HYPERPARATHYROIDISM

Hyperparathyroidism, which is caused by overproduction of parathormone by the parathyroid glands, is characterized by bone decalcification and the development of renal calculi (kidney stones) containing calcium.

Which of the following is not a Clinical Manifestation of Hyperparathyroidism?

apathy

cardiac dysrhythmias vomiting

diarrhea

apathyfatiguemuscle weaknessnausea and vomitingconstipationhypertensioncardiac dysrhythmias

Clinical Manifestations

Which of the following is not a diagnostic tool for Hyperparathyroidism?

X-ray

UA MRI

UTZ

Assessment and Diagnostic Findings

Elevation of serum calcium levels elevated concentration of parathormone. Radioimmunoassays for parathormone are sensitive and differentiate primary hyperparathyroidism from other causes of hypercalcemiafine-needle biopsy

Assessment and Diagnostic Findings

Bone changes may be detected on x-ray or bone scans. The double-antibody parathyroid hormone test is used to distinguish between primary hyperparathyroidism and malignancyUltrasoundMRIthallium scan

Surgical Removal of the parathyroid glands is called?

Parathyroidostomy

Parathyroidectomy

Parathyroplasty

Parathyroidotomy

Surgical Management

The recommended treatment for primary hyperparathyroidism is the surgical removal of abnormal parathyroid tissue

Parathyroidectomy - involved a bilateral neck exploration under general anesthesia.

Complications: Hypercalcemic Crisis

Acute hypercalcemic crisis can occur with extreme elevation of serum calcium levels. Serum calcium levels greater than 15 mg/dL (3.7 mmol/L) result in neurologic, cardiovascular, and renal symptoms that can be life-threatening.

Which is not a management of Hypercalcemic crisis?

Diuretic Dopamine

IV Fluids

Phos-phate

Treatment includes: rehydration with large volumes of IV fluidsdiuretic agents to promote renal excretion of excess calcium phosphate therapy to correct hypophosphatemia and decrease serum calcium levels by promoting calcium deposition in bone

HYPOPARATHYROIDISM

The most common cause of hypoparathyroidism is inadequate secretion of parathormone after interruption of the blood supply or surgical damage to parathyroid gland tissue during thyroidectomy, parathyroidectomy, or radical neck dissection.

Which of the following is not a Clinical Manifestation of Hypoparathyroidism?

depression

ECG changes High fever

hypotension

Tetany is the chief symptom of hypoparathyroidism — is a general muscle hypertonia, with tremor and spasmodic or uncoordinated contractions occurring with or without efforts to make voluntary movements.

Clinical Manifestations

•Trousseau’s sign is positive when carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with a blood pressure cuff.

•Chvostek’s sign is positive when a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye

anxiety,irritability,depressiondelirium. ECG changes hypotension

Clinical Manifestations

A positive Trousseau’s sign or a positive Chvostek’s sign suggests tetany. Tetany develops at serum calcium levels of 5 to 6 mg/dL (1.2 to 1.5 mmol/L) or lower.

Serum phosphate levels are increased

x-rays of bone show increased density.

Assessment and Diagnostic Findings

Which is not a management of Hypoparathyroidism?

Milk Ca Gluconate

ParenteralParathormone

Tracheostomy

immediate administration of IV calcium gluconate.

sedative agents such as pentobarbital to decrease neuromuscular irritability and seizure activity

Parenteral parathormone can be administered to treat acute hypoparathyroidism with tetany.

Management

Tracheostomy or mechanical ventilation may become necessary, along with bronchodilating medications, if the patient develops respiratory distress.

A diet high in calcium and low in phosphorus is prescribed.

Although milk, milk products, and egg yolk are high in calcium, they are restricted because they also contain high levels of phosphorus.

Spinach also is avoided because it contains oxalate, which would form insoluble calcium substances.

Oral tablets of calcium salts, such as calcium gluconate, may be used to supplement the diet. Variable dosages of a vitamin D preparation to enhance calcium absorption from the GI tract.

Cushing Syndrome

Cushing syndrome is caused by overproduction of the adrenal hormone cortisol; this usually results from increased ACTH production due to a pituitary tumor.

It may occur from a malignant or benign tumor of the adrenal cortex.

The peak age of occurrence is 6 or 7 years, but the syndrome can occur as early as infancy.

Clinical Manifestations

Which of the following is not a diagnostic tool for Hyperparathyroidism?

DexamethasoneSupressionTest

UA CT Scan

Lumbar Tap

Assessment and Diagnostic Findings

Children with Cushing syndrome have elevated plasma cortisol and increased urinary free-cortisol levels.

