Chapter 33: The Child with Endocrine Dysfunction

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Homeostasis in the body is maintained by what is collectively known as the neuroendocrine system. What is the name of the nervous system that is involved?
a. Central
b. Skeletal
c. Peripheral
d. Autonomic

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ANS: D
The autonomic nervous system (composed of the sympathetic and parasympathetic systems) controls involuntary functions. In combination with the endocrine system, it maintains homeostasis. The central, skeletal, and peripheral subdivisions of the nervous system are not part of the neuroendocrine system.

A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which knowledge?
a. Therapy is most successful if it is started during adolescence.
b. Replacement therapy requires daily subcutaneous injections.
c. Hormonal supplementation will be required throughout child's lifetime.
d. Treatment is considered successful if children attain full stature by adolescence.

ANS: B
Additional support is required for children who require hormone replacement therapy, such as preparation for daily subcutaneous injections and education for self-management during the school-age years. Young children, obese children, and those who are severely GH deficient have the best response to therapy. Replacement therapy is not needed after attaining final height. The children are no longer GH deficient. When therapy is successful, children can attain their actual or near-final adult height at a slower rate than their peers.

A child with growth hormone (GH) deficiency is receiving GH therapy. When is the best time for the GH to be administered?
a. At bedtime
b. After meals
c. Before meals
d. After arising in morning

ANS: A
Injections are best given at bedtime to more closely approximate the physiologic release of GH. After meals, before meals, and after arising in the morning do not parallel the physiologic release of the hormone.

What is a condition that can result if hypersecretion of growth hormone (GH) occurs after epiphyseal closure?
a. Cretinism
b. Dwarfism
c. Gigantism
d. Acromegaly

ANS: D
Excess GH after closure of the epiphyseal plates results in acromegaly. Cretinism is associated with hypothyroidism. Dwarfism is the condition of being abnormally small. Gigantism occurs when there is hypersecretion of GH before the closure of the epiphyseal plates.

Peripheral precocious puberty (PPP) differs from central precocious puberty (CPP) in which manner?
a. PPP results from a central nervous system (CNS) insult.
b. PPP occurs more frequently in girls.
c. PPP may be viewed as a variation in sexual development.
d. PPP results from hormonal stimulation of the hypothalamic gonadotropin-releasing hormone (Gn-RH).

ANS: C
PPP may be viewed as a variation in sexual development. PPP results from hormone stimulation other than the hypothalamic Gn-RH. Isolated manifestations of secondary sexual development occur. PPP can be missed if these changes are viewed as variations in pubertal onset. CPP results from CNS insult, occurs more frequently in girls, and results from hormonal stimulation of the hypothalamic Gn-RH