Endocrinology (Alice) (3%) Flashcards
mc endocrine dz in peds
T1DM
rf for T1DM
fam hx/histocompatability antigens:
DR3
DR4
what type of breathing is associated w. DKA
kussmaul respirations
dx criteria for DM (4)
-random BG > 200 mg/dL PLUS symptoms
-2 separate 8 hr fasting BG > 126
-2 hr OGTT > 200
-A1C >/= 6.5
how does C peptide relate to T1 vs T2 diabetes
T1DM: low vs inappropriately low during fasting
T2DM: high
what abs are associated w. T1DM
insulin abs
GAD65
IA-2
if >/= 1 is present, consider T1DM
what type of infxn might make you concerned for DM in a kid
prolonged candidal infxn
A1C goal for pediatric DM
< 7.5
t/f: hypercalcemia is more concerning in kids than adults
t!
hypercalcemia is often discovered when a kid is worked up for
FTT
4 signs of end organ damage with hyperparathyroidism
nephrocalcinosis
nephrolithiasis
acute pancreatitis
bone pathology
t/f: most kids with hyperparthyroidism present w. end organ damage
t!
most are symptomatic at presentation
ddx for hypercalcemia in peds (10)
family hypocalciuric hyperCa
NSHPT (neonatal severe primary hyperparathyroidism )
subcutaneous fat necrosis
williams syndrome
primary hyperparathyroidism
humoral malignancy
osteolytic malignancy
granulomatous dz
vit D toxicity
immobilization
pharm for pediatric hypercalcemia
increase urinary excretion:
calcitonin
bisphosphonates
zoledronic acid
_ is recommended for all peds w. primary hyperparathyroidism
parathyroidectomy
mcc of hyperthyroidism in peds
graves dz
others:
thyroid nodule
acute supporative thyroiditis
adult sx of hyperthyroidism that is uncommon in peds
exophthalmos
3 sx of hyperthyroidism in peds that Smarty PANCE stresses
palpitations
change in behavior
change in school performance
what is neonatal graves dz
infant born to mom w. graves dz -> passage of TSH receptor abs cross placenta
t/f: neonates will graves dz often have a goiter
t!
tx for hyperthyroidism in peds
same as adults:
PTU
methimazole
radioiodine
med preferred in pediatric hyperthyroidism
methimazole
fewer s.e
t/f: half of kids w. graves dz have spontaneous remission w.in 12-24 mo
t!
management of kid who had hyperthyroidism but then went into remission
lifelong TSH monitoring
tx for neonatal graves
propranolol
+/- methimazole
most self resolve w.in 2-3 mos
3 mo old infant - presents w. intermittent choking, constipation, lethargy, hoarse cry - on PE she is floppy and 25th %ile for weight w. protuberant abdomen, dry skin, brittle hair, and a low hairline
hypothyroidism
causes of hypothyroidism in peds (6)
hashimoto’s -> mc
panhypopituitarism
ectopic thyroid dysgenesis
antithyroid meds
surgery for hyperthyroidism
congenital hypothyroidism (cretinism)
presentation of congenital hypothyroidism (cretinism) (5)
hypotonia
lethargy
macroglossia
large fontanelles
dry skin
2 rf for congenital hypothyroidism
female
fam hx
PE findings of congenital hypothyroidism (5)
delayed puberty
immature body proportions
coarse, puffy facies
think hair
DTRs w. delayed rxn time
tx for hypothyroidism in peds
levothyroxine
weight classifications for peds
underweight: BMI < 5th %ile
normal weight: BMI 5th - 85th %ile
overweight: BMI >/= 85th %ile
obese: BMI >/= 95th %ile
severe obesity: BMI >/= 120th %ile OR >/= 35
what lab value is most effecacious for eval of NAFLD in kids
ALT
management of severely obese kids or overweight/obese kids w. comorbidities
referral
sugar recs for kids
25g (6 tsp) sugar daily
gah! dumb rec…so much sugar :(
2 non pathologic causes of short stature
familial
constitutional
definition of familial short stature
-growth curves </= 5th %ile by 2 yo
-healthy otherwise: normal bone age and puberty onset
definition of constitutional delay
-kid develops </= 5th %ile at normal growth velocities -> parallel to growth curve
-pubety delayed -> delay in bone age
3 pathologic causes of short stature
-disproportionate short stature
-proportionate short stature
postnatal causes
characteristics of disproportionate short stature (2)
short limbs
average sized trunk
2 causes of disproportionate short stature
rickets
achondroplasia (dwarfism)
characteristics of proportionate short stature (PSS)
small person
normal proportions
2 classifications of pss
prenatal
postnatal
5 prenatal causes of pss
intrauterine growth retardation
placental dysfxn
intrauterine infxns
teratogens
chromosomal abnl (trisomy 21, turner’s)
8 postnatal causes of pss
malnutrition
chronic systemic dz
psychosocial
drugs
hypothyroid
GH deficiency
glucocorticoid excess
precocious puberty
how do you determine bone age in peds
AP xray of left wrist
differentiates familial short stature from constitutional delay
advanced bone age in peds indicates
precocious puberty
short stature + normal bone age
familial short stature
short stature + delayed bone age
constitutional delay
what labs would you order to rule out GH deficiency in kid w. short stature (2)
IGF-1
IGF-BP3
