Endocrine

Question 1

What are some risk factors for Type 1 diabetes?

Answer 1

identical twin has 30-40% chance of developing disease

increased risk if parent has insulin-dependant diabetes

increased risk of HLA-DR3 or HLA-DR4

Question 2

When does Type 1 Diabetes normally present?

Answer 2

preschool or teen years

spring and autumn

Question 3

How does Type 1 diabetes normally present?

Answer 3

polyuria

polydipsia

weight loss

less common : enuresis, skin sepsis and candida

Question 4

How is Type 1 diabetes diagnosed?

Answer 4

usually confirmed in symptomatic child - >11.1 mmol/L random blood glucose

> 7mmol/L fasting blood glucose

increased HbA1c

Question 5

When should Type 2 be suspected?

Answer 5

Fam Hx

Indian Subcontinent

Severely Obese

Signs of insulin resistance (acanthosis nigricans)

PCOS

Question 6

What are some signs of diabetic ketoacidosis?

Answer 6

acetone on breath

vomiting

dehydration

abdo pain

hyperventilation (Kussmaul)

hypovolaemic shock

drowsiness

coma and death

Question 7

How would you manage Diabetic Ketoacidosis?

Answer 7

hosp admission

subcut insulin

IV fluids

Question 8

What are some general non-medical ways of Type 1 diabetic management?

Answer 8

Injection of Insulin - technique and sites

Diet - less refined carbs, less than 30% fat intake, ‘carb counting’ for insulin calculation

‘sick-day-rule’ during illness to prevent DKA

blood glucose monitoring

recognition and treatment of hypoglycaemia

Question 9

Why is it impt to keep rotating insulin injection sites?

Answer 9

avoid lipohypertrophy

Question 10

What is the typical insulin regime for a child with Type 1 diabetes?

Answer 10

insulin pump OR

short-acting (Lispro, Glulisine) before each meal and snack

long-acting (Glurgine or Detemir) in late evening/and or before breakfast

Question 11

What should the blood glucose range be in children? HbA1c?

Answer 11

4-10 in children

4-8 in adolescents

HbA1c - 58 mmol/mol (7.5%)

Question 12

What is hypoglycaemia in children and neonates?

Answer 12

Diabetic children <4 mmol/L (very rare in non-diabetic children)

Neonates <2.6 mmol/L

Question 13

How would hypoglycaemia present?

Answer 13

hunger

tummy ache

sweatiness

faint

irritability

seizures

coma

Question 14

In children, what is an easy cure for hypoglycaemia?

Answer 14

Lucozade tablets

Question 15

What are some problems with glucose control w children?

Answer 15

sweets and snacks

illness (increased insulin)

exercise (decreased insulin)

puberty (GH, oestrogen and testosterone all antagonise insulin) > increase from 0.5-1U/Kg/day > 2U/kg/day

can learn that glycosuria can be used to aid losing weight

Question 16

What are some consequences of prolonged hypoglycaemia in neonates?

Answer 16

epilepsy

severe learning difficulties

microcephaly

Question 17

Why are infants at higher risk of hypoglycaemia?

Answer 17

high energy requirements

relatively poor reserves of glucose from gluconeogenesis and glycogenesis

Question 18

How would you treat hypoglycaemia in infants?

Answer 18

IV infusion glucose

corticosteroid

Question 19

After birth what are the levels of TSH like?

Answer 19

surge in TSH&raquo_space; increase T3 and T4, then TSH drops to adult levels

preterm infants may have very low levels of T4, and normal TSH

Question 20

What is the biggest complication associated with hypothyroidism?

Answer 20

learning difficulties

Question 21

What are some causes of hypothyroidism?

Answer 21

maldescent of thyroid and athyrosis

dyshormogensis (inbred)

iodine deficiency

tsh deficiency

Question 22

What is normally seen on the Guthrie test if hypothyroidism?

Answer 22

increased TSH

Question 23

What is most common cause of hyperthyroid?

Answer 23

Graves

Question 24

What is a cause of hypoparathyroidism?

Answer 24

DiGeorge syndrome

Addison’s

Question 25

What syndrome is hyperparathyroidism associated with?

Answer 25

William syndrome

Question 26

What is Cushing’s? What are some causes?

Answer 26

Glucocorticoid excess

normally side effect of long-term gluco-corticoid treatment - nephrotic syndrome, asthma

Question 27

How does Cushing’s present?

Answer 27

growth failure

short

face and trunk obesity

red cheeks

hirsutism

striae

HTN

bruising

carb intolerance

osteopenia

*normally obese and short children

Question 28

Diagnosis and Treatment of Cushing’s?

Answer 28

diurnal variation of cortisol - 24 hr urine free cortisol

Dex

Question 29

What is congenital adrenal hyperplasia?

Answer 29

group of autosomal recessive disorders

affect adrenal steroid biosynthesis

in response to resultant low cortisol levels the anterior pituitary secretes high levels of ACTH

ACTH stimulates the production of adrenal androgens that may virilize a female infant

Question 30

How does CAH present?

Answer 30

virilisation of the external genitalie in female infants (clitorial hypertrophy and variable fusion of labia)

enlarged penis and scrotum pigmented

salt-losing adrenal crisis - vomiting, weight loss, floppiness and circulatory collapse

tall stature in male non salt losers

muscular build, adult body odour, pubic hair and acne

precocious puberty

Question 31

How would you diagnoses CAH?

Answer 31

increased 17 alpha -hydroxyprogesterone

low sodium

high potassium

metabolic acidosis

hypoglycaemia

Question 32

How would you manage CAH?

Answer 32

females - corrective surgery to ext genitalia (as they have uterus and ovaries)

males in salt-losing crisis - saline, dextrose and hydrocortisone IV

long term - glucocorticoids

fludrocortisone

monitor growth, skeletal maturity and plasma androgens and 17 alpha-hydroxyprogesterone