Pediatric Endocrinology Flashcards
What hormones are produced by the posterior pituitary gland?
- Oxytocin
2. ADH
What hormones are produced by the anterior pituitary gland?
- FSH
- LH
- ACTH
- TSH
- PRL
- Indorphins
- GH
FLAT PIG
[SMR landmarks]
Identify the stage for boys:
Testes enlarge
Stage 2
[SMR landmarks]
Identify the stage for boys:
Penis enlarge
Pubic hair begins
Stage 3
[SMR landmarks]
Identify the stage for boys:
Curly pubic hair
Stage 4
[SMR landmarks]
Identify the stage for boys:
adult testis, pubic hair to medial surface of thigh
Stage 5
[SMR landmarks]
Identify the stage for girls:
Thelarce
Stage 2
TWOlarche = TWOtoy
[SMR landmarks]
Identify the stage for girls:
Enlarged breast and areaola
Stage 3
Imagine 3 as breast
[SMR landmarks]
Identify the stage for girls:
Pubic hair becomes curly
Papilla form secondary mound
Stage 4
[SMR landmarks]
Identify the stage for girls:
pubic hair forms adult triangle spreading to the medial surface of the thigh
Stage 5
[Breast Development]
Identify the stage:
Prepubertal
Elevation only of papilla
Stage 1
[Breast Development]
Identify the stage:
breast bud forms below the areaola
Stage 2
Imagine 2, bud
[Breast Development]
Identify the stage:
Enlargement and elevation of breast and areaola
Stage 3
Imagine, 3 as breast
[Breast Development]
Identify the stage:
secondary mound
Stage 4
[Breast Development]
Identify the stage:
Recession of the secondary mound and smooth breast contour
Stage 5
[Male Genitalia Development]
Identify the stage:
Enlargement of testes
No enlargement of penis
Stage 2
[Male Genitalia Development]
Identify the stage:
Testes continues to enlarge
Penis begins to enlarge
Stage 3
- Lengthens first
- Then later in diameter
[Male Genitalia Development]
Identify the stage:
Continued lengthening and enlargement of glans
Stage 4
[Male Genitalia Development]
Identify the stage:
adult size and proportion
Stage 5
[Staging for pubic hair]
Both sexes
Fine vellus hair
Stage 1
[Staging for pubic hair]
Both sexes
Sparse straight hair
Stage 2
[Staging for pubic hair]
Both sexes
darker
curlier
Stage 3
3 = curl
[Staging for pubic hair]
Both sexes
escutcheon covers a smaller area; hair resembles adult type
Stage 4
[Staging for pubic hair]
Both sexes
hair increase in volume, spread onto the medial thigh
Stage 5
What is the sequence of sexual development in girls?
- Thelarche (10-11)
- Pubarche
- Menarche (12.5 average)
What is the sequence of development in boys?
- Gonadarche
- Pubarch
- 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?
- Metanephrine from Epinephrine
2. Normatanephrine from Norepinephrine
What is the immediate substrate of HVA?
- 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?
- Glucose >200
- venous pH <7.3
- 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?
- 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
- 8am - elevated
- 8pm - decline by 50%
in cushing, diurnal rhtytm is lost
Treatment for cushing syndrome if due to bilateral adrenal tumors
Subtotal adrenalectomy