Endocrine Flashcards
Type I Diabetes mellitus presentation
<19 yo
Polyuria, polydipsia, nosturia
Weight loss, lethargy
DKA is often the initial presentation (anorexia, nausea, vomiting, dehydration, stupor, and,
ultimately, coma)
Type I Diabetes mellitus pathophys
Pancreatic β cells fail to repsond to stimuli and undergo autoimmune destruction
Type I Diabetes mellitus w/u
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
Type I Diabetes mellitus tx
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
Type II Diabetes mellitus pathophys
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
Type II Diabetes mellitus presentation
DKA
Hyperglycemia w/o ketonuria
Polyuria, polydipsia
Lethargy
Often occurs at onset of puberty as this causes ↑ insulin resistance
Type II Diabetes mellitus w/u
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
Type II Diabetes mellitus tx
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
Overweight BMI
BMI 85-95th percentile
25-29.9
Obese BMI
BMI > 95th percentile
30-34.9
Severe obesity BMI
BMI > 120th percentile or BMI > 35
Obesity tx
Refer all obese children < 2 to a specialist
Tx for underlying eating disorders
Firm limits on screen time
Establish habitual physical activity
Educational handouts
Hypercalcemia common causes
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
Hypercalcemia presentation
Asymptomatic until >12 mg/dL
Anorexia, nausea, constipation, polyuria, polydipsia, dehydration, Δ in consciousness (lethargy, stupor, coma)
Orthostatic hypotension, tachycardia
Hypercalcemia w/u
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
Hypercalcemia tx
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
Hyperthyroidism presentation
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
Hyperthyroidism w/u
↑ T3 and free T4
Low TSH levels
Peroxidase Ab and thyroglobulin Ab are + in Graves dz but not toxic multibodular goiter
Hyperthyroidism tx
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)
Hypothyroidism presentation
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
Hypothyroidism w/u
Primary: ↑ TSH, ↓ T4
Secondary: low or nrml TSH and ↓ T4
Antithyroid peroxidase and antithyroglobulin Ab in serum confirms autoimmune
Hyponatremia
Hypothyroidism tx
Levothyroxine 25-200 micrograms QD
T4 needs inc in 3rd trimester of preg and with some meds
Once stable check levels twice yearly
Short stature presentation
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
Short stature w/u
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
