Paediatric endocrinology Flashcards
What percentage of diabetes cases in children present with DKA?
25%
What are some key indicators of high blood glucose in children?
Increased drinking
Increased urination
New bedwetting
Weight loss
What are some key indicators of DKA in children?
Vomiting- should also stop urine output when vomiting if infectious
Stomach pains
Sighing breathing
Smell on breath
How is DM diagnosed in children?
Same as adults:
FBG >7
RBG >11
What can complicate glucose blood readings in children?
Dirty hands
How do you treat DKA in <18YOs?
Base treatment volume on weight
Slow fluid resuscitation
Start insulin after 1h IV fluid resus- can cause cerebral oedema otherwise.
What are the targets in children’s diabetic control?
4-7 mmol/l- before meal
5-9 mmol/l- 2h after meal
4-7 mmol/l- before bed.
What are the early complications of diabetes in children?
Microalbuminemia CV autonomic neuropathy Sensory nerve damage Retinopathy Vascular endothelial pathology
What are some causes of primary congenital thyroid disease?
Gland dysplasia +/- abnormal site
Incorrect formation of thyroid hormone formation
What are some causes of secondary congenital thyroid disease?
Congenital pit disease
Hypopituitarism
What are some clinical symptoms of congenital thyroid disease?
Jaundice
Poor feeding but normal weight gain
Hypotonia- low muscle tone
Skin and hair changes
How is congenital thyroid disease normally detected?
Guthrie heel prick test on day 5 of life. Measured T4 and TSH
How long do you have treat thyroid disease in children before damage occurs?
Up to 3 months but target is 2 weeks
What happens if you don’t have thyroid hormone after 3 months?
Cretinism
How does hypothyroidism tend to present in children?
Slow progress Growth failure Poor general health Educational difficulties Goiter
What do blood tests show of hypothyroidism in children?
High TSH
Low fT4
High thyroid cell antibodies
How do you treat thyroid hormone in children?
Thyroxine
How does hyperthyroidism tend to present in children?
Behaviour problems Sleep disturbance Eating difficulties Goiter High pulse Early puberty
How common is hyperthyroidism in children?
Very rare
What do blood tests show of hyperthyroidism in children?
Low TSH
High fT4
How do you treat hyperthyroidism in children?
BB
Suppress- Carbimazole +/- thyroxine
Cure- Radio-iodine (must be >16) or surgery
What can cause primary underactive adrenal disease in children?
Adrenal hypoplasia
Inborn error of met
Congenital Adrenal Hyperplasia
What can cause secondary underactive adrenal disease in children?
Pit disease (Congenital or acquired) Suppression secondary to steroid therapy
What can cause overproduction of steroids (Cushing’s syndrome) in children?
High dose cortisol therapy
Cushing’s disease
What causes Congenital Adrenal Hyperplasia?
Loss of the 21 hydroxylase enzyme causing testosterone build up.
How can Congenital Adrenal Hyperplasia present?
Female- Ambiguous genitalia
Male- Early puberty
Addison Crisis
What is Addison crisis?
Low Na
High K
Hypotension
