 180–192. doi:10.1111/
pedi.12174
Majzoub, J. A., Muglia, L. J., & Srivatsa, A. (2014). Disorders of the posterior pituitary. In M. Sperling (Ed.). Pediatric endocrinol- ogy (4th ed. pp. 405–443). Philadelphia, PA: Elsevier.
Marik, P. E., Pastores, S. M., Annane, D., Meduri, G. U., Sprung, C. L., Arlt, W., . . . Vogeser, M. (2008). Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: Consensus statements from an international task force by the American College of Critical Care Medicine. Critical Care Medicine, 36(6), 1937–1949.
doi:10.1097/CCM.0b013e31817603ba
McCance, K., & Huether, S. (Eds.). (2015). Pathophysiology: The bio- logic basis for disease in adults and children (7th ed.). St. Louis, MO: Mosby/Elsevier.
Miller, W., & Flück, C. (2014). Adrenal cortex and its disorders. In M. Sperling (Ed.). Pediatric endocrinology (4th ed., pp. 471–
532). Philadelphia, PA: Elsevier.
Molina, P. (2013). Endocrine physiology (4th ed.). New York, NY:
McGrawHill.
Plumpton, K., Anderson, B. J., & Beca, J. (2010). Thyroid hormone and cortisol concentrations after congenital heart surgery in infants younger than 3 months of age. Intensive Care Medicine, 36, 321–328. doi:10.1007/s0013400916484
Price, A., Losek, J., & Jackson, B. (2016). Hyperglycaemic hyperosmolar syndrome in children: Patient characteristics, diagnostic delays and associated complications. Journal of Paediatrics and Child Health, 52(1), 80–84. doi:10.1111/jpc.12980 Robinson, A., & Verbalis, J. (2016). Posterior pituitary. In S. Melmed,
K. S. Polonsky, P. R. Larsen, & H. M. Kronenberg (Eds.), Williams textbook of endocrinology (13th ed., pp. 300–333).
Philadelphia, PA: Elsevier.
Rossano, J., & Shaddy, R. (2014). Heart failure in children:
Etiology and treatment. Journal of Pediatrics, 165(2), 228–233.
doi:10.1016/j.jpeds.2014.04.055
Salvatore, D., Davies, T., Schlumberger, M.J., Hay, I., & Larsen, P.
(2016). Thyroid physiology and diagnostic evaluation of patients with thyroid disorders. In S. Melmed, K. S. Polonsky, P. R. Larsen, & H. M. Kronenberg (Eds.), Williams textbook of endocrinology (13th ed.). New York, NY: Elsevier.
Sarafoglou, K., Hoffmann, G., & Roth, K. (2017). Pediatric endocri- nology and inborn errors of metabolism (2nd ed.). New York, NY:
McGrawHill.
Schoenwolf, G., Bleyl, S., & Brauer, P., & FrancisWest, P. (2015).
Larsen’s human embryology (5th ed.). New York, NY: Churchill Livingstone.
Simone, S. (2012). Endocrine disorders: Diabetes insipidus, syndrome of inappropriate antidiuretic homone, and cerebral salt wasting. In K. ReuterRice & B. Bolick (Eds.). Pediatric acute care: A guide for interprofessional practice (pp. 376–384).
Burlington, MA: Jones & Bartlett.
Sperling, M., Tamborlane, W., Battelino, T., Weinzimer, S., &
Phillip, M. (2014). Diabetes mellitus. In M. Sperling (Ed.), Pediatric endocrinology (4th ed., pp. 846–900). Philadelphia, PA: Elsevier.
Srinivasan, S., & Misra, M. (2015). Hyperthyroidism in children.
Pediatrics in Review, 36(6), 239–248. doi:10.1542/pir.366239 Srinivasan, V., & Agus, M. (2014). Tight glucose control in critically
ill children—A systematic review and metaanalysis. Pediatric Diabetes, 15, 75–83. doi:10.1111/pedi.12134
Taketomo, C. K., Hodding, J. H., & Kraus, D. (2015). Pediatric and neonatal dose handbook (22nd ed.). Cleveland, OH:
LexiComp.
Talwar, S., Kumar, M., Choudhary, S., & Airan, B. (2016). Thyroid hormone supplementation following openheart surgery in children. Indian Journal of Thoracic and Cardiovascular Surgery, 32(1), 17–22. doi:10.1007/s1205501504114
Templin, D. (2006). Endocrine system. In M. C. Slota (Ed.), Core cur- riculum for pediatric critical care nurses (2nd ed., pp. 446–496).
St. Louis, MO: Elsevier.
Thompson, A. (2016). Endocrine disorders: Diabetes insipidus.
In A. KlineTilford & C. Haut (Eds.), Lippincott certification review: Pediatric acute care nurse practitioner. Philadelphia, PA:
Wolters Kluwer.
Thornton, P., Stanley, C. A., De León, D., Harris, D., Haymond, M., Hussain, K., . . . Wolfsdorf, J. (2015). Recommendations from the Pediatric Endocrine Society for evaluation and manage
ment of persistent hypoglycemia in neonates, infants, and children. Journal of Pediatrics, 167(2), 238–245. doi:10.1016/
j.jpeds.2015.03.057
von Saint Andrevon Arnim, A., Farris, R., Roberts, J., Yanay, O., Brogan, T., & Zimmerman, J. (2013). Common endocrine issues in the pediatric intensive care unit. Critical Care Clinics, 29(2), 335–358. doi:10.1016/j.ccc.2012.11.006
Webb, E., & Krone, N. (2015). Current and novel approaches to children and young people with congenital adrenal insuf
ficiency. Best Practice & Research Clinical Endocrinology and Metabolism, 29, 449–468. doi:10.1016/j.beem.2015.04.002 White, M. (2016). Endocrine disorders: Adrenal insufficiency. In A.
KlineTilford & C. Haut (Eds.), Lippincott certification review:
Pediatric acute care nurse practitioner. Philadelphia, PA: Wolters Kluwer.
Wolfsdorf, J., Allgrove, J., Craig, M., Edge, J., Glaser, N., Jain, V., . . . Hanas, R. (2014). Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatric Diabetes, 15(Suppl. 20), 154–179.
doi:10.1111/pedi.12165
Yee, A., Burns, J., & Wijdicks, E. (2010). Cerebral salt wasting:
Pathophysiology, diagnosis, and treatment. Neurosurgery Clinics of North America, 21, 339–352. doi:10.1016/j .nec.2009.10.011
Zeitler, P., Haqq, A., Rosenbloom, A., & Glaser, N. (2011).
Hyperglycemic hyperosmolar syndrome in children:
Pathophysiological considerations and suggested guide
lines for treatment. Journal of Pediatrics, 158(1), 9–14.e2.
doi:10.1016/j.jpeds.2010.09.048
REFERENCES ■ 529
DEVELOPMENTAL ANATOMY OF THE GASTROINTESTINAL SYSTEM
A. Embryologic Development of the Digestive