Peds Endocrine
DI vs SIADH
DI increased urine output ADH decreased hypernatremia dehydrated excessive thirst low urine osmolality SIADH decreased urine output ADH increase hyponatremia water retention excessive thirst high urine osmolality low serum osmolality
Clinical manifestations of hypopituitarism
normal growth during first year delayed closure of anterior fontanel (want it to close around 8 months) slowed growth curve after first year appear overweight/obese due to stunted height increased abdominal fat delayed sexual development: appear much younger than they Panhypopituitarism manifestations (Box 47.1)
What age does lymphocytic thyroiditis (Hashimoto's disease) most often occur?
occurs most frequently after age 6 years, peaks during adolescence
Medication management of juvenile hypothyroidism (one thing to remember in particular)
oral thyroid hormone replacement prompt treatment: brain growth in infant *administer in increasing amounts over 4 to 8 weeks to avoid symptoms of hyperthyroidism* children to take responsibility for medication regimen as soon as they are able
What is Cushing syndrome? What causes it?
overproduction of cortisol (sugar) may be caused by excessive or prolonged steroid therapy Condition: reversible once steroids are discontinued
Look at HESI pg 194. Tanner Puberty Staging
Girls: Breast changes, rapid increase in height and weight, growth of pubic hair, appearance of axillary hair, menstruation, abrupt deceleration of linear growth Boys: Enlargement of testes. growth of pubic hair, axillary hair, facial hair, and body hair; rapid increase in height; changes in larynx and voice; nocturnal emissions; abrupt deceleration of linear growth
What is are the primary cause of adrenal medullary hyperfunction?
catecholamine-secreting tumors
Care management of hyperparathyroidism
recognition of disorder bone pain/fractures behavior changes, GI symptoms, cardiac irregularities
What is Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
resulrs from oversecretion by the posterior pituitary gland (increased ADH) -*Retention of fluid* fluid retention hypotonicity Excess ADH: filtered water absorbed back into circulation
What is precocious puberty?
sexual development in boys <9 or girls <8 Mean age of puberty for AA girls: 9.6. Caucasian 10.2 Disorder of gonads, adrenal glands, or hypothalamic-pituitary gonadal axis *Premature release of gonadotropin hormones*
What is lymphocytic thyroiditis?
autoimmune chronic inflammation of the thyroid *most common cause of thyroid disease in children and teenagers*
What is the mean age of puberty in girls
AA 9.6 Caucasian 10.2
What is acromegaly?
Excess GH after epiphyseal closure
Most childhood cases of diabetes mellitus are what type?
1
When is the best time to administer GH SQ?
bedtime
Drug management for congenital adrenal hyperplasia
glucocorticoids (bc they're lacking cortisol)
cardinal signs of diabetes insipidus
polyuria, polydipsia
What medication is given to GH deficiency pt
somatotropin SQ DUH (if they are GH deficient then give them GH)
Teaching parents for administration of drug for Diabetes insipidus (and other teachings)
*teach the difference between diabetes insipidus and diabetes mellitus. They will not be giving insulin, they'll be giving vasopressin instead* daily hormone replacement nasal spray, or IV SQ or IM injection *Teach to shake thoroughly prior to each injection* *treatment is required for life (2-3 times daily)* medical bracelets children should learn to give injections when age appropriate -as soon as they can, let them give themselves their own medications school nurse/teachers should be aware of illness
What diagnostic labs are evaluated to determine lymphocytic thyroiditis?
*thyroid function tests usually normal* TSH may be mildly elevated Antithyroid antibodies are present bc it's autoimmune
What is hypopituitarism ?
