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Endocrine Flashcards

1
Q

what is the most common presenting complaint in pediatric endocrinologist

A

growth disturbances

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2
Q

what is fetal growth dependent on?

A

maternal factors (placental sufficiency, maternal nutrition, IGF-2 and insulin)

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3
Q

what is late infancy and childhood dependont on (hormones)

A

GH/IGF-1 axis and thyroid hormone

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4
Q

what is pubertal growth dependent on?

A

sex hormones
GH/IGF-1 axis
thyroid gland

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5
Q

what can you use skeletal age for?

A

To see how much more they will be able to grow

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6
Q

with endocrine problems what is a child’s weight usually like?

A

normal or excessive weight gain

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7
Q

what are some causes of short stature that are endocrine problems?

A

GH deficiency/ resistance
Hypothyroid
DM

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8
Q

what is a condition where they were following the growth curve but then curve became flat

A

acquired hypothyroidism

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9
Q

what are three causes of growth hormone deficiency?

A

congenital (SOD)
genetic (gene for GH)
acquired (histiocytosis)

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10
Q

what is the most common form of growth hormone deficiency

A

idiopathic

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11
Q

do children with GH deficiency growth normally in the first year?

A

Yes

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12
Q

when does growth drop off established percentile in children with GH deficiency

A

2nd year

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13
Q

Workup for GH deficiency

A 
Xray (bone maturation)
CBC (anemia)
ESR (inflammatory)
urinalysis, BUN/Cr (renal function)
electrolytes, stool for fat
karyotype (trisomies)
thyroid function, IGF-1
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14
Q

Tx for GH defieincy

A

replacement of GH

correct underlying dz process

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15
Q

what is tall stature associated with?

A

pituitary adenoma

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16
Q

what is the difference between gigantism and acromegaly

A

gigantism (epiphysis open)

acromegaly (epiphysis closed)

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17
Q

what is the most common cause of hypothyroid in children?

A

Hashimotos thyroiditis

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18
Q

what labs do you order for hypothyroid?

A

TSH

free T4

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19
Q

what is the most common neonatal metabolish disorder?

A

congenital hypothyroidism

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20
Q

what is an early marker of acquired (juvenile hypothyroidism)

A

growth deceleration

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21
Q

what genetic conditions is there increased incidence of hypothyroidism

A

Trisomy 21

Turner’s

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22
Q

Tx for hypothyroidism?

A

Levothyroxine

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23
Q

what is teh msot common cause of goiter and thyroiditis in childhood?

A

hashimotos (chronic lymphocytic)

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24
Q

child presents with pale, gray, cool mottled skin. Nonpitting edema, constipation, large tongue, poor muscle tone, lordosis, bradycardia, hoarse cry or voice. Lateral thinning of eyes.

A

Hypothyroid

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25
Q

what will labs look like with hypothyroids

A

T3, T4 and FT4 decreased

TSH elevated

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26
Q

what is the most common cause of excess thyroid hormone?

A

Graves

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27
Q

what sex is affected more by graves dz?

A

girls

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28
Q

what is a physical sign of graves?

A

goiter

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29
Q

what causes graves dz?

A

Antibodies directed at TSH receptor that simulated thyroid hormone production.

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30
Q

Patient presents with nervousness, emotional lability, hyperactivity, weight loss, insomnia, personality changes, diarrhea, palpitations, heat intolerance, tremor, increased sweating.

A

Hyperthyroid

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31
Q

what do labs look like with hyperthyroid

A

TSH supressed

FT4, T3 elevated

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32
Q

Tx for hyperthyroid

A 
B blocks
antithyroid meds (PTU, methimazole)
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33
Q

is precocious puberty more common in girls or boys and what is the cause?

A

girls, idiopathic (activation of hypothalamus, central problem )

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34
Q

Girls younger than 8 going through pubertal changes

A

precocious puberty

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35
Q

what test would you get on a girl with central precocious puberty?

A

assses with MRI

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36
Q

what are peripheral causes of precocious puberty

A

ovarian cyst (estrogen)
adrenal tumor
CAH

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37
Q

patient will have symptoms of estrogen excess- breast development and vaginal bleeding?

A

ovarian cysts or tumors

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38
Q

patient wil have adrenarche – pubic hair, axillary hair, acnea, some increased body odor. what type tumor do they likely have (peripheral precocious puberty)

A

adrenal tumors

39
Q

what labs to get for precocious puberty?

A

GnRH (FSH and LH should increase)

if low likely peripheral cause leading to increased estrogen and supression of FSH/ LH

40
Q

what imaging do you get for peripheral precocious puberty cause?

A

US of ovaries and adrenal

41
Q

Treatment for central precocious puberty

A

Lupriolid which will down regulate teh pituitary GnRH receptors and decrease gonadotropin secretion

42
Q

HOw do you treat peripheral precocious puberty caused by CAH?

A

glucocortidcoids

43
Q

How do you tx an ovarian cyst?

A

Watch and wait- regress

44
Q

Precocious puberty in boys occurs before what age?

45
Q

true precocious puberty is boys is usually caused by what?

A

CNS abnormality

46
Q

If a boy under age 9 has large testes is the precocious puberty caused by a central or peripheral process?

A

central process

47
Q

what labs do you get for precocious puberty in boys?

