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PEDS II final > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What are the 2 peaks of presentation for type 1 Diabetes in childre

A
  • 4-6
  • 10-14
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2
Q

what ethnicities have highest risk for type 1 Diabetes

A
  • non-hispanic white -> AA -> hispanic, native americans
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3
Q

if both parents have type 1 Diabetes, risk of child with type 1 Diabetes is

A

30%

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4
Q

if one identical twin has type 1 Diabetes , chance of other twin having type 1 Diabetes is

A

30-55%

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5
Q

risk factors for type 1 Diabetes in children

A
  • viral infections, particularly enterovirus
  • immunization
  • diet
  • higher socioecominic status
  • obesity
  • vit D deficiency
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6
Q

clinical presentation associated with type I DM in chlidren

A
  • polydipsia
  • polyuria
  • weight loss
  • ketoacidosis (>30% present with DKA)
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7
Q

how is Type 1 Diabetes diagnosed in children

A

same as adult, 1 of the following 4

  1. A1G > or = 6.5
  2. FPG > or = 126
  3. 2 hr plasma glucose > or = 220 during OGTT test
  4. random plasma glucose > or = 200 in patient with classic symtpoms of hyperglycemia
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8
Q

pancreatic autoantibodies are present in which type of diabetes

A

type 1 Diabetes

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9
Q

highest risk of hypoglycemia in type 1 Diabetes is in what age range

A

infants/toddlers

  • consistent feeding schedule/pattern is essential
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10
Q

type 1 Diabetes in children treatment goals for

  • target A1C
  • before meal BS
  • bedtime BS
A
  • target A1C: < 7.5 %
  • before meal BS: 90-130
  • bedtime BS: 90-150
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11
Q

when should blood glucose be monitored for children with type 1 diabetes

A
  • at least 4 times daily (fasting, before meals, bedtime)
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12
Q

dose of insulin for infant/toddler/early school age

A

0.5-1.0 unites/kg/day

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13
Q

patients on glucocorticoid therapy require what change of dose to insulin therapy

A

require higher dosing

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14
Q

intensive therapy for children with type 1 diabetes includes

A
  • basal insulin
  • correction insulin
  • and ingestion-driven insulin
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15
Q

on average, 1 unit of insulin is required to cover how many grams of carbs in

  • children 1-6yo
  • prepubertal children
  • pubertal adolescents
A
  • children 1-6yo: 20 g carbs
  • prepubertal children: 10-12 g carbs
  • pubertal adolescents: 8-10 g carbs
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16
Q

When should you consider to switch to an insulin pump

A
  • recurrent severe hypoglycemia
  • wide fluctuations in blood glucose levels
  • microvascular complications
  • lifestyle impacted significantly by use of BS and MDI regimen
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17
Q

dose for insulin pump

A
  • initial daily insulin pump dose (basal) is 10-20% less than previous MDI dosing
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18
Q

children with type 1 diabetes : recommended follow up and preventative care

A
  • 4x per year
  • podiatric at 10 yo
  • opto at 6 yo with dilatation exams at 10 yo
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19
Q

list the risk factors for type 2 diabetes in children

A
  • obesity: central or visceral
  • family history
  • ethnicity: black, hispanic, native americans
  • gender: girls: boys 1.5:1
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20
Q

common clinical presentation of children with type 2 diabetes

A
  • polydipsia and polyuria without ketonuria/acidosis (57-70%)
  • DKA (5-13%)
  • hyperglycemia hyperosmolar state: uncommon
21
Q

asymptomatic children should be screened for type 2 diabetes if

A
  1. overweight/obese (BMI >85% percentile) and have 2 or more of following
    • T2DM in 1st or 2nd degree relative
    • high risk ethnic group
    • signs of insulin resistance
    • maternal hx GDM while child in utero
22
Q

when should asymptomatic children be screened for type 2 diabetes (time)

A
  • age 10 or onset of puberty
  • repeat every 3 years
23
Q

non-pharm tx of children with type 2 diabetes

A
  • weight reduction : BMI < 85% percentile
24
Q

pharm tx for children with type 2 diabetes

A
  • metformin and insulin are the only approved tx
    • 1st line: metformin
    • add insulin -> in ketosis or severe hyperglycemia (random BS >250 or A1C > 9) or mixed T1 and T2 features
25
Q

how often should children with type 2 diabetes be monitored? What should be monitored?