*growth hormone deficiency* deficient secretion of pituitary hormones (not secreting enough) *inhibits growth/development of secondary sex characteristics* Consequences: depend upon degree of dysfunction -gonadotropin deficiency: growth probs in testes/ovaries -GH deficiency -Thyroid stimulating hormone (TSH) deficiency: affects thyroid gland, which if you remember, the thyroid regulates metabolic rate or heart, digestion, bone/muscle, -Corticotropin: in hypothalamus, CRH stimulates ACTH in the pituitary gland, which stimulates the adrenal glands to produce cortisol in the blood stream to help deal with stress
The parent of a child tells the nurse that the child voids excessive urine and immediately drinks large amounts of water. The parent also says that the child's bed is often wet in the morning. Which condition does the nurse suspect in the child? Diabetes insipidus (DI) Chronic adrenocortical insufficiency Cushing syndrome Congenital adrenal hyperplasia (CAH)
A child with DI exhibits excessive thirst and excessive urination, which also causes bedwetting or enuresis. Chronic adrenocortical insufficiency is the nonfunctioning of the adrenal tissue and is indicated by weight loss, dehydration, increased sleeping, and muscular weakness. Cushing syndrome is often caused by excessive or prolonged steroid therapy, in which the child acquires a cushingoid appearance such as excessive hair growth, moon face, and fat red cheeks. CAH is indicated by the presence of ambiguous genitalia in infants at birth.
The nurse plans to teach an adolescent diagnosed with type 1 diabetes about exercise and lifestyle changes that can help manage the diabetic condition. What information should the nurse include in the teaching plan? Select all that apply. "The type and duration of exercise should be planned around your interests and capabilities." "You can have snacks before you exercise to compensate for decreasing blood glucose levels." "You can administer oral hypoglycemic agents before you start your exercise regimen." "You should not exercise."
A, B It is advisable to plan the exercise type and duration based on the child's interests and capabilities. Because exercise decreases blood glucose levels, the child should have snacks before or during prolonged activity to compensate. Oral hypoglycemic agents will reduce the glucose levels further if taken while exercising, so the child should not do this. Exercise is not harmful to patients with diabetes, so nurses or medical providers should not advise against it.
A 15-year-old child has type 2 diabetes mellitus and needs dietary instruction from the nurse. Which statements from the nurse would provide the child with important information on nutritional needs? Select all that apply. "You should have enough calories for your energy, growth, and development." "You can regularly have soft drinks, concentrated sweets, and high-calorie meals." "Food intake should correspond to the timing and action of the insulin prescribed." "You can have pizza, homemade apple pie, and hot chocolate before bedtime." "You should plan to incorporate snacks between meals and at bedtime."
A, C, D The nutritional needs of a 15-year-old child with type 2 diabetes mellitus are no different from those of other healthy children. The child would need sufficient calories for daily energy expenditure, growth, and development. However, unlike children without diabetes mellitus, they need insulin injected subcutaneously, coordinated with their food intake so that peak effect, duration of action, and absorption rate are optimized to regulate their blood glucose levels. Snacks are also necessary to prevent hypoglycemia, and they should be timed between meals and at bedtime depending on the activity time and action of the insulin prescribed. The child cannot have soft drinks, concentrated sweets, and high-calorie meals. They should not eat pizza, homemade apple pie, and hot chocolate anytime they feel hungry because it may increase their blood glucose levels.
Drugs/SEs and other treatment for Graves' disease
BB Antithyproid drugs (propylthiouracil and methimazole) *Teach SE is leukopenia: teach parents to report sore throat and fever immediately*
When discussing a child's precocious puberty with the parents, what should the nurse tell them? The child is not yet fertile. Heterosexual interest is usually advanced. Dress and activities should be appropriate to chronologic age. Appearance of secondary sexual characteristics does not proceed in the usual order.
Because of the early sexual maturation of the child, both family and child require extensive teaching. Included in this teaching is that the child should be engaged in activities according to chronologic age. Functioning sperm or ova may be produced, thereby making the child fertile at an early age. Heterosexual interest is usually appropriate to chronologic age. The secondary sexual characteristics proceed in the usual order.
The nurse is working with an 11-year-old child who has type 1 diabetes mellitus. The nurse advises the child's parents to monitor the glucose levels at home. What should be the blood glucose levels if the diabetes mellitus is well managed? Select all that apply. A random blood glucose level that is consistently less than 200 mg/dL A random blood glucose level that is consistently less than 400 mg/dL An 8-hour fasting blood glucose level that is regularly less than 126 mg/dL An 8-hour fasting blood glucose level that is regularly less than 300 mg/dL
Blood glucose levels of less than 200 mg/dL and an 8-hour fasting blood glucose level of less than 126 mg/dL indicate that the child is healthy. Therefore, if the random blood glucose level consistently approaches 400 mg/dL, then the child's parents need to report it to the health care provider. It is also important to consult the health care provider if the 8-hour fasting blood glucose level regularly approaches 300 mg/dL. In both the cases, the child is showing poorly managed diabetes.
