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Paediatrics > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

define DKA

A

pH <7.3 or plasma HCO3- <15
and
blood ketones >3mmol/l
- sometimes: blood glucose >11mmol/l

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2
Q

cause of death DKA children

A

cerebral oedema (maj)
hypokalaemia
aspiration pneumonia (ileus or gastric paresis)

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3
Q

risk of DKA in patient per year

A

1-10%

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4
Q

DKA pathophysiology

A

absolute deficiency of insulin…counter rise in glucagon, cortisol, catecholamines and GH…increased gluconeogenesis…raises blood glucose and breakdown of fatty tissue…increased ketones…hyperglycaemia causes an osmotic diuresis…polyuric and pt becomes dehydrated + vomiting = worsening acidosis and dehydration

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5
Q

DKA risk factors

A

non compliance with insulin
device failure
changing insulin requirement during puberty
increased ingestion of glucose
infection

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6
Q

clinical features DKA

A

mean duration of 16.5 days of sx
- generally unwell
- lethargic
- N+V
- abdo pain
- headache and irritability
- confusion

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7
Q

examination DKA

A

deep, sighing breathing (kussmaul breathing)
tachypnoea
subcostal and intercostal recession
shock
dehydration
abdo pain
ketotic breath

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8
Q

signs of neurological compromise (cerebral oedema) DKA

A

irritability
slowing pulse
hypertension
reduced conscious level
papilloedema

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9
Q

DKA ddx

A

hyperosmolar hyperglycaemic state (no ketone production nor acidosis)
new presentation of type 1 SM
sepsis
appendicitis

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10
Q

DKA severity

A

mild - venous pH 7.20-7.29 or HCO3 <15
mod - 7.10-7.19 or <10
severe - <7.10 or <5

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11
Q

DKA management

A

A-E assessment
children in shock :
initial bolus - 20ml/kg of 0.9% NaCl over 15 mins
ongoing fluids - up to 40ml/kg total
children not in shock:
initial - 10ml/kg over 1 hr
ongoing fluids - calculate fluid deficit based on % dehydration (subtract initial bolus from this and add maintenance)

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12
Q

DKA - not clinically dehyrdrated and not vomiting

A

oral fluids and subcut insulin
but most will require IV fluids and insulin infusion (insulin should be delayed for 1-2 hours after IV fluid therapy). Dose of 0.05-0.1 units/kg/hr of soluble insulin

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13
Q

DKA fluids

A

resus fluids - given as bolus when in shock
deficit fluids - calculated from assumed dehydration. if bolus given for pt who is NOT IN SHOCK (subtract from this), DONT if pt is in shock
maintenance - 100 ml/kg/d for first 10 kg, 50 ml/kg/d for next 10 kg, 20ml/kg/day thereafter up to 80 kg

IMPORTANT to give 0.9% NaCl with 20mmol K in each 500ml bag. however if in AKI - anuric, so may result in hyperkalaemia - not administer K until urine passed

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14
Q

DKA resolved

A

clinically well
drinking and tolerate fluids
blood ketones <1mmol/l or pH normal
…then stop tx one hour later

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15
Q

hyperthyroidism prevalence

A

higher in girls and increasing age
neonatal thyrotoxicosis with mothers who have autoimmune hyperthyroidism

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16
Q

causes of hyperthyroidism

A

Grave’s
toxic multinodular goitre
toxic adenoma
thyroid carcinoma
neonatal hyperthyroidism
hCG-secreting tumours
functioning pituitary adenoma

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17
Q

risk fx of hyperthyroidism

A

family hx
personal or fhx of autoimmune disease
increase iodine intake
smoking (thyroid eye disease!)
female

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18
Q

hyperthyroidism ddx

A

transient thyroiditis
hashimotos (hashitoxicosis)
eating disorder
DM
phaeochromocytoma

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19
Q

neonatal thyrotoxicosis

A

if mother has grave’s - baby has TFT done between day 5-14 to check TFT

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20
Q

grave’s management childreb

A

carbimazole as propylthiouracil as increased s/e
administer via titration or block with higher dose and then replacement levothyroxine is given
NICE - titrating for 2 years and stop to see if gone into remission

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21
Q

s/e of anti-thyroid drugs

A

rashes, nausea
agranulocytosis
hepatitis
acute pancreatitis

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22
Q

neonatal hyperthyroidism management

A

self limiting within 1-3 mths, may require tx with propranolol or carbimazole

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23
Q

radioactive iodine therapy

A

not recommended <6 yrs old or with active eye disease or severely uncontrolled hyperthyroidism

