ENDOCRINE DISORDERS

MIDWIFERY III
DISORDERS OF ENDOCRINE SYSTEM
1. Diabetes mellitus
2. Hyperthyroidism
3. Hypothyroidism
4. Growth hormone deficiency
5. Cushing’s syndrome
 DIABETES MELLITUS
Definition :
• It’s a common chronic , metabolism syndrome characterized by glycemia as a
cardinal biochemical feature.
The major forms of diabetes are classified as:
1) Type 1, which is caused by a deficiency of insulin secretion due to pancreatic
β-cell damage
2) Type 2, which is a consequence of insulin resistance that occurs at the level of
skeletal muscle, liver, and adipose tissue with different degrees of β-cell
impairment.
Causes of diabetes Signs and symptoms of
mellitus diabetes
• Headache
• Abdominal crumping
• Genetic predisposition • Fatigue
• Viral infection • Fruity breath odor
• Mental status changes
• Chemicals, environmental • Nausea
factors • Thin appearance and possible
malnourishment
• Obesity (type 2 diabetes) • Vomiting
• weakness
PATHOPHYSIOLOGY
• Type 1 DM is an autoimmune disorder that damages and destroys the
b cells of the pancreas, resulting in inadequate insulin secretion. This
deficiency of insulin leads to inability of cells to take up glucose. The
end result is hyperglycemia, glucose accumulation in the blood, and
the body's inability to use its main source of fuel efficiently.
• Type 2 DM the pancreas usually produces insulin but the body is
resistant to the insulin or there is an inadequate insulin secretion
response.
 DIAGNOSIS OF DIABETES
MELLITUS
• DM is diagnosed based on any of the following four abnormal glucose
metabolites:
• 8-hour fasting blood glucose level of 126 mg/dl or more,
• a random blood glucose value of 200 mg/dl or more accompanied by classic signs of
diabetes,
• an oral glucose tolerance test (OGTT) finding of 200 mg/dl or more in the 2-hour
sample, or
• hemoglobin A1C of 6.5% or more
• Postprandial blood glucose determinations and the traditional OGTTs have yielded low
detection rates in children and are not usually necessary for establishing a diagnosis.
• Serum insulin levels may be normal or moderately elevated at the onset of diabetes;
delayed insulin response to glucose indicates impaired glucose tolerance.
Management and treatment of
Diabetes
 1.Drug therapy
a) Insulin Replacement Therapy
Insulin replacement therapy is the cornerstone of management of type 1 DM. The frequency, dose, and
type of insulin are based on how much the child needs to achieve a normal, average blood glucose
concentration and to prevent hypoglycemia. Often, the regimen consists of :
• Rapid-acting insulin (e.g., NovoLog) reaches the blood within 15 minutes after injection. The insulin
peaks 30 to 90 minutes later and may last as long as 5 hours.
• Short-acting (regular) insulin (e.g., Novolin R) usually reaches the blood within 30 minutes after injection.
The insulin peaks 2 to 4 hours later and stays in the blood for about 4 to 8 hours.
• Intermediate-acting insulins (e.g., Novolin N) reach the blood 2 to 6 hours after injection. The insulins
peak 4 to 14 hours later and stay in the blood for about 14 to 20 hours.
• Long-acting insulin (e.g., Lantus) takes 6 to 14 hours to start working. It has no peak or a very small peak
10 to 16 hours after injection. The insulin stays in the blood between 20 and 24 hours.
• mixed together (e.g., Novolin 70/30). For example, you can buy regular insulin and NPH insulins already
mixed in one bottle, which makes it easier to inject two kinds of insulin at the same time.
b) Oral Diabetic Medications