Clinical manifestations of hyperthyroidism
Cardinal signs: emotional lability physical restlessness, characteristically at rest decelerated school performance varacious appetite with weight loss in 50% of cases fatigue Physical signs: tachycardia widened pulse pressure dyspnea on exertion exophthalamus (protruding eye balls) Wide-eyed, staring expression with eyelid lag Tremor Goiter (hypertrophy and hyperplasia) Warm, moist skin Accelerated linear growth Heath intolerance (may be severe) Fair fine and unable to hold a curl Systolic murmurs *From notes* irritability hyperactivity tachycardia short attention span tremors insomnia emotional instability exophthlmos heat intolerance irregular menstruation
Types of precocious puberty: Central precocious puberty vs. Peripheral precocious puberty
Central: 80% of case Early maturation and development of gonads and secondary sex characterisitcs -GnRh: LH & FSH- estrogen & testosterone Peripheral: premature development of breasts, pubic and axillary hair, and menses -No GnRh involvement
Clinical manifestations of Juvenile hypothyroidism (Box 47.5)
Decelerated growth -less when acquired at later age Myexedematous skin changes: -dry skin -puffiness around eyes -sparse hair -constipation -sleepiness -mental decline
Review of endocrine patho
Endocrine glands located in: hypothalamus, pineal gland, pituitary gland, thyroid/parathyroid, thymus, adrenal glands (kidneys), pancreas, testes/ovaries endocrine organs produce hormones--hormones are released into bloodstream--circulated to target organ--regulated by positive/negative feedback system *Dysfunction: we have a hypersecretion or a hyposecretion* What do endocrine hormones do? -growth and development -energy -glucose/fluid/sodium levels -sexual development -stress
What does thyroid hormone regulate?
basal metabolic rate thyroid secretes two types of hormones -thyroid hormone(which is made up of T3 and T4) -calcitonin
A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse if he can still play soccer, baseball, and swim. The nurse's response should be based on what knowledge? Exercise is contraindicated. Soccer and baseball are too strenuous, but swimming is acceptable. Exercise is not restricted unless indicated by other health conditions. The level of activity depends on the type of insulin required.
Exercise is encouraged for children with diabetes because it lowers blood glucose levels. Insulin and meal requirements require careful monitoring to ensure that the child has sufficient energy for exercise. Exercise is highly encouraged. The decrease in blood glucose can be accommodated by having snacks available. Sports are encouraged to help regulate the insulin, and food should be adjusted according to the amount of exercise. The child needs to be cautioned to monitor responses to the exercises. The level of activity does not depend on the type of insulin used. Long- and short-acting insulin both may be used to compensate for the effects of training and sporting events.
An infant is born with ambiguous genitalia. Tests are being done to assist in gender assignment. The parents tell the nurse that family and friends are asking what caused the baby to be this way. What is the nurse's most appropriate action? Explain the disorder so parents can explain it to others. Help parents understand that no one knows how this occurs. Suggest that parents avoid family and friends until the gender is assigned. Encourage parents not to worry while the tests are being done.
Explaining the disorder is the most therapeutic approach while the parents await the gender assignment of their child. The disorder is caused by decreased enzyme activity required for adrenal cortical production of cortisol. Suggesting that the parents avoid family and friends is impractical and would isolate the family from their support system while awaiting test results. The parents will be concerned. Telling the parents not to worry without giving them specific alternative actions would not be effective.
Key physical assessment of the endocrine system
Family hx of endocrine disorders height/weight/head circumference -BC GROWTH HORMONES body odors fat distribution/muscle mass -more distributed around abdomen in some dysfunctions facial features hair patterns
During the summer many children are more physically active. What changes in the management of the child with diabetes should be expected as a result of more exercise? Increased food intake Decreased food intake Increased risk of hyperglycemia Decreased risk of insulin shock
Food intake should be increased in the summer when the child is more active. Races and other competitions may require more food than other practice times. The child will require increased food on days of increased activity. The increased activity lowers blood glucose levels. Blood sugars must be monitored closely to avoid the administration of too much insulin during a time of reduced need.
