Endocrine emergencies Flashcards
Most common endocrine emergency
Hypoglycemia
Kids are so susceptible because of: Increased metabolic demands Need for constant glucose source for brain development Small glycogen stores Fewer gluconeogenesis precursors
Most common cause of hyperthyroidism in kids
Graves
Presenting symptoms of hyperthyroidism
Palpitations Sinus tachycardia School difficulties Labile emotions Hyperactivity New onset psychiatric symptoms
Symptoms of a thyroid storm
Fever Sweating Tachycardia Hypertension Agitation Confusion N/V
3 main systems
CVS
GI
CNS
Treatment of thyroid storm
Supportive care O2 IVF - Dextrose containing IV Beta-blocker Routine hyperthyroid Tx - Methimazole, propylthiouracil, iodine
Symptoms of congenital hypothyroidism
present at 6-12 weeks (if not caught by neonatal screen)
Constipation Large posterior fontanelle Poor feeding Hypotonia Jaundice Hypothermia
Neonatal hyperthyroid symptoms
Present with neonatal thyrotoxicosis First 2 weeks of life Irritability Sweating Weight loss Poor feeding Vomiting Diarrhea Exophthalmos Goiter Hyperthermia Tachycardia Jaundice Hepatomegaly Cardiac failure
Sx of acute adrenal insufficiency
Dehydration with hypovolemic shock Profound hypoglycemia Hyponatremia Hyperkalemia Hypotension Abdominal pain Altered LOC
Triggered by infection or other physiologic stressor (trauma, surgery etc.)
Other classic signs for adrenal crisis in CAH- ambiguous genitalia in a female, hyperpigmented scrotum in a male
2-5 weeks of life
Emergency treatment for acute adrenal insufficiency
ABCD
Correction of hypoglycemia
Stat stress steroids - Hydrocortisone IV/IM
Fluid resuscitation
Monitoring VS, cardiac, resp, perfusion, glucose, electrolytes
Correct electrolyte abnormalities:
- Hyperkalemia - Sodium polystyrene sulfonate, glucose/insulin, calcium gluconate, sodium bicarbonate
Initial labs: Random cortisol levels Electrolytes Glucose ACTH levels (adrenocorticotropic hormone) Plasma renin activity Aldosterone level Urine electrolytes
Most common form of congenital adrenal hyperplasia (CAH) and incidence
21-hydroxylase deficiency
95% of all cases
Salt-wasting in 30-70%of cases
Incidence is 1 in 10,000-20,000
Presenting symptoms of salt-wasting CAH
Ambiguous genitalia in a female
Hyperpigmented scrotum in a male
2-5 weeks of life
Nonspecific signs mimicking sepsis: Dehydration with hypovolemic shock Profound hypoglycemia Hyponatremia Hyperkalemia Hypotension Abdominal pain Altered LOC Poor feeding Lethargy Poor weight gain Irritability Vomiting
Metabolic acidosis, hyponatremia, hyperkalemia
Treatment of salt-wasting CAH
ABCD - check glucose
IVF resuscitation
Treat hypoglycemia
Treat hyperkalemia (don’t use insulin/glucose method though - likely worsen hypoglycemia)
Most common cause of amenorrhea in adolescents
Pregnancy
OCP use
Pituitary infarction
Uterine synechiae in postpartum adolescents
Outflow obstruction (imperforate hymen, vaginal or uterine agenesis)
Hypoestrogenic state (anorexia, athlete)
DDx of dysfunctional uterine bleeding
Immaturity of the hypothalamic-pituitary axis PCOS Prolactinomas Thyroid dysfunction Von Willebrand disease Diabetes Adrenal hyperplasia Adrenal tumors Other chronic illnesses
2 acute complications of T1DM
DKA
Hypoglycemia
