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The endocrine system has three components: the cell, which sends a chemical message via
a hormone; target cells, which receive the message; and the environment through which the
chemical is transported from the site of synthesis to the sites of cellular action.
Deficiencies of the anterior pituitary hormones may be due to organic defects or have an
idiopathic etiology and may occur as a single hormonal problem or in combination with
other hormonal deficiencies. Pituitary dysfunction is manifested primarily by growth
disturbance.
Hypopituitarism is diminished or deficient secretion of pituitary hormones. The
consequences of the condition depend on the degree of dysfunction. It often leads
to:
Gonadotropin deficiency with absence or regression of secondary sexual
characteristics
Growth hormone (GH) deficiency, in which children display retarded somatic
growth
Thyroid-stimulating hormone deficiency, which produces hypothyroidism
Corticotropin deficiency, which results in manifestations of adrenal hypofunction
The principal disorder of posterior pituitary hypofunction is diabetes insipidus (DI).
Also known as neurogenic DI, central diabetes insipidus results from the
undersecretion of antidiuretic hormone (ADH), also known as vasopressin.
Oversecretion of the posterior pituitary antidiuretic hormone (ADH) causes the disorder
known as syndrome of inappropriate antidiuretic hormone (SIADH).
Disorders of thyroid function include hypothyroidism, autoimmune thyroiditis, goiter,
and hyperthyroidism.
Growth cessation or retardation in a child whose growth has previously been normal should
alert the observer to the possibility of hypothyroidism. Children with hypopituitarism
generally grow normally during the first year and then follow a slowed growth curve that is
below the third percentile. In children with a partial GH deficiency, the growth retardation is
less marked than in children with complete GH deficiency. Height may be retarded more
than weight because, with good nutrition, these children can become overweight or even
obese.
A complete diagnostic evaluation should include a family history, a history of the childs
growth patterns and previous health status, physical examination, psychosocial
evaluation, radiographic surveys, and endocrine studies.
Lymphocytic thyroiditis (also known as Hashimoto disease or juvenile autoimmune
thyroiditis) is the most common cause of thyroid disease in children. The enlarged thyroid
gland is usually detected by the practitioner during a routine examination, although it may
be noted by parents when the youngster swallows. In most children, the entire gland is
enlarged symmetrically (although it may be asymmetric) and is firm, freely movable, and
nontender.
Therapy for hyperthyroidism is directed at retarding the rate of hormone secretion and
may include drug therapy, thyroidectomy, or radioiodine therapy.
Copyright 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
Key Points - Print 33-2
Copyright 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
Key Points - Print 33-3
Copyright 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.