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Pediatric Board Prep > Endocrinology > Flashcards

Endocrinology Flashcards

0
Q

What two anterior pituitary hormones are increased with hypothyroidism:

A

TSH, prolactin

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1
Q

Describe the hypothalamic pituitary axis:

A 
GnRH -> FSH and LH
CRH -> ACTH
TRH -> TSH (-SS)
GHRH -> GH
DA -> prolactin (-SS)

From posterior pit: oxytocin and vasopressin

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2
Q

What are FDA approve used for GH?

A

GH deficiency, Chronic renal failure, Turner syndrome, PWS, SGA if not caught up by age 2, ISS, noonan, AIDS wasting, SHOX def

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3
Q

Triad of septo-optic dysplasia:

A 
Optic nerve hypoplasia/absence
Hypothalamic insufficiency (inc DI)
Midline defect
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4
Q

Define delayed puberty:

A

Males: no changes after age 14
Females: no changes after age 13 or greater than 5 years between onset and completion of puberty

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5
Q

Define precocious puberty:

A

8 in girls, 9 in males

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6
Q

What drugs block the release of T3 and T4 from the thyroid?

A

Lithium and iodine

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7
Q

What drugs block the peripheral conversion of T4 to T3?

A

Propranolol
Glucocorticoids
Propylthiouracil
Amiodarone

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8
Q

How does taking oral contraceptives affect thyroid function tests?

A

Estrogen, narcotics, hepatitis increase TBG. This increases the total T4, but TSH and Free T4 are normal

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10
Q

Radio iodine uptake (RAIU) is increased in what disorders?

A

Graves’ disease increased

* distinguishes from thyroiditis which is decreased

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11
Q

What is a thyroid scan?

A

Uses technetium uptake to produce a picture. Identifies a nodule as hot or cold.
(Cold nodules = Cancer, if this get fine needle aspirate)

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11
Q

What bony finding supports the diagnosis of congenital hypothyroidism?

A

Delayed bone maturation. Distal femoral epiphysis is usually present at birth but is absent in congenital hypothyroidism

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12
Q

When should you start therapy for congenital hypothyroidism?

A

As close to two weeks as possible

Tx: Synthroid 10-15 micrograms/kg/day

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13
Q

What should mothers avoid giving to their baby with thyroxine replacement?

A

Soy formula and iron. They bind the tablets

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14
Q

What are the thyroid autoantibodies?

A

Antithyrolobulin (ATA) and antithyroperoxidase (antiTPO) -* both present in hashimotos and graves

Thyroid stimulating immunoglobulin (TSI) is in graves only

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15
Q

MEN I

A

Hyperplasia or neoplasia of the PPPs
Pancreas
Pituitary, anterior
Parathyroid

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16
Q

MEN II A

A

Hyperparathyroidism
Pheochromocytoma
Medullary carcinoma

17
Q

most common cause of congenital hypothyroidism

A

thyroid agenesis

18
Q

2 CAH enzyme deficiencies ass with HTN

A
  1. 17 alpha hydroxylase

2. 11 beta hydroxylase def (also has virilization)

19
Q

phosphorous wasting syndrome, short stature with disproportionately short LE

A

Familial hypophosphatemic rickets, x-linked.
Normal Ca, low phos, Normal PTH
Tx: oral neutral phos salts with calcitriol (1,25 Vit D increases Ca availability)((when replace PO4, develop hypocalcemia because Ca taken in to the bone)

20
Q

Labs for Hypo PTH vs Hyper PTH vs PseudohypoPTH vs PseudopseudohypoPTH

A
  1. HypoPTH: Ca down/Phos up
  2. HyperPTH: Ca up/Phos down
  3. PseudohypoPTH: PTH resistant, ca down/phos up. AD. short and stocky
  4. PseudopseudoPTH: phenotype of #3 with normal labs
21
Q

familial hypocalciuric hypercalcemia

A

AD

hypercalcemia,hypocalcemia, normal PTH

22
Q

side effects of growth hormone

A

SCFE, pseudotumor cerebri, transient carbohydrate intolerance, transient hypothyroidism

23
Q

21 OH deficiency

A

75% salt wasters, female ambiguous genitalia, 2 wk old adrenal crisis, elevated 17 OH progesterone

24
Q

upper-to-lower segment ratios

A 
infants (legs relatively shorter) U:L 1.7
children U:L 1.0
puberty U:L 0.85-0.95
Marfan low U:L
achondroplasia high U:L
25
Q

pseudohermphrodites

A

“overdone female” - exposure to androgens, normal internal structures, external masculinized
“underdone male” - androgen insensitivity, breasts, internal male, undervirilized

26
Q

Denys-Drash

A

46 XY, defect SRY, no testicular fxn/no MIS. internal female structures. renal failure by 3, Wilms Tumor

27
Q

5 alpha reductase deficiency

A

raised as female until puberty
testes produce testosterone only during puberty, +MIS. +female external until puberty, male internal structures/external virilized during puberty.

28
Q

46 XY, uterus and fallopian tubes but no ovaries (no estrogen), virilized, cryptochordism

A

persistent mullerian duct syndrome

29
Q

primary amenorrhea, external female genitalia “blind vaginal pouch” with intraabdominal testes that release testosterone

A

androgen insensitivity

defect in androgen receptor, XY, inc testosterone

30
Q

testing for Cushing syndrome

A
  1. 24 hr urinary free cortisol (high)
  2. if unclear (obesity vs Cushings) low dose dex suppression. check cortisol level which will be >5 (cant suppress)
  3. ACTH dep vs indep, do high dose dex test which will suppress ACTH dep
31
Q

What is ACTH stim test used for?

A

differentiate 1 and 2ndary Adrenal insufficiency

  1. healthy: aldosterone should double from a respectable base value (around 20 ng/dl)
  2. primary: base value is usually in the mid teens or less and rise to less than double the base value
  3. secondary: doubling to quadrupling from a low base aldosterone value
32
Q

SIADH

A

low serum Na, decreased UOP, euvolemic
Urine Osm>serum Osm
Urine Na>20 meq/L
Tx: fluid restriction

33
Q

MEN 2B

A

pheochromocytoma, medullary thyroid cancer, and neurofibromas

34
Q

DI

A

increased UOP, hypernatremia
urine Osm<serum Osm
Central tx: DDAVP
Nephrogenic: drink water, thiazides

35
Q

cerebral salt wasting

A

low serum Na, increased UOP, hypovolemic

Urine Osm>serum Osm

36
Q

Conns syndrome

A

adrenal adenoma, leading to hyperaldo

37
Q

Therapy for neonatal graves

A

Methimazole, propranolol, iodine

38
Q

Levothyroxine starting dose

A

Newborn 10-15 micrograms/kg/day

Adults 2-3 micrograms/kg/day

39
Q

what meds should pt with urticaria pigmentosa avoid

A

narcotics, radiocontrast material, NSAIDS

-pigmented lesions that turn into hives and blisters especially with rubbing, typically described in first 6 mo of life

Pediatric Board Prep (11 decks)

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