Pediatric Endocrinology

Question 1

Rule of thumb for insulin initiation

Answer 1

0.5 units/kg/day, giving 2/3 dose in AM and 1/3 in evening

Question 2

Frequency of DM screening for at-risk kids

Answer 2

Begin at age 10 or onset of puberty (whichever comes first) and repeat every 2 years

Question 3

Only approved oral hypoglycemic medication for kids

Answer 3

Metformin–850mg twice a day or 500mg three times a day–

Does not stimulate insulin action, but reduces gluconeogenesis

Question 4

Hyperthyroidism

Answer 4

• Graves disease is most common cause
• Labs: Increased T3, T4, low TSH, ANA usually elevated without evidence of lupus
• Refer to endocrinology

Question 5

Hypothyroidism

Answer 5

• congenital, newborn screen, Hashimoto’s (autoimmune acquired)
• Labs: elevated TSH, low T4 (T3 not a good indicator), increased serum cholesterol and liver enzymes
• Refer to endocrinologist, Synthroid hormone replacement

Question 6

Explain the thyroid negative feedback loop

Answer 6

T3,T4–>hypothalamus–>TRH–>pituitary–>TSH–>thyroid–>T3,T4