Endocrine in Pregnancy and Paediatrics Flashcards by S B

what are the key events in the ovarian cycle

1 - follicular growth
2 - ovulation
3 - luteal function

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what hormone is high during ovulation

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what day is progesterone measure

day 21

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what does the follicle stage/ovum produce

oestradiol

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what does the corpus luteum produce

progeseteron

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what is detected in pregnancy test

hCG - hormone produced by embryo following implantation

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what hormones does the placenta release

Human Placental Lactogen
Placental Progesterone
Placental Oestrogens

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what hormone does the pituitary release in respect to pregnancy

prolactin

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what are the gonadotrophic hormones

FSH

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what contributes to gestational diabetes

rise in progesterones
Human Placental Lactogen
insulin resistance in the mother

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when does gestational diabetes disappear

at most 6 weeks after delivery

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complications in pregnancy with gestational diabetes

congenital malformation
prematurity
macrosomia - large birth weight

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complications in neonate with gestational diabetes

Resp distress
Hypoglycaemia
Hypocalcaemia

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what are some of the abnormalities that can be seen

Spina Bifida
Caudal Regression Syndrome
Ureteric duplication

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why does macrosomia happen in gestational diabetes

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

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Mx of pregnancy in T1 and 2 DM

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

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

accelerated retinopathy

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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 ```