Pediatric Endocrinology Flashcards by Clyde Silverio

What hormones are produced by the posterior pituitary gland?

Oxytocin

2. ADH

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What hormones are produced by the anterior pituitary gland?

FSH
LH
ACTH
TSH
PRL
Indorphins
GH

FLAT PIG

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[SMR landmarks]

Identify the stage for boys:

Testes enlarge

Stage 2

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[SMR landmarks]

Identify the stage for boys:

Penis enlarge
Pubic hair begins

Stage 3

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[SMR landmarks]

Identify the stage for boys:

Curly pubic hair

Stage 4

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[SMR landmarks]

Identify the stage for boys:

adult testis, pubic hair to medial surface of thigh

Stage 5

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[SMR landmarks]

Identify the stage for girls:

Thelarce

Stage 2

TWOlarche = TWOtoy

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[SMR landmarks]

Identify the stage for girls:

Enlarged breast and areaola

Stage 3

Imagine 3 as breast

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[SMR landmarks]

Identify the stage for girls:

Pubic hair becomes curly
Papilla form secondary mound

Stage 4

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[SMR landmarks]

Identify the stage for girls:

pubic hair forms adult triangle spreading to the medial surface of the thigh

Stage 5

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[Breast Development]

Identify the stage:

Prepubertal
Elevation only of papilla

Stage 1

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[Breast Development]

Identify the stage:

breast bud forms below the areaola

Stage 2

Imagine 2, bud

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[Breast Development]

Identify the stage:

Enlargement and elevation of breast and areaola

Stage 3

Imagine, 3 as breast

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[Breast Development]

Identify the stage:

secondary mound

Stage 4

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[Breast Development]

Identify the stage:

Recession of the secondary mound and smooth breast contour

Stage 5

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[Male Genitalia Development]

Identify the stage:

Enlargement of testes
No enlargement of penis

Stage 2

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[Male Genitalia Development]

Identify the stage:

Testes continues to enlarge
Penis begins to enlarge

Stage 3

Lengthens first
Then later in diameter

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[Male Genitalia Development]

Identify the stage:

Continued lengthening and enlargement of glans

Stage 4

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[Male Genitalia Development]

Identify the stage:

adult size and proportion

Stage 5

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[Staging for pubic hair]
Both sexes

Fine vellus hair

Stage 1

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[Staging for pubic hair]
Both sexes

Sparse straight hair

Stage 2

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[Staging for pubic hair]
Both sexes

darker
curlier

Stage 3

3 = curl

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[Staging for pubic hair]
Both sexes

escutcheon covers a smaller area; hair resembles adult type

Stage 4

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[Staging for pubic hair]
Both sexes

hair increase in volume, spread onto the medial thigh

Stage 5

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What is the sequence of sexual development in girls?

1. Thelarche (10-11) 2. Pubarche 3. Menarche (12.5 average)

What is the sequence of development in boys?

1. Gonadarche 2. Pubarch 3. Adrenarche

Age cutoff for precocious puberty in girls?

8 years old

Age cutoff for precocious puberty in boys?

9 years old

Age cutoff for delayed puberty in girls?

13 years old

Age cutoff for delayed puberty in boys?

14 years old

[When to suspect abnormality] if at age 13 there is no ___

thelarche

[When to suspect abnormality] If at age 14 there is no

menses

[When to suspect abnormality] If at age 16 there is menses but no ___

secondary sex characteristics

[Growth delay] Short stature is defined as ___ SD

2 or more SD below the mean height for children

[Growth delay: short stature] If Bone age is equal to the chronological age

Familial Short Stature

[Growth delay: short stature] If Bone age is less than the chronological age

Constitutional Short Stature

Failure to thrive means that the weight is persistently less than ___ percentile

5th percentile

If the growth curve crosses 2 major percentile lines on growth chart, the child is said to have ___

Failure to thrive

What is the normal urine osmolality?

500 to 800 mOsm/kg water

What is the random urine osmolality

300 to 900 mOsm/kg water

What is the normal serum osmolality

<280

What is the normal serum sodium

<135

What is the normal urine Na

40 to 220 mEqs/L/day

What is the normal urine Na

40 to 220 mEqs/L/day

What are the cardinal features of Diabetes insipidus?

Polyuria | Polydipsia

What test will help you distinguish central and nephrogenic DI?

Water deprivation test | ADH administration

Diagnosis of DI Serum osmolality Urine osmolality

Serum > 300 mOsm/kg Urine <300

Diagnosis of Nephrogenic DI Serum osmolality Urine osmolality

Serum osmolality >290 Urine osmolality <290

Diagnosis of SIADH Serum osmolality Serum Na Urine osmolality

Serum osmolality <280 Serum Na <135 Urine osmolality >100 Urine Na >25

Disappearance of this antibody signifies remission of Grave's Disease

TRSAb

Drug for graves disease that inhibits peripheral conversion of T4 to T3

PTU

Drug for graves that can cause transient leukopenia

Methimazole

Most common site of origin of pheochromocytoma is the

Adrenal medulla

Most often location of pheochromocytoma

right side

What are the immediate substrate of VMA?

1. Metanephrine from Epinephrine | 2. Normatanephrine from Norepinephrine

What is the immediate substrate of HVA?

1. 3-methoxy-dopamine from dopamine

[Diagnosis] ``` Headache palpitations abdominal pain dizziness pallor vomiting sweating convulsions ``` abdominal mass

Pheochromocytoma

Urinary excretion of _____ is increased in pheochromocytoma

VMA

What antibody is present in 80-90% of newly diagnose DM in pediatric patients?

Islet cell antibodies

What is the criteria for DKA in children?

1. Glucose >200 2. venous pH <7.3 3. HCO3 <15

{Classificaiton of DKA: ISPAD] HCO3 <10 pH <7.2

moderate

{Classificaiton of DKA: ISPAD] HCO3 <5 pH <7.1

severe

What is the initial hydrating fluid used in DKA?

pNSS

When will you administer glucose (5% solution in 0.2 pNSS) in patients with DKA?

if the blood glucose approaches 300mg/dL

To reduce cerebral edema in patients being treated for DKA, the rate of fluid infusion should be limited to

4L/m2/day or less

What is the dose of regular insulin for patients with DKA?

1. 0.1 U/kg of regular insulin followed by | 2. Constant infusion of 0.1 U/kg/hr insulin

What is the most common cause of thyroid disease in children and adolescents?

Thyroiditis Associated with HLA-DR4 and HLA-DR5

Dose of Levothyroxine in pediatric patients with hypothyroidism

50 to 150 ug/day

most common enzyme deficiency causing CAH

21-hydroxylase

[Diagnose] ``` low Na Low Cl High K Low serum cortiso Increased serum aldosteronel Increase plasma renin ```

CAH Tx: hydrocortisone

Most common cause of Cushing syndrome in infants?

Functioning adrenocortical tumor

Normal pattern of cortisol decline

1. 8am - elevated 2. 8pm - decline by 50% in cushing, diurnal rhtytm is lost

Treatment for cushing syndrome if due to bilateral adrenal tumors

Subtotal adrenalectomy