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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
Q

If hypoglycaemia is persistent, what is a child at risk of developing? (2)

A

Epilepsy

LD

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26
Q

Causes hypoglycaemia in children ( 7)

A

Fasting
Insulin XS (exogenous, insulinoma, AI, Beckwiths)
W/o Insulin XS (liver disease, hormone deficiency)
Fructose intolerance
Maternal DM
Aspirin poisoning
Galactosemia

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27
Q

In which children should you check glucose levels (3)

A

If they’ve become:
Septic/shocked
Have prolonged seizures
Altered state consciousness

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28
Q

Ix hypoglycaemia (3)

A

Glucose levels
Bloods if cause unknown - GH, IGF-1, cortisol, insulin, C-peptide, FFA + ketones, AA, lactate
Urine

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29
Q

Tx hypoglycaemia (3)

A

IV glucose - 2mg/kg 10% dextrose
Delay/no response - IM glucagon
Corticosteroids if possibility hypopituaritism/hypoadrenalism

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30
Q

Incidence DM

A

1/500

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31
Q

If a twin is diabetes, what is the % of the other twin getting it

A

30-40%

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32
Q

PS DM (4)

A

Polyuria/nocturnal enuresis
Thirst
W loss
Tiredness

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33
Q

How is DM diagnosed (4)

A

Gluc >11.1
Glucosuria
Ketonuria
Fasting gluc >7

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34
Q

What are the 3 main types of insulin regime

A

Rapid acting
Short acting
Intermediate

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35
Q

What regimen are most infants started on?

A

Basal bolus regimen

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36
Q

What is the basal bolus regimen?

A

Bolus - s.acting before snack
Basal - long acting in evening
0.5-1 U/kg

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37
Q

How often should Hb1aC in a diabetic child be measured

A

3 times a year

38
Q

7 problems with diabetic control

A 
Eating too many sweets @parties 
Infreq monitoring 
Illness 
Exercise 
Eating disorders 
Family disturbance 
Poor motivation
39
Q

Preventing complications in diabetic child (5)

A 
Growth + pubertal development 
BP 
Renal disease screen
Eyes (every 5years) 
Feet - good care
40
Q

DKA triad

A

Hyperglycaemia >11/1
Ketonaemia >3
Acidosis ph <7/3or HCO3 <15

41
Q

Precipitating factors DKA (5)

A 
Infection
Inadequate insulin 
Unknown DM
Dx - steroids, thiazides
Stress - pregnancy, trauma, surgery
42
Q

Features DKA (8)

A 
Pear drop breath
Vomiting 
Dehydration 
Abdo pain 
Hyperventilation - Kusmmal breathing 
Hypovolaemic shock 
Drowsiness 
Coma + death
43
Q

Ix DKA (7)

A 
Blood gluc
Blood ketones
U+E
ABG
Urinary gluc + ketones
ECG - T wave changes hypokalaemia
Weight
44
Q

Mx DKA (4)

A

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
Q

Which centile is obesity?

A

98th

46
Q

RF obesity (8)

A 
Energy/high fat diet
Sedentary lifestyle 
Low SE status 
FH 
Hypothyroidism 
Cushings 
Prader-Willi
Genetic - Leptin deficiency
47
Q

When would drug treatment be used for obesity?

A

If > 12 and severely/extremely obese

48
Q

Which chromosome is involved in Prader-WIlli

A

Chromosome 15

49
Q

Characteristics Prader Willi

A 
Hyperohagia
Hypotonia 
Hypogonadism 
Short stature
Learning/social difficulties 
Developmental delay 
ASD
50
Q

PS T2DM children (4)

A 
Acanthosis nigricans 
Obesity
HTN
FHX
NO incr thirst or urination
51
Q

Tx T2DM in children (4)

A

Diet
Incr activity
Metformin
Insulin

52
Q

What is Diabetes insipidus

A

Hyposecretion/insensitivity to ADH

Hence inability to concentrate urine in distal tubules –> incr volume dillute urine

53
Q

Central causes diabetes insipidus (6)

A 
Insufficient prod/secretion of ADH
Damage to hypothalamus/pit gland 
Head injury/surgery 
Brain tumour 
Meningitis 
Genetic disorder
54
Q

Nephrogenic causes diabetes insipidus

A 
Lack of kidney response to normal ADH
Kidney failure 
SCD
PKD
Genetics
Lithium
55
Q

Features Diabetes insipidus (3)

A

Incr thirst
Incr urine output
Dehydration

56
Q

What are the 4 phases of normal growth?

