Endocrine Flashcards
What are the causes of short stature?
Pathological causes of short stature
- Chromosomal abnormalities
- Chronic disease
- Malnutrition
- Psychosocial disease
- Drugs and endocrine disorders (GH deficiency, glucocorticoid excess, hypothyroidism)
In these disease, there may be history points that are abnormal or abnormalities of physical exam
What are the history factors that are important to elicit? (6)
- signs of illness or malnutrition
- Chronic illness
- timing of puberty
- familial growth pattern
- Social Stressor
- Use of meds
What are signs on physical exam of short stature? (5)
- signs of illness or malnutrition
- Stigma of cushing syndrome
- hypothyroidism
- Prader-Willi
- Turner
What are the s/s of hypothyroidism at birth?
As progresses… (6)
- No obvious signs during the first month of life
As progresses… - Lethargy, growth deceleration, large fontanels, brady, hypotonia, macroglossia
Hypothy can lead to mental retardation
What are the signs of hypothyroidism in older kids? (17)
- Weakness, muscle fatigue
- poor growth
- arthralgias
- cramps
- cold intolerance
- constipation
- wt gain
- mental physical slugishness
- poor motor coordination
- dry skin
- thinning hair and brittle nails
- puffy eyes
- thick tongue
- edema of hands and feet
- alopecia
- decreased deep tendon reflexes
- hypoactive bowel sounds and diminished heart sounds
What is the workup for short stature? (9)
- bone age is helpful in making sure that the child does not have constitutional growth delay
- Insulin growth factor (IGF-1, IGPB-3)
- Karyotype
- Thyroid function
- Tissue transglutaminase IGA for celiac disease
- stool for O&P
- sweat test
- urinanalysis
- Head MRI
What is the workup for hypothyroidism? (6)
- Elevated TSH
- T4 and free t4 are both low or low normal
- increased liver enzymes
- Hyponatremia/hypoglycemia
- anemia
- t3 not a good test
What are the signs of constitutional growth delay? (4)
- The typical growth pattern is abnormal size at birth, followed by a decrease in both height and weight velocity in the first years of life
- Normal velocity following lower percentile
- Height and weight are equally affected
- Familial short stature shows a typical pattern described above
How do you differentiate constitutional growth delay from familial short stature?
- while familial short stature looks like constitutional grwoth delay early on there is a difference in both bone age and pubertal staging.
- In children with CGD, there is a delay in bone age as well as puberty and they attain normal adult height
Familial short stature
- Normal short stature
- Bone age is the same as chronological age
- FInal height is decreased from normal
What are the signs of abnormal growth in children? (1)
- If the growth falls of the curve by 2 SD, and is not between the mid parental height
What are the signs of growth failure? (3)
- Height falling from >2SD below mean or from previously established growth
- failure to grow more than 4 cm per year
- Being at the 5th percentile or lower
What is associated with diabetes T1? (2)
- Human leukocyte antigens
2. circulation islet cell antibodies can be found during the first few weeks
What triggers DMT1? (1)
- Infectious or toxic agents that are thought to trigger the pancreatic B cells in predisposed people
What are the sx of DM T1? (7)
- Polydipsia, polyphagia, polyuria
- nocturnal enuresis
- wt loss and hunger
- fatigue, weakness, and paresthesia
- loss of SUBq fat and muscle wasting
- peripheral neuropathy
- skin and vaginal infection
What are dx testing associated with DM T1 (5)
- serum fasting blood sugar >126mg/dL on 2 separate occasions
- Random sugar of greater than 200
- Polyuria, polydipsia, and wt loss
- plasma ketones
- BUN, CR, may be elevated
What is impaired glucose intolerance?
fasting blood glucose between 100 and 125
What is conventional split dose insulin?
- 2/3 NPH with 1/3 regular insulin in AM
Evening dose of 1/2 NPH and 1/2 regular
A 70kg pt 35 units of insulin a day 10 units of regular and 15 units NPH in am 5 units of regular and 5 units of NPH in PM
What is somogyi effect?
Boards like this
- Early AM hyperglycemia due to nocturnal hypoglycemia stimulating a surge of counter regulatory hormones that raise blood sugar, hypoglycemic at 3am and elevated BS at 7am
TX = reduce or eliminate the HS insulin
What is dawn phenomenon? (4)
Tissue is desensitized to insulin nocturnally
Blood sugar is progressively higher through the night and is elevated at 7am
Due to presence of growth hormone at night
TX = add or increase dose of HS insulin
What is T2 Diabetes
- 90% of diabetes
- Not linked to HLA or islet cell antibodies
- Obesity and family hx are factor
What is the tx of T2 diabetes?
metformin 500mg TID or 850 BID
What is hyperthyroidism or graves disease?
causes
- Diffuse enlargement of the thyroid
2. Can be from toxic adenoma, subacute thyroiditis, TSH secreting tumor, high dose amiodarone
What is tx for hyperthyroidism (4)
Propranolol for sx of tachy
Methimazole 30-60mg/day
Proplthiouracil 300mg-600mg daily
Radioactive iodine
