Endo Flashcards
(27 cards)
What are the two distinctive aspects to 11B-hydroxylase deficiency?
Virilization (XX child) and hypertension
NO salt wasting
How do you tell 21-hydroxylase deficiency from 11-B-hydroxylase deficiency?
21 has salt wast, 11 b has hypertension
What is the most common form of CAH?
21-hydroxylase deficiency
How do boys typically present with 21-hydroxylase deficiency?
adrenal crisis at 2 weeks of life
Is it more common in CAH to have salt-wasting or non-salt-wasting?
salt-wasting –> 21-hydroxylase deficiency and 3-B-Hydroxysteroid dehydrogenase
Name lab findings in patients with salt-wasting disease.
low sodium and chloride, elevated potassium and BUN
High renin and inappropriately low aldosterone for the high renin
What physical exam finding in male infants can help diagnose CAH?
small testes for degree of virilization
What is treatment for CAH
hydrocortisone (glucocorticoids) inhibits androgens and progression of virilization
-if salt wasting - add fludrocort for mineralocorticoid effect
What is the antibody in Graves disease
thyroid-stimulating immunoglobulin
What antibody is positive in Chronic autoimmune thyroiditis?
thyroid peroxidase antibody and antithyroglobulin antibodies
Primary adrenal insufficiency require replacement in what
glucocorticoid and mineralocorticoids
What are presenting signs of adrenal crisis?
vomiting, hypotension, and weakness
labs - hypoglycemia, hyponatremia, and hyperkalemia
What is treatment for adrenal crisis?
IV fluids with dextrose, stress dose steroids –> hydrocortisone 50-100 mg/m2
Why do you not give fludrocortisone for adrenal crisis?
high dose hydrocortisone has mineralocorticoid effects
At what age should you pursue work-up for premature onset of puberty?
boys <9 yo and girls <7-8 yo
When is the ideal time to screen for congenital hypothyroidism?
Day 3 - peak of TSH at 12 HOL followed by peak of T4 and T3 at 24 HOL
What is the difference between free T4 and T4 laboratory testing?
Total T4 measures free T4 plus thyroxine-binding globulin
In what scenario might a baby have an abnormal T4 with normal TSH and normal free T4?
TBG deficiency
When treating hyponatremia, what is the optimal change?
<10 mEq/L every 24 hours
What is the risk of correcting hypernatremia too quickly?
Cerebral edema
Treatment for hypophosphatemic rickets?
phosphorus and calcitriol - calcitriol used to maximize reabsorption of phosphorus
What are clinical findings of growth hormone deficiency?
poor linear growth, decreased head circumference, prominent frontal bone, micropenis, delayed puberty
What medication is indicated for increased albuminuria in poorly controlled diabetes?
ACEI or ARBs –> effect glomerular flow by dilation of efferent arteriole to reduce albumin excretion
What is normal testicular volume?
12-19