What is the disease name for hyperthyroidism
Graves' disease
Hyperparathyroidism: primary vs secondary
Primary: adenoma of the gland Secondary: chronic renal disease, congenital anomalies of urinary tract
What labs do you need to monitor for parathyroid meds
Renal function, BP, serum vitamin D levels
Clinical manifestations of panhypopituitarism: Thyroid-stimulating-hormone
Short stature with infantile proportions Dry, coarse skin; yellow discoloration, pallor cold intolerance constipation somnolence (mood) bradycardia dyspnea on exertion Delayed dentition, loss of teeth
T/F Congenital adrenal hyperplasia babies are sterile
T bc they are born with abnormal genitalia
The parents of a child who is being treated for congenital adrenal hyperplasia (CAH) tell the nurse that they are planning for a new child again. Which is the best response by the nurse? "You must wait until your child is well." "Your next child will have CAH too." "You should go for genetic counseling." "The second child will be at risk for cardiac arrest."
The nurse advises the parents to go for genetic counseling because CAH is an autosomal recessive disorder that is passed down through families. Asking the parents to wait until the child gets well is not appropriate because the therapy takes a long time. It is inappropriate to state that the next child will have CAH as prenatal diagnosis and treatment can reduce the chances of CAH in the child. Children with CAH are at a risk for cardiac arrest due to salt-wasting crisis.
What does the adrenal cortex secrete?
Three groups of "steroids" Think SSS glucocorticoids (cortisol, corticosterone): *Sugar* mineralocorticoids (aldosterone): *Salts* *Sex* steroids (androgens, estrogens, and progestins) Adrenal medulla secretes catecholamines: epi/norepi
What is thyrotoxicosis and *how do you treat it?*
Thyroid storm -may occur from sudden release of hormone Treat with antithyroid drugs and propanolol
What action does the nurse take when the child on insulin therapy suddenly begins to tremble and sweat? Provide a glass of orange juice. Give the prescribed dose of glucagon. Provide a snack of eggs and fruits. Provide a glass of water.
Trembling and sweating in a child on insulin therapy indicates a low blood glucose level. Therefore, the nurse provides a glass of orange juice, which contains carbohydrates that reduce the blood glucose level. Glucagon is administered when increased levels of blood glucose cause unconsciousness or seizures. A starch-protein snack is provided after a simple carbohydrate in a liquid form is given to the child. A glass of water does not contain carbohydrates that are needed to reduce the blood glucose level.
What is important to remember when you are doing an endocrine studies as a diagnostic tool?
You can't go on just the first test. Have to continuously do it at different points
Clinical manifestations of panhypopituitarism: gonadotropins
absence of sexual maturation or loss of secondary sexual characteristics atrophy of genitalia, prostate gland, breasts Amenorrhea w/o menopausal symptoms decreased spermatogenisis
Hyperparathyroidism is commonly caused by
adenoma (benign tumor) surgical removal
What is pheochromocytoma?
adrenal tumor that secretes catecholamines (epi/norepi: fight or flight hormones)
clinical manifestations of hypoparathyroidism
calcium levels low/ phosphate levels high dry scaly skin with eruptions brittle hair, thin nails with transverse grooves headache, seizure, emotional lability, depression, confusion, memory loss early signs: anxiety/depression later signs: paresthesia/heightened neuromuscular exitability Chvostek sign (tap carotid gland and then they will twitch in the face), Trousseau sign (compression of the arm leads to hands curling), Tetany
SSx of hypo/hyperglycemia
confusion shaking sweating lethargic 3 P's
Two types of juvenile hypothyroidism: congenital vs acquired
congenital: congenital hypoplastic thyroid gland may provide sufficient amounts of TH during the first 1 or 2 years but be inadequate when rapid body growth increases demands on the glands acquired: from thyroidectomy radiation infection *Rarely occurs from dietary insufficiency in the US*
What do you need to monitor in a pt with DI?
daily weights electrolytes, BUN, urine specific gravity
Therapeutic management of cushing disease
dependent upon the cause care management for steroids -steroid administration early morning -alternate-day schedule
What is the principal disorder of the posterior pituitary gland and what does it do to the body?
diabetes insipidus NOTHING TO DO WITH INSULIN results from hyposecretion of antidiuretic hormone (ADH) -main organ affected is kidneys produces uncontrolled diuresis -spilling urine (large amounts of output) -clear, diluted urine sometimes an early sign of a neurological problems primary causes: familial or idiopathic Secondary causes: trauma, tumors, CNS, infection, aneurysm -head traumas/neurosurgeries should be closely monitored for DI
How do you assign the sex of a baby to a congenital adrenal hyperplasia baby?
