Endocrine and Growth Flashcards
Which thyroid hormone is the active hormone?
T3
which thyroid hormone is the circulating hormone?
T4
Effect of thyroid hormones on growth plate
Chondrocyte growth + maturation
Incidence congenital hypothyroidism
1/4000
Causes of congenital hypothyroidism (4)
Absence thyroid/athyrosis
Dyshormonogenesis
Iodine deficiency
TSH deficiency
Features congenital hypothyroidism (9)
Usually asymp FTT/feed Prolonged jaundice Constipation Pale, cold + mottled skin Large tongue Hoarse cry/features Umbilical hernia Developmental delay
Tx congenital hypothyroidism
Thyroxine @2-3w
Lifelong Tx
Cause of hypothyroidism
AI Thyroiditis
Which congenital syndromes lead to an increased risk of hypothyroidism
Downs
Tuners
Clinical features hypothyroidism (14)
FTT/short stature Cold intolerance Dry skin Cold peripheries Bradycardia Dry thin hair Pale puffy eyes w/ decr eyebrows Goitre Constipation Delayed puberty Obesity Slipper upper femoral discs Deterioration of school work LD
Ix hypothyroidism
Guthrie (incr TSH)
TFT
Mx hypothyroidism
Lifelong levothyroxine
What is hyperthyroidism usually due to?
Graves
Features hyperthyroidism (12)
Anxiety, restless, tremor Sweating Diarrhoea Decr W Incr growth Incr bone maturity TachyC Warm peripheries Goitre (no bruit) LD Psychosis Pre-tibial myxoedema
Ix hyperthyroidism
TFT
Mx hyperthyroidism (4)
Anti-thyroid Dx - carbimazole. PTU
B-blockers
Surgery (subtotal thyroidectomy)
Radioiodine (kill thyroid producing cells)
What is Cushings?
Incr glucocorticoids
Features Cushings (10)
FTT Face/trunk obesity Red cheeks Hirsutism Striae HTN Bruising DM Mm wasting Osteopenia
How to distinguish Cushings from obesity
Obese children - av/> av height
Cushings < av height
Causes of Cushings (3)
Iatrogenic - IV/PO corticosteroid chronic use
Pit adenoma - incr ACTH
Ectopic ACTH prod tumours
Hypoglycaemia
Plasma glucose <2.6mmol
PS hypoglycaemia (3)
Sweating
pallor
CNS signs - irritable, headache, seizures
Which neonates are at incr risk of having hypoglycaemia in the first 24hours?
IUGR Pre-term Mothers w/ DM Large Hypothermic Polycythaemia Ill
Why can many neonates tolerate low blood glucose levels?
B/c can utilise lactate + ketones as E stores
If hypoglycaemia is persistent, what is a child at risk of developing? (2)
Epilepsy
LD
Causes hypoglycaemia in children ( 7)
Fasting
Insulin XS (exogenous, insulinoma, AI, Beckwiths)
W/o Insulin XS (liver disease, hormone deficiency)
Fructose intolerance
Maternal DM
Aspirin poisoning
Galactosemia
In which children should you check glucose levels (3)
If they’ve become:
Septic/shocked
Have prolonged seizures
Altered state consciousness
Ix hypoglycaemia (3)
Glucose levels
Bloods if cause unknown - GH, IGF-1, cortisol, insulin, C-peptide, FFA + ketones, AA, lactate
Urine
Tx hypoglycaemia (3)
IV glucose - 2mg/kg 10% dextrose
Delay/no response - IM glucagon
Corticosteroids if possibility hypopituaritism/hypoadrenalism
Incidence DM
1/500
If a twin is diabetes, what is the % of the other twin getting it
30-40%
PS DM (4)
Polyuria/nocturnal enuresis
Thirst
W loss
Tiredness
How is DM diagnosed (4)
Gluc >11.1
Glucosuria
Ketonuria
Fasting gluc >7
What are the 3 main types of insulin regime
Rapid acting
Short acting
Intermediate
What regimen are most infants started on?
Basal bolus regimen
What is the basal bolus regimen?
Bolus - s.acting before snack
Basal - long acting in evening
0.5-1 U/kg