Oral diabetic medications, also referred to as hypoglycemic, antidiabetic, or

antihyperglycemic medications, are used in DM type 2 if glycemic control cannot
be achieved by diet and exercise
 2. Diet
• The appropriate diet for a child or adolescent with diabetes is a
balanced, healthy diet that meets the child's growth and
development needs.
• The child and family need to understand the effect that food has on
the child's glucose levels.
• Monitoring carbohydrate intake is an important component of diet
management and assists with glycemic control.
• Limit sweets, ensure consistent food intake (eat often and try to
avoid skipping meals), monitor carbohydrate intake, eat whole
grains and plenty of fruits and vegetables, and limit fat.
3. Exercise
• Regular exercise can improve glycemic control and can prevent the
development of type 2 diabetes
• Therefore, it is important for the child to maintain or increase his or her
activity levels.
• Children with type 2 DM are often overweight, so the exercise plan is very
important in helping the child to lose weight as well as assisting with the
hypoglycemic effects of the medications
4 . Management Of Complications
• monitor for signs of complications such as acidosis, coma, hyperkalemia or hypokalemia,
hypocalcemia, cerebral edema, or hyponatremia.
• Assess for the development of hypoglycemia or hyperglycemia every 2 hours
• Monitor the child's status closely during peak times of insulin action.
• Perform blood glucose testing as ordered or as needed if the child develops symptoms this helps
to prevent future severe complications such as: retinopathy ,Dyslipidemia, nephropathy, poor
wound healing, vascular complications and failure to grow
HYPOTHYROIDISM
 Hypothyroidism
• This refers to a decrease in T3 and T4
Causes
• Most common cause of congenital hypothyroidism is;
• Iodine deficiency, abnormalities in development of thyroid {thyroid dysgenesis}
Clinical presentation
• Most of the neonates are asymptomatic at birth due to presence of
maternal thyroid hormone. Very often the first clinical is prolongation
of physiological jaundice.
• The other clinical presentation are;
1. Macroglossia – the tongue is larger than normal
2. Thin eyebrows
3. Hypotonia – decreased muscle tone
4. Constipation
5. Non-pitting edema
6. Macrocytic anemia
7. Cardiomegaly
8. Large fontanelles
9. Dry skin
 Diagnosis
• Since the neonates are asymptomatic at birth, screening of all the
newborns is essential for diagnosis of hypothyroidism.
• TSH is estimated either in the cord blood at the time of birth or in baby's
blood obtained from heel prick after 3 days of birth { in 1st 48hrs of birth
false positive result can be seen}. Day 5-7 days

Treatment
• Levothyroxine at a dose of 10-15/kg is the drug of choice.
HYPERTHYROIDISM
 Hyperthyroidism
• The most common cause of hyperthyroidism in children is Graves disease and can be
caused by thyroiditis, thyroid cancer and acute iodine overdose.
Clinical presentation
The peak age of presentation is adolescence and is more common in girls. The earliest findings are;
I. Emotional disturbance
II. Tremor
III. Increased appetite
IV. Exophthalmos
V. Moist skin
VI. Cardiovascular abnormalities i.e. tachycardia, atrial fibrillation, mitral regurgitation
The baby is usually hyperactive along with other findings like;
I. Microcephaly
II. Ventriculomegaly
III. Hepatosplenomegaly
IV. Jaundice
V. Accelerated bone age
VI. Goiter
VII. Triangular face
 Diagnosis
• Increased serum of T3 and T4
• Diagnosis of graves disease is confirmed by elevated levels of
TSRAb{TSH receptor stimulating Antibody}.

Treatment
• Anti-thyroid drugs propylthiouracil and methimazole can be used for
treatment. However methimazole is the drug of choice in children.
GROWTH HORMONE DEFICIENCY
GROWTH HORMONE DEFICIENCY

• Is a condition common in children that occurs when a person’s pituitary gland

does not produce enough growth hormones
CAUSES
I. Congenital- this includes genetic mutation, isolated growth hormone deficiency
and multiple pituitary deficiencies.
II. Acquired- examples are tumors of the hypothalamus and pituitary, irradiation,
infections like encephalitis, injury during or after birth.
CLINICAL FEATURES
• Hypoglycemia
• Seizure
• Cold sensitivity
• Delayed puberty
• Delayed dentition with overcrowding of teeth
• Delayed bone age
DIAGNOSIS
• Growth hormone in children is diagnosed if the serum GH value is less than
10ng/ml
  
TREATMENT AND MANAGEMENT
• Involves the use of supplemental GH.
• Removal of any tumors that might be the underlying problem.
• GH therapy
• Treatment is continued until near final height is achieved, determined by a
growth rate of less than one inch/year, bone age greater than 16 years in boys
and greater than 14 years in girls
CUSHING’S SYNDROME
 DEFINITION:
Cushing’s syndrome is a disorder caused by
having high level of free circulating cortisol in the
body for a long time.
 AETIOLOGY
• Iatrogenic: Cushing syndrome, frequently a result of
administration of large amounts of exogenous
corticosteroids.
• Food dependent: Inappropriate sensitivity of adrenal
glands to normal postprandial increases in secretion of
gastric inhibitory polypeptide.
SYMPTOMS OF CUSHINGS SYNDROME.
a. Excess weight gain in the upper body
b. Fat pad on the back of the neck.
c. Red streaks on the belly.
d. Thin arms and legs.
e. Slow growth rate.
f. Fragile, darkened, thin skin.
g. Bone and muscle weakness.
h. Hyperglycemia.
i. Moon face
j. Red cheeks.
DIAGNOSTIC STUDIES.
• Blood tests- To measure the levels of cortisone in the body.
• Urine tests- Used to measure the levels of cortisone in the body. 24
hour urine is measured.
• X-rays-Provides images of the inside of the body showing
abnormalities.
• Dexamethasone suppression tests- This test shows if the excess
cortisol are from the pituitary gland or from tumors.
MANAGEMENT OF CUSHINGS SYNDROME.
• Changing dose of glucorcorticoid hormone medications.
• Surgery to remove a tumor (adrenal tumor, pituitary gland tumor).
• Take medicines to block the excess production of cortisol.
• Radiation treatment of pituitary gland.