A dexamethasone suppression test confirms the diagnosis.

A CT scan or ultrasound reveals the enlarged adrenal or pituitary gland

Which is not a management of Cushing’s Disease?

Hormone ReplacementTherapy

Epinephrine

IntubationSurgery

Surgical removal of the causative tumor (Adrenalectomy)

Hormone replacement therapy

Management

After adrenal surgery, observe the child carefully for signs of shock:

without epinephrine from the adrenal gland, the body’s ability to maintain blood pressure is severely compromised, and severe hypotension can result.

Acute Adrenocortical Insufficiency

The function of the entire cortical adrenal gland suddenly becomes insufficient. Usually this occurs in association with severe overwhelming infection, typically involving hemorrhagic destruction of the adrenal glands. It is seen most commonly in meningococcemia. It also can occur when corticosteroid therapy that has been maintained at high levels for long periods is abruptly stopped.

Which of the following is not a Clinical Manifestation of Addison’s Dse?

Hypothermia

Seizure High fever

Hypotension

blood pressure drops to extremely low levels;the child may be pulseless.elevated temperaturedehydration hypoglycemiaseizures Sodium and chloride blood levels are very low, serum potassium is elevated

Without treatment, death can occur abruptly

Clinical Manifestations

Which is not a management of Addison’s Dse?

DefibDopamine

Solu-Cortef D5 0.9 NaCl

immediate replacement of cortisol (with IV hydrocortisone sodium succinate [Solu-Cortef ]); administration of deoxycorticosterone acetate (DOCA), the synthetic equivalent of aldosterone;

Management

IV 5% glucose in normal saline solution to restore blood pressure, sodium, and blood glucose levels.

A vasoconstrictor may be necessary to elevate the blood pressure further.

Management

Type 1 Diabetes Mellitus

Type 1 diabetes is a disorder that involves an absolute or relative deficiency of insulin in contrast to type 2 where insulin production is only reduced.

Type 1 diabetes (formerly referred to as juvenile diabetes or insulin-dependent diabetes) occurs almost exclusively in childhood.

Type 1 Diabetes Mellitus

The disease affects as many as 1 in 1500 children before 5 years of age and increases to 1 in 350 by age 16.

The incidence is equal among girls and boys.

Etiology

It apparently results from immunologic damage to insulin-producing cells in susceptible individuals.

Environmental effects may be necessary to create this immunologic response. Why autoimmune destruction of islet cells occurs in some children and not in others is unknown, but children with this disorder have a high frequency of certain human leukocyte antigens (HLA), particularly HLA-DR3 and HLA-DR4, located on chromosome 6 that may lead to susceptibility.

If glucose is unable to enter body cells because of a lack of insulin, it builds up in the bloodstream (hyperglycemia)

Clinical Presentation

When the kidneys detect hyperglycemia (greater than the renal threshold of about 160 mg/dL), the kidneys attempt to lower it to normal levels by excreting excess glucose into the urine, causing glycosuria and the body also excretes a large amount of fluid (polyuria).

Clinical Presentation

Excess fluid loss, in turn, triggers the thirst response (polydipsia) producing the three cardinal symptoms of diabetes: polyuria, polydipsia, and hyperglycemia.

Clinical Presentation

Which of the following is not a diagnostic tool for Hyperglycemia?

Hb1aC

Troponin T Fasting Blood Glucose

2hr Postprandial

The first symptoms likely to be reported are increased thirst and increased urination. Increased urination may begin as bedwetting (enuresis) in a previously toilet-trained child. In addition, children may have constipation because of the dehydration.

Assessment and Diagnostic Findings

Random plasma glucose level greater than 200 mg/dL (normal range, 70 to 110 mg/dL fasting, 90 to 180 mg/dL not fasting)

Fasting blood glucose level greater than 126 mg/dL

Two-hour plasma glucose level greater than 200 mg/dL during an oral glucose tolerance test (GTT)

Assessment and Diagnostic Findings

Glycosylated hemoglobin (HbA1c) evaluation (normal value is 1.8 to 4.0)A value greater than 6.0 reflects an excessive level of serum glucose.

Assessment and Diagnostic Findings

Measuring glycosylated hemoglobin provides information about what the child’s glucose levels have been during the preceding 3 to 4 months, because red blood cells have a life span of 120 days.

Which is not a management of Diabetes Mellitus?

Sweets Insulin

Nutrition Exercise

Therapy for children with type 1 diabetes involves five measures:

insulin administration, regulation of nutrition exercise,stress management, andblood glucose and urine ketone monitoring

Which is not a complication of Diabetes Mellitus?