diagnose and assign sex to the child according to genotype -sometimes we can't tell what sex to assign which is why we do genotype screening *reconstructive surgery may be required* not all cases are diagnosed at birth
How is pheochromocytoma diagnosed?
diagnosed with 24 hour urine testing to test for catecholamines
Care management (not drugs) of pituitary hyperfunction (one in particular to remember)
early identification of children with excessive growth rates early treatment for improved outcomes *observation for signs of tumor* emotional support addressing body image concerns
Clinical manifestations of lymphocytic thyroiditis
enlarged thyroid -usually symmetric -*firm, nontender* -Freely moveable tracheal compression -sense of fullness -hoarseness -dysphagia -*rarely causes airway obstruction*
First sign of diabetes insipidus?
enuresis (bed wetting)
What is pituitary hyperfunction?
excess GH before closure of epiphyseal shafts results in overgrowth of long bones patients can reach heights of 8 feet or more Vertical growth is accompanied by increased muscle (muscle mass usually goes along with growth) Weight is generally in proportion to height
Cushingoid appearance
excessive hair growth moon faces, red cheeks weight gain pendulous abdomen with red striae poor wound healing ecchymosis
teaching for DM and exercise
extra snacks before and during exercise hydration
diagnostic evaluation of growth hormone deficiency
family hx growth patterns and previous health status physical examination radiographic survey (skeletal survey MRI) Endocrine studies: GH stimulation test -can't go on just the first test. Have to continuously do it at different points
How is diabetes insipidus diagnosed and what occurs during this test?
fluid deprivation test -withhold fluids until they get to a dehydrated state -Normally urine starts to become more concentrated, but with DI it will stay clear and flowing
Drug management hypoparathyroidism
goal is to maintain calcium and phosphate levels IV calcium Vitamin D & oral calcium= long term therapy monitor renal function, BP, serum vitamin D levels maintain seizure and safety precautions
How would parents describe a hypothyroidism baby?
good, quiet baby
What is the most sensitive hormone that can be affected in the body?
growth hormone which is why it's usually the first hormone affected if there is a problem
Clinical manifestations of acromegaly
head lips, jaw, nose paranasal, mastoid sinuses separation and malocclusion of teeth
What are normal SEs of GH SQ medication?
headaches and achiness in muscles
What is the SSx that an *infant* has diabetes insipidus?
irritability; *relieved with feedings of water but not milk* dehydration often occur
What is Graves' Disease
hyperthyroidism excess secretion of TH Enlarged thyroid gland exophthalmos (widened eye balls) incidence peaks between ages 12-14 years, but condition may be present at birth familial association exists Diagnostics: *elevated T3/T4/Decreased TSH*
Read over goiter
hypertrophy of the thyroid gland congenital -usually results from maternal ingestion of antithyroid drugs during pregnancy acquired -result of neoplasm, inflammatory disease, dietary deficiency (but rarely in children), or increased secretion of pituitary thyrotropic hormone
Calcium/phosphate levels in hypo vs hyper parathyroidism
hypo: low calcium high phosphate hyper: increased calcium/ decreased phosphorous
Care management of pheochromocytoma
identification of the condition severe HTN & tachy dysrhythmias may occur behavioral changes
Care management of GH deficiency (not drug)
identifying and assisting with the diagnosis (growth patterns) child and family support (education for GH administration) Emotional adjustment of the child SE headaches and achiness in the muscles best time to administer is at bed time
Care management of SIADH (one in particular)
immediate treatment: fluid restriction Accurate measurements of I&O Observation for signs of fluid overload *seizure precautions bc they are hyponatremic* ADH-antogonizing medications Child and family education -fluid restrictions
What is congenital adrenal hyperplasia?
