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Summary chapter 26 pediatric primary care burns
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hypo - pit - thyroid axis stimulates ... which in turn ... - hypo-pit-thyroid axis produces TRH which stimulates pituitary production of TSH, TSH stimulates the thyroid gland to secrete T4 which is converted to T3. The T4 inhibits TRH and pituitary TSH secretion free, unbound T3 and T4 - is...

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  • August 2, 2023
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  • 2023/2024
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chapter 26 pediatric primary care burns

hypo - pit - thyroid axis stimulates ... which in turn ... - hypo-pit-thyroid axis produces TRH which
stimulates pituitary production of TSH, TSH stimulates the thyroid gland to secrete T4 which is converted
to T3. The T4 inhibits TRH and pituitary TSH secretion



free, unbound T3 and T4 - is biologically active



primary hypothyroidism - congenital/aquired f>m

due to abnormality of thyroid formation in fetal life or problem with thyroid



Hashimotos - most common cause of aquired primary hypothyroidism.

autoimmune condition leading to destruction of the thyroid gland

features: dry skin, constipation, hair loss, fatigue, cold intolerance, apathy, depressed relaxation of
tendons, and weakness and sharp deceleration in growth



hx: + for fx of thyroid autoimmune



dx: high TSH and low T4



cretinism - untreated congential primary hypothyroidism

present with borad nasal bridge, coarse facial features, mental retardation, short stature, puffy
appearance of hands, protuberant tongue. Treatment by 3-4 wks of age eliminates this from happening



Hyperthryoidism - excessive thyroid hormone secretion from the thyroid gland.

presents: increased metabolism, tachycardia, weight loss, increased bowel movements, heat
intolerance, nervousness, tremor and widened pulse pressure

skin is warm and moist, hair is fine

plummer nail

,restless

short attention span

fatigue



hyperthyroidism can be caused by - graves or hyperthyroid phase of Hashimotos thyroiditis



less common causes:

functioning adenomas

toxic multinodular goiters

selective pituitary T3 resistance



Graves disease - stimulating antibody overrides the TSH receptor increases the production of thyroid
hormone.



features: hyperthyroidism features plus lid lag, proptosis, exophthalmos

hyperthyroid gland can increase 3-4x its size

warm to palpation

bruit may be heard over the gland



T4 AND T3 are elevated and TSH concentration is suppressed.



Cushings syndrome - excessive glucocorticoids due to either excess endogenous or exogenous steroid
exposure.



cushings syndroem physical features - rounded face, plethora, central obesity, impaired linear growth,
fatigue, and hypertension. irritable, muscle weakness, muscle wasting causing thin extremities, buffalo
hump.

skin is thin frail and easily brusied.

osteopenia, osteoporosis

amenorrhea

, CNS efffects: moody, psychosis, and idiopathic intracranial hypertension



Cushings disease treatment - removal of tumor that is secreting ACTH and/or removal of the adrenal
gland



endogenous syndrome due to adrenal tumors, pit tumors, f>M



dianostic for cushing disease - confirmation of elevated cortisol concentrations

24 h urine with cortisol

midnight salivary cortisol measurements

high ACTH concentration

CT for evaluation of adrenal tumor

**if cushing disease pituitary MRI is study of choice



addisons disease presents with - primary adrenal insufficiceny

presents with: weight loss, anorexia, electrolyte abnormalities, hyperpigmentation of genitalia, palms,
flexor creases, and areolae, ill appearance, thin habitus, and microcardia on CXR, vitiligo, weak and
confused.



Primary adrenal insufficiency is characterized by



and the 4 main causes are - conditions that directly affect the adrenal glands ie adrenal tumor or
destruction of adrenal tissue via autoimmune disease. glucocorticoid and mineralcorticoid deficiences
which is caused by the loss of cortisol negative feedback which leads to increase ACTH and melanin
secretion



4 causes

adrenal destruction

adrenal hypoplasia

familial glucocorticoid deficiency

impaired steroidogenesis

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