Paediatric Endocrine Flashcards
How is hyperglycaemia in a child managed?
Insulin
Dietician referral
Advice on hypoglycaemia
Advice of changing regime if sick
What insulin regimes can be offered to children?
Twice daily - long acting
Multiple - rapid acting - good if active lifestyle
How often should diabetic children be testing their BM?
At least 4x a day
How regularly should diabetic children have a review assessment?
Minimum once annually
What should be done in a diabetic review?
HbA1C Lipid profile Urinary albumin excretion Renal and thyroid function Eye examination Examine injection sites Blood pressure
What level of plasma glucose is considered to be hypoglycaemia?
<3mmol/L
What triad do you need to diagnose hypoglycaemia?
Whipples triad
Signs and symptoms
Low blood glucose level
Relief of symptoms with increasing blood glucose
What causes hypoglycaemia?
Increased insulin Increased activity Low sugar intake Alcohol and paracetamol Insulinoma Insulin like growth factor secreting tumour (adrenal) Starvation
How does hypoglycaemia present?
Lethargic Shaking Paraesthesia in lips Hungry Difficulty concentrating Confusion and LOC
At what ages do ketotic hypo’s occur?
Between 18 months and 5 years
Generally self resolve by 9yo
What do you see in ketotic hypos?
Same symptoms +
N&V
Fainting
Seizures
How are ketotic hypos managed?
Advice of regular snacking
What investigations are done to assess hypoglycaemia?
Insulin radioimmunoassay 72 hour fasting C peptide plasma conc Pro-insulin measurements Pituitary and adrenal function Blood and urine sulphonylureas
What would a raised c-peptide indicate?
Hypoglycaemia due to increased endogenous insulin
If c peptide is low/normal, what would this indicate?
Hypoglycaemia due to exogenous insulin
How is hypoglycaemia managed in an emergency?
Depend on conscious level: Fruit juice Sugar gel for mouth IM glucagon 1mg IV dextrose - 50ml 50% (destroy veins) 200ml 10% or 100ml 20%
How is hypoglycaemia managed in the long term?
Small meals
Avoid refined carbs and simple sugars
Diazoxide can be used if chronic
Outline the epidemiology of hypothyroidism in children
1 in 4000
Twice as likely in girls
What are the possible causes for hypothyroidism in children?
Hypothalmic/pituitary dysfunction - 5%
Thyroid gland insufficiency - 75%
Problem with thyroid hormone - 10%
How can hypothalmic/pituitary gland cause hypothyroidism?
Ischaemic damage, tumour or other congenital defect can result in reduced stimulation of the thyroid gland
Other pituitary disorders seen
What abnormalities can be seen with the thyroid gland?
Missing
Ectopic
Underdeveloped
What problems can be seen with the thyroid hormone?
TSH unresponsive
Thyroglobulin structure defect
How can hypothyroidism present?
Constipation
Macroglossia
Prolonged jaundice
Hypotonia
Feeding difficulty Drowsy Cry Large fontanelle Myxoedema Low temp Nasal obstruction Cardiomegaly
If hypothyroidism isn’t picked up, what can be seen in children?
Short Depressed nasal bridge Narrow palpebral fissure Swollen eyelids Hypertelorism - wide spaced eyes Delayed mental development and learning difficulty
How is hypothyroidism picked up?
High TSH and low T4 on screening
What is transient hypothyroidism?
Maternal carbimazole use
OR
Maternal autoantibodies cross placenta and block baby thyroid function
How is transient hypothyroidism treated?
None needed unless persist for >2 weeks
Improve after delivery
How is hypothyroidism treated?
I-thyroxine
Regular monitoring of TFT, growth and milestones
What is childhood hypothyroidism?
Develop in childhood
Usually Hashimoto’s autoimmune thyroiditis
Can be de-quervain or acute suppurative thyroiditis
What are the risk factors for childhood hypothyroidism?
Turners
Downs
What are the signs of childhood hypothyroidism?
Slowing of growth
Delayed puberty
Same signs as adults