A

Foetal stage
Infantile stage
Childhood
Pubertal

57
Q

What is the size of a foetus dependent on? (2)

A

Size of mother

Placental nutrition

58
Q

What 3 things do you need for childhood growth?

A

Good nutrition
Thyroid hormone
Vit D

59
Q

How does Russel Silver Syndrome present from birth? (4)

A 
Poor growth
LBW
Short eight
Differences in size of both sides of body
Cafe-au-lait spots
60
Q

What is mid-parental height

A

Mean of fathers and mothers height + then
If M - +7
If F - -7

61
Q

Whats involved in the GH provocation test? (4)

A

Insulin
Glucagon
Clonidine
Arginine

62
Q

Indications GH provocation test (4)

A

Turners
Prader Willi
Chronic renal failure
IUGR

63
Q

Tx GH deficiency

A

Biosynthetic GH (SC daily)

64
Q

When does breast development start in females?

A

8.5-12years

65
Q

When does menarche happen in females?

A

2.5 years after the start of puberty

66
Q

Early puberty females

A

<8

67
Q

Late puberty females

A

> 13

68
Q

What is first sign of puberty in males

A

Testicular enlargement

69
Q

When does testicular enlargement begin in males?

A

8.5-13 years

70
Q

when does pubic hair begin to grow in men

A

betw 10-14

71
Q

Early puberty boys

A

<9

72
Q

Early puberty girls

A

> 14

73
Q

If puberty is early or late, how can you assess?

A

Bone age measurement

Pelvic USS F - assess uterine size + endometrial thickness

74
Q

What are the 2 types of precocious puberty?

A 
Gonadotrophic dependent (central/true PP)
Gonadotrophic independent - pseudo/false PP
75
Q

What is gonadotrophin dependent precocious puberty?

A

Premature activation of HPA axis

Pituitary releases LH + FSH

76
Q

Causes of gonadotrophin dependent precocious puberty (3)

A

Idiopathic/FH
CNS abnormality - hydrocephalus, tumour
Hypothyroidism

77
Q

What is gonadotrophin independent precocious puberty

A

XS sex steroids

Feedback hence decr LH + FSH

78
Q

Causes gonadotrophin independent precocious puberty (4)

A

Adrenal disorder - tumour, hyperplasia
Ovarian tumour
Testicular tumour
Exogenous sex steroid

79
Q

Ix (7)

A 
Sex steroid 
Gonadotrophin levels - FSH/LH 
TSH/T4 Males - look at testes
MRI 
Bone age measurement 
Pelvic USS in females
80
Q

What is thelarche

A

Premature breast development (6m –> 2y)

81
Q

What is pubarche

A

Premature pubic hair development

82
Q

How can you differentiate Thelarche from precocious puberty

A

No pubic hair/growth spurt Thelarche

83
Q

Prognosis Thelarche

A

Non-progressive

Self limiting

84
Q

How to exclude precocious puberty from Pubarche

A

USS ovaries

85
Q

If you have pubarche, what are you at increased risk of having?

A

PCOS

86
Q

Causes of late puberty (6)

A

Constitutional delay of growth + puberty
Systemic disease e.g. CF, Chrons, anorexia
HPA axis disorder
Kleinfelters, Turners
Steroid hormone deficiency
Acquired gonadal damage

87
Q

Boys - investigations for delayed puberty -2

A

Pubertal staging + testicular volume

ID chronic system disorder

88
Q

Girls - investigations for delayed puberty - 3

A

Karyotype (Turners)
Thyroid hormone
Sex steroid

89
Q

What is gynacomastia

A

Enlargement of male breast tissue

>2cm palpable, firm, subareolar + ductal tissue

90
Q

Causes gynaecomastia (7)

A 
Androgen resistance 
Kleinfleter's 
Leydig cell tumour 
Adrenal tumour 
CAH
Hyperthyroid 
Obesity

CP2 PAEDS (18 decks)

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