endo Flashcards
male pubertal development sequence
testicular growth pubarche penile growth spermarche peak height
female pubertal development sequence
thelarche
pubarche
peak height velocity
menarche
delayed puberty age cutoffs
girls: 13
boys: 14
premature adrenarche
elevated DHEA and DHEA-S
low testosterone
assoc: exogenous androgen, androgen secreting tumor, late onset CAH, PCOS
causes of premature thelarche
premature HPA activation
exogenous estrogen
estrogen producing tumor
benign (infants/toddlers - resolves by age 4)
consequence of precocious puberty
short adult height
when to use GnRH with precocious puberty
<6 yo
male
rapid sx
psychosocial disturbances
inheritance of androgen insensitivity
X linked
syndromes assoc with pan hypo pit
Prader Willi
Kallmann
septo-optic dysplasia
where does Mullerian inhib factor come from?
Y chromosome
male infant with shock and excessive scrotal pigmentation
CAH
female infant with shock and posterior labial adhesions
CAH
most common cause of CAH
21-hydroxylase deficiency
high 17 OHP levels
can have salt wasting variety
cafe au lait spots, bony abnormalities, and endocrinopathies
McCune Albright
Cushing Syndrome dx
gold standard: 24hr urinary free cortisol excretion
midnight sleeping plama cortisol
dex suppression
DI, exophthalmos, lytic bone lesions
Hand Schuller Christian triad of Langerhans Cell histiocytosis
post pituitary involvement
hormones from post pit
ADH
oxytocin
rate of height growth prior to puberty
5-6cm/year
micropenis, short stature, hypoglycemia, septo-optic dysplasia, breech presentation
congenital GH deficiency
calculate mid parental height
sum of parents heights
+ 5 if boy, - 5 if girl
divide by 2
+/- 2 inches
macrocephaly, cognitive defects, tall stature
Sotos syndrome
can you mix synthroid with soy formula
no - decreases absorption
boy with normal TSH and low total T4
X-linked thyroxine binding globulin deficiency
dx confirmed with TBG level
no replacement necessary
differentiate Hashitoxicosis and Graves
radioiodine uptake - high in Graves, low/normal in Hashi
tx Hashimoto
lifelong levothyroxine
tx Graves
methimazole
no PTU
surgery if methimazole ineffective
tx neonatal thyrotoxicosis
methimazole until maternal Abs cleared
constipation, fatigue, muscle weakness
hypercalcemia
causes of hypercalcemia
Williams
ingestion (vitamin D, A, thiazides)
skeletal disorders/immobilization
hyperparathyroidism
tx hypercalcemia
fluids, lasix, EKG
muscle spasms, vomiting, seizures resistant to benzos
hypocalcemia
can have prolonged QT
causes of hypocalcemia
pseudohypoparathyroidism (PTH resistance) nutritional DiGeorge nephrotic syndrome renal
hypocalcemia and hyperPh
hypoPTH
hypercalcemia and hypoPh
hyperPTH
hypocalcemia and hypoPh
vit D deficiency
hypocalcemia resistant to Ca replacement
think about mag
bone pain, growth delay, widening of joint spaces
Rickets
serum alk phos ALWAYS elevated
causes of vit D deficient Rickets
BF w/o supps no sun exposure low BW/prematurity vegan diets liver disease --> poor absorption
low Ca, normal 25-OH vit D, low 1,25-OH vit D
vit D dependent rickets
AR
inadequate renal prod of activated vit D
tx vit D dependent rickets
D2 and 1,25 vit D
low Ph, low Ca, high alk phos, high PTH, high 1,25 vit D
hereditary vitamin D resistant rickets
end organ resistance
AR
low Ph, normal Ca, high alk phos, normal PTH, normal vit D levels
X linked hypophosphatemic rickets
XL dominant
tx: 1,25 vit D and phos
