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Y4 Paeds > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What is type 1 diabetes ?

A

A disease where the pancreas stops being able to produce insulin.When the pancreas is not producing insulin the cells of the body cannot take glucose from the blood and use it so it remains in the blood and causes hyperglycaemia.

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2
Q

What is the ideal blood glucose concentration ?

A

4.4 - 6.1 mmol/L

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3
Q

What cells produce insulin ?

A

Beta cells in the islet of langerhans

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4
Q

How does insulin reduce blood sugar levels ?

A
  • it causes cells to absorb glucose from the blood and use it as fuel.
  • it causes muscle and liver cells to absorb glucose from the blood and store it as glycogen.
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5
Q

What is glucagon ?

A

A hormone that increases blood sugar levels

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6
Q

Where is glucagon produced ?

A

Alpha cells in the islet of langerhans

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7
Q

How does glucagon increase blood sugar levels ?

A

It tells the liver to break down stored glycogen into glucose. This is called glycogenolysis.
It also tells the liver to convert proteins and fats into glucose.

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8
Q

What is ketogenesis ?

A

It occurs when there is insufficient supply of glucose and glycogens stores are exhausted such as prolonged fasting.
The liver takes fatty acids and converts them to ketones

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9
Q

What is the classic triad of symptoms of hyperglycaemia ?

A

Polyuria
Polydipsia
Weight loss

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10
Q

What is the longer term management of type 1 diabetes ?

A

Patient and family education is essential
Subcutaneous insulin regimes
Monitoring dietary carbohydrates
Monitoring blood sugar levels on waking, after each meal and before bed

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11
Q

What is a general insulin regime ?

A

Long acting background insulin given once a day
Short acting insulin injected 30 minutes before the intake of carbohydrates

Insulin pump can be used

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12
Q

What is a risk of repeatedly injecting insulin into the same spot ?

A

Lipodystrophy where subcutaneous fat hardens and prevents absorption of the sinus in

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13
Q

What is a basal bolus regime ?

A

The basal part refers to an injection of long acting insulin - background insulin throughout the day

The bolus part refers to an injection of a short acting insulin usually 3 times a day before meals

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14
Q

What is an insulin pump ?

A

A small device that continuously infuses insulin at different rates to control blood sugar levels.
The pump pushes insulin through a small plastic tube that is inserted under the skin.
Child needs to be over 12.

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15
Q

What are some advantages of using an insulin pump ?

A

Better blood sugar control
More flexibility with eating
Less injections

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16
Q

What are some disadvantages of using an insulin pump ?

A

Difficulties learning to use the pump
Having it attached at all times
Blockages in the infusion set
Small risk of infection

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17
Q

What are the 2 types of insulin pumps ?

A

Tethered pump
Patch pump

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18
Q

What are some short term complications of insulin and blood glucose management ?

A

Hypoglycaemia
Hyperglycaemia ( DKA )

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19
Q

What is hypoglycaemia and how can it occur ?

A

A low blood sugar level which is usually caused by giving too much insulin, not enough carbohydrates or not processing the carbohydrates properly.

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20
Q

what are some symptoms of hypoglycaemia ?

A

Hunger
Tremor
Sweating
Irritability
Dizziness
Pallor

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21
Q

What can more severe hypoglycaemia lead to ?

A

Reduced consciousness
Coma
Death if untreated

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22
Q

How is hypoglycaemia treated ?

A

Combination of rapid acting glucose ( lucozade )and slow acting carbohydrates ( biscuit )

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23
Q

What are some options for treating severe hypoglycaemia ?

A

IV dextrose and IM glucagon

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24
Q

What are some others causes of hypoglycaemia ?

A

Hypothyroidism
Glycogen storage disorders
Growth hormone deficiency
Liver cirrhosis

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25
Q

What are some macro vascular complications of diabetes ?

A

Coronary artery disease
Peripheral ischaemia
Stroke
Hypertension

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26
Q

what are some microvascular complications of diabetes ?

A

Peripheral neuropathy
Retinopathy
Kidney disease

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27
Q

Which infections are associated with diabetes ?

A

UTI
Pneumonia
Skin and soft tissue infections - feet
Fungal infections - oral and vaginal candidiasis

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28
Q

What monitoring should be performed on someone with diabetes ?

A

HbA1c - measure every 3 - 6 months
Capillary blood glucose
Flash glucose monitoring - Libre system

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29
Q

How are ketone levels measured ?

A

Urine dipstick and in the blood using a ketone meter.

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30
Q

How does diabetes cause ketoacidosis ?

A

When the cell in the body have no fuel and think they are starving they initiate the process of ketogenesis so they have a usable fuel.
Over time the glucose and ketone levels get higher. Initially the kidneys produce bicarbonate to buffer the ketone acids in the blood and maintain a normal pH.
Over time the ketone acids use up the bicarb and the blood starts to become acidic. This is called ketoacidosis.

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31
Q

How does diabetes cause dehydration ?

