Metabolic Disorders Flashcards
may have no clinical signs OR
Tendon xanthomas (finger extensions or achilles tendon)
Arcus corneae <4-5yo
Tuberous xanthomas or xanthelasma
Pediatric Hyperlipidemia
APA / USPSTF pedi hyperlipidemia screening guidleines
AAP: if risk factors: screen b/ween 2-3 and then again at 9y/o unless sx;
USPSTF: Universal screening for all kids b/t 9-11, again b/w 17-21 with fasting lipid profile or non-fasting HDL. Screening by age 2 if family hx
USPSTF recommends screening r/t RF; family hx of hyperlip or cardiac dx should be screened!
Annual for ALL diabetics (1 & 2)
More reg basis testing r/t results
20- 45: evaluate global risk assessment q five years
Middle-aged (men 45 - 65); women (55 - 65): absence of atherosclerotic CVD: screen q 1-2 yrs
Hyperlipidemia
= able to lower LDL-C 50%, good for primary prevention in pts with LDL > 190, diabetic pt with LDL 70-189 and ppl with 10 year risk > 7.5%
2nd prevention for ppl with known ASCVD
Atorvastatin (40-80 mg) & Rosuvastatin (20-40 mg)
When to reassess after starting statin therapy
Reassess lipid panel, CMP 6wks after initiation of therapy
THEN q6-12 mos (more frequent if uncontrolled DM, weight gain)
PRIOR to starting statin therapy
CMP (LFTs), lipids, CK (if hx of muscle sx)
Determine intensity based on risk assessment tool and LDL level
Female gender (none during pregnancy or lactation!)
Evaluate ALL meds (including supplements)
Some meds interact → myalgias
Moderate to high intensity statins (p.1166)
Patients with clinical ASCVD
LDL > 190
Age 45-70, LDL 70-189
Age 45-70 w / ASCVD risk >7.5%
Cluster of cardiometabolic conditions that predisposes an individual to the development of other comorbid conditions that can be life-changing
Comorbid conditions of concern: CAD, HTN, DM
Metabolic Syndrome
** Insulin resistance
Elevated waist circumference, triglycerides, BP, fasting glucose and decreased HDL (must have 3 of these) PE:
Insulin resistance → hallmark finding!
Genetic abnormalities, childhood malnutrition, visceral adipose tissue
Metabolic Syndrome
3 of following for diagnosis
Elevated waist circumference, elevated triglycerides, decreased HDL, elevated BP, elevated fasting glucose
Metabolic Syndrome
Criteria for dx
Waist circumference >95th percentile, fasting blood sugar >110, HDL <40, triglycerides >110, BP 90th percentile
* = based on age and sex
PEDS Met Syn
Two of the following required for diagnosis of PCOS
Androgen excess
AND
Ovulatory dysfunction OR polycystic ovaries (12 or more follicles 2-9mm in diameter or >25 follicles/ovary)
assessing patterns of hair growth) >15 indicates moderate to severe hirsutism and high suspicion for PCOS. Virilization (husky voice, increased pectoral muscle mass, acne, male pattern alopecia) with hirsutism indicates evaluation for PCOS
Ferriman-Gallwey scoring system
what to check for PCOS
FSH/ LH