inability to produce cortisol (sugar) *family of disorders caused by decreased enzyme activity required for cortisol production in the adrenal cortex. The adrenal gland produces excessive amounts of cortisol precursors and androgens to compensate* overproduction of adrenal androgens (sex) virilization in females: male secondary sex hormones varying degrees of ambiguous genitalia *salt-wasting crisis frequently occurs: can't regulate salt water balance
Drug that helps with precocious puberty
leuprolide (Lupron) -slows prepubertal growth to normal rates treatement is discontinued at age when normal pubertal changes are expected to resume
SSx of congenital hypothyroidism in newborn (HESI)
long gestation (>42 weeks) large hypoactive infant delated meconium passage feeding problems (poor suck) prolonged physiologic jaundice hypothermia Symptoms in early infancy if untreated with thyroxine: large, protruding tongue coarse hair/hairline will appear low lethargy, sleepiness flat expression constipation hypotonia Delay of serum phenylalanine testing will lead to CNS damage, including mental retardation
What is another name for Hashimoto's disease?
lymphocytic thyroiditis OR autoimmune thyroiditis
What happens with abrupt withdrawal of steroids (to try and treat Cushing)
may precipitate acute adrenal insufficiency -*Sometimes we can't stop the steroids. We may need to alter them every other day or
What may be revealed while undergoing diagnostic screening for pituitary hyperfunction?
may reveal a tumor -can surgically remove. If we remove all or part of the pituitary gland, we are going to have to replace all of the other hormones that will be missing *diagnostic evaluation of pituitary hyperfunction is the same as hypopituitarism*
What is gland is also known as the "master gland"
pituitary gland 2 main lobes: anterior and posterior
Clinical manifestations of Panhypopituitarism: Antidiuretic hormone
polyuria polydipsia (thirsty. Drinking lots of fluids) dehydration
Clinical manifestations of Type 1 DM
polyuria, polydipsia, polyphagia weight loss hyperglycemia glucose in the urine *increased susceptibility to infection* -often in females, UTIs first sign excessive fatigue
What is often an early sign of DM in childeren?
recurrent vaginal and UTI infections are often an early sign (of type 2), especially in adolescents
What causes hypoparathyroidism?
secondary to other conditions: Infection and autoimmune syndromes postoperatively after thyroidectomy -*report immediately if they have numbness or tingling* conditions during neonatal period due to maternal factor -maternal hyperparathyroidism -maternal DM -formula with high phosphate to calcium ratio
SSx of SIADH
serum osmolality low urine high Hyponatremia (dilutional): anorexia, NV, cramps, irritability, neuro changes, seizures *symptoms alleviated when ADH is decreased*
Clinicalmanifestations of panhypopituitarism: adrenocorticotropic hormone
severe anorexia, weight loss hypoglycemia hypotension hyponatremia, hyperkalemia adrenal apoplexy, especially in response to stress circulatory collapse *remember what cortisol does for the body:* Because most bodily cells have cortisol receptors, it affects many different functions in the body. Cortisol can help control blood sugar levels, regulate metabolism, help reduce inflammation, and assist with memory formulation. It has a controlling effect on salt and water balance and helps control blood pressure.
Clinical manifestations of panhypopituitarism: GH
short stature but proportional height and weight delayed epiphyseal plate closure Delayed bone age proportional to height Premature aging common in later life Increased insulin sensitivity
Drug/procedure management of pheochromocytoma
surgical removal of tumor or tumors May require bilateral adrenalectomy and lifelong glucocorticoid and mineralocorticoid therapy
Clinical manifestations of pheochromocytoma
tachycardia/palpitations headache/dizziness poor weight gain/growth failure NV
If at pt is undergoing removal of tumor in pituitary gland, what is important to teach the pt?
that hormone replacement therapy will be needed in some cases after surgery -thyroid extract -cortisone -sex hormones
What is the main function of the parathyroid?
to maintain serum calcium level -increasing release of calcium and phosphate from bone demineralization -increasing absorption of calcium and excretion of phosphate by the kidneys -promote calcium absorption in GI tract
What is the goal of therapy for Graves' disease?
to retard rate of hormone secretion
What are labs going to look like in a DI pt? Urine osmolality? Serum osmolality? Specific gravity?
urine osmolality high serum osmolality low specific gravity low
When is medication therapy ended for a hypopituitarism pt with GH deficiency?
when growth rates are less than 1 inch/year & bone age is more than: Girls: 14 years of age Boys: 16 years of age
What do you do when you have a positive fluid deprivation test for diabetes insipidus?
you give them vasopressin (ADH) and see if it alleviates polyuria/polydipsia if it does, homeboy's got DI
