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CP2 PAEDS > Endocrine and Growth > Flashcards

Endocrine and Growth Flashcards

1
Q

Which thyroid hormone is the active hormone?

A

T3

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2
Q

which thyroid hormone is the circulating hormone?

A

T4

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3
Q

Effect of thyroid hormones on growth plate

A

Chondrocyte growth + maturation

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4
Q

Incidence congenital hypothyroidism

A

1/4000

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5
Q

Causes of congenital hypothyroidism (4)

A

Absence thyroid/athyrosis
Dyshormonogenesis
Iodine deficiency
TSH deficiency

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6
Q

Features congenital hypothyroidism (9)

A 
Usually asymp 
FTT/feed 
Prolonged jaundice 
Constipation 
Pale, cold + mottled skin 
Large tongue 
Hoarse cry/features 
Umbilical hernia
Developmental delay
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7
Q

Tx congenital hypothyroidism

A

Thyroxine @2-3w

Lifelong Tx

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8
Q

Cause of hypothyroidism

A

AI Thyroiditis

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9
Q

Which congenital syndromes lead to an increased risk of hypothyroidism

A

Downs

Tuners

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10
Q

Clinical features hypothyroidism (14)

A 
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
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11
Q

Ix hypothyroidism

A

Guthrie (incr TSH)

TFT

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12
Q

Mx hypothyroidism

A

Lifelong levothyroxine

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13
Q

What is hyperthyroidism usually due to?

A

Graves

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14
Q

Features hyperthyroidism (12)

A 
Anxiety, restless, tremor 
Sweating 
Diarrhoea 
Decr W
Incr growth 
Incr bone maturity 
TachyC 
Warm peripheries 
Goitre (no bruit) 
LD
Psychosis 
Pre-tibial myxoedema
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15
Q

Ix hyperthyroidism

A

TFT

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16
Q

Mx hyperthyroidism (4)

A

Anti-thyroid Dx - carbimazole. PTU
B-blockers
Surgery (subtotal thyroidectomy)
Radioiodine (kill thyroid producing cells)

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17
Q

What is Cushings?

A

Incr glucocorticoids

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18
Q

Features Cushings (10)

A 
FTT
Face/trunk obesity 
Red cheeks 
Hirsutism 
Striae 
HTN
Bruising 
DM 
Mm wasting 
Osteopenia
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19
Q

How to distinguish Cushings from obesity

A

Obese children - av/> av height

Cushings < av height

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20
Q

Causes of Cushings (3)

A

Iatrogenic - IV/PO corticosteroid chronic use
Pit adenoma - incr ACTH
Ectopic ACTH prod tumours

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21
Q

Hypoglycaemia

A

Plasma glucose <2.6mmol

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22
Q

PS hypoglycaemia (3)

A

Sweating
pallor
CNS signs - irritable, headache, seizures

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23
Q

Which neonates are at incr risk of having hypoglycaemia in the first 24hours?

A 
IUGR
Pre-term 
Mothers w/ DM 
Large 
Hypothermic 
Polycythaemia 
Ill
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24
Q

Why can many neonates tolerate low blood glucose levels?

