Lecture 4 - Endocrine Flashcards
Height velocity is ideally calculated over at least ____time frame
6 months
How many cm/year should a child <4 years grow?
7cm
How many cm/year should a child 4-6 years grow?
6cm
How many cm/year should a 6+ year old grow?
5cm a year til puberty
When is the peak velocity for height in males and females?
males 13.5 years
females 11.5 years
Arm span
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
What do discordant arm span and height indicate?
skeletal dysplasias rather than hormone deficiencies
When is short stature benign for pathologic?
benign
- constitutional growth delay
- familial short stature
- idiopathic short stature
pathologic
- endocrine
- genetic syndromes
- nutritional disorders
- chronic illness/drugs
Constitutional delay
“late bloomers”
When do you first start to see familial short stature?
deceleration in growth 6-18 months
What endocrine problems can lead to short stature?
hypothyroidism
untreated precocious puberty
turner syndrome
growth hormone deficiency
GH deficiency in neonates
midline defects
microphallus
hypoglycemia
growth hormone not relevant for growth in 1st year of life
GH deficiency in children
decreasing growth velocity
low IGF -1 and IGFBP - 3 levels or low GH levels during stimulation
rapid increase in growth velocity after starting GH
How do children present with DM?
unexplained weight loss polyuria polydipsia polyphagia poor growth altered mental status fruity breath tachypnea
What is the treatment for DM in children?
if Type 1 - start insulin
if Type 2 - start insulin IF:
-ketones
-glucose runs >300 mg/dL
if not, then metformin is 1st line
Expected Daily Insulin Requirements
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
What is the insulin to carb ratio?
1 unit insulin for every 10 grams carbohydrate
rule of 500
500/TDD
Rule of 1800
used to determine how much blood glucose will drop with 1 unit of insulin –used to normalize hyperglycemia
1800/TDD
TDD: total daily dose
What is used to maintain euglycemia during fasting?
basal insulin
How do you calculate the TDD of insulin needed?
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
How do you determine the bolus amount of insulin?
I:C ratio
hyperglycemia correction factor (insulin sensitivity factor - ISF) this is the rule of 1800
Go back through the lecture deck and do the two examples for DM
Do it
When does insulin requirement decrease?
honeymoon period
(recovery of remaining endogenous insulin production after initiating exogenous insulin therapy)
exercise
When do insulin requirements increase?
DKA
Illness
Puberty
What are the injection sites for insulin?
upper arms
abdomen
hips and buttocks
front and outer side of thighs
Why is injection site rotation important?
to prevent lipohypertrophy which interferes with insulin absorption
Sick Day Management
- check glucose every 3-4 hours until feeling well
- give a correction factor dose with rapid-acting insulin every 3-4 hours based on the blood glucose check (even if not eating)
- check urine ketones every 3 -4 hours
- encourage fluid intake - ideally given 1 oz per year of age per hour in small frequent sips (if glucose level >200, sugar free fluids)
Which factors during sick day management warrant evaluation?
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
When do you add insulin to children with type 2 DM?
add insulin if HbA1C >9% despite max dose of metformin
BMI >95th percentile in children greater than 2 is considered?
obese
What are the risk factors for obesity in children?
screen time
decreased physical activity
the build environment
food choices and availability
What are the Ddx for obesity?
Endocrine - Cushings, hypothyroidism
Genetic - Prater-Willi, Bardet - Biedl
CNS - hypothalmic tumor, trauma
Other - drugs, eating disorders
What are some endocrine comorbidities of obesity?
PCOS
precocious puberty
What are the 3 domains of treatment for obesity?
diet
physical activity
the family and environment
What is the exercise requirement for obese pts?
moderate to vigorous physical activity for at least 60 minutes a day
5-2-1-0 Rule
for obesity
5- servings fruits/vegetables daily
2 - hours of screen time max
1 - hour physical activity
0 - sugar sweetened beverages
