markers in type 1 DM
islet cell antibodies, antibodies to glutamic acid decarboxylase, islet cells and insulin
features type 1 DM
2 peaks- pre school and teenagers. children present - few weeks history of polyuria, polydipsia, weight loss
other features type 1 DM
enuresis, skin sepsis, candida, infection
late features type 1 DM
DKA
features DKA
vomiting, dehydration, abdominal pain, Kussmauls breathing (hyperventilation),hypovolaemic shock, coma, death, drowsy, acetone breath
diagnosis type 1
random >11, glycosuria, ketonuria. fasting >7 or incr HbA1c
rapid acting insulin analogues
insulin lispro, glulisine, aspart
long acting insulin analogues
detemir, glargine
when should you give short acting regular insulin before meals
15-30 mins before meal
why should you rotate injection sites with insulin
prevent lipohypertrophy or lipoatrophy
onset rapid acting insulin
30-60m
onