An 8-month-old previously well infant is brought to the emergency room with vomiting, lethargy, dehydration, and failure to thrive. Intravenous administration of fluids is begun. Serum electrolyte values are sodium 124 mEq/L, chloride 88 mEq/L, and potassium 6.8 mEq/L. Serum glucose level is 35 mg/dL. The child is hypotensive and has areas of hyperpigmentation. The most likely diagnosis is

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Pediatric Endocrine Nursing Questions Questions

Question 1 of 5

An 8-month-old previously well infant is brought to the emergency room with vomiting, lethargy, dehydration, and failure to thrive. Intravenous administration of fluids is begun. Serum electrolyte values are sodium 124 mEq/L, chloride 88 mEq/L, and potassium 6.8 mEq/L. Serum glucose level is 35 mg/dL. The child is hypotensive and has areas of hyperpigmentation. The most likely diagnosis is

Correct Answer: A

Rationale: Addison disease (adrenal insufficiency) matches the presentation: hyponatremia, hyperkalemia, hypoglycemia, hypotension, and pigmentation.

Question 2 of 5

The next best step in the evaluation of the child in the previous question is to obtain a

Correct Answer: B

Rationale: Head MRI is needed to rule out hypothalamic-pituitary lesions causing central precocious puberty.

Question 3 of 5

A 14-year-old presents with poor growth and delayed puberty. She denies headaches or poor school performance. She is physically sluggish and has a small goiter, and her serum cholesterol is 500 mg/dL. The most likely diagnosis is

Correct Answer: A

Rationale: Hashimoto’s thyroiditis causes hypothyroidism with goiter, delayed puberty, and elevated cholesterol.

Question 4 of 5

The underlying disorder affecting the child in the previous question is most likely

Correct Answer: A

Rationale: Type I autoimmune polyendocrinopathy (APS-1) includes Addison’s, hypoparathyroidism (hypocalcemia), and candidiasis (nail rash).

Question 5 of 5

The hypothalamus secretes releasing or inhibiting factors to control the anterior pituitary gland. Of the following, the pituitary hormone that is elevated in a hypothalamic disease is

Correct Answer: D

Rationale: Hypothalamic disease often disrupts inhibitory control, such as dopamine’s inhibition of prolactin. Thus, prolactin levels rise due to lack of suppression, unlike other hormones (A, B, C, E) which are stimulated by hypothalamic releasing factors and may decrease in hypothalamic dysfunction.

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