Endocrinology Flashcards
How might a patient with type 1 diabetes present
25-50% present with diabetic ketoacidosis
Polyuria
Polydipsia
Weight loss
What investigations are needed for type 1 diabetes
Bloods (FBC, U&Es, glucose, TFTs, insulin antibodies)
Blood cultures (if suspect infection)
HbA1c
What is the management for type 1 diabetes
Education
SC insulin regime (background long acting, plus short acting before meals)
Monitor dietary carbohydrate intake
Monitor blood sugar levels
Monitor for complications
What are the short term complications of type 1 diabetes
Hypoglycaemia:
- Hunger, tremors, sweating, irritability, dizziness, pallor, reduced consciousness, coma, death
- Management: rapid acting glucose, slow acting carbohydrates, IV dextrose, IM glucagon
Hyperglycaemia
- Increase insulin dose
What are the long term complications of type 1 diabetes
Macrovascular (coronary artery disease, peripheral ischaemia, poor healing, stroke, hypertension)
Microvascular (peripheral neuropathy, retinopathy, glomerulosclerosis)
Infection-related (UTIs, pneumonia, skin infections)
What is diabetic ketoacidosis
Life threatening emergency
Liver converts fatty acids to ketones
Acetone smell on breath
Get metabolic acidosis
Severe dehydration
Get potassium imbalance (normally driven into cells by insulin)
What are children with DKA at high risk of developing, how is this risk managed
High risk of developing cerebral oedema (if dehydrated brain cells corrected too fast)
Need neuro observations
Signs: headaches, altered behaviour, bradycardia, altered consciousness
Management: slow IV fluids, IV mannitol, IV hypertonic saline
How might a child with diabetic ketoacidosis present
Polyuria
Polydipsia
Nausea and vomiting
Weight loss
Acetone smell on breath
Dehydration
Hypotension
Altered consciousness
Symptoms of underlying trigger (sepsis)
What investigations are needed for diabetic ketoacidosis
Blood glucose > 11
Blood ketones > 3
pH < 7.3
What is the management for diabetic ketoacidosis
Correct dehydration evenly over 48 hours
Fixed rate insulin infusion
Avoid fluid boluses
Treat underlying trigger
Prevent hypoglycaemia (IV dextrose)
Add potassium to IV fluids
Monitor for signs of cerebral oedema
Monitor glucose, ketones, and pH
What are the adrenal hormones affected in adrenal insufficiency
Cortisol
Aldosterone
What is primary adrenal insufficiency
Aka Addison’s disease
Adrenal glands damaged
Mostly autoimmune
What is secondary adrenal insufficiency
Due to low ACTH stimulating adrenal glands
Damage to pituitary (congenital hypoplasia, surgery, infection, radiotherapy)
What is tertiary adrenal insufficiency
Inadequate CRH release from hypothalamus
Due to long term steroid use (over 3 weeks, hypothalamus suppressed)
How might babies with adrenal insufficiency present
Lethargy
Vomiting
Poor feeding
Hypoglycaemia
Jaundice
Failure to thrive
How might older children with adrenal insufficiency present
Nausea and vomiting
Poor weight gain
Reduced appetite
Abdominal pain
Muscle weakness
Cramps
Developmental delay
Bronze hyperpigmentation of skin
What investigations are needed for adrenal insufficiency
Bloods (U&Es, cortisol, ACTH, aldosterone, renin)
Addison’s: low cortisol, high ACTH, low aldosterone, high renin
Secondary: low cortisol, low ACTH, normal aldosterone, normal renin
Short synacthen test (ACTH stimulation test, measure at 0, 30, and 60 mins, should double)
What is the management for adrenal insufficiency
Replace steroid hormones (hydrocortisone for cortisol, fludrocortisone for aldosterone)
Give patients steroid card
Increase dose during acute illness
Regular monitoring (growth and development, bloods)
What is an Addisonian crisis, how is it managed
Adrenal crisis
Presentation: reduced consciousness, hypotension, hypoglycaemia, hyponatraemia, hyperkalaemia
Management: intensive monitoring, IV hydrocortisone, IV fluids, correct hypoglycaemia, monitor U&Es
What is congenital adrenal hyperplasia
Congenital deficiency of 21-hydroxylase enzyme
Underproduction of cortisol and aldosterone
Overproduction of androgens
Autosomal recessive
How does mild congenital adrenal hyperplasia present
During childhood or after puberty
Females: tall for age, facial hair, absent periods, deep voice, early puberty
Males: tall for age, deep voice, large penis, small testicles, early puberty
How does severe congenital adrenal hyperplasia present
Hyponatraemia, hyperkalaemia, hypoglycaemia
Poor feeding
Vomiting
Dehydration
Arrhythmias
Females: ambiguous genitalia, enlarged clitoris
What is the management for congenital adrenal hyperplasia
Cortisol replacement (hydrocortisone)
Aldosterone replacement (fludrocortisone)
Corrective surgery for ambiguous genitalia
Where is growth hormone produced
Anterior pituitary
What are the congenital causes of growth hormone deficiency
Disruption of growth hormone axis
Genetic mutation
Underdevelopment of anterior pituitary
What are the acquired causes of growth hormone deficiency
Infection
Trauma
Surgery
How might a patient with growth hormone deficiency present
At birth: micropenis, hypoglycaemia, severe jaundice
Poor growth (severely slowed from age 2-3)
Short stature
Slow development of movement and strength
Delayed puberty
What are the investigations for growth hormone deficiency
Growth hormone stimulation test (measure response to glucagon or insulin)
Test for associated hormonal deficiencies
MRI brain (structure of pituitary)
Genetic testing
X-ray wrist (bone age)
DEXA scan
What is the management for growth hormone deficiency
Daily SC growth hormone injections (somatropin)
Treat associated hormone deficiencies
Closely monitor height and development
How might a child with congenital hypothyroidism present
At newborn heel prick test
Prolonged neonatal jaundice
Poor feeding
Constipation
Increased sleeping
Reduced activity
Slow growth and development
How might a child with acquired hypothyroidism present
Usually autoimmune
Associated with type 1 diabetes and coeliac disease
Fatigue
Poor growth
Weight gain
Poor school performance
Constipation
Dry skin
Hair loss
What is the management for hypothyroidism
Levothyroxine