A

Hyperglycaemia overwhelms the kidneys and glucose starts being filtered into the urine. The glucose in the urine draws water out with it in a process called osmotic diuresis. This causes the patient to urinate a lot ( polyuria ).
This results in severe dehydration.
The dehydration stimulates the thirst centre to tell the patient to drink lots of water.
This excessive thirst is called polydipsia.

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32
Q

How does diabetes cause potassium imbalance ?

A

Insulin normally drives potassium into cells.
Without insulin, potassium is not added to and stored in cells.
Serum potassium can be high or normal in DKA as the kidneys continue to balance blood potassium with the potassium excreted in urine.
However total body potassium is low because no potassium is stored in cells.
This causes hypokalaemia and can lead to fatal arrhythmias.

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33
Q

How does DKA treatment lead to cerebral oedema ?

A

Dehydration and high blood sugar concentration cause water to move from the intracellular space in the brain to the extracellular. This causes brain cells to shrink.
Rapid correction of dehydration and hyperglycaemia causes a rapid shift in water from the extracellular space to the intracellular space in the brain cells.
This causes the brain to swell and become oedematous which can lead to brain cell destruction and death.

34
Q

What signs are present if someone with DKA has cerebral oedema ?

A

Headaches
Altered behaviour
Bradycardia
Changes to consciousness

35
Q

What is the management for cerebral oedema in DKA ?

A

Slowing IV fluids
IV mannitol
IV hypertonic saline

36
Q

How does DKA present ?

A

Polyuria
Polydipsia
Nausea and vomiting
Weight loss
Acetone smell to their breath
Altered consciousness

37
Q

What are the 3 criteria for diagnosing DKA ?

A

Hyperglycaemia - blood glucose over 11
Ketosis - blood ketones above 3
Acidosis - pH under 7.3

38
Q

What are the principles of DKA management in children ?

A
  1. Correct dehydration evenly over 48 hours
  2. Give a fixed rate insulin infusion
    Avoid fluid boluses to minimise the risk of cerebral oedema
    Treat underlying triggers
    Prevent hypoglycaemia
    Add potassium to IV fluids
    Monitor glucose, ketones and pH
39
Q

What is Addison’s disease ?

A

Specific condition where the adrenal glands have been damaged, resulting in reduced secretion of cortisol and aldosterone. This is also called primary adrenal insufficiency.
Common cause - autoimmune

40
Q

What is secondary adrenal insufficiency ?

A

Caused by inadequate ACTH stimulating the adrenal glands resulting in low levels of cortisol being released.
This is the result of loss of damage to the pituitary gland. This can be due to congenital underdevelopment of the pituitary gland, surgery, infection, loss of blood flow or radiotherapy.

41
Q

What is tertiary adrenal insufficiency ?

A

The result of inadequate CRH release by the hypothalamus.
Usually results from long term steroid use.

42
Q

What are some features of adrenal insufficiency in babies ?

A

Lethargy
Vomiting
Poor feeding
Hypoglycaemia
Jaundice
Failure to thrive

43
Q

What are some features of adrenal insufficiency in older children ?

A

Nausea and vomiting
Poor weight gain or weight loss
Reduced appetite
Abdominal pain
Muscle weakness
Developmental delay
Bronze hyperpigmentation

44
Q

What are the investigations that should be performed when suspecting adrenal insufficiency ?

A

Test for the diagnosis with cortisol, ACTH, aldosterone and renin levels

45
Q

What findings are seen when doing investigations in addisons ?

A

Low cortisol
High ACTH
Low aldosterone
High renin

46
Q

What findings are seen when doing investigations in secondary adrenal insufficiency ?

A

Low cortisol
Low ACTH
Normal aldosterone
Normal renin

47
Q

What is the short synACTHen test ?

A

The short synACTHen test can be used to confirm adrenal insufficiency.
It is ideally performed in the morning when the adrenal glands are best.
The test involves giving synACTHen.
The blood cortisol is measured at baseline, 30 and 60 minutes after administration.

48
Q

What indicates primary adrenal insufficiency on a synACTHen test ?

A

A failure of cortisol to rise ( less than double the baseline ) indicates primary adrenal insufficiency.

49
Q

What is the management for adrenal insufficiency ?

A

Replacement steroids
Hydrocortisone - replace cortisol
Fludrocortisone - replace aldosterone

50
Q

What should happen to steroids for a patient with addisons if they are sick ?

A

The dose of steroid needs to be increased
Blood sugar needs to be monitored with diarrhoea or vomiting regular IM injections of steroid.

51
Q

What is addisonian crisis ?

A

The term used to describe an acute presentation of severe addisons where the absence of steroid hormones result in a life threatening presentation.

52
Q

How does an addisonian crisis present ?

A

Reduced consciousness
Hypotension
Hypoglycaemia, hyponatraemia and hyperkalaemia

53
Q

What is usually the first presentation of Addison’s disease ?

A

Adrenal crisis
Triggered by Infection or Trauma

54
Q

What is the management of addisonian crisis ?

A

Intensive monitoring
Parenteral steroids - IV hydrocortisone
IV fluid resus
Correct hypoglycaemia
Careful monitoring of electrolytes and fluid balance

55
Q

What is congenital adrenal hyperplasia ?

A

Caused by a congenital deficiency of the 21-hydroxylase enzyme. This causes underproduction of cortisol and aldosterone and overproduction of androgens from birth.
Autosomal recessive

56
Q

What are the steroid hormones ?

A

Testosterone
Glucocorticoid
Mineralcorticoid

57
Q

What is testosterone ?

A

An androgen hormone.
It is found in high levels in men and low levels in women.
It acts to promote male sexual characteristics.

58
Q

What is glucocorticoid ?

A

Acts to help the body deal with stress, raise blood glucose, reduce inflammation and suppress the immune system.

59
Q

What is mineralcorticoid ?

A

Hormone that acts on the kidneys to control the balance of salt and water in the blood.

60
Q

What is aldosterone ?

A

Aldosterone is the main mineralcorticoid hormone.
It is released by the adrenal gland in response to renin.
Aldosterone acts on the kidneys to increase sodium reabsorption and increase potassium secretion into the urine.

61
Q

What is the pathophysiology of congenital adrenal hyperplasia ?

A

21-hydroxylase is the enzyme responsible for converting progesterone into aldosterone and cortisol. Progesterone is also used to create testosterone. In congenital adrenal hyperplasia there is a defect in the 21-hydroxylase enzyme therefore extra progesterone is present as it cant be converted to cortisol or aldosterone. It is instead converted into testosterone.
The result is a patient with low aldosterone, low cortisol and abnormally high testosterone.

62
Q

How does congenital adrenal hyperplasia present at birth ?

A

Virilised genitalia - ambiguous
Enlarged clitoris

63
Q

How does congenital adrenal hyperplasia present after birth ?

A

Poor feeding
Vomiting
Dehydration
Arrhythmia

64
Q

How does congenital adrenal hyperplasia present in childhood or after puberty in females ?

A

Tall for their age
Facial hair
Absent periods
Deep voice
Early puberty

65
Q

How does congenital adrenal hyperplasia present in childhood or after puberty in males ?

A

Tall for their age
Deep voice
Large penis
Small testicles
Early puberty

66
Q

How is congenital adrenal hyperplasia managed ?

A

Cortisol replacement - hydrocortisone
Aldosterone replaced - fludrocortisone
Female patients with virilised genitals may require corrective surgery

67
Q

What is growth hormone ?

A

Produced by the anterior pituitary gland.
It is responsible for stimulating cell reproduction and the growth of organs, muscles, bones and height.
Stimulates the release of insulin-like growth factor 1 by the liver.

68
Q

What is congenital growth hormone deficiency ?

A

Results from a disruption to the growth hormone axis at the hypothalamus or pituitary gland. It can be due to a genetic mutation or another condition where the pituitary gland is underdeveloped or damaged.

69
Q

What is acquired growth hormone deficiency ?

A

Can be secondary to infection, trauma or interventions such as surgery.

70
Q

How does growth hormone deficiency present at birth ?

A

Micropenis
Hypoglycaemia
Severe jaundice

71
Q

How does growth hormone deficiency present in older infants and children ?

A

Poor growth
Short stature
Slow development
Delayed puberty

72
Q

What are some investigations for growth hormone deficiency ?

A

Growth hormone simulation test
Genetic testing
MRI brain
X ray or DEXA scan - determine bone age

73
Q

What is the growth hormone stimulation test ?

A

It involves measuring the response to medications that normally stimulate the release of growth hormone. Examples of these include : glucagon, insulin, arginine and clonidine.
In growth hormone deficiency there will be a poor response to stimulation.

74
Q

What is congenital hypothyroidism ?

A

Is where the child is born with an under active thyroid gland.
It can be the result of an underdeveloped thyroid gland or a fully developed gland that does not produce enough hormone.

75
Q

When is congenital hypothyroidism screened for ?

A

Newborn blood spot screening test

76
Q

If not picked up at birth how does congenital hypothyroidism present ?

A

Prolonged neonatal jaundice
Poor feeding
Constipation
Increased sleeping
Reduced activity
Slow growth and development

77
Q

What is acquired hypothyroidism ?

A

Where a child or adolescent develops an underactive thyroid gland when previously it was functioning.

78
Q

what is the most common cause of hypothyroidism ?

A

Autoimmune thyroiditis - hashimoto’s
It is associated with anti-thyroid peroxidase and anti-thyroglobulin antibodies.

79
Q

What are some conditions associated with autoimmune thyroiditis ?

A

Type 1 diabetes
Coeliac disease

80
Q

What are some symptoms of hypothyroidism ?

A

Fatigue and low energy
Poor growth
Weight gain
Poor school performance
Constipation
Dry skin and hair loss

81
Q

What is the management of hypothyroidism ?

A

Levothyroxine - titrate to an appropriate dose

82
Q

What investigations should be performed when suspecting hypothyroidism ?

A

Thyroid function test
TSH, T4 and T3.
Thyroid USS and antibodies

Y4 Paeds (14 decks)

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