Endocrine Flashcards

1
Q

What are the signs & symptoms of type 1 DM?

A
5-7yrs & pre-puberty
Symptoms over a period of weeks
Polyuria
Polydipsia
Nocturia/enuresis
Weight loss
Infections (Candida)
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2
Q

How is type 1 DM investigated?

A

Random glucose: >11.1
Urine dip
Bloods: U&Es, autoantibodies
Blood pH: Exclude DKA

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3
Q

What is the pathophysiology of T1DM?

A

Autoimmune disorder
T-Cell mediated destruction & progressive loss of pancreatic beta cells
Insulin deficiency & hyperglycaemia

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4
Q

How is T1DM managed?

A

Insulin
Child: 0.5-1u/kg/day
Adolescent: 1-2u/kg/day

Annual flu vaccine
Retinal checks

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5
Q

What are the blood sugar targets for a child with T1DM?

A

HbA1c: 48mmol/mol measured 4times a year

Weight & growth measured at the same time

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6
Q

What are the different insulin regimes available?

A

2 dose:Short acting & intermediate acting
3 dose:Short acting & intermediate at breakfast, short at evening meal, intermediate at bedtime
Basal bolus: Bedtime long-acting bolus, fast acting w/every meal
Continuous subcut infusion: Short acting

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7
Q

What are the advantages of each type of insulin regimen?

A

2 dose: Simple
3dose: Reduced frequency of nocturnal hypoG
Bolus: Mimics physiological secretion, flexibility w/meals & exercise, insulin dose adjustment
Infusion: Red frequency of hypoG, flexibility w/meals & exercise, insulin dose adjustment, no bolus

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8
Q

What are the disadvantages of each type of insulin regimen?

A

2does: Mix insulins, peak action not correspond with meal times, hypoG so between meal snacks
Bolus: More injections, more frequent BM monitoring
Infusion: No long acting insulin, interruption- risk of DKA, greater management expertise, more frequent BM monitoring

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9
Q

What are the complications of impaired sugars in T1DM?

A

HypoG: <3.5, hunger, pallor, sweating, dizziness Tx: Oral glucose
Unwell: Insulin requirements change (25-30%)
DKA: Dehydration, hyperglycaemia, ketones
Long-term: Microalbuminaemia, retinopathy

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10
Q

What are the long-term complications of T1DM?

A

Microvascular: Retinopathy, diabetic nephropathy, peripheral & autonomic neuropathy
Macrovascular: HTN, Coronary heart disease
Almost never seen in children

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11
Q

What autoimmune conditions are children with T1DM at risk of?

A

Autoimmune thyroiditis
Coeliac disease
Adrenal insufficiency
All screened for annually

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12
Q

What are the RFs for T2DM?

A
Obesity
FHx
PCOS
SGA
Ethnicity: Asian, Afro-carribbean
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13
Q

How is T2DM investigated?

A
Presence of risk factors
Absence of pancreatic autoAb
Lack of absolute/persistent insulin deficiency
Random plasma glucose >11
Evidence of insulin resistance
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14
Q

How is T2DM managed?

A

Mild: Lifestyle intervention
Drugs: 200-500mg/day Metformin
Long-acting Insulin

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15
Q

What are the causes of hypothyroidism?

A

Congenital: Thyroid dygenesis, Iodine deficiency
Acquired: RT/Surgery, Intracranial tumours, medications, iodine deficiency

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16
Q

What are the signs & symptoms of hypothyroidism?

A

Congenital: Umbilical hernia, Jaundice, Constipation, Hypotonia, Hoarse cry, Dry skin, Poor feeding
Acquired: Goitre, Weight gain, Delayed growth & skeletal maturation, Dry coarse skin, Mental slowness

17
Q

How is hypothyroidism investigated?

A

Congenital: Guthrie heel prick test, Bloods: High TSH, Low T4
Acquired: Bloods: High TSH, Low T3/T4, autoimmune- Thyroid antibody screen

18
Q

How is hypothyroidism managed?

A

Congenital & Acquired: Levothyroxine
Congenital: Monthly T4, TSH levels
Acquired: 4-6monthly TFTs

19
Q

What are the complications of hypothyroidism?

A

Short stature
Poor motor coordination
Ataxia

20
Q

What is Phenylketonuria?

A

Inborn error of amino acid metabolism due to absence of phenylalanine hydroxylase enzyme
Converts Phenylalanine to Tyrosine
Important in formation of catecholamines, melanin & neurotransmitters
Autosomal Recessive

21
Q

What are the signs & symptoms of Phenylketonuria?

A
Developmental delay
Progressive mental retardation
Seizures
Fair hair
Light blue eyes
Vomiting
Musty odour
Derm abnormalities
Self-mutillation
22
Q

How is Phenylketonuria investigated?

A

Heel Prick
Aminoaciduria
MRI
Genetic testing

23
Q

How is Phenylketonuria managed?

A

Protein restriction
Weekly: Biochem monitoring till school age then 2weekly
Adolescents: Monthly

24
Q

What are the complications of Phenylketonuria?

A

High plasma levels of Phenylalanine
Formation of phenylpyruvic acid & phenylethylamine
Neurotoxic- learning disabilities & seizures by 6-12m

25
What are the specific signs of different vitamin deficiencies?
``` Night Blindness: Vit A Rickets: Vit D Bleeding: Vit K Beri Beri & Wernickes: Vit B1 Scurvy: Vit C ```
26
What are the causes of Rickets?
Vit D deficiency: Dark skin, Sun-cream Defect in Vit D: CKD, enzyme deficiency, anti-epileptics metabolism/action Phosphate deficiency Calcium deficiency
27
What are the signs & symptoms of Rickets?
``` Frontal bossing wide sutures Craniotabes Rachitic rosary Harrison's sulcus (chest in under rib cage) Skeletal deformities- Bowing of legs Growth delay/arrest Bone pain/fractures Muscle weakness ```
28
How is Rickets investigated?
25-Hydroxyvitamin D <25 Bone Profile: Ca, PO4, LFTs-ALP X-ray: Osteopenia, cupping of distal ends of bones
29
How is Rickets treated?
Colecalciferol 50000u/week for 6weeks then maintenance dose 1,25 Dihydroxy Vit D3 replacement therapy For 8-12weeks 6m: 3000u <12yr: 6000u >12: 10000u
30
What are the signs & symptoms of DKA in a child?
Signs associated w/Diabetes: Polydispia, polyuria, lethargy, weight loss Signs associated w/ketoacidosis: Abdo pain, N&V, laboured breathing
31
What are the causes of DKA?
Often triggered by an acute infection e.g pharyngitis
32
Why is laboured breathing seen in DKA?
Body trying to compensate for the acidosis by blowing off excess CO2.