Endocrine in Pregnancy and Paediatrics Flashcards
what are the key events in the ovarian cycle
1 - follicular growth
2 - ovulation
3 - luteal function
what hormone is high during ovulation
LH
what day is progesterone measure
day 21
what does the follicle stage/ovum produce
oestradiol
what does the corpus luteum produce
progeseteron
what is detected in pregnancy test
hCG - hormone produced by embryo following implantation
what hormones does the placenta release
Human Placental Lactogen
Placental Progesterone
Placental Oestrogens
what hormone does the pituitary release in respect to pregnancy
prolactin
what are the gonadotrophic hormones
LH
FSH
what contributes to gestational diabetes
- rise in progesterones
- Human Placental Lactogen
- insulin resistance in the mother
when does gestational diabetes disappear
at most 6 weeks after delivery
complications in pregnancy with gestational diabetes
congenital malformation
prematurity
macrosomia - large birth weight
complications in neonate with gestational diabetes
Resp distress
Hypoglycaemia
Hypocalcaemia
what are some of the abnormalities that can be seen
Spina Bifida
Caudal Regression Syndrome
Ureteric duplication
why does macrosomia happen in gestational diabetes
maternal hyperglycaemia»_space; foetal hyperglycaemia»_space; foetal hyperinsulinemia»_space; macrosomia and neonatal hypoglycaemi
Mx of pregnancy in T1 and 2 DM
Folic acid 5mg
Consider changing tablets to insulin
Avoid ACEi, Statin
why should eyes be checked regularly in T1 and T2 DM during pregnancy
accelerated retinopathy
Mx of pregnancy in all diabetics
Good blood sugar control
Monitor HbA1c and BP
what should be ensured during labour
good blood glucose control
IV insulin and IV dextrose
Mx of GDM
Metformin
what are the implications of GDM
50% will develop T2DM after 10-15 years
what happens as a result of there being a increased demand on the thyroid during pregnancy
increase in size
increased T4 levels
plasma protein binding increases
if there is pre-existing hypothyroidism what is advised in pregnancy
increased thyroxine dose by 25mg
check TFTs monthly
how does pregnancy cause thyrotoxicosis
increased hCG, increase thyroxine
thus decreases TSH
resolves by 20w gestation
Hyperthyroid Mx in pregnancy
LOW DOSE anti-thyroid drugs - Propylthiouracil 1st trimester - Carbimazole 2/3rd trimester
what is carbimazole not used in 1st trimester of pregnancy
Can cause embryopathy
Scalp abnormalities
GI abnormalities
Choanal & Oesophageal atresia
why is Propylthiouracil only used in 1st trimester
risk of liver toxicity
what should be check for in pregnancy during 3rd trimester and why
TRAb antibodies
they can cross the placenta and cause neonatal transient hyperthyroidism
what are the primary causes of congenital thyroid disease
Gland dysplastic + / - abnormal site (e.g. sublingual)
inborn error of thyroid hormone metabolism
what are secondary/tertiary causes of congenital thyroid disease
Congenital pituitary disease
usually associated with hypopituitarism (GH, ACTH, Gonadotrophin deficiency)
symptoms of congenital thyroid disease
delayed jaundice
poor feeding but ‘normal’ weight pain
hypotonia
skin and hair changes
what is Guthrie test and when is it done
Capillary blood spot on to dry blotting paper
Measurement of TSH and / or T4 levels
Day 5 after birth
why does congenital thyroid disease need to be treated quickly
Absence of thyroxine after 3 months of age leads to permanent developmental delay “Cretinism”
what is Cretinism
condition of severely stunted physical and mental growth due to untreated congenital deficiency of thyroid hormones (congenital hypothyroidism) usually due to maternal hypothyroidism.
what are causes of acquired thyroid disease in the young
delayed congenital Down syndrome post infectious autoimmune iodine deficiency and nutrition
symptoms of hypothyroidism in the young
growth 'failure' delayed puberty prolonged neonatal jaundice poor general health educational difficulties Goitre
Tx for hypothyroidism in the young
thyroxine replacement for life
- Levothyroxine
symptoms of hyperthyroidism in the young
behaviour problems; sleep disturbance; eating difficulties
goitre
precocious puberty
high thyroid cell antibody titres
Tx of hyperthyroidism in young
Carbimazole
causes of underactive adrenal gland in the young i.e. low steroid production
Primary
- Adrenal hypoplasia
- Congenital adrenal hyperplasia
Secondary
- pituitary disease (congenital/acquired)
- secondary to steroid therapy
causes of overactive adrenal gland in the young i.e. Cushing Syndrome
- high dose cortisol therapy
- Cushing’s disease
what can congenital adrenal hyperplasia cause
ambiguous genitalia (inter sexuality)
what is congenital adrenal hyperplasia
deficiency in an enzyme, most commonly 21 hydroxylase
results in absent cortisol
rise in ACTH causes hyperplasia
high testosterone
symptoms/signs of CAH
vomiting dehydration ambiguous genitalia virilisation precocious puberty hyponatramia hyperhalaemia
