Endocrinology

Question 1

What is the definition of precocious puberty?

Answer 1

Before age 8 in girls and before age 9 in boys

Question 2

List red flags in precocious puberty

Answer 2

• Rapid progression, bone age advanced > 2 years
• Predicted adult height < 150cm or < 2 SD below mid parental height
• CNS symptoms and signs

Question 3

Define premature thelarche in girls

Answer 3

Isolated breast development, 6-24 months of age, not exceeding SMR III, no change in growth percentile

Question 4

Define premature adrenarche

Answer 4

Pubic hair, axillary hair, body odour, acne but no thelarche, early secretion of adrenal androgens (DHEA), no change in growth percentile, bone height = height age

Question 5

Define delayed puberty

Answer 5

Absence of sexual characteristics after 13 years in girls and 14 years in boys

• Elevated LH/FSH with low testosterone/estrogen = primary gonadal failure
• Low LH/FSH with low testosterone/estrogen = permanent or functional pituitary or hypothalamic dysregulation

Question 6

If a child comes in with an injury, how to figure out how much extra insulin to give them to prevent ketosis?

Answer 6

10-20% of total daily dose of insulin given as rapid acting insulin. Calculate sum of all insulin doses over a 24 hour period to get the total daily dose.

Question 7

What is the initial dose of insulin to start on a new T1DM who is not in DKA?

Answer 7

0.4-0.6units/kg/day

Question 8

According to the Canadian guidelines, which prepubertal children need to be screened for DM2?

Answer 8

Screening for DM2 should be done every 2 years using FPG in children with any of the following:

1. > 3 RFs in non pubertal or > 2 RFs in pubertal children
   a. Obesity (BMI>95th)
   b. High risk ethnic group (Aboriginal, African, Asian, Hispanic or South American)
   c. FHx DM2 or exposure to hyperglycemia in utero
   d. Signs of insulin resistance: acanthosis nicrigans, HTN, dyslipidemia, NAFLD, PCOS
2. Impaired fasting glucose or impaired glucose tolerance
3. Use of atypical antipsychotic medications

Question 9

What is a normal stretched penile length?

Answer 9

2.5cm = lower limit of normal

Question 10

What is a normal clitoral length?

Answer 10

9mm = upper limit of normal

Question 11

List a differential diagnosis for 46 XX DSD

Answer 11

• Congenital adrenal hyperplasia
• Virilizing maternal disease
• Maternal androgen use
• Ovotesticular DSD, XX testicular DSD, gonadal dysgenesis

Question 12

What basic labs should be done for 46 XX DSD?

Answer 12

• 17 hydroxyprogesterone
• Serum lytes
• Glucose
• ACTH
• Renin
• Testosterone
• LH
• FSH

Question 13

List the differential diagnosis for 46 XY DSD

Answer 13

• Leydig cell failure
• Testosterone synthesis defect
• 5 a reductase deficiency
• Gonadal dysgenesis
• Rare forms of CAH

Question 14

What is the most common type of CAH?

Answer 14

21 hydroxylase deficiency

Question 15

What is the dose for stress dosing in adrenal insufficiency?

Answer 15

• Minor stress: 2-3 X replacement orally

- Major stress 50-100mg/m2 IM/IV stat and continued as divided dose q6-8h

Question 16

List the definition of pathologic fracture patterns in kids

Answer 16

• 2 or more long bone fractures by 10 years
• 3 or more long bone fractures by 19 years
• 1 or more vertebral compression fractures (loss of >20% vertebral body height at any age)