Endocrine Flashcards
Most common presenting complaint to pediatric endocrinologist
growth disturbances
fetal growth dependent on
maternal factors
late infancy growth dependent on
GH/IGF-1 axis and thyroid hormone
pubertal growth dependent on
sex hormones as well as GH/IGF-1 axis and the thyroid gland
define short stature
height less than 3% on growth chart
endocrine causes of short stature
growth hormone deficiency or resistance
hypothyroid
diabetes mellitus
Decreased growth velocity, delay in skeletal maturation. Short stature (below 5th percentile), grows normally for first year but drops off during the 2nd. Height may be more retarded than weight
growth hormone deficiency
most common form of growth hormone deficiency
idiopathic
treat GH deficiency
correct underlying disease replace GH (only for FDA approved conditions
what do you worry about with excessive GH secretion (rare)
pituitary adenoma
most common cause of hypothyroid in childhood. Most common cause of goiter and thyroiditis
Hashimotos thyroiditis (autoimmune thyroiditis)
most common neonatal metabolic disorder
congenital hypothyroid
treat hashimoto
levothyroxine (not if euthyroid)
who has increased incidence of hashimoto
trisomy 21, turners
physical and mental sluggishness, pale, gray, cool mottled skin. Non pitting edema, constipation, large tongue, poor muscle tone, lordosis, bradycardia, hoarse cry or voice, skin dry, coarse, scaly, yellowish. Lateral thinning of eyebrows
hypothyroid
most common cause of hyperthyroidism in kids
graves
nervousness, emotional lability, hyperactivity, weight loss. Insomnia, personality changes, diarrhea ,palpitations, heat intolerance,tremor, increased sweating
hyperthyroid (graves)
labs for graves
TSH low
FT4, T3, T4 elevated
labs for hashimoto
T3, T4, and FT4 decreased. TSH elevated
treat hyperthyroid
beta blocker, antithyroid meds (PTU, methimazole)
this is more common in girls. Younger than 8 years old
precocious puberty (central idiopathic precocity)
central precocious puberty
CNS abnormality (tumor) familial
peripheral precocious puberty
ovarian cyst, adrenal tumors, CAH
adrenarche – pubic hair, axillary hair, acnea, some increased body odor
adrenal tumor
Symptoms of estrogen excess – breast development and vaginal bleeding
ovarian cysts or tumors
treat central precocious puberty
GnRH analog- Leuprolide
boys- pseudoprecocious puberty
peripheral stimulation, GnRH independent, small testes
boys- true precocious puberty
central stimulation, GnRH dependent, large testes
define delayed puberty in boys and girls
boys 14 no signs, girls 13 no signs
primary hypogonadism
absence / malfunction/ destruction of ovarian or testicular tissue
central hypogonadism
pituitary or hypothalamic dysfunction (panhypopituitarism, CNS tumor, gonadotropin deficiency)
most common cause of delayed puberty in boys
Kleinfelter syndrome
labs for primary vs central hypogonadism
primary: LH, FSH elevated
central: LH, FSH low
treat hypogonadism
sex steroid replacement
most common cause of female virilization, pseudohermaphrodite
CAH
most frequent cause of ambiguous genitalia in the newborn
CAH
labs for CAH
elevated 17 OH, deficiency of 21 hydroxylase, electrolyte imbalances
treat CAH
hydrocortisone, mineralcorticoid
most common etiology of CAH
deficiency of 21 hydrocylase
adrenal insufficiency
uncommon
CAH
autoimmune destruction (Addisons)
adrenal excess
uncommon, Cushings
Exogenous steroids most common cause of cushings in children
test for adrenal insufficiency
ACTH stim test
treat adrenal insufficiency
replace hydrocortisone, fludrocortisone
Truncal adoposity with thin extremities, moon facies, muscle wasting, weakness, easy bruising, purplish striae
HTN, osteoporosis, glycosuria, hyperglycemia
Cushing’s syndrome
test for cushings
urinary cortisol level
dexamethasone suppression test
type I DM
insulin dependent, juvenile diabetes or IDDM
most common type of DM in children
type I (this is almost not true anymore)
what other endocrine system would you check in a kid with type I DM
thyroid (hypothyroid can be associated)
treat type I DM
insulin, diet,exercise, stress management, glucose monitoring
triad type I DM
polyuria
polydipsia
polyphagia
ancanthosis nigricans
changes in skin related to type II DM
type II DM
“Non-insulin dependent” – insulin resistance and insulin insensitivity
type II DM has an association with this syndrome
polycystic ovarian syndrome
what do children die from in DKA
cerebral edema
ketone effect on serum pH
lower (the produce free hydrogen ions)
treat DKA
replace fluid
insulin
replace body salts
correct acidosis
