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Peds II > Exam 3 - Endocrine > Flashcards

Exam 3 - Endocrine Flashcards

1
Q

When do the two peaks of Type 1 DM occur in childhood?

A

Ages 4-6 and 10-14

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2
Q

What population is at the highest risk of Type 1 DM?

A

Non-hispanic white population

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3
Q

What genes show an increased risk of developing Type 1 DM in whites?

A

HLA-DR3, HLA-DR4

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4
Q

What is the classic and most common presentation associated with Type 1 DM?

A

The 3 “P”s:

  • Polyuria
  • Polydipsia
  • Polyphagia

+ weight loss/fatigue

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5
Q

What are the three presentations in which Type 1 DM can present?

A
  1. “Classic”
  2. DKA
  3. Silent (incidental) Discovery
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6
Q

What is the diagnostic criteria for Type 1 DM?

A

One of the following 4 signs of abnormal glucose metabolism:

  1. Fasting plasma glucose of 126 or higher
  2. Random plasma glucose of 200 or higher
  3. Plasma glucose > 200 two hours after oral glucose tolerance test
  4. Hemoglobin A1C > 6.5%
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7
Q

What will be found in Type 1 DM that will be not found in Type 2 DM?

A

Pancreatic Auto-Antibodies

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8
Q

What is important to note regarding the ideal fasting blood glucose in the different age ranges related to Type 1 DM?

A

As age increases, the ideal fasting blood glucose can be lowered due to the decreased risk of hypoglycemia

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9
Q

What are the different types of insulin?

A
  • Rapid acting (lispro, aspart, glulisine)
  • Short-acting (regular insulin)
  • Intermediate-acting (NPH insulin)
  • Long-acting (glargine, detemir)
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10
Q

When is short-acting insulin administered?

A

Administered as a pre-meal bolus 5-30 minutes before meal

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11
Q

When is intermediate-acting insulin administered?

A

Administered in a targeted manner in combo with long-acting insulins

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12
Q

When is long-acting insulin administered?

A

1-2 times per day

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13
Q

Which type of insulin administration method is most prone to hypoglycemia?

A

Syringe

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14
Q

What BMI percentiles defines overweight and obese?

A

Overweight: 85th-95th percentile

Obese: 95th percentile or greater

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15
Q

In what populations is childhood obesity the highest?

A
  • American Indian
  • African American
  • Mexican American
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16
Q

What is the exercise recommendation for pediatrics?

What is the recommendation regarding screen time?

A

Recommended 30-60 minutes of physical activity per day

Restrict non-academic screen time to 2 hours per day

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17
Q

What is the most common presentation of Type 2 DM in pediatrics?

A

Asymptomatic

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18
Q

While Type 2 pediatric patients are typically asymptomatic upon presentation, what are some signs/symptoms that could occur?

A
  • Fatigue
  • Irritability
  • Overweight/obese
  • Acanthosis nigricans
  • Polydipsia
  • Polyuria
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19
Q

When should we screen for Type 2 DM in children?

A

Children who are 10 years or older if they are overweight/obese AND have 2 or more of the following:

  • Type 2 DM in first/second-degree relative
  • High-risk ethnic group
  • Signs of insulin resistance or conditions associated with insulin resistance
  • Maternal history of DM or gestational DM when child was in utero

Repeat screening every 3 years

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20
Q

How is Type 2 DM diagnosed?

A
  1. Fasting plasma glucose of 126 or higher
  2. Random plasma glucose of 200 or higher
  3. Plasma glucose > 200 two hours after oral glucose tolerance test
  4. Hemoglobin A1C > 6.5%
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21
Q

Which two DM tests are most commonly used to diagnose Type 1 DM?

A
  1. Fasting plasma glucose of 126 or higher

2. Random plasma glucose of 200 or higher

22
Q

What is the first line medication treatment for Type 2 DM?

A

Metformin

23
Q

When is insulin therapy recommended in Type 2 DM?

A

When random glucose is 250 or higher or hemoglobin A1C is > 9%

24
Q

How often should A1C be measured in Type 2 DM?

A

Every 3 months

25
Q

What is the first line treatment for HTN in Type 2 DM patients that are 13 years or older?

A

ACE-I or ARBs

26
Q

What is the second line treatment for HTN in Type 2 DM patients that are 13 years or older?

