Endocrinology/Growth - Obesity/Thyroid Disease

Question 1

Define obesity?

Answer 1

Overweight = BMI > 91st centile
Obese = BMI > 98th centile

Question 2

What are the RF for Obesity?

Answer 2

• Changes in the environment + behaviour relating to diet/activity
• Increased consumption of energy-dense foods
• Decreased energy expenditure
• Low socioeconomic homes more likely to be obese
• Endogenous cause – e.g. hypothyroidism + Cushing syndrome
• Prader-Willi

Question 3

How is obesity managed in children?

Answer 3

primary care management

• healthy eating - decrease portion sizes, no sugary drinks, increase protein, less snacking, more family meals
• increase physical activity to 60 mins daily
• drug treatment in over 12year olds who are extremely obese (Orlistat/Metformin)

Question 4

What are the presenting features of T2DM?

Answer 4

• Slow + insidious onset
• Most common in overweight or obese patients from a minority group
• Signs of insulin resistance
• Strong FHx
• Acanthosis nigricans
• PCOS
• HTN
• Retinopathy

Question 5

What is the early treatment for T2 diabetes?

Answer 5

• Diabetes education + lifestyle changes (diet, exercise, weight control)
• Pharmacologic therapy with metformin, insulin, a sulfonylurea or another hypoglycaemic agent
• Lipid-lowering agents + BP medications to achieve cardioprotection if necessary

Question 6

What is Prader Willi Syndrome?

Answer 6

imprinting disorder

features: obesity, learning difficulties, developmental delay, feeding problems, early hypotonia

Question 7

What are the clinical features of congenital hypothyroidism?

Answer 7

usually asymptomatic
failure to thrive
feeding probs
prolonged jaundice
constipation
pale dry mottled skin 
large tongue
hoarse cry 
umbilical hernia 
delayed development

Question 8

How does acquired hypothyroidism present?

Answer 8

females > males 
short stature
cold intolerance 
cold peripheries 
constipation 
dry skin
bradycardia
goitre
delayed puberty 
obesity 
learning difficulties

Question 9

How is congenital hypothyroidism investigated and managed?

Answer 9

Detected on Guthrie test
Treatment with thyroxine at 2-3 weeks of age (lifelong)
Early treatment of learning difficulties

Question 10

How is acquired hypothyroidism managed?

Answer 10

treated with thyroxine

Question 11

What are the clinical features of hyperthyroidism?

Answer 11

anxiety 
restlessness
sweating 
diarrhoea 
weight loss 
rapid growth in height 
tremor 
tachycardia, wide pulse pressure 
warm, vasodilated peripheries 
goitre (bruit) 
learning difficulties, behaviour problems 
psychosis 
eye signs - exomphalos, lid retraction, lid lag

Question 12

How is hyperthyroidism managed?

Answer 12

• 1st line - medical with drugs such as cardimazole or propylthiouracil that interfere with thyroid hormone synthesis
• B-blockers for symptomatic relief
• risk of neutropenia with anti-thyroid meds so watch for infection
• surgery
• radioiodine

Question 13

How is hyperthyroidism investigated?

Answer 13

• thyroid hormone levels
• TSH levels
• antithyroid perioxisomal antibodies

Question 14

Why is early treatment in hypothyroidism important?

Answer 14

to prevent learning difficulties

Question 15

Is Cushings common in children?

Answer 15

NO v rare

usually iatrogenic cause from long term steroid use

Question 16

How does diabetes insipidus present?

Answer 16

non specific 
vigorous suck with vomiting 
fever without cause
constipation 
excessively wet diapers
irritability 
nocturia

Question 17

Which children are at risk of developing diabetes insipidus?

Answer 17

• head trauma, tumour and neurosurgical procedures
• destructive lesions of the pituitary or hypothalamus or both
• genetic

Question 18

What are the features of gynaecomastia?

Answer 18

• ranges from discrete to 1-3 cm, round, mobile, usually tender masses to enlarged breasts
• benign and self limiting