Lecture 4 - Endocrine

Question 1

Height velocity is ideally calculated over at least ____time frame

Answer 1

6 months

Question 2

How many cm/year should a child <4 years grow?

Answer 2

7cm

Question 3

How many cm/year should a child 4-6 years grow?

Answer 3

6cm

Question 4

How many cm/year should a 6+ year old grow?

Answer 4

5cm a year til puberty

Question 5

When is the peak velocity for height in males and females?

Answer 5

males 13.5 years

females 11.5 years

Question 6

Arm span

Answer 6

growth parameter

in boys: the arm span should be less than the height (within 2 cm) before 11 years of age

in girls: the arm span should be less than the height (within 2 cm) before 11-14 years of age

Question 7

What do discordant arm span and height indicate?

Answer 7

skeletal dysplasias rather than hormone deficiencies

Question 8

When is short stature benign for pathologic?

Answer 8

benign

• constitutional growth delay
• familial short stature
• idiopathic short stature

pathologic

• endocrine
• genetic syndromes
• nutritional disorders
• chronic illness/drugs

Question 9

Constitutional delay

Answer 9

“late bloomers”

Question 10

When do you first start to see familial short stature?

Answer 10

deceleration in growth 6-18 months

Question 11

What endocrine problems can lead to short stature?

Answer 11

hypothyroidism
untreated precocious puberty
turner syndrome
growth hormone deficiency

Question 12

GH deficiency in neonates

Answer 12

midline defects
microphallus
hypoglycemia

growth hormone not relevant for growth in 1st year of life

Question 13

GH deficiency in children

Answer 13

decreasing growth velocity
low IGF -1 and IGFBP - 3 levels or low GH levels during stimulation
rapid increase in growth velocity after starting GH

Question 14

How do children present with DM?

Answer 14

unexplained weight loss 
polyuria
polydipsia
polyphagia
poor growth 
altered mental status 
fruity breath 
tachypnea

Question 15

What is the treatment for DM in children?

Answer 15

if Type 1 - start insulin

if Type 2 - start insulin IF:
-ketones
-glucose runs >300 mg/dL
if not, then metformin is 1st line

Question 16

Expected Daily Insulin Requirements

Answer 16

units of insulin/kg/day

(age and weight are the determinants)

infants (0-2 years): <0.5 units/kg/day

pre-pubertal: 0.5 - 1 units/kg/day

Adolescents (pubertal): 1 units/kg/day

Question 17

What is the insulin to carb ratio?

Answer 17

1 unit insulin for every 10 grams carbohydrate

rule of 500
500/TDD

Question 18

Rule of 1800

Answer 18

used to determine how much blood glucose will drop with 1 unit of insulin –used to normalize hyperglycemia

1800/TDD

TDD: total daily dose

Question 19

What is used to maintain euglycemia during fasting?

Answer 19

basal insulin

Question 20

How do you calculate the TDD of insulin needed?

Answer 20

TDD = estimated insulin requirement x pts weight (kg)

the estimated insulin requirement is based on age
infants 0-2 years <0.5 units/kg.day
pre-pubertal: 0.5-1 units/kg/day
adolescents (pubertal): 1units/kg/day

Question 21

How do you determine the bolus amount of insulin?

Answer 21

I:C ratio

hyperglycemia correction factor (insulin sensitivity factor - ISF) this is the rule of 1800

Question 22

Go back through the lecture deck and do the two examples for DM

Answer 22

Do it

Question 23

When does insulin requirement decrease?

Answer 23

honeymoon period
(recovery of remaining endogenous insulin production after initiating exogenous insulin therapy)
exercise

Question 24

When do insulin requirements increase?

Answer 24

DKA
Illness
Puberty

Question 25

What are the injection sites for insulin?

Answer 25

upper arms
abdomen
hips and buttocks
front and outer side of thighs

Question 26

Why is injection site rotation important?

Answer 26

to prevent lipohypertrophy which interferes with insulin absorption

Question 27

Sick Day Management

Answer 27

1. check glucose every 3-4 hours until feeling well
2. give a correction factor dose with rapid-acting insulin every 3-4 hours based on the blood glucose check (even if not eating)
3. check urine ketones every 3 -4 hours
4. encourage fluid intake - ideally given 1 oz per year of age per hour in small frequent sips (if glucose level >200, sugar free fluids)

Question 28

Which factors during sick day management warrant evaluation?

Answer 28

persistent vomiting (more than twice after starting sick day rules) with moderate to large urine ketone levels
inappropriately rapid breathing
altered mental status
inability to perform sick day rules

Question 29

When do you add insulin to children with type 2 DM?

Answer 29

add insulin if HbA1C >9% despite max dose of metformin

Question 30

BMI >95th percentile in children greater than 2 is considered?

Answer 30

obese

Question 31

What are the risk factors for obesity in children?

Answer 31

screen time
decreased physical activity
the build environment
food choices and availability

Question 32

What are the Ddx for obesity?

Answer 32

Endocrine - Cushings, hypothyroidism

Genetic - Prater-Willi, Bardet - Biedl

CNS - hypothalmic tumor, trauma

Other - drugs, eating disorders

Question 33

What are some endocrine comorbidities of obesity?

Answer 33

PCOS

precocious puberty

Question 34

What are the 3 domains of treatment for obesity?

Answer 34

diet
physical activity
the family and environment

Question 35

What is the exercise requirement for obese pts?

Answer 35

moderate to vigorous physical activity for at least 60 minutes a day

Question 36

5-2-1-0 Rule

Answer 36

for obesity

5- servings fruits/vegetables daily
2 - hours of screen time max
1 - hour physical activity
0 - sugar sweetened beverages