Endocrine Flashcards
def. hypoglycemia
BG
endocrine causes of hypoglycemia
- ketotic hypoglycemia
- GH deficiency
- panhypothyroid
- ACTH def.
- addisons
- exo insulin
non-endo causes of hypoglycemia
- sepsis/shock
- liver disease
- ingestion
- inborn errors of metabolism
Sx of hypoglycemia
- sweating
- weakness
- tachycard.
- tremor
- lethargy
- irritability
- confusion
- seizure
- coma
Tx of hypo
5ml/kg of D10W or 2ml/kg D25W
if no IV give glucagon IM or SC
peak ages of T1DM
4-6 and 10-14
- fam Hx significant
3 major emergencies of T1DM
- DKA
- intercurrent illness
- hypoglycemia
DDx for T1DM
- T2DM
- genetic defect in B-cells
- meds
- diseases of exocrine panc.
presentation of T1DM
- polyuria/dypsia
- weight loss
- enuresis
- recent infectiong
- vomiting
- abdo pain
- fam/ Hx
Phx for T1DM
- vitals
- dehydration signs
- lethargy
- Kussmauls
- ketone breath
lab Dx of DM1
- HBa1c > 6.5
- fasting BG > 7
- random BG >11
- urine glucose and ketones
non-DKA mgmt of DM1
- initiate daily dose insulin .4-.6 unit/kg/day
- 2/3 in arm, 1/3 in leg
- 1/3 rapid, 2/3 intermediate
long term mgmt of DM1
- visits q3mos
- illnesses - do not stop insulin, check glucose andketones q4h, ensure fluid intake, ER if vomiting
- hypoglycemia - juice, dextrose tabs
def. short stature
DDx for short
Alone - neglect Bone dysplasia Chromosome - turners, DS Delayed growth - constitutional delay Endocrine - GH def., cushings Familial GI malabsorption - celiac, chrons
def. of non-path short stature
normal growth velocity
3 main types of non-path short
- constitutional delay
- normal velocity
- delayed bone age and puberty
- attain near normal height
- may need short term androgens - family short
- normal bone age, growth velocity, puberty
- Fam Hx
- no Tx - syndromic
- special growth charts for turner and achondroplasia
7 types pf patho short
- primordial - all 3 affected
- chromo
- skeletal dysplasias
- IUGR
- teratogen
- placental insuff. - endocrine
- GH def.
- hypothyroid
- hypopit.
- hyper cort - Chronic disease
- cyanotic heart
- malnutrition
- malabsorption - neglect
Phx for short
- charts
- vitals
- arm span
- systemic changes with endocrine
- sex dev. staging
- upper to lower segment
def. upper to lower segment ration (U/L)
- lower landmark is pubic sym
- normal
newborn - 1.7
4yo - 1.4
adult 0.9 M 1 F
investigations
- midparental height (P102)
2 bone age - endo workup
- chronic illness (lytes, Cr, BUN, LFT, IgG/M/A, ESR
- malabsorption - fecal fat, albumin, celiac screen, sweat chloride
- karyotype
Normal age and dev. order for female puberty
7-13
breast>pubarche>growth>menarche
- early common but less worrysome
Normal age and dev. order for male puberty
9-14
testes>pubarche>peak growth
- early puberty uncommon, but worrysome
Phx for puberty
- growth charting
- stigmata of endocrinopathy - hirsuit, virilization
- tanner staging
3 parts of tanner stage
- pubic hair
- breast dev.
- penis dev.
def. precocious puberty
secondary sexu dev.
isosexual vs. contrasexual
isosexual - phenotypically appropriate sex char
contrasexual - opposite to genotypic type
complications of early puberty
- decreases adult height
- psych outcomes
2 general cat. of etiology of early puberty
- central (GnRh dep)
2. peripheral - GnRh indep.)
features of central early puberty
- bone age adv. + growth accel + sex chars
- high LH/FSH and T and E
- premature HPG activation
- F:M 9:1
features of peripheral
- low LH/FSH, high T and E
-
6 tests to always do for precocious
- bone age
- LH/FSH
- E and T
- DHEA-S
- 17- hydroxyprogesterone
- TSH, T4
mgmt of central early
goal to preserve height
- GnRH agonsist - downregulate when given continuously
mgmt of peripheral early
goals to treat underlying path, limit sexsteroid effects
- ketoconazole, spironolactone, tomoxifen,
intdications to medically delay puberty
- male
- bone age faster than height
- age
def. late puberty
13 in F, 14 in M
- late worse in girls
- absebce of menarche by 16 or 5 years after onset
features of central late
- low LH/FSH and T/E
- delayed bone age
- late HPG activation
feat. of peripheral late
- primary gonadal failure
- high FSH/LH, low T/E
Hx for late
- wieght loss
- family stature
- fam. Hx
- med illness
7 investigations to always do for late
- bone age
- CBC, lytes
- ESR/CRP
- FSH,LH,T/E
- TSH, T4
- IGF-1
- urinalysis
mgmt of late
- ID and fix cause
- hormone replacement (T/E)
