Endocrine 3 Flashcards
What are the values for obesity in children?
• For clinical use, overweight is a BMI >91st centile and obese is a BMI >98th centile, very severe obesity is
>3.5 SD above the mean- extreme obesity >4 SD
• For children over 12 yrs-overweight is BMI >25, obese >30, very severe obesity >35 and extreme obesity Is
>40kg/m2
What is the drug treatment used for obesity in >12?
extreme obesity (>40kg/m2) or have a BMI >35kg/m2 o Orlistat- is a lipase inhibitors, which reduces the absorption of dietary fat and thus produces steatorrhoea, fat intake should be reduced to avoid the unpleasant GI side effects o Metformin- is a biguanide that increases insulin sensitivity, decreases gluconeogenesis and decrease GI glucose absorption
What are common syndromes associated with obesity?
- Orthopaedic- slipped upper femoral epiphysis, tibia vara (bow legs), abnormal foot structure and function
- Idiopathic intracranial hypertension- headaches, blurred optic disc margins
- Hypoventilation syndrome daytime somnolence, sleep apnoea, snoring, hypercapnia, heart failure
- Gallbladder disease
- Polycystic ovarian syndrome
- Type 2 DM
- Hypertension
- Abnormal blood lipids
- Other medical sequelae- eg. asthma, changes in left ventricular mass, increased risk of certain malignancies (endometrial, breast & colonic)
- Psychological sequelae- low self-esteem, teasing, depression
How does type 2 diabetes present?
• It tends to be commoner in girls, the range of onset is generally 12-16yrs
acanthosis nigricans, obesity and hypertension
there may be a strong family history and no history of excess thirst or increased urination
• Treatment should include activity, diet, metformin and potential insulin therapy where required
What is Prader-Willi?
Occurs when a child has 2 copies of chromosome 15q11-13 inheritred from the maternal side
• Angelman syndrome occurs when there are 2 copies of the same region inherited from the paternal side
1 in 15,000-30,000 people, but appears to be more sporadic than familial
What are the clinical features of Prader-Willi?
o Characteristic facies- almond shaped eyes, narrowing of the forehead at the temple, narrow bridge of nose, thin upper lip and upturned mouth o Hypotonia o Neonatal feeding difficulties o Failure to thrive in infancy o Obesity in later childhood o Hypogonadism o Developmental delay o Learning difficulties
What are the features of congenital hypothyroidism?
Usually asymptomatic FTT Feeding problems Prolonged jaundice Constipation Pale, cold, mottled dry skin Coarse facies Large tongue Hoarse cry Goitre Umbilical hernia Delayed development
What are the features of acquired hypothyroidism?
Female > males Short stature/growth failure Cold intolerance Dry skin Cold peripheries Bradycardia Thin, dry hair Pale, puffy eyes with loss of eyebrows Goitre Slow-relaxing reflexes Constipation Delayed puberty Obesity Slipped upper femoral epiphysis Deterioration in school work Learning difficulties
What are the features of hyperthyroidism?
Anxiety Increased appetite Sweating Diarrhoea Weight loss Rapid growth in height Advanced bone maturity Tremor Tachycardia, wide PP Warm peripheries Goitre (bruit) Learning difficulties/behavioural Psychosis Exophthalmos Ophthalmoplegia Lid retraction Lid lag
What occurs with thyroid hormones during birth?
small amount of thyroxine transfer from the mother to the foetus
foetal thyroid predominantly produces ‘reverse T3’, which is a derivative of T3 and is largely inactive
What occurs with thyroid hormones after birth?
there is a surge in the level of TSH which is accompanied by a marked rise in T3 & T4 levels
TSH declines to the normal adult range within a week
• Preterm infants may have very low levels of T4 for the 1st few weeks of life- TSH is normal. No additional thyroxine is required
What does congenital hypothyroidism cause?
o Maldescent of the thyroid & athyrosis
o Dyshormonogenesis
o Iodine deficiency
o TSH deficiency
What is juvenile hypothyroidism?
usually caused by autoimmune thyroiditis
an increased risk in Down or Turner children
Treated with thyroxine
How is congenital hypothyroidism detected?
Guthrie test
identifying a raised TSH in the blood
thyroid dysfunction secondary to pituitary abnormalities may not be picked up at neonatal screening as they will have a low TSH
• Treatment with thyroxine is started at 2-3 weeks of age
What is the management for hyperthyroidism?
Carbimazole or Propylthiouracil
beta-blockers can be added for symptomatic relief of anxiety, tremor and tachycardia
• Medical treatment is given for about 2yrs, which should control thyrotoxicosis, but the eye signs may not resolve
• Radioiodine treatment is simple and is no longer considered to result in later neoplasia
• Neonatal hyperthyroidism-may occur in infants of mothers with Graves disease from the transplacental transfer of TSIs, treatment is required as it is potentially fatal, but it resolves spontaneously with time
