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402- Paediatrics > Endocrine > Flashcards

Endocrine Flashcards

1
Q

DKA features [7]

A

Polyuria, polydipsia

Abdominal pain/ vomiting/ nausea

Hyperventilation/ Kusmal breathing

Tachycardia, hypotensive

Reducing GCS

Succussion/ gastric splash

Ketone breath

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2
Q

Features of severe DKA

A

GCS < 12

pH <7.2

O2 < 90%

Ketones > 7 ?

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3
Q

Investigations in DKA

A

Bloods

  • U+Es: hypokalaemia,
  • Glucose, HBA1c
  • FBC= infection
  • VBG
  • CRP, culture

Ketones

ECG

Urine dip/ urinalysis

Imaging
- CXR if infective signs

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4
Q

Initial management of DKA

A

Analgesia for pain

IV fluid resus

  • Saline 0.9% 1L over 1 hours
  • K+ if hypokalaemic

Fixed-rated insulin

  • 0.1mg/ Kg
  • Until glucose reaches 14 mmol/L
  • Stop short acting insulin, continue long-acting

Oxygen if hypoxic

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5
Q

Further management of DKA

A

When glucose reaches 14mmol/L

  • Start dextrose 10%
  • Give insulin 30mins after first feed

Give K+
- Monitor at least 4 hourly

Transition to variable rate insulin

  • When significant clinical improvement
  • Stop dextrose and saline
  • Overlap with Long actin insulin
  • Stop IV insulin after 2nd meal
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6
Q

Precipitating factors for DKA [5]

A

Poor glycaemia control

Acute infection

  • UTI
  • Pnuemonia/ respiratory tract

Surgery

Stress

Trauma

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7
Q

Life-threatening complications of DKA [3]

A

Cerebral oedema

Hypokalaemia

Aspiration pnemonia

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8
Q

Addison’s disease

- Presentation

A

Low cortisol features

  • Hypotension
  • Weight loss
  • Fatigue

Low mineralocorticoid features

  • Polydipsia, polyuria
  • Postural hypotension

Hyperpigmented skin

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9
Q

Initial Investigations for addison’s disease

A

Standing and sitting BP
BMI

Bloods

  • U+Es= low na, raised K+
  • Glucose= low

9am salivary cortisol
- Low

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10
Q

Special investigations for addison’s disease

A

SynACTHen test
- Low cortisol production

Abdominal ultrasound
- rule out CAH

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11
Q

Risk factors for addison’s disease

A

Family Hx

Autoimmune endocrinological disease

  • T1 DM
  • Thyroid disease

Post infective

  • TB
  • HIV
  • Disseminated fungal infection
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12
Q

Addisonian crisis

- Features

A

Acute, abdominal pain
- Vomiting/ nausea

Lethargy

Altering consciousness

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13
Q

Examination and investigative findings for addisonian crisis

A

Hypotension

Hyponatraemia, hypoglycaemia

Hyperkalaemia

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14
Q

Management of addisonian crisis

A

Analgesia for pain

A-E
- IV fluid saline resuscitation

IV hydrocortisone

  • > 6= 100mg
  • > 1= 50mg
  • <1= 25mg

IV hydrocortisone in 5% glucose over 24 hours by IV infusion.

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15
Q

What enzyme is the most common deficient in congenital adrenal hyperplasia?

A

21-hydroxylase

  • Converts progesterone into aldosterone + cortisol
  • In CAH backlog of progesterone is pushed down the testosterone synthesis pathway.

Less common
- 11-beta hydroxylase

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16
Q

Presentation of CAH

A

Precocious puberty

Salt wasting

  • low weight/ failure to thrive
  • fatigue
  • Hyponatraemia, hypokalaemia

Hypoglycaemia

Severe

  • Virilisation of genitals in females (clitomegaly)
  • Amenorrhea (females)
  • Deep voice
17
Q

Complications of gigantism [5]

A

Hyperhidrosis

Recurrent headaches

Cardiomyopathy

Hypopituitarism

Thyroid cancer

18
Q

_______ inhibits the release of growth hormone

A

Somatostatin

19
Q

GH acts on the liver to release ______

A

IGF-1

20
Q

What genetic conditions are associated with gigantism?

A

Multiple endocrinological neoplasia type 1

Neurofibromatosis

McCune Albright syndrome

21
Q

Features of gigantism

A

Intracranial

  • Headache
  • Visual disturbance

MSK

  • Tall stature/ high velocity growth
  • Carpal tunnel
  • enlarged hands, feet

Skin

  • Thicker, oily
  • Skin tags
  • Hyperhidrosis

Development
- Delayed puberty

Metabolic

  • Hyperglycaemia
  • Hypertension
22
Q

Diagnostic tests for gigantism

A

Plasma IGF-1

Oral glucose tolerance test
- 75g glucose does not lower GH levels <1mcg/L

Imaging
- Pituitary MRI

23
Q

Management of gigantism

A

Somatostatin analogues= octreotide IM

  • Reduce GH production
  • Started before surgery

2nd line
- Carbogoline (dopamine agonist)

Surgery
- Transphenoidal hypophysectomy

402- Paediatrics (15 decks)

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