Endocrinology Flashcards
Obesity RF:
- maternal wt at start of pregnancy
- *pregnancy wt gain
- maternal DM
- *maternal smoking
- IUGR
- *LGA
- genetics= parental obesity (more about genetics than envirn’t alone)
- *Low SES (vs. developing nation more link with high SES)
Protective:
- BF
- higher maternal education
2 y.o. chid adopted. T or F: this patient will be obese regardless of bio parents?
False.
Will be thin if bio parents thin.
Define obesity
min. 97th %tile (WHO chart)
Name the mnemonic for causes of obesity:
The Obesity “GAMET”
- Genetic Syn
- Acquired
- Monogenic
- Endocrine
- Tumour (hypothal)
Provide one example of a dx that causes obesity in each GAMET category:
GAMET=
- Genetic= abN P/E
> Prader Willi Syn (neo low tone, small hand/feet, IQ, hypogonad)
> Bardet Biedl (polydactyly, hypogonad, retinal)
> Alstorem (DM + eye+ IQ)
- Monogenic (CC in < 6 mo. b/c no satiety)
> MC4R defect (Leptin deficiency) - Hypothalamic Tumour
> Hypopituitarism
- Endo (not gaining ht) > Cushing > GH deficiency > Hyperinsulinemism > Hypothyroidism
- Acquired (highly heritable)
List complications of obesity via system:
CNS: pseudotumour cerebri
CVS: dyslipidemia, HTN
Pul: OSA, asthma
Endo: T2DM, Metabolic syndrome, PCOS
GI: gallbladder dx, non alcohol fatty liver dx
Ortho: SCFE, tibia vara or Blount dx (bowing of tibia), MSK issue (joint or back pain)
Neuro: migraines
Behave: anxiety, depression, low SE
List obesity screening:
Start: 10 y.o. then q2y (or earlier if early puberty or signs of complications)
- AST, ALT
- Fasting Lipids (TG, HDL, LDL)
- HbA1C
Define normal ages for puberty in M and F:
M: 9-14
F: 8-13
What is the first sign of puberty in F?
Breast bud (thelarche)-> Adrenarche (pubic hair)-> Growth ++ -> Menarche (at Tanner 4)
what is the first sign of puberty in M?
Testicular enlargement (4cc) -> Penile growth -> Pubic Hair -> Growth +++ at tanner stage 4-5
How long is menarche after thelarche?
Usually 2 years
Where are girls and boys near their 12th birthday?
F: Just about to have menarche (12.5 years)
M: Adrenarche (Pubic Hair)
At Tanner Stage 4 where are F and M?
F= Double breast contour + Menstruation. M= Growth spurt.
Describe the F Tanner Stage for Breast Development:
1= preadolescent *2= breast mound, areola increased 3= breast + areola enlarge, no sep *4= Areola second mound 5= mature nipple projects
Describe the F Tanner Stage for Pubic Hair:
1= preadolescent *2= sparse, medial labia 3= darker, start curl *4= coarse, less < adult 5= adult
Which is true in puberty:
- Double breast contour Tanner 3
- menses Tanner 4
- Max penile growth Tanner 2
- Axillary hair Tanner 3
Menses Tanner 4.
- Double breast T4
- M enlarge penis at T3
- Voice change T4 (breaks in T3)
- Axillary hair T4
Describe the male Tanner Stages:
1= Testes < 4cc
No pubic hair
No penile growth
2= *Testes 4 cc
Pubic hair minimal
Penis early increase
3= Testes 12 cc
*Pubic hair coarse dark curly on pubis
* Penis increase ++
Voice may break
4= Pubic growth just not fully spread
*++ growth spurt
Axillary hair, voice, acne
5= adult
Facial hair
What is the action of insulin:
Glycogen synthesis
Action of glucagon:
Gluconeogenesis
What do the growth curves look like for:
- Familial Short Stature
- Constitutional delay
- Russel-Silver (Prenatal)
- CF or RF (Post natal)
Familial: start and stay just below
Constitutional: normal till 6-9 mo then fall off and catch up at end); normal velocity in the middle
Prenatal: start and stay parallel ++ below
Post-natal: FINE -> FALL
chronic dx= wt fall before ht
endo= wt fine, ht fall
Indications for GH therapy in short stature:
“Turn, Grow, Prader Willi SIR”
>Turner >Growth H deficiency >Prader Willi >SGA (not caught up by 2y.o.) >Idiopathic (2.25 SD corrected for bone age= man < 5'3" or F < 4'10") >RF (chronic; pre transplant)
Other from Nelson’s: SHOX gene abnormality, Noonan syndrome
Pro and Con of starting GH in Prader Willi
(+)= may prevent excess wt gain later
(-): can increase risk of sleep apnea
General GH risks:
- Pseudotumour cerebi
- SCFE if high BMI
T or F: Cushing’s is most common endocrinopathy causing short stature?
False
- Hypothyroidism most common.