Endocrine Flashcards
What is congenital hypothyroidism
When hypothyroidism presents at birth
Types of congenital hypothyroidism
Athyreosis
Thyroid dysgenesis
Dyshormonogenesis
Ix for congenital hypothyroidism
All babies screened at birth
Heel prick blood test
The Guthrie Card
Rx for congenital hypothyroidism
Paediatric endocrinologist
Levothyroxine
Causes of acquired hypothyroidism
Autoimmune (Hashimoto’s Thyroiditis)
Hypopituitarism
Trisomy 21
Define acquired hypothyroidism
Hypothyroidism acquired after birth
Clinical features of hypothyroidism
Stunted growth (short limbs) Delayed dentition Inactivity Lack of energy Constipation Dry skin Slow mental development Poor school performance Delayed puberty Slow speech Hair loss Weight gain
Rx for acquired hypothyroidism
Levothyroxine
Which type of DM is mainly seen in children
Type I
Pathology of Type I DM
Autoimmune condition
T cell mediated destruction of pancreatic beta cells
Insulin deficiency
Therefore, glc in the blood cannot be taken up by tissues
Blood glc increases
THINK symptoms DM
Thirsty
Thinner
Tired
Toilet
Ix for DM
Test immediately:
Random blood glc >11mmol/l
Fating blood glucose >7mmol/l
Rx for DM
MDT team
Insulin
(may benefit from sub. cut insulin infusion)
What is the most concerning complications of DKA in children
Cerebral oedema
Pathology of DKA
Insulin deficiency
Rise in counter-regulatory hormones (e.g glucagon, cortisol, growth hormone)
Inappropriate gluconeogenesis
Accelerate catabolism from lipolysis of adipose tissues
Increased fatty acid circulation
Clinical features of DKA
Confusion Dehydration (severe) Vomiting Polyuria Polydipsia W.t loss Abdominal pain Sweet smelling breath ‘pear drops’ Rapid, deep ‘sighing’ respiration (Kussmaul’s Respiration)
Children <5yrs DM signs
Heavier than usual nappies Blurred vision Candidiasis (oral, vulval) Constipation Recurring skin infections Irritability Behavioural changes
Ix for DKA
Hyperglycaemia:
>11mmol/l
Acidosis:
Venous pH <7.3
Ketones present:
Urine (dipstick)
Blood
Emergency Rx of DKA
Fluid resuscitation (0.9% IV saline no K+)
IV fluids maintenance (+ correction of K+)
Start IV insulin (after 1hr of fluid)
Avoid bicarbonate
What should you avoid RX in DM
Bicarbonate
Most common cause of obesity in children
Simple obesity
Common causes obesity
Poor diet
Decreased exercise
Genetics FH
Which medications can cause weight gain children
Sodium valproate
Carbamezepine
Steroids
Medical causes obesity in children
Hypothyroidism
Cushing’s Syndrome
GH deficiency
Prader-Willi Syndrome
What is abnormal relating to obesity
Short and obese
For <4yrs which charts should be used to measure child obesity
WHO charts
For >4yrs which measurement should be used to measure child obesity
BMI
Is Ix commonly needed for obesity
No rarely needed
Rx for obesity
Diet modification
Exercise
If underlying condition treat
Medium term consequences child obesity
Insulin resistance Type II DM Sleep apnoea Orthopaedic problems Non-alcoholic fatty liver disease
Long term consequences child obesity
Atherosclerosis Early onset CVD Some cancers (part. breast and bowel) Subfertility Hypertension
Is diet alone Rx recommended
No
which gender go through puberty earlier?
Females
Common causes short stature
short parents
Late growth spurt
Pathological causes short stature
Undernutrition Hypothyroidism Turner Noonan Deprivation Iatrogenic - steroids Chronic illness (JIA, coeliac)
Which staging system is used to measure puberty
Tanner
Causes delayed puberty
Gonadal dysgenesis (Turner, Klinfelter) Chronic disease (asthma, Crohn's) Impaired HCG axis
What does Tanner Staging take into account
Breasts
Pubic hair
Genitals
Axillary hair
