Endocrine Flashcards
What are some risk factors for Type 1 diabetes?
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
When does Type 1 Diabetes normally present?
preschool or teen years
spring and autumn
How does Type 1 diabetes normally present?
polyuria
polydipsia
weight loss
less common : enuresis, skin sepsis and candida
How is Type 1 diabetes diagnosed?
usually confirmed in symptomatic child - >11.1 mmol/L random blood glucose
> 7mmol/L fasting blood glucose
increased HbA1c
When should Type 2 be suspected?
Fam Hx
Indian Subcontinent
Severely Obese
Signs of insulin resistance (acanthosis nigricans)
PCOS
What are some signs of diabetic ketoacidosis?
acetone on breath
vomiting
dehydration
abdo pain
hyperventilation (Kussmaul)
hypovolaemic shock
drowsiness
coma and death
How would you manage Diabetic Ketoacidosis?
hosp admission
subcut insulin
IV fluids
What are some general non-medical ways of Type 1 diabetic management?
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
Why is it impt to keep rotating insulin injection sites?
avoid lipohypertrophy
What is the typical insulin regime for a child with Type 1 diabetes?
insulin pump OR
short-acting (Lispro, Glulisine) before each meal and snack
long-acting (Glurgine or Detemir) in late evening/and or before breakfast
What should the blood glucose range be in children? HbA1c?
4-10 in children
4-8 in adolescents
HbA1c - 58 mmol/mol (7.5%)
What is hypoglycaemia in children and neonates?
Diabetic children <4 mmol/L (very rare in non-diabetic children)
Neonates <2.6 mmol/L
How would hypoglycaemia present?
hunger
tummy ache
sweatiness
faint
irritability
seizures
coma
In children, what is an easy cure for hypoglycaemia?
Lucozade tablets
What are some problems with glucose control w children?
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
What are some consequences of prolonged hypoglycaemia in neonates?
epilepsy
severe learning difficulties
microcephaly
Why are infants at higher risk of hypoglycaemia?
high energy requirements
relatively poor reserves of glucose from gluconeogenesis and glycogenesis
How would you treat hypoglycaemia in infants?
IV infusion glucose
corticosteroid
After birth what are the levels of TSH like?
surge in TSH»_space; increase T3 and T4, then TSH drops to adult levels
preterm infants may have very low levels of T4, and normal TSH
What is the biggest complication associated with hypothyroidism?
learning difficulties
What are some causes of hypothyroidism?
maldescent of thyroid and athyrosis
dyshormogensis (inbred)
iodine deficiency
tsh deficiency
What is normally seen on the Guthrie test if hypothyroidism?
increased TSH
What is most common cause of hyperthyroid?
Graves
What is a cause of hypoparathyroidism?
DiGeorge syndrome
Addison’s
What syndrome is hyperparathyroidism associated with?
William syndrome
What is Cushing’s? What are some causes?
Glucocorticoid excess
normally side effect of long-term gluco-corticoid treatment - nephrotic syndrome, asthma
How does Cushing’s present?
growth failure
short
face and trunk obesity
red cheeks
hirsutism
striae
HTN
bruising
carb intolerance
osteopenia
*normally obese and short children
Diagnosis and Treatment of Cushing’s?
diurnal variation of cortisol - 24 hr urine free cortisol
Dex
What is congenital adrenal hyperplasia?
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
How does CAH present?
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
How would you diagnoses CAH?
increased 17 alpha -hydroxyprogesterone
low sodium
high potassium
metabolic acidosis
hypoglycaemia
How would you manage CAH?
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
