Paediatric aspects of diabetes and endocrinology Flashcards
What are common signs of T1DM in children?
Drinking ++
Peeing +++
Bedwetting
Wt loss
What are symptoms of DKA in children?
Vomiting
Stomach pain
Sighing breathing
Pear drops on breath
What immunological tests should be in suspection of T1DM?
GGAD (glutamic acid decarboxylase)
ICA (islet cell antibodies)
IAA (insulin antibodies)
IA2
What is C peptide?
Will still be present in early diabetes
Connects the alpha and beta chains of insulin together and is a direct measure of insulin production
What is a common history of diabetes?
Young boy vomiting at school
Bed wetting
Risk of dehydration
How is T1DM diagnosed?
FBG over 7
RBG over 11.1
Why is fluid carfeully managed in children presenting with DKA?
Fluid overload in DKA can lead to cerebral oedema = death
Insulin commences 1 hour after IV fluids stared
What are the targets of the childrens diabetes team?
All children to attend specialised childrens diabetic clinic MDT team Normal growth and development Aim for HbA1c below 58 mmol/mol Microvascular screening from age 12
What are early changes of vascular disease in children with T1DM?
Microalbuminuria CV autonomic neuropathy Sensory nerve damage Reinopathy Cheiroarthropathy Skin vascular changes Vascular endothelial pathology
What is the insulin carb ratio?
1 unit of insulin = 10g of carbs
What is the insulin sensitivity factor?
How much your BG drops with a unit of insulin
What is primary congenital thyroid disease?
Gland dysplastic +/- abnormal site (sublingual)
Inborn error of thyroid hormone metabolism
What is secondary/tertiary congenital thyroid disease?
Congenital pituitary disease
Usually associated with hypopituitarism (GH, ACTH, gonadotrophin deficiency)
What are the clinical symptoms of congenital thyroid disease?
Delayed jaundice
Poor feeding but normal weight gain
Hypotonia (umbilical hernia, constipation)
Skin and hair changes
What screening test is done on newborn babies?
Guthrie test on day 5 post birth
What does the guthrie test screen for?
Sickle cell disease
CF
Congenital hypothyroidism
6 metabolic conditions
Why will a fetus not be harmed by hypothyroidism?
Protected by placental thyroid hormones
What will occur if hypothyroidism is not treated by 3 months?
Permanent developmental delay
What is acquired thyroid disease in the young?
Delayed congenital
Post infectious
Autoimmune
Iodine deficiency
In what other autoimmune conditions would you screen for thyroid disease of the young?
T1DM
Down syndrome
Coeliac disease
What are the signs of hypothyroidism?
Slow progress Growth failure Poor general health Educational difficulties Goitre Thyroid function tests (high TSH, low fT3/4) High thyroid cell antibody titres
What is the treatment for hypothyroidism in the child?
Thyroxine replacement for life
Dose related to size of child
What are the general symptoms of hyperthyroidism?
Behaviour problems, sleep disturbance, eating difficulties
Goitre, high RH
Precocious puberty
Thyroid function tests (low TSH, high fT3/4)
High thyroid cell antibody titres
What is the treatment of hyperthyroidism?
Beta blockade
Suppressant therapy: carbimazole +/- thyroxine
Radioiodine
Surgery
What does the adrenal cortex produce?
Mineralocorticoids
Glucocorticoids
Adrenal androgens
What does the adrenal medulla produce?
Catecholamines
What is primary adrenal disease?
Adrenal hypoplasia (absent/dysplastic/destroyed)
Inborn error of metabolism
Congenital adrenal hyperplasia
What is secondary adrenal disease?
Pituitary disease
Suppression secondary to steroid therapy
What can cause an overproduction of steroids?
High dose cortisol therapy Cushing disease (primary adrenal or secondary pituitary)
What can congenital adrenal hyperplasia lead to?
Hyperpigmentation of scrotum
Virilisation of female
What lead to congenital adrenal hyperplasia?
Defect in the enzyme 21-hydroxylase in the steroid hormone synthesis pathway in the adrenal gland which leads to a lack of aldosterone, cortisol and an excess of testosterone
What is virilisation in males and females?
Female: ambigous genitalia
Male: precocious puberty
What is an addison crisis?
Absent aldosterone and cortisol: hyponatremia, hyperkalemia and hypotension
Need to give salt and cortisol
What can cause ambigous genitalia?
CAH or other steroid abnormalities
Gene or chormosomal abnormalities
Congenital defects