A

B/c can utilise lactate + ketones as E stores

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25
If hypoglycaemia is persistent, what is a child at risk of developing? (2)
Epilepsy | LD
26
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
27
In which children should you check glucose levels (3)
If they've become: Septic/shocked Have prolonged seizures Altered state consciousness
28
Ix hypoglycaemia (3)
Glucose levels Bloods if cause unknown - GH, IGF-1, cortisol, insulin, C-peptide, FFA + ketones, AA, lactate Urine
29
Tx hypoglycaemia (3)
IV glucose - 2mg/kg 10% dextrose Delay/no response - IM glucagon Corticosteroids if possibility hypopituaritism/hypoadrenalism
30
Incidence DM
1/500
31
If a twin is diabetes, what is the % of the other twin getting it
30-40%
32
PS DM (4)
Polyuria/nocturnal enuresis Thirst W loss Tiredness
33
How is DM diagnosed (4)
Gluc >11.1 Glucosuria Ketonuria Fasting gluc >7
34
What are the 3 main types of insulin regime
Rapid acting Short acting Intermediate
35
What regimen are most infants started on?
Basal bolus regimen
36
What is the basal bolus regimen?
Bolus - s.acting before snack Basal - long acting in evening 0.5-1 U/kg
37
How often should Hb1aC in a diabetic child be measured
3 times a year
38
7 problems with diabetic control
``` Eating too many sweets @parties Infreq monitoring Illness Exercise Eating disorders Family disturbance Poor motivation ```
39
Preventing complications in diabetic child (5)
``` Growth + pubertal development BP Renal disease screen Eyes (every 5years) Feet - good care ```
40
DKA triad
Hyperglycaemia >11/1 Ketonaemia >3 Acidosis ph <7/3or HCO3 <15
41
Precipitating factors DKA (5)
``` Infection Inadequate insulin Unknown DM Dx - steroids, thiazides Stress - pregnancy, trauma, surgery ```
42
Features DKA (8)
``` Pear drop breath Vomiting Dehydration Abdo pain Hyperventilation - Kusmmal breathing Hypovolaemic shock Drowsiness Coma + death ```
43
Ix DKA (7)
``` Blood gluc Blood ketones U+E ABG Urinary gluc + ketones ECG - T wave changes hypokalaemia Weight ```
44
Mx DKA (4)
Fl - over 42-72hrs + monitor Insulin infusion 0.05-0.1U/Kg. Change to 4% dextrose after 24hrs to avoid hypogylcaemia K+ ID and Tx cause
45
Which centile is obesity?
98th
46
RF obesity (8)
``` Energy/high fat diet Sedentary lifestyle Low SE status FH Hypothyroidism Cushings Prader-Willi Genetic - Leptin deficiency ```
47
When would drug treatment be used for obesity?
If > 12 and severely/extremely obese
48
Which chromosome is involved in Prader-WIlli
Chromosome 15
49
Characteristics Prader Willi
``` Hyperohagia Hypotonia Hypogonadism Short stature Learning/social difficulties Developmental delay ASD ```
50
PS T2DM children (4)
``` Acanthosis nigricans Obesity HTN FHX NO incr thirst or urination ```
51
Tx T2DM in children (4)
Diet Incr activity Metformin Insulin
52
What is Diabetes insipidus
Hyposecretion/insensitivity to ADH | Hence inability to concentrate urine in distal tubules --> incr volume dillute urine
53
Central causes diabetes insipidus (6)
``` Insufficient prod/secretion of ADH Damage to hypothalamus/pit gland Head injury/surgery Brain tumour Meningitis Genetic disorder ```
54
Nephrogenic causes diabetes insipidus
``` Lack of kidney response to normal ADH Kidney failure SCD PKD Genetics Lithium ```
55
Features Diabetes insipidus (3)
Incr thirst Incr urine output Dehydration
56
What are the 4 phases of normal growth?
Foetal stage Infantile stage Childhood Pubertal
57
What is the size of a foetus dependent on? (2)
Size of mother | Placental nutrition
58
What 3 things do you need for childhood growth?
Good nutrition Thyroid hormone Vit D
59
How does Russel Silver Syndrome present from birth? (4)
``` Poor growth LBW Short eight Differences in size of both sides of body Cafe-au-lait spots ```
60
What is mid-parental height
Mean of fathers and mothers height + then If M - +7 If F - -7
61
Whats involved in the GH provocation test? (4)
Insulin Glucagon Clonidine Arginine
62
Indications GH provocation test (4)
Turners Prader Willi Chronic renal failure IUGR
63
Tx GH deficiency
Biosynthetic GH (SC daily)
64
When does breast development start in females?
8.5-12years
65
When does menarche happen in females?
2.5 years after the start of puberty
66
Early puberty females
<8
67
Late puberty females
>13
68
What is first sign of puberty in males
Testicular enlargement
69
When does testicular enlargement begin in males?
8.5-13 years
70
when does pubic hair begin to grow in men
betw 10-14
71
Early puberty boys
<9
72
Early puberty girls
>14
73
If puberty is early or late, how can you assess?
Bone age measurement | Pelvic USS F - assess uterine size + endometrial thickness
74
What are the 2 types of precocious puberty?
``` Gonadotrophic dependent (central/true PP) Gonadotrophic independent - pseudo/false PP ```
75
What is gonadotrophin dependent precocious puberty?
Premature activation of HPA axis | Pituitary releases LH + FSH
76
Causes of gonadotrophin dependent precocious puberty (3)
Idiopathic/FH CNS abnormality - hydrocephalus, tumour Hypothyroidism
77
What is gonadotrophin independent precocious puberty
XS sex steroids | Feedback hence decr LH + FSH
78
Causes gonadotrophin independent precocious puberty (4)
Adrenal disorder - tumour, hyperplasia Ovarian tumour Testicular tumour Exogenous sex steroid
79
Ix (7)
``` Sex steroid Gonadotrophin levels - FSH/LH TSH/T4 Males - look at testes MRI Bone age measurement Pelvic USS in females ```
80
What is thelarche
Premature breast development (6m --> 2y)
81
What is pubarche
Premature pubic hair development
82
How can you differentiate Thelarche from precocious puberty
No pubic hair/growth spurt Thelarche
83
Prognosis Thelarche
Non-progressive | Self limiting
84
How to exclude precocious puberty from Pubarche
USS ovaries
85
If you have pubarche, what are you at increased risk of having?
PCOS
86
Causes of late puberty (6)
Constitutional delay of growth + puberty Systemic disease e.g. CF, Chrons, anorexia HPA axis disorder Kleinfelters, Turners Steroid hormone deficiency Acquired gonadal damage
87
Boys - investigations for delayed puberty -2
Pubertal staging + testicular volume | ID chronic system disorder
88
Girls - investigations for delayed puberty - 3
Karyotype (Turners) Thyroid hormone Sex steroid
89
What is gynacomastia
Enlargement of male breast tissue | >2cm palpable, firm, subareolar + ductal tissue
90
Causes gynaecomastia (7)
``` Androgen resistance Kleinfleter's Leydig cell tumour Adrenal tumour CAH Hyperthyroid Obesity ```

CP2 PAEDS (18 decks)

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