434 Unit 4 | Common Illnesses or Disorders in Childhood and Home Care
Assessment Assessment for precocious puberty includes the following measures. Clinical Presentation ● Presence of breast development (Tanner stage 2 or greater) for girls younger than 8 years ● Presence of testicular development (Tanner stage 2 or greater) for boys younger than 9 years ● Café au lait spots, presence of bone lesions on x-ray may indicate McCune-Albright syndrome (Brillante & Guthrie, 2019). ● Advanced bone age; bone age x-ray of the left hand and wrist to determine the actual age of the bones in compari- son with the child’s actual (chronological) age; bone age above normal merits further evaluation (Harrington & Palmert, 2020) ● Increased height velocity ● GnRH stimulation test results with increased LH response greater than 5 to 6 IU/L (Pyra & Schwarz, 2021). ● Simulated peak LH/FSH ratio above 0.66 to 1.0 (Pyra & Schwarz, 2021). Diagnostic Testing ● Serum studies include levels of LH, estradiol, FSH, and testosterone. ● Provocative stimulation testing: GnRH stimulation testing and leuprolide acetate stimulation testing ● Radiological studies such as bone age x-ray and MRI ● Scrotum is reddened and thinner ● Tanner stage 2 pubic hair or greater ● Vaginal mucosa pink and thicker ● Sebaceous activity on face; acne ● Careful monitoring of height velocity is necessary to deter- mine whether treatment methods are providing effective hormone suppression. ● Carefully assess sexual characteristics (Tanner staging) at each visit. ● Administer a gonadotropin-releasing hormone agonist (GnRHa) to stop the progression of pubertal develop- ment and suppress the release of gonadotropin hormones monthly. ● If GnRHa is given intramuscularly, assess injection sites for signs of sterile abscess. ● Perform psychological assessment of the child’s response to the advanced pubertal development to determine whether psychological referral is indicated. Caregiver Education ● Provide education about the condition and treatment options prescribed. Nursing Interventions ● Early identification and treatment are essential.
CRITICAL COMPONENT Symptoms of Precocious Puberty
● Teach parents the importance of dressing the child age-ap- propriately despite the development of sexual characteristics. ● Encourage the importance of medication compliance to avoid elevation of gonadotrophic hormones and advancement of sexual characteristics and height velocity. ● Discuss with the parents the need to talk about issues of sexual- ity at an earlier age than normal. Protective guidance measures should be offered, because children with precocious puberty may be at risk for sexual advances by older children, teens, or adults. ● Educate parents that medication should suppress the child’s moodiness and emotional lability. ● Educate parents that use of GnRHa will not cause infertility problems later in life and that once the child is at an age where puberty is appropriate, the medication can be discontinued, and spontaneous puberty will appear normally. • Testis 3 mL or less by Tanner stage • Adolescent gynecomastia of boys • Glandular enlargement greater than 0.5 cm of the male breast tissue • Most common between 13 and 14 years of age, but usually resolves by age 17 years • May be caused by high estrogen-to-testosterone ratio (Stanley & Misra, 2021) Variations in pubertal development may lead the health-care professional to suspect precocious puberty. These variations are usually benign and do not progress into full sexual pubertal development but must be evaluated frequently to make a definitive diagnosis. They include: • Premature thelarche • Isolated breast development that occurs earlier than normal • Most common when younger than 2 and older than 6 • No increased growth velocity • May have unilateral/bilateral breast development with areolae maturation • No other signs of puberty are present • Premature adrenarche • Early development of pubic hair in girls younger than 8 and boys younger than 9 • No increase in growth velocity • Tanner 2 or greater pubic hair • May also be accompanied by axillary hair, body odor, mild acne, and oily skin • May also be seen in girls born prematurely
HYPOTHYROIDISM
Hypothyroidism is caused by an underactive thyroid gland. The thyroid gland produces three types of hormones: T4 (thyroxine), T3 (triiodothyronine), and TSH. Hypothyroidism can be con- genital or acquired.
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