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Pediatric Residency > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What amount of linear growth is expected to occur when assessing a pt for growth delay?

A

2 inches/ year

if closer intervals of evaluation, make sure tracking on growth curve

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2
Q

What are the three major causes of linear growth delay? (4)

A
  1. malnutrition (secondary to GI issue like celiac)
  2. Growth hormone deficiency
  3. Constitutional delay of growth
  4. idiopathic/ familial short stature
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3
Q

What is the most common cause of hypothyroidism?

A

Autoimmune (Hashimoto’s)

see elevated TSH, low or low-normal fT4, and possible antibodies to thyroglobulin or peroxidase

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4
Q

What are the 4 common causes of hypothyroidism?

A
  1. Autoimmune (Hasimoto’s)
  2. Radioactive Iodine treatment/ surgery for hyperthyroid
  3. Pituitary Malfunction
  4. Congenital Hypothyroidism
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5
Q

What diagnostic tests are used when a pt has signs and symptoms suggestive of hypothryoidism?

(fatigue, mental depression, feel cold, weight gain, dry skin & hair, constipation, menstrual irregularities)

A

TSH and freeT4

expect elevated TSH, low or low-normal fT4

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6
Q

What diagnostic test is used to assess the need for dosage change in a pt with hypothyroidism treated with levothyroxine?

A

TSH level

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7
Q

When a pt presents with new onset growth delay/ short stature, what diagnostic tests should be considered? (7)

A
  1. thyroid function test (TSH, fT4)
  2. celiac testing (tTG Ig Ab)
  3. growth factors ( IGF-1 and IGF-BP3)
  4. bone age
  5. CMP (assess renal function, electrolyte abnormalities, bone disease, liver function)
  6. vitamin D and zinc (assess nutritional status)
  7. ESR and CRP (assess for inflammatory)

(reflex GH stimulation if decreased growth factors; brain MRI if GH stim positive or other signs of pituitary malfunciton)

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8
Q

How do you calculate the mid-parental height for a girl?

A

= [(height of father in cm -13 cm) + mother’s height in cm] / 2

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9
Q

How do you calculate the mid-parental height for a boy?

A

= [(height of mother in cm + 13 cm) + father’s height in cm] / 2

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10
Q

What is the diagnostic criteria for Growth Hormone Deficiency? (3)

A
  1. 2 or more positive GH stimulation tests
  2. catch up growth with low dose GH treatment
  3. family history of GH deficiency or GH mutations
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11
Q

What medications can be used for growth hormone stimulation testing? (4)

A
  1. arginine
  2. clonidine
  3. glucagon
  4. L-dopa
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12
Q

How often should you follow-up a patient on GH therapy for growth hormone deficiency/ delay growth?

A

every 3-6 months

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13
Q

What is the recommended starting dose for a pt on GH therapy for growth hormone deficiency?

A

0.18- 0.3 mg/kg/week subcutaneous injections

(discontinue if growth velocity

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14
Q

What is the target for determining dose adjustments of GH hormone therapy? (2)

A
  1. growth rate greater than 10 cm/ year

2. IGF-1 level in upper half of normal range

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15
Q

What are side effects of GH therapy (growth hormone therapy)? (5)

A
  1. injection site reaction
  2. hyperglycemia
  3. joint pain and swelling
  4. increased ICP
  5. increased risk of secondary malignancy in pt with hx of treated malignancy
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16
Q

What diagnostic tests should be performed routinely in a pt on GH therapy for GH deficiency? (3)

A
  1. thyroid function test (TSH, fT4; annually)
  2. IGF-1 (at least annually once stable dose)
  3. Bone age (consider annually?)
17
Q

What is the difference between thyrotoxicosis and thyroid storm?

A

thyroid storm is life-threatening thyrotoxicosis (clinically symptomatic hyperthyroid) with multi-organ involvement

18
Q

What are the 3 most common causes of hyperthyroidism?

A
  1. Grave’s Disease (TSH receptor antibodies)
  2. toxic thyroid adenoma
  3. toxic multinodular goiter

(other causes: pituitary adenoma, pituitary resistance to thyroid hormone, congential hyperthyroidism)

19
Q

What diagnostic testing is used for suspected hyperthyroidism (wt loss, fatigue, palpitations, SOB, heat intolerance, depression, eye abnormalities, sweating, tremor, neck swelling)?

A

TSH (low), free T4 (high or high-normal)

if normal free T4- subclincal hyperthyroidism
(if high free T4- hyperthyroidism)

20
Q

What further diagnostic testing is used to distinguish the cause of hyperthyroidism?

A

thyroid scan for radioiodine uptake

(diffuse and high- Graves disease)
(single/ multiple focal increased amid decreased- toxic adenoma or multinodular goiter)
(low- thyroiditis or nonthyroidal cause)

21
Q

What is the next best step in determining cause of hyperthyroidism if thyroid scan is unclear?

A

thyroid antibodies and serum thyroglobulin

Pediatric Residency (6 decks)

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