Endocrine

Question 1

Type I Diabetes mellitus presentation

Answer 1

<19 yo

Polyuria, polydipsia, nosturia

Weight loss, lethargy

DKA is often the initial presentation (anorexia, nausea, vomiting, dehydration, stupor, and,
ultimately, coma)

Question 2

Type I Diabetes mellitus pathophys

Answer 2

Pancreatic β cells fail to repsond to stimuli and undergo autoimmune destruction

Question 3

Type I Diabetes mellitus w/u

Answer 3

Difrentiate from DM2 by islet auto Ab screen

Random plasma glucose >200 mg/dL w/classic sx or fasting levels of ≥126 mg/dL on more than one occasion is diagnostic

HbA1c reflects glycemic control over the preceding 8-12 wks, ≥6.5% is diagnostic of DM

Question 4

Type I Diabetes mellitus tx

Answer 4

Formal training and education using a diabetes team

Intensive insulin regimen

Address depression and anxiety

Annual urine microalbumin

Ophtho visits at age 10 or after 3-5 years of diagnosis

Lipid screens

Periodic autoimmune thyroid and celiac screening

Question 5

Type II Diabetes mellitus pathophys

Answer 5

Distribution of fat to the upper body (central obesity) is assoc w/ highest risk

The basic physiology is twofold:
insulin resistance to β cell–produced insulin and relative insulin deficiency, especially with dz progres- sion

Resistance is ↑ with aging, sedentary lifestyle, and abdominovisceral obesity

Question 6

Type II Diabetes mellitus presentation

Answer 6

DKA

Hyperglycemia w/o ketonuria

Polyuria, polydipsia

Lethargy

Often occurs at onset of puberty as this causes ↑ insulin resistance

Question 7

Type II Diabetes mellitus w/u

Answer 7

Random glucose >200 mg/dL (w/ sx), fasting glucose ≥ 126 mg/dL on more than one occasion or HbA1c ≥ 6.5%

Differentiate from DM1 by presence of excess weight, acanthosis nigricans, HTN, dyslipidemia, PCOS, FH, ethnic group risk factors

Screen at risk children with BMI > 85th percentile and 2+ additional risk factor screen q 3 years

Question 8

Type II Diabetes mellitus tx

Answer 8

Treat co-morbidities

If asymptomatic → lifestyle Δ only w/ wt loss and ↑ activity → if noimprovement → metformin

If severe → begin insulin then wean off to metformin

Screen for HTN, dyslipidemia, NAFLD

Annual ophtho visits

Annual microalbumin screens

Annual diabetic neuropathy screens

Question 9

Overweight BMI

Answer 9

BMI 85-95th percentile

25-29.9

Question 10

Obese BMI

Answer 10

BMI > 95th percentile

30-34.9

Question 11

Severe obesity BMI

Answer 11

BMI > 120th percentile or BMI > 35

Question 12

Obesity tx

Answer 12

Refer all obese children < 2 to a specialist

Tx for underlying eating disorders

Firm limits on screen time

Establish habitual physical activity

Educational handouts

Question 13

Hypercalcemia common causes

Answer 13

MC caused by lunc ca, SCC of head, neck and esophagous, MM, lymphoma, RCC

Can also be caused by vitamin D intoxication, hyperparathyroidism, and sarcoidosis

Question 14

Hypercalcemia presentation

Answer 14

Asymptomatic until >12 mg/dL

Anorexia, nausea, constipation, polyuria, polydipsia, dehydration, Δ in consciousness (lethargy, stupor, coma)

Orthostatic hypotension, tachycardia

Question 15

Hypercalcemia w/u

Answer 15

Serum Calcium high

Corrected calcium = meas total calcium + [0.8 (4 x albumin)]

Chest radiography → underlying pulm mass

UA to checm for hematuria (an early sign of RCC)

24 hr urine Calcium → if elevated urine calcium → malig neoplasm or paraneoplastic process, if dec urine ca → hyperparathyroidism

Question 16

Hypercalcemia tx

Answer 16

Isotonic saline forvol depletion

Loop diuretics if the pt is
hypervolemic after vol repletion
Bisphosphonates can also be considered in severe hypercalcemia

Manage the underlying cause

Question 17

Hyperthyroidism presentation

Answer 17

Weight loss despite good intake

Anxiety, warm, moist skin, onycholysis, insomnia

Fine tremor, fatigue, muscle cramps, weakness

Women report menstrual irregularity

Tachycardia, palpitations, PVC, forceful heartbeat

Δ in bowel pattern, menorrhagia, brittle hair, heat intol, hyperreflexia

3% of pts experience pretibial myxedema

Question 18

Hyperthyroidism w/u

Answer 18

↑ T3 and free T4

Low TSH levels

Peroxidase Ab and thyroglobulin Ab are + in Graves dz but not toxic multibodular goiter

Question 19

Hyperthyroidism tx

Answer 19

β- blockers (propranolol) to control sx (tachycardia, termor, diaphoresis, anxiety, palpitation)

PTU (good forpregnancy or breast feeding) and MMI

Check TSH levels in 4-6 wks

Thyroidectomy, radioactive iodine ablation, iodinated contrast agents (temporart)

Question 20

Hypothyroidism presentation

Answer 20

Weakness, dry or coarse skin, lethargy, slow speech, cold intolerange, eyelid edema, forgetfulness, facial edema, constipation, coarse hair, weight gain, facial dullness, depression, anemia, brdycardia, hyporeflexia

Palpable diffusely enlarged thyroid w/ fine nodules is often presnet

Question 21

Hypothyroidism w/u

Answer 21

Primary: ↑ TSH, ↓ T4

Secondary: low or nrml TSH and ↓ T4

Antithyroid peroxidase and antithyroglobulin Ab in serum confirms autoimmune

Hyponatremia

Question 22

Hypothyroidism tx

Answer 22

Levothyroxine 25-200 micrograms QD

T4 needs inc in 3rd trimester of preg and with some meds

Once stable check levels twice yearly

Question 23

Short stature presentation

Answer 23

Apparent b4 2nd yr of life

Manifests as deceleration in height

Height closely matches parental height

Nml devel w/o toher signs or sx of dz

Question 24

Short stature w/u

Answer 24

CBC, ESR, US, BUN and Cr, serum electrolytes including Ca2+ and phos, exam of stool for fat, karyotype, IGF and IGT-binding protein 3

Radiography of distal radius will reveal bone age = to chronological age

Question 25

Short stature tx

Answer 25

Reassure parents that deceleration is normal and expected, especially if both parents are short.