Endocrinology

Question 1

Symptoms/signs of diabetes type 1?

Answer 1

• Early: polydipsia, polyuria, weight loss. Less commonly enuresis (urinary incontinence) + recurrent infection.
• Some children present late in DKA

Question 2

What are the signs of DKA

Answer 2

acetone smell on breath, vomiting, dehydration, abdo pain, hyperventilation/Kussmaul breathing, hypovalaemic shock, coma/death

Question 3

Diagnosis of diabetes

Answer 3

random blood >11.1 mmol/L or fasting blood glucose >7 mmol/L. Or raised HbA1c.

Question 4

Education needed for child with diabetes

Answer 4

• technique and sites of insulin injection
• understanding of diabetes
• reduced refined carb diet, healthy diet
• Adjustment of diet and insulin for exercise and sick day rules
• blood glucose monitoring and blood ketones when well

Question 5

What regime is usually used to manage diabetes

Answer 5

basal injection of long acting insulin. bolus injection of short acting insulin before meals

Question 6

How do you prevent lipodystrophy

Answer 6

Rotate the injection spot for insulin so subcutaneous fat doesn’t harden and prevent normal absorption of insulin

Question 7

Over what time period does Hba1C measure glucose control

Answer 7

Over a period of last 3 months

Question 8

How does chronic exposure to hyperglycaemia lead to problems

Answer 8

Causes damage to endothelial cells of blood vessels. High levels of sugar also causes suppression of the immune system, creating optimal environment for infectious organisms to thrive.

Question 9

What is main cause of CAH and what does it result in

Answer 9

Congenital deficiency of 21-hydroxylase enzyme. Causes underproduction of cortisol and aldosterone, and overproduction of androgens from birth.

Question 10

What is the function of aldosterone and where is it released

Answer 10

Released by adrenal gland in response to renin. Acts on kidneys to increase sodium reabsorption into the blood and increase potassium secretion into urine.

Question 11

Presentation of CAH in severe cases

Answer 11

• Hyponatremia, hyperkalaemia, hypoglycaemia -> vomiting, weight loss, floppiness, circulatory collapse, dehydration, arrhythmia (salt losing crisis)
• females: virilised/ambiguous genitalia + enlarged clitoris.

Question 12

CAH presentation in milder cases

Answer 12

Skin pigmentation, Tall for age, facial hair, deep voice, absent periods/large penis, small testicles, early puberty

Question 13

Management of CAH

Answer 13

Hydrocortisone/cortisol replacement, aldosterone replacement, corrective surgery (if virilised genitalia)