24
Q

total thyroidectomy

A

indications - <6 yrs old, etc

25
Q

complications of untreated hyperthyroidism

A

weight loss
hypercalcaemia
osteoporosis
CVS dysfunction, afib

26
Q

hyperthyroidism prognosis

A

40-75% relapse within 2 years

27
Q

congenital hypothyroidism epidemiology

A

1:2000 - 1:4000

28
Q

congenital hypothyroidism pathophysiology

A

thyroid dysgenesis - developmental abnormality -> either agenesis or ectopic (dysgenesis)
thyroid dyshormogenesis - anatomically normal thyroid gland, enzymatic defect so can not produce thyroid hormone normally

29
Q

congential hypoithyroidism risk

A

female
prematurity
low birth weight
twins

30
Q

clinical features congenital hypothyroidism

A

asx - screening programme (between 5th and 8th day of life)
feeding difficulties
lethargy + increased sleeping
constipation
prolonged jaundice
hoarse cry

31
Q

examination congenital hypothyroidism

A

poor growth
macroglossia
myxedema
large fontanelles
hypotonia
bradycardia
distended abdomen with umbilical hernia
goitre

32
Q

most sensitive test for congential hypothyroidism

A

TSH
(NOTE: depends on child’s age)

33
Q

long term tx of hypothyoridism

A

transient - may not require tx after 2 years
if permanent - trialled off levothyroxine at 2/3 years of age to decide if lifelong tx required

34
Q

complications of delayed tx congenital hypothyroidism

A

impaired neurocognitive development and growth

35
Q

ADRENAL CORTISOL INSUFFIENCIENCY RISK FACTORS

A

high doses of steroids for prolonged periods
surgery to adrenal gland
radiation therapy
any pituitary insult

36
Q

children adrenal cortisol insufficiency

A

delayed puberty alongside other sx

37
Q

adrenal cortisol insufficiency primary

A

congenital adrenal hyperplasia
congenital adrenal hypoplasia
familial glucocorticoid deficiency
selective mineralocorticoid deficiency
addison’s
autoimmune polyglandular syndromes 1,2,4

38
Q

adrenal cortisol insufficiency secondary

A

steroid withdrawal
hypopituitarism
catastrophic infection/illness - waterhouse-friderichsen syndrome and adrenal necrosis

39
Q

adrenal cortisol insufficiency management

A

fluid resus
IM hydrocortisone
other steroid replacmenet
babies in 1st year of life - NaCl supplements
sick day rules
medical alert bracelet and emergency hydrocortisone

40
Q

adrenal cortisol insufficiency complciations

A

addisonian crisis
arrhythmias
neonatal - disorders of sexual development
baby - collapse and seizures

41
Q

puberty begins in girls

A

10.5

42
Q

puberty begins in boys

A

11.5

43
Q

precocious puberty

A

pubertal changes before age of 8 in girls and 9 in boys

44
Q

late onset puberty

A

physical changes (breast and testicular development) not begun before age of 13.5 in boys and 13 in girls. or girls not had period by 16

45
Q

consonant puberty

A

the order of characteristics’ development typically follows a set sequence for both girls and boys

46
Q

stages of sexual development

A

tanner scale

47
Q

end of puberty linked

A

to fusion of epiphyseal growth plates

48
Q

puberty in girls

A

adrenarche - increased sebaceous gland activity (acne), sweating, hair growth (axillary then pubic), body odour
thelarche - for 5/6 years
menarche - menstuation, coincides with stage 3 of breast development. average as is 12.9
growth - typically grow 5-10cm from date of menarche

49
Q

puberty in boys

A

adrenarche - increased hair, deepened voice, ability to ejaculate
testicular development - measured using orchidometer, increased pigmentation, scrotal thickening, penile growth and thickening
growth - increased body size and muscle bulk, usually between 14-17

50
Q

complications of puberty

A

acne
gynecomastia(imbalance of oestrogen and androgens at puberty onset)

51
Q

types of precocious puberty

A

true - early activation of HPA axis
fale - gonadotrophin independent, isolated development of one characteristic

52
Q

causes of true precocious puberty

A

hydrocephalus
post sepsis, surgery, trauma
brain tumour

53
Q

causes of false precocious puberty

A

CAH
exogenous sex steroids
ovarian/testicular tumours
hypothyroidism
McCune albright syndrome

54
Q

consequences of early puberty

A

short stature - loses 2/3 years of typical GH
psychological
early menarche
safeguarding concerns

55
Q

late onset puberty causes boys

A

maturational delay
hypogonadotropic hypogonadism (high LH and FSH if gonadal failure or both low if pituitary failure)
kallman’s syndrome
tumours
infection
trauma
glycogen storage disorders

56
Q

late onset puberty causes boys

A

tuner’s
anorexia
low birth weight
primary ovarian failure

57
Q
A

Paediatrics (17 decks)

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