Examination and nursing of children with growth hormone deficiency

Examination and nursing of children with growth hormone deficiency

Definition
Clinical manifestation Auxiliary examination Treatment points Nursing diagnosis Nursing measures

Examination and nursing of children with growth hormone deficiency

Definition Growth hormone deficiency: also known as pituitary dwarfism.

It is due to partial or complete lack of growth hormone synthesized and secreted in the anterior pituitary, or growth and development disorders caused by structural abnormalities, receptor defects, etc., resulting in children lower than the same age, same sex, normal height of normal children in the same area 2 One standard deviation (-2SD) or below the 3rd percentile of the pediatric growth curve.

Examination and nursing of children with growth hormone deficiency

Cause

  1. Genetic factors (5%) 2. Dysplasia: pituitary development, abnormal development

Primary

Acquired

  1. Idiopathic hypothalamic and pituitary dysfunction: hypothalamic and pituitary dysfunction.

Organic, secondary to infection, intracranial tumor, head trauma, etc.

Psychosocial growth inhibition, primary hypothyroidism, temporary, etc. can cause GH secretion function to be low, and can return to normal after the elimination of external adverse factors or primary disease treatment.

Examination and nursing of children with growth hormone deficiency

Height and weight at birth are normal, and growth is slow after 5 months, 1-2 years old. The height is less than 4 cm/year, the appearance is obviously smaller than the actual age, the face is childish, the hands and feet are small, and the height is low.
In normal height average,

  1. Primary, but the proportion of the upper and lower parts is normal, and the body shape is well-proportioned. Growth disorder
  2. Bone maturity delay
  3. Postponement of puberty (gonadin deficiency) Delay in the opening of the teeth and the cardia.
  4. Normal intelligence

Examination and nursing of children with growth hormone deficiency

Clinical manifestation

  1. Secondary growth hormone deficiency can occur at any age and is associated with the corresponding symptoms of the primary disease.
    Intracranial tumors often have symptoms such as headache, vomiting, and increased symptoms of intracranial pressure and optic nerve compression.

Examination and nursing of children with growth hormone deficiency

Auxiliary inspection
1) X-ray examination: Short children need to take a left-handed X-ray to determine the bone age. Under normal circumstances, the difference between bone age and actual age should be between ±1 years old, and excessive or excessive advancement is abnormal.

2) routine examination: blood, urine routine examination, liver and kidney function and blood biochemistry, electrolytes, blood gas examination, blood calcium, phosphorus, zinc, alkaline phosphatase determination

3) Chromosome examination: If the girl is short or has mild deformity, a cell chromosome examination should be performed to determine whether it is Turner syndrome.

Examination and nursing of children with growth hormone deficiency

4) Endocrine examination:

(1) thyroid function: measuring serum T3, T4 or TSH;

(2) Growth hormone-insulin-like growth factor I axis (GH-IGF-I) function assay

5) Brain MRI examination:

 Can display the size of the anterior and posterior pituitary, diagnose pituitary non-development, dysplasia, neurofibroma, craniopharyngioma and so on.

Commonly used growth hormone secretion test

Examination and nursing of children with growth hormone deficiency

GHD diagnosis height lower than the same age, the same gender normal mean -2SD

Height growth rate <4cm / y well-proportioned, childish, full of sebum, intelligent normal part of the child may be accompanied by diabetes insipidus or a low bone age behind the actual age of 2 years old two drugs GH jintropin excitation test, GH peaks are <10μg / L Skull MRI shows anterior pituitary reduction

 Examination and nursing of children with growth hormone deficiency

Treatment points

— Using recombinant human growth hormone replacement therapy (intracranial tumor surgery, malignant tumor, severe diabetes)
Disabled! )

The therapeutic dose is 0.1u/kg per day, subcutaneous injection half an hour before going to bed every night (a small number of children will have a decrease in thyroid hormone levels during hormone replacement therapy, so thyroid function needs to be detected, and thyroid hormone supplementation is necessary if necessary)

Examination and nursing of children with growth hormone deficiency

— Common side effects of growth hormone therapy:
Thyroid function reduces glucose metabolism changes. Idiopathic benign intracranial pressure

Antibody production

Injection of local redness, swelling or rash to induce tumors

Examination and nursing of children with growth hormone deficiency

Nursing diagnosis

– growth retardation

– self-conceptual disorder

– anxiety

– lack of knowledge

Associated with growth hormone deficiency

Related to growth retardation

Related to short stature

Related to lack of testing and disease knowledge

Examination and nursing of children with growth hormone deficiency

   Nursing measures 1. Reasonable exercise: The right amount of exercise can not only promote the secretion of growth hormone, but also increase the appetite after full exercise, which is helpful for the child to increase. Activities that contribute to heightening include jogging, skipping, dancing, playing basketball, playing volleyball, swimming, etc. Because the development of bones requires a certain amount of longitudinal pressure, and excessive pressure, such as weightlifting, can hinder the longitudinal growth of bones, children should try to avoid. For children in the growing season, exercise is a means of promoting development, but not excessive exercise. Excessive exercise can make the child physically and mentally exhausted, causing the child to have no mood to eat, and to fall asleep, which is not conducive to health and is not good for the increase.

Examination and nursing of children with growth hormone deficiency

Nursing measures

  1. Dietary care: A reasonable protein diet is a source of energy for bone and muscle growth, and at the same time promotes the secretion of growth hormone, which is one of the most basic factors for children’s growth and development. Therefore, in the diet of children’s diet, protein-rich foods such as eggs, fish, soy products and dairy products should be given frequently.
  2. Psychological care: creating a good family environment Parents’ care The development of the body is influenced by the social environment and the family environment, especially in children of lower ages, especially affected by the family environment. If a child grows up in a single-parent family, the parent’s low care often affects the body’s growth. Generally, the short stature caused by the lack of proper care is called “mental shortness”. Therefore, it is necessary to create a healthy and caring environment for your child, which will help your child’s physical and mental health.

Examination and nursing of children with growth hormone deficiency

Nursing measures

  1. Follow-up: All children with a short stature should be followed up for a long time. Growth hormone therapy
    Follow-up should be performed every 3 months: height is measured and growth rate is assessed, compared with before treatment. If the treatment is effective, the height of the first year will increase by at least 0.25 SDS. In addition, tests for IGF1, IGFBP-3, T4, TSH, blood glucose, and insulin should be performed to adjust the GH dose and thyroxine in time. The bone age is checked once a year. During the course of treatment, sexual development should be observed and treated as needed. Suspected intracranial lesions should pay attention to regular repeated cranial MRI scans.

Leave a Comment

Your email address will not be published.