Paediatric aspects of diabetes and endocrinology Flashcards
How common is type 1 diabetes
250 children attend the paediatric diabetes service
one of the most common chronic diseases seen in children
Becoming more common
What is the incidence of type 1 diabetes in children
1 in 450
In 25% of new cases, what is the presentation for type 1 diabetics
DKA
What are 4 classic symptoms of type 1 diabetes
polyuria
polydipsia
weight loss
general malaise
What are symptoms of DKA
vomiting abdominal pain altered consciousness acidotic breathing dehydration
What would a fasted blood glucose level be to suggest type 1 diabetes
7 or more
What would a random blood glucose level be to suggest type 1 diabetes
11 or more
If DKA is left untreated what can it lead to
Coma and death
What would be seen in urinalysis in DKA
pH
What are some of the other risks/ problems of type 1 diabetic children
Based on weight (10ml/kg)
careful fluid resuscitation
risk of cerebral oedema
insulin commenced 1 hour after IV fluids started
What are some of the early changes of vascular diabetes in children with type 1 diabetes
microalbuminuria cardiovascular autonomic neuropathy sensory nerve damage retinopathy cheirarthropathy skin vascular changes vascular endothelial pathology
In what way can we achieve optimal glycaemic control in type 1 diabetes
Early intensification - multiple daily injection, pumps, insulin adjustment from the start
consistent approach
consistent targets
good support - friends, school, family
What part of the body is faulty in primary thyroid disease
thyroid gland
What part of the body is faulty in secondary thyroid disease
Pituitary
What part of the body is faulty in tertiary thyroid disease
Hypothalamus
What is secondary/ tertiary thyroid disease usually associated with
hypopituitarism
What are some clinical symptoms that may be present in congenital thyroid disease
delayed jaundice
poor feeding, but normal weight gain
hypotonia
skin and hair changes
What is the test performed for congenital thyroid disease
Guthrie Test
How is the Guthrie test performed
On day 5 of after birth
capillary blood on dry blotting paper
Test for TSH and T4
Why is the Guthrie test not performed immediately at birth?
The TSH and T4 levels take a few days to normalise
How can we diagnose congenital thyroid disease
Absence of thyroxine in the first 2 weeks of life
Why does a foetus appear normal who has congenital disease
They have been protected by placental thyroid hormones
What is a major complication of congenital thyroid disease
Developmental delay
what type of disease is acquired thyroid disease
Autoimmune
What are some symptoms of hypothyroidism in children
Growth failure delayed puberty poor general health educational difficulties goitre
What would be the results of thyroid function tests in hypothyroidism
Low free T4 and T3
High TSH
High thyroid cell antibody titres
What is the treatment for hypothyroidism in children
Thyroxine replacement for life
Dose depends on the size of the child
What are some of the general symptoms of hyperthyroidism
Behaviour problems Sleep disturbance eating difficulties Goitre high pulse rate precocious puberty
What would the results of the thyroid function test be in a patient with hyperthyroidism
Suppressed TSH
high free T4 and T3 levels
high thyroid cell antibody titres
What is the initial treatment for hyperthyroidism
Beta blockade
What is the treatment for suppressant therapy in hyperthyroidism
Carbimazole +/- thyroxine
What are some permanent treatment strategies for hyperthyroidism
Radio-iodine or surgery
What is more common in children- hypothyroidism or hyperthyroidism
Hypothyroidism
If a patient has an underachieve adrenal gland, what do they produce low doses of
Steroids
What is the main cause of primary adrenal disease
Congenital adrenal hyperplasia
What is also known as overactive production of steroids
Cushing syndrome
What is the treatment for Cushing disease
cortisol therapy
What are signs of Virilisation in males and then in females
Males - precocious puberty
Females - ambiguous genitalia
