Endocrine in Pregnancy and Paediatrics

Question 1

what are the key events in the ovarian cycle

Answer 1

1 - follicular growth
2 - ovulation
3 - luteal function

Question 2

what hormone is high during ovulation

Answer 2

LH

Question 3

what day is progesterone measure

Answer 3

day 21

Question 4

what does the follicle stage/ovum produce

Answer 4

oestradiol

Question 5

what does the corpus luteum produce

Answer 5

progeseteron

Question 6

what is detected in pregnancy test

Answer 6

hCG - hormone produced by embryo following implantation

Question 7

what hormones does the placenta release

Answer 7

Human Placental Lactogen
Placental Progesterone
Placental Oestrogens

Question 8

what hormone does the pituitary release in respect to pregnancy

Answer 8

prolactin

Question 9

what are the gonadotrophic hormones

Answer 9

LH

FSH

Question 10

what contributes to gestational diabetes

Answer 10

• rise in progesterones
• Human Placental Lactogen
• insulin resistance in the mother

Question 11

when does gestational diabetes disappear

Answer 11

at most 6 weeks after delivery

Question 12

complications in pregnancy with gestational diabetes

Answer 12

congenital malformation
prematurity
macrosomia - large birth weight

Question 13

complications in neonate with gestational diabetes

Answer 13

Resp distress
Hypoglycaemia
Hypocalcaemia

Question 14

what are some of the abnormalities that can be seen

Answer 14

Spina Bifida
Caudal Regression Syndrome
Ureteric duplication

Question 15

why does macrosomia happen in gestational diabetes

Answer 15

maternal hyperglycaemia&raquo_space; foetal hyperglycaemia&raquo_space; foetal hyperinsulinemia&raquo_space; macrosomia and neonatal hypoglycaemi

Question 16

Mx of pregnancy in T1 and 2 DM

Answer 16

Folic acid 5mg
Consider changing tablets to insulin
Avoid ACEi, Statin

Question 17

why should eyes be checked regularly in T1 and T2 DM during pregnancy

Answer 17

accelerated retinopathy

Question 18

Mx of pregnancy in all diabetics

Answer 18

Good blood sugar control

Monitor HbA1c and BP

Question 19

what should be ensured during labour

Answer 19

good blood glucose control

IV insulin and IV dextrose

Question 20

Mx of GDM

Answer 20

Metformin

Question 21

what are the implications of GDM

Answer 21

50% will develop T2DM after 10-15 years

Question 22

what happens as a result of there being a increased demand on the thyroid during pregnancy

Answer 22

increase in size
increased T4 levels
plasma protein binding increases

Question 23

if there is pre-existing hypothyroidism what is advised in pregnancy

Answer 23

increased thyroxine dose by 25mg

check TFTs monthly

Question 24

how does pregnancy cause thyrotoxicosis

Answer 24

increased hCG, increase thyroxine
thus decreases TSH
resolves by 20w gestation

Question 25

Hyperthyroid Mx in pregnancy

Answer 25

LOW DOSE anti-thyroid drugs - Propylthiouracil 1st trimester - Carbimazole 2/3rd trimester

Question 26

what is carbimazole not used in 1st trimester of pregnancy

Answer 26

Can cause embryopathy
Scalp abnormalities
GI abnormalities
Choanal & Oesophageal atresia

Question 27

why is Propylthiouracil only used in 1st trimester

Answer 27

risk of liver toxicity

Question 28

what should be check for in pregnancy during 3rd trimester and why

Answer 28

TRAb antibodies

they can cross the placenta and cause neonatal transient hyperthyroidism

Question 29

what are the primary causes of congenital thyroid disease

Answer 29

Gland dysplastic + / - abnormal site (e.g. sublingual)

inborn error of thyroid hormone metabolism

Question 30

what are secondary/tertiary causes of congenital thyroid disease

Answer 30

Congenital pituitary disease

usually associated with hypopituitarism (GH, ACTH, Gonadotrophin deficiency)

Question 31

symptoms of congenital thyroid disease

Answer 31

delayed jaundice
poor feeding but ‘normal’ weight pain
hypotonia
skin and hair changes

Question 32

what is Guthrie test and when is it done

Answer 32

Capillary blood spot on to dry blotting paper
Measurement of TSH and / or T4 levels

Day 5 after birth

Question 33

why does congenital thyroid disease need to be treated quickly

Answer 33

Absence of thyroxine after 3 months of age leads to permanent developmental delay “Cretinism”

Question 34

what is Cretinism

Answer 34

condition of severely stunted physical and mental growth due to untreated congenital deficiency of thyroid hormones (congenital hypothyroidism) usually due to maternal hypothyroidism.

Question 35

what are causes of acquired thyroid disease in the young

Answer 35

delayed congenital 
Down syndrome
post infectious
autoimmune
iodine deficiency and nutrition

Question 36

symptoms of hypothyroidism in the young

Answer 36

growth 'failure' 
delayed puberty
prolonged neonatal jaundice 
poor general health
educational difficulties 
Goitre

Question 37

Tx for hypothyroidism in the young

Answer 37

thyroxine replacement for life

- Levothyroxine

Question 38

symptoms of hyperthyroidism in the young

Answer 38

behaviour problems; sleep disturbance; eating difficulties
goitre
precocious puberty
high thyroid cell antibody titres

Question 39

Tx of hyperthyroidism in young

Answer 39

Carbimazole

Question 40

causes of underactive adrenal gland in the young i.e. low steroid production

Answer 40

Primary

• Adrenal hypoplasia
• Congenital adrenal hyperplasia

Secondary

• pituitary disease (congenital/acquired)
• secondary to steroid therapy

Question 41

causes of overactive adrenal gland in the young i.e. Cushing Syndrome

Answer 41

• high dose cortisol therapy

- Cushing’s disease

Question 42

what can congenital adrenal hyperplasia cause

Answer 42

ambiguous genitalia (inter sexuality)

Question 43

what is congenital adrenal hyperplasia

Answer 43

deficiency in an enzyme, most commonly 21 hydroxylase
results in absent cortisol
rise in ACTH causes hyperplasia
high testosterone

Question 44

symptoms/signs of CAH

Answer 44

vomiting
dehydration
ambiguous genitalia
virilisation
precocious puberty
hyponatramia
hyperhalaemia