ENDOCRINOLOGY

Question 1

Type 2 Diabetes in Adolescents - Risk Factors

Answer 1

1. Ethnicity: Blacks, Asians, Native Americans
2. Family History of diabetes
3. Gestation Diabetes in Mother
4. Low birth weight
5. Rapid weight gain in childhood
6. Low socioeconomic status
7. Antipyschotics

Question 2

Type 2 Diabetes in Adolescents

1. Diagnosis

Answer 2

• Guidelines recommend screening using either fasting, random, or 2-h post-challenge glucose, or HbA1c .
• Raised HbA1c should be confirmed with a second HbA1c test.
• Symptoms (e.g., thirst, polyuria, weight loss, and fatigue) in adolescents should be type 1 diabetes, unless there are strong indications for other forms of diabetes.

Question 3

Type 2 Diabetes in Adolescents

1. Symptoms/ Clinical Presentation

Answer 3

The classic features of type 2 diabetes in adolescence are obesity, evidence of insulin resistance (e.g., acanthosis nigricans, seen in 86% of participants in the TODAY cohort), absence of autoantibodies, and a strong family history of type 2 diabetes, with ethnic minority groups being most at risk.

Severe acute presentations of type 2 diabetes are uncommon in adolescents. Only 67% (⅔) present with symptoms of diabetes, with a third identified through screening of at-risk adolescents. Acute symptoms at presentation are rarely those of diabetic ketoacidosis, found in only 6–11% of incident cases.

Question 4

Type 2 Diabetes in Adolescents

1. Should there be routine screening for obese adolescents?
2. What is the most common complication of diabetes in adolescents?

Answer 4

1. There is no evidence to support screening of obese adolescents for type 2 diabetes. The vast majority of obese adolescents do not have type 2 diabetes and do not develop it in adolescence.
2. Renal disease is the most common and earliest complication of adolescent type 2 diabetes, with a higher risk of progression than in childhood type 1 diabetes or adult type 2 diabetes.

TYPE 1 is still more common in prepubertal adolescents than type 2 is

Question 5

Type 2 Diabetes in Adolescents

1. Management
2. Monitoring- at diagnosis, at each visit, annually

Answer 5

1. Metformin and insulin are the only drugs currently licensed for use in adolescent type 2 diabetes.
2. ISPAD suggests screening for all potential complications at diagnosis, including for obstructive sleep apnea, nonalcoholic fatty liver disease, and depression, as well as for pregnancy. Thereafter ISPAD suggests monitoring of HbA1c levels and blood pressure at each visit and annual monitoring of retinopathy, microalbuminuria, dyslipidaemia, and liver function, with less frequent screening for obstructive sleep apnea and depression. Evaluation of smoking and other substance use should be part of annual screening.

Question 6

HYPOTHYROIDISM

1. List FOUR risk factors for thyroid disease.

Answer 6

• Personal history of thyroid disease
• Strong family history of thyroid disease
• Diagnosis of autoimmune disease (RA, SLE, Prencious anemia, Vitilgo, T1DM, Celiac)
• Past history of neck irradiation
• Drug therapies such as lithium and amiodarone
• Women over age 50
• Elderly patients
• Women 6 weeks to 6 months post-partum

Question 7

Hypo vs HyperTSH

Compare and contrast symptoms

Answer 7

Question 8

Hypothyroidism

-What autoimmune conditions are associated

Answer 8

1. RA
2. SLE
3. Type 1 DM
4. Pernicious anemia
5. Vitiligo
6. Celiac

Question 9

Subclinical Hypotsh

• Values of TSH and T4
• When to treat

Answer 9

TSH high. T4 normal. Most normalize within 5 year. 2-5 % then progress to full hypoTSH

No treatment is TSH <10 ; Normal T4 ; Asx; Not pregnant

• Consider treatment in the following cases:
  
  • TSH≥ 10 mIU/L
  • TSH< 10 mIU/L in addition to one of the following: positive TPO, Goitre, Pregnancy, Strong family history of autoimmune disease

Question 10

Hypothyroidism

• When does post partum hypoTSH usually occur
• What is the classic

Answer 10

1. 6-12 months post partum
2. Classic triphasic course: hyperthyroid → hypothyroid → recovery

Question 11

Hypothyroidism

• Indications for referall to specialist

Answer 11

• Children and infants
• Patients in whom it is difficult to render and maintain a euthyroid state
• Pregnancy
• Women planning conception
• Cardiac disease (CAD, arrhythmias)
• Presence of goiter, nodule, or other structural changes in the thyroid gland
• Presence of other endocrine disease such as adrenal and pituitary disorders
• Unusual causes of hypothyroidism such as those induced by agents ex. amiodarone and lithium
• Central hyptsh (decreased TSH and decreased T4)
• Myxedema coma