module 2 - endo Flashcards
when to refer to endo for growth hormone therapy
- hypothyroid
- low IGF-1 or IGFBP - 3
other hormone deficiency is confirmed - unexplained persistent slow growth
What other conditions to screen for in DM1
- hypothyroid
- Celiac disease
Target A1c for DM1
<7.5%
Medication for children with DM2
- 1st try lifestyle modification
- metformin and insulin
Rapid acting Insulin
novolog, humalog, and Apidra
duration 3-5 hrs
short acting insulin
regular
duration 5-8 hrs
Intermediate insulin
NPH
duration 12-24hrs
Long acting insulin
levemir, lantus, tresiba
duration up to 24 hrs
When would pancreatic antibodies be useful
to confirm DM1, especially when uncertainty of type
clinical manifestations of Adrenal insufficiency
hyperpigmentation, salt craving, postural hypotension, hyperkalemia, and elevated plasma renin activity
Dx for adrenal insufficiency
serum glucose blood gasses and bicarb show meta acidosis electrolytes (hyponatremia, hyperkalemia) serum cortisol (>20) ACTH (elevated) serum 17-OHP Serum renin (elevated) aldosterone
Hyperthyroid labs
free T4 and total T4 - elevated
TSH - suppressed below sensitivity
central hypothyroid labs
TSH - normal
free T4 - low
congenital hypothyroid labs
NBS
TSH - elevated
free T4 normal or low
Thyroid Binding Globulin Deficiency labs
total T4 - low
free T4 and TSH - normal
PCOS - presenting symptoms
irregular menstrual cycle hirsutism Acne thinning hair/hair loss obesity darkening of skin skin tags
normal progression of puberty in girls
Live virus vaccines should be delayed until 6 months after cardiopulmonary bypass and exposure to red blood cells and plasma.
normal progression of puberty in boys
Boys should reach sexual maturity rating stage 5 within 4.5 years of initiation of puberty.
Delayed puberty definition and most common cause
Delayed puberty is when a boy 14 years or older or a girl 13 years or older has no clinical features of puberty on physical exam or puberty has not progressed within a timely manner. The most common cause of delayed puberty is CGD (constitutional growth delay).
Premature Adrenarche
Presenting Symptoms: early onset of pubic/axilla hair in boys before 10Y and girls before 8Y without other features of true puberty; mostly idiopathic
-may be caused by congenital adrenal hyperplasia (CAH), topical testosterone exposure; rarely adrenal tumor
-bone and height may be slightly advanced for age
-DHEA may be slightly elevated but correlate with Tanner staging
Diagnostic Studies: Serum 17-OPH to exclude CAH, 24-hour urine collection for 17-ketosteroids OR imaging of adrenal glands to exclude tumor
Prognosis: increased risk for PCOS and metabolic syndrome
Obesity definitions
BMI greater than or equal to 95th percentile for age and gender
-extreme obesity: BMI greater than or equal to 120th percentile for age and gender