A

Lh
FSH
17 OHP (for CAH)

48
Q

what imaging do you get for a boy for precocious puberty (central)?

A

cranial MRI

49
Q

delayed puberty is no signs by age ___ in boys and age ___ in girls

A

14 in boys, 13 in girls

50
Q

how do you evaluate a child with delayed puberty?

A

wrist xray for bone maturity

51
Q

what labs do you get for delayed puberty?

A

Lh, FSH (if elevated will be primary hypogonadoism)

52
Q

what is the most common cause of delayed puberty in boys?

A

Kleinfelter syndrome

53
Q

what is primary hypogonadism?

A

absence / malfunction/ destruction of ovarian or testicular tissue

54
Q

If there is low LH, FSH what is the cause of delayed puberty?

A

central hypogonadism- other pituitary hormone deficiencies, chronic dz, CNS abnormalities

55
Q

tx for delayed puberty

A

sex steroids

56
Q

most common cause of female pseudohermaphrodite, virilized

57
Q

abnormal develop of testes, defects of sex steroid biosynthesis (testosterone, DHT) androgen receptor defects

A

Male pseudohermaphrodite

undervirilized

58
Q

what is the most frequent cause of ambiguous genitalia in the newborn?

59
Q

what is the most common form of CAH?

A

Elevated 17-hydroxyprogesterone (17-OH)

due to deficiency of 21-hydroxylase

60
Q

how do you treat CAH?

A

hydrocortisone

mineralocorticoid

61
Q

CAH infants are at risk for what?

A

electrolyte imbalances (hypoNa, hyperK, metabolic acidosis)

62
Q

what is the most common cause of excess adrenals in children?

A

exogenous steroids(for RA, lupus, etc)

63
Q

what does a mineralcorticoid deficiency lead to?

A

hypoNa

HyperK

64
Q

child preents with vomiting, dehyration, acidosis, hypotensive shocks. what type adrenal insufficiency do they have?

A

glucocorticoid deficiency

65
Q

tx for adrenal insufficiency?

A

replace hydrocortisone

fludrocortisone

66
Q

what is test for adrenal insufficiency?

A

ACTH stimulation test (cortisol and aldosterone should increase markely after adiministeration of ACTH)

67
Q

Truncal adoposity with thin extremities, moon facies, muscle wasting, weakness, easy bruising, purplish striae
HTN, osteoporosis, glycosuria, hyperglycemia

A

Cushing syndrome

68
Q

what is the most common cause of elevated serum corticosteroids in children <12

A

prolonged exogenous administration of glucocorticoid hormone

69
Q

what condition destroys the adrenal gland. will have a negative ACTH stimulation test (adrenal insufficiency)

A

Addison’s

70
Q

what is the most common cause of elevated serum corticosteroids in children <12

A

prolonged exogenous administration of glucocorticoid hormone

71
Q

what supression test can you do with Cushing’s syndrome?

A

Dexamethasone suppression test – dex suppresses adrenal function normally (cortisol should go down normally)

72
Q

If cushing syndrome is due to a pituitary adenoma, will there be a reponse to dex?

73
Q

what supression test can you do with Cushing’s syndrome?

A

Dexamethasone suppression test – dex suppresses adrenal function normally (cortisol should go down normally)

74
Q

when will a child show symptoms of DM type 1?

A

after 90% of pancreatic islets are destroyed

75
Q

what causes diabetes type 1?

A

immunologic destruction of beta cells of pancreatic islets (occurs over months to years )

76
Q

3 main symptoms of DM Type 1?

A

polyuria
polysdipsia
polyphagia

77
Q

what is the most common endocrine/ metabolic disorder of childhood?

A

Diabetes mellitus type 1

78
Q

what other metabolic disorder is a child with DM at risk for?

A

hypothyroid (2-5%)

79
Q

first lab you order w/ suspicion?

A

fasting blood glucose

80
Q

what other metabolic disorder is a child with DM at risk for?

A

hypothyroid (2-5%)

81
Q

complication of DMT1

A

renal failure and loss of vision

neuropathy

82
Q

what has been shown to reverse or delay kidney damage in people with DM?

83
Q

what do children die from in DKA?

A

cerebral edema (most likely involves osmolar shift of fluid into cells)

84
Q

patient presents with Vomiting
Kussmaul Breathing +/- acetone odor
Abdominal pain
Somnolence  loss of consciousnesscoma

A

Diabetic ketoacidosis

85
Q

3 main signs of DKA

A

ketonuria - diptick/ urinalysis
ketonemia - serum
ketoacidosis pH <7.30

86
Q

why a children with DM peeing and thirsty all the time?

A

osmotic diuresis due to all the sugar

87
Q

Tx for hypoglycemia?

A

IV glucose
bolus 2 ml/Kg of D10W
constant infusion

88
Q

why a children with DM peeing and thirsty all the time?

A

osmotic diuresis due to all the sugar

89
Q

what type DM is Acanthosis nigricans associated with?

90
Q

what part of the adrenal gland produces aldosterone?

A

Zona glomerulosa

91
Q

What part of the adrenal gland produces glucocorticoids and mineralcorticoids

A

Zona fasciculata

92
Q

What part of the adrenal gland produces androgens and estrogens

A

zona reticularis

93
Q

what help maintain BP by supporting vascular tone and promoting Na and H2O retention.

A

glucocorticoids

PEDS (11 decks)

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