Peds Endocrine

Question 1

what should you consider in an infant who is born with hypoglycemia and a small penis (<2 cm in length)

Answer 1

panhypopituitarism

Question 2

def. micropenis

Answer 2

stretched penile length of < 1.8 cm

Question 3

healthy, full term newborn develops altered mental status w/in 48 hours of birth - what should you be considering?

Answer 3

1. rule out sepsis - most common 2. inborn errors of metabolism i.e. urea cycle defect or organic acidemia

Question 4

how can you differentiate between urea cycle defect and organic acidemia on initial labs?

Answer 4

urea cycle defect -severe hyperammonemia + resp alkalosis organic acidemia - mild hyperammonemia + metabolic acidosis

Question 5

Symptoms: Neonatal hyperthyroidism

Answer 5

• jitteriness
• tachycardia
• HTN
• diarrhea
• poor feeding/poor weight gain
• exophthalmos

Question 6

Tx. Neonatal Hyperthyroidism

Answer 6

• medical emergency!
• Methimazole inhibits the addition of iodine to thyroglobulin but does not block the release of preformed thyroxine or triiodothyronine (T3).
• Esmolol is a short-acting cardioselective beta-blocker with a rapid onset,; tx of tachycardia and HTN
• Iodine drops: blocks release of T3 and T4 and suppresses the activity of thyroid peroxidase.
• Glucocorticoids: reducing the conversion of T4 to T3 and, potentially, by decreasing the production of TSIs.

Question 7

Infant with micropenis and hypoglycemia

• what are you worried about?
• next step in dx?

Answer 7

1. panhypopituitarism
2. measurement of non-stimulated gonadotropin and GH levels

Question 8

Tx: Congenital Primary Hypothyroidism

Answer 8

Levothyroxine

• infants require higher doses than adults
• 10-15 ug/kg/day (vs 2-3 in adults)
• remeasure hormone levels 10-14 days after initiation to ensure TSH is normalizing

Question 9

Which hormone should you measure to dx Vitamin D deficiency

Answer 9

25-hydroxyvitamin D

• storage form

Question 10

Clinical Features: Addison’s Disease

Answer 10

• primary adrenal insufficiency.
• unexplained or severe hypoglycemia
• hyperpigmentation of the skin (even in sun protected areas) due to high levels of corticotropin activating the melanocortin-stimulating hormone receptor.

Question 11

Diagnosis: Addison’s Disease

Answer 11

• early AM cortisol level
  
  • An early-morning cortisol concentration of less than 5 μg/dL (138 mmol/L)
• concurrent measurement of corticotropin