Endocrinology Flashcards
What are the RFs for neonatal hypoglycaemia in the first 24hrs? (7)
IUGR (poor glycogen stores)
Preterm (poor glycogen stores)
Maternal DM (sufficient glycogen but islet hyperplasia/ hyperinsulinaemia) LGA
Hypothermic
Polycythaemic
Ill any reason
What are some features of neonatal hypoglycaemia? (5)
Apnoea/tachypnoea
Tachycardia
Sweating
CNS signs:
Lethargy/drowsy/coma
Jittery/ Irritable/ Seizures
Why can many newborns tolerate low blood glucose levels?
What level is optimum for neurodevelopment?
Can use lactate + ketones as energy stores
Glucose >2.6 for neurodevel (long-term → permanent neuro-disability)
What are some clinical features of hypoglycaemia in children (not neonates) (3)
Sweating
Pallor
CNS signs (irritability, headache, seizures, coma)
What are some causes of hypoglycaemia in children (8)
Fasting
XS insulin: DM, B-cell tumours, drugs (sulphonylureas), autoimm (insulin-R Abs), Beckwith syndrome
W/o hyperinsulinaemia: liver disease, ketotic hypogly, congen metabolism error
Galactosaemia Fructose intolerance Maternal DM Hormonal defc Aspirin/alc poisoning
What is the incidence of T1DM in U16s
What countries commoner from?
RFs (2)
2 in 1000 by 16y/o
Commoner in northern countries
RFs: identical twin or mat/paternal affected (pat>mat)
What is the typical presentation of T1DM before DKA? (4)
What are some less common symptoms? (3)
Polyuria
Polydipsia
Wt loss
Nocturnal enuresis in young children
Enuresis
Skin sepsis
Thrush
How is an official Dx of T1DM made?
Glucose > 11.1, Glycosuria + Ketonuria
if doubt then fasting glucose > 7 or raised HbA1c
What circumstances would you suspect T2DM in a child? (3)
Indian
FH
Severely obese
+ signs of insulin resistance
What information is given in the intensive educational programme after a Dx of T1DM? (7)
Basic understanding Injection techniques Diet Adjustments for sickness/exercise Blood glucose checks Recongition of hypo Support groups / psych support
What advice can be given about injection technique in T1DM? What sites?
Antero-lateral thigh, buttocks + abdo
To avoid lipohypertrophy: rotate sites + pinch/45degree angle
What sort of diet is recommended for T1DM
High complex carbs
Low fat content
High fibre
Avoid high sugar content foods
What blood glucose should be aimed for in children with T1DM?
What HbA1c should be aimed for?
BM 4-6 (in reality 4-10 to avoid hypo)
HbA1c <7.5% or <58mmol/mol
At what glucose levels will well-defined hypoglycaemic symptoms develop in children?
What is the initial management?
Glucose < 4
Initially sugary drink then → IM glucagon
What problems with T1DM are faced in adolescence / puberty? (2)
How can these be dealt with?
Adherence (smoking, alcohol, drugs, body image)
Increased insulin need due to antagonistic GH / oestrogen / testosterone
Establish short-term goals (avoid hypos, normal home/school life)
United team approach
+ve peer pressure from activities
What are the problems faced in T1DM (children all ages)? (7)
Sweets Exercise Eating disorders Family disturbance e.g. divorce Lack of motivation / support Unreliable glucose monitoring Illness (common in young) affects appetite + increases insulin requirement
What are the long term complications of T1DM? (7) + how are these monitoring
Growth/pubertal development (poss some delay + obesity common in esp girls)
Retinopathy - check 5yrly
Feet - encourage good care
BP - check yrly
Renal - screen for microalbuminuria
Coeliac - low threshold for autoimmune Ix
Thyroid - low threshold for autoimmune Ix
List some presentation features of a DKA? (8)
Acetone breath (pear drops) Vomiting Dehydration Abdo pain Hyperventilation (acidosis) Hypovolaemic shock Drowsiness Coma/death
What essential/early Ix are done in DKA? (7)
Blood glucose (bedside + lab) Urinary glucose/ketones Blood gas (acidosis) U&Es (dehydration) ECG (t-wave changes with hypokalaemia) Weight Any precipitating cause e.g. infection (blood/urine cultures)
Describe the stepwise approach management of a DKA? (in order or priority) (6) (FIPARI)
Fluids - if in shock resuscitate w. normal saline (+ monitor fluid balance /U&Es)
Insulin infusion - 0.05-0.1U/kg/hr, titrated to blood glucose, not as bolus, change fluid to dextrose when <14
Potassium (initial rise then fall) - replace once urine passed, continuous cardiac monitoring
Acidosis - correct with fluids/insulin (monitor capillary ketones), avoid HCO3- unless shocked/unresponsive to Tx
Re-establish oral fluids, diet + subcut insulin
ID/Treat underlying cause
What are the RFs/associations with constitutional delay in growth? (3)
What physical features seen? (4)
FH (occurred in parent of same sex)
XS exercise / diet
Males commoner
Delayed sexual changes for age
Bone age delay
Long legs/back
Eventually should reach target height
What are some causes of short stature? (1+10)
Non-pathological: constitutional delay in growth Pathological: Familial IUGR / extreme prematurity Chromsomal disorder / syndromes Disproportionate short stature
Hypothyroidism
GH defc
XS corticosteroids / Cushings syndrome
Nutrition
Chronic illness
Psychosocial deprivation
What measurement is the best indicator of growth failure?
What value is classed as abnorm
Height velocity (sensitive indicator) Persistently <25th centile is abnormal
How is the genetic target height estimated? (boys/girls)
Mid-parental height =
Mean of mums/dads
+7cm (boys)
-7cm (girls)
What are some causes of GH defc? (5)
Isolated defect: Laron syndrome - GH receptor defect / insensitivity Secondary to Panhypopituitarism: Congenital mid-facial defects Craniopharyngioma Hypothalamic tumour Trauma (head injury, meningitis)
How does the recognition of hypothyroidism Dx/treatment at different times affect final height?
Congenital hypothyroidism Dx - no long-term effects on stature
Not Dx for yrs → short stature
Once treated → rapid catch up growth/entry in puberty → limits final height
What chronic illnesses in children may present with short stature? (3)
Crohn’s
Coeliac
Chronic renal failure