A

Thiazide diuretics, CCB, beta blockers

***Note: beta blockers can mask symptoms of hypoglycemia, so not preferred therapy

27
Q

What are the goals for lipid levels in adolescents with diabetes (LDL, HDL, triglycerides)?

A
  • LDL < 100
  • HDL > 35
  • Triglycerides < 150
28
Q

What are the recommendations for treatment of hyperlipidemia in adolescents with diabetes?

A
  • 6 months of nonpharmacologic therapy first
  • Drug therapy with HMG-CoA reductase inhibitors if LDL > 130, older than 10 years of age and obesity/other CV risk factors
29
Q

What is the definition of short stature?

A

Child whose height is 2 standard deviations or more below the mean for children of that sex and chronological age (height is < 2.3 percentile)

30
Q

Describe Familial Short Stature?

A

Bone age is normal, but child is short.
Check mean parental height.
One or both parents are short.

31
Q

What is the most common cause of short stature?

A

Constitutional delay of growth; “Late-Bloomers”

Bone age and puberty are delayed, but adult height will be normal.

32
Q

What is the most common cause of pathologic short stature?

A

GH Deficiency

33
Q

What should you rule out when assessing for pathologic short stature?

A

Rule out hypothyroidism, Turner Syndrome, and skeletal disorders

34
Q

What will be seen on diagnostic tests in pathologic short stature due to GH deficiency?

A
  • Low IGF-1
  • Low IGFBP-3
  • Delayed bone age (left hand/wrist xray)
35
Q

What is the first line treatment for GH deficiency?

A

Recombinant Human Growth Hormone Therapy (rhGH)

***must treat prior to closure of epiphyseal plate

36
Q

What is the general treatment for GH deficiency?

A
  • rhGH
  • Monitor IGF-1 levels
  • Monitor bone age annually
37
Q

What are some possible side effects of rhGH?

A
  • Pseudotumor cerebri
  • Hyperglycemia/insulin resistance
  • Gynecomastia
  • Increase conversion of T4 to T3 without hypothyroidism
38
Q

What are some syndromes that cause pathological short stature?

A
  • Turner Syndrome
  • Noonan Syndrome
  • Prader-Willi Syndrome
  • Achondroplasia
39
Q

What gene is mutated in Achondroplasia?

A

FGFR3 gene

40
Q

What are some diagnostic studies that can be used to evaluate for Gigantism?

A
  • Serum IGF-1 will be elevated
  • GH fails to fall below 1 ng/mL in GH Suppression Test
  • MRI to evaluate pituitary and hypothalamus
41
Q

What is the treatment for Gigantism?

A
  • Surgery
  • Radiation
  • Medical management with octreotide
  • Bromocriptine
42
Q

Define precocious puberty.

A

Onset of secondary sexual characteristics before age 8 in girls and before age 9 in boys.

43
Q

Which type of precocious puberty has elevated GnRH and gonadotropins?

A

Central precocious puberty: Gonadotropin-dependent

44
Q

Which type of precocious puberty has elevated gondal steroids and low gonadotropins?

A

Peripheral precocious puberty: Gonadotropin-independent

45
Q

What are causes of Central precocious puberty: Gonadotropin-dependent?

A
  • Idiopathic

- CNS tumors or abnormalities

46
Q

What is the treatment for Central precocious puberty: Gonadotropin-dependent?

A

GnRH agonists

47
Q

What is over 95% of congenital adrenal hyperplasia caused by?

A

21-hydroxylase deficiency

48
Q

What is 21-hydroxylase activity not involved in the synthesis of?

A

Androgens

49
Q

What syndrome is associated with short stature, aortic coarctation, and streaked gonads?

A

Turner’s Syndrome

50
Q

What syndrome is autosomal dominant, causes short stature, is associated with CHD/pulmonic stenosis, and has pectus sternal deformities?

A

Noonan Syndrome

51
Q

What syndrome causes short stature due to a chromosome 15 defect and is the most common syndromic form of obesity?

A

Prader-Willi Syndrome

52
Q

What syndrome is autosomal dominant, causes short stature, and is associated with disproportionate rhizomelic shortening of long bones, macrocephaly, and bradydactylyl?

A

Achondroplasia

Peds II (11 decks)

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