A
  • body weight, BMI and A1C should be measured every 3 months
26
Q

What is defined as being abnormally tall

A
  • > 97% percentile with Z score > or = 2
27
Q

How can you determine if child’s growth is abnormally rapid?

A
  1. height-for-age curve has deviated across 2 major height percentile curves OR
  2. if child growing more rapidly than the following rates
    • age 2-4: > 3.5 in/yr
    • age 4-6: > 3.3 in/yr
    • age 6-puberty: > 2.4 in /yr for boys and >2.5 in/yr for girls
28
Q

determine bone age (aka skeletal maturity) from

A
  • a left ahnd and wrist radiograph
29
Q

most common cause of pituitary gigantism

A

hypothalamic GHRH

30
Q

pituitary gigantism is typically isolated but may be seen in context of these coexisting disorders

A
  • McCune Albright syndrome (MAS)
  • Multiple endocrine neoplasia type I
  • Carney complex
31
Q

clinical presentation

  • rapid growth -> abnormal height precedes rapid weight gain
  • large hands/feet
  • coarsening of facial features
  • excessive sweating
  • amenorrhea with or without galactorrhea
A

pituitary gigantism

32
Q

gold standard for definitive diagnosis of pituitary gigantism

A

GH suppression test

33
Q

treatment approach for pituitary gigantism

A
  • surgery
  • radiation
  • consider estrogen/testosterone administration to accelerate epiphyseal fusion
34
Q

what is the definition of short stature

A
  • a child whose height is 2 standard deviations or more below the mean for children of that gender and chronological age (or < 3rd percentile)
35
Q

What are the most common causes (normal variants) of short stature after age 1

A
  • familial (genetic) short stature)
  • delayed growth
  • idiopathic short stature
36
Q

pathological causes of growth failure

A
  • systemic disorder
  • dwarfism (GH deficiency)
  • genetic disease
  • skeletal dysplasia
37
Q

clinical characteristics

  • height below 3rd percentile
  • growth rate slower than expected
  • normal body proportions
  • delayed/no sexual development
  • chubby body build
  • normal intelligence
  • HA, V, vision problems, polydipsia
A

pituitary dwarfism

38
Q

what are the diagnostic tests for pituitary dwarfism

A
  • IGF-BP
  • GH stimulation test: insulin-induced hypoglycemia, arginine
39
Q

tx of pituitary dwarfism

A
  • recombinant growth hormone
    • SQ once daily in evening
    • titrate to goal IGF-1 range
40
Q

What is precocious puberty

A
  • onset of pubertal development at an age that is 2-2.5 SD earlier than population norms
  • onset of secondary sexual development before the age of 8 in girls and 9 yo in boys
41
Q

central precocious puberty is dependent on

A

Gonadotropin-dependent

  • early maturation of HPG axis accompanies by accelerated bone growth and advanced bone age along with pubertal sxs
42
Q

peripheral precocious puberty is independent of

A
  • gonadotropin-independent
  • excessive sex hormone from gland itself of excessive ectopic source
43
Q

3 classifications of precocious puberty

A
  1. cental: gonadotropin-dependent
  2. peripheral: gonadotropin-independent
  3. benign or non-progressive variants
    • high levels of DHEA
44
Q

etiology of central precocious puberty

A
  • idiopathic: 80-90% girls, 25-60% boys
  • intracranial disturbance
    • hamartomas most common
  • genetic
45
Q

most common cause of peripheral precocious puberty in boys

A

hCG-secreting germ cell tumor

46
Q

treatment of central precocious puberty

A
  • GnRH agonists
47
Q

define ambiguous genitalia

A
  • newborns born with a atypical genital appearance or discrepancy between external genitalia and gonadal/chromosomal sex
    • results in inability to declare gender at birth
48
Q

long term medical concerns of ambiguous genitalia

A
  • gonadal and kidney malignancy
  • decreased bone density
  • higher risk of testicular/ovarian torsion and infertility

PEDS II final (3 decks)

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