Endocrine cases lec Flashcards
causes of hypothyroidism
radioactive iodine therapy thyroid surgery previous Tx with thiomide drugs autoimmune thyroiditis iodine deficiency lithium, amiodarone hypothalamic or pituitary insufficiency
TSH inc T4 dec
primary hypothryoidism
TSH and T4 decreased
central hypothyroidism
TSH increased T4 normal
subclinical hypothyroidism
TSH increased T4 increased
use of oral contraceptives
medical management hypothyroidism
levothyroxine
repeate TSH every 6 weeks until stabilized
consider liothyronin if no response(problem is in the liver)
What is required for Dx of metabolic syndrome
3 of 5 are met Abdominal obesity BP >130/85 TG >150 HDL men 100
what is considered obese in men and women
men >102 cm
women >88cm
causes of metabolic syndrome
obesity insulin R increasing age proinflammatory state genetics endocrine
labs and imaging for metabolic syndrome
fasting lipids fasting glucose HbA1c liver funciton tests Free testosterone level
medical management in metabolic syndrome
dyslipidemia
HTN control
insulin control
ddx addisons
adrenal fatigue substance abuse malignancy DM HIV
causes of addisons
withdrawal long term corticosteroids sheehan autoimmune adrenal insufficiency TB HIV waterhouse friderichesen syndrome fungal disease adrenal hemorrhage or infarction from anticoagulants metastatic disease drugs sarcoidosis amyloidosis
lab levels that suggest addisons
low cortisol and high ACTH
no increase in cortisol after an ACTH stimulation test
in utero size depends on
ETOH tobacco, stress
after how long do children generally reach there general growth velocity percentil
18-24 mo
what is growth fialure
pathologic state abnormally low rate
loss of 2+ percentile lines
reasons for growth failure
failure to thrive, hormonal, metabolic
what is idiopathic short stature
height > 2SD below average
familial short stature
short in comparison to matched population but consistent with familial
what is non familial short stature
short in comparison to both population and family
what is consititutional delay of growth and puberty
temporary delay in the skeletal growth and height of child with no other physical abnormalities causing the delay
catch up later
what helps narrow differential for short stature
onset of growth delay
signs of Turners
webbed neck, low set ears, broad chest
what are signs of noonan
webbed neck, double curve scoliosis and rib deformities
signs russel silver
triangular face, clinodactyly, blue sclera, lack of subcut fat
what are signs of skel dysplasias
multiple fractures, missing collar bones, underdeveloped joints, impaired tooth development
work up for dropping off the growth chart (severe growth failure)
CMP, CBC, Esed rate, liver function tests, UA
imaging: bone age with XR of left hand and wrist
if GH stimulation test is +
GH deficiency
Tx GH deficiency
daily growth hormone injections
what is the idea behind somatosensory mapping
relationships maintained through proprioception via articular surfaces, ligaments, tendons and muscles
removes obstacles to optimal biomechanical function to encourage optimal somatosensory mapping
What are growth spurts
period of rapid growth or rapid motion of the body
when is the best time to manipulate a child with growth deficiency
before projected growth spurt
what areas are good to Tx in growth deficiency
junctions, limbs/joints, cranial base (most proprioception)
set up for diaphragm release in child
doc posterior and reachs fingers anteriorly inferior border rib cage
posteriorly thumbs are engaging thoracolumbar junction 11-12 ribs T12-L1
methods to Tx cervial thoracic junction
BLT
first rib and thoracic inlet
seated toddler alternative approach
