Paediatric endocrinology

Question 1

What percentage of diabetes cases in children present with DKA?

Answer 1

25%

Question 2

What are some key indicators of high blood glucose in children?

Answer 2

Increased drinking
Increased urination
New bedwetting
Weight loss

Question 3

What are some key indicators of DKA in children?

Answer 3

Vomiting- should also stop urine output when vomiting if infectious
Stomach pains
Sighing breathing
Smell on breath

Question 4

How is DM diagnosed in children?

Answer 4

Same as adults:
FBG >7
RBG >11

Question 5

What can complicate glucose blood readings in children?

Answer 5

Dirty hands

Question 6

How do you treat DKA in <18YOs?

Answer 6

Base treatment volume on weight
Slow fluid resuscitation
Start insulin after 1h IV fluid resus- can cause cerebral oedema otherwise.

Question 7

What are the targets in children’s diabetic control?

Answer 7

4-7 mmol/l- before meal
5-9 mmol/l- 2h after meal
4-7 mmol/l- before bed.

Question 8

What are the early complications of diabetes in children?

Answer 8

Microalbuminemia
CV autonomic neuropathy
Sensory nerve damage
Retinopathy
Vascular endothelial pathology

Question 9

What are some causes of primary congenital thyroid disease?

Answer 9

Gland dysplasia +/- abnormal site

Incorrect formation of thyroid hormone formation

Question 10

What are some causes of secondary congenital thyroid disease?

Answer 10

Congenital pit disease

Hypopituitarism

Question 11

What are some clinical symptoms of congenital thyroid disease?

Answer 11

Jaundice
Poor feeding but normal weight gain
Hypotonia- low muscle tone
Skin and hair changes

Question 12

How is congenital thyroid disease normally detected?

Answer 12

Guthrie heel prick test on day 5 of life. Measured T4 and TSH

Question 13

How long do you have treat thyroid disease in children before damage occurs?

Answer 13

Up to 3 months but target is 2 weeks

Question 14

What happens if you don’t have thyroid hormone after 3 months?

Answer 14

Cretinism

Question 15

How does hypothyroidism tend to present in children?

Answer 15

Slow progress
Growth failure
Poor general health
Educational difficulties
Goiter

Question 16

What do blood tests show of hypothyroidism in children?

Answer 16

High TSH
Low fT4
High thyroid cell antibodies

Question 17

How do you treat thyroid hormone in children?

Answer 17

Thyroxine

Question 18

How does hyperthyroidism tend to present in children?

Answer 18

Behaviour problems
Sleep disturbance
Eating difficulties
Goiter
High pulse
Early puberty

Question 19

How common is hyperthyroidism in children?

Answer 19

Very rare

Question 20

What do blood tests show of hyperthyroidism in children?

Answer 20

Low TSH

High fT4

Question 21

How do you treat hyperthyroidism in children?

Answer 21

BB
Suppress- Carbimazole +/- thyroxine
Cure- Radio-iodine (must be >16) or surgery

Question 22

What can cause primary underactive adrenal disease in children?

Answer 22

Adrenal hypoplasia
Inborn error of met
Congenital Adrenal Hyperplasia

Question 23

What can cause secondary underactive adrenal disease in children?

Answer 23

Pit disease (Congenital or acquired)
Suppression secondary to steroid therapy

Question 24

What can cause overproduction of steroids (Cushing’s syndrome) in children?

Answer 24

High dose cortisol therapy

Cushing’s disease

Question 25

What causes Congenital Adrenal Hyperplasia?

Answer 25

Loss of the 21 hydroxylase enzyme causing testosterone build up.

Question 26

How can Congenital Adrenal Hyperplasia present?

Answer 26

Female- Ambiguous genitalia
Male- Early puberty
Addison Crisis

Question 27

What is Addison crisis?

Answer 27

Low Na
High K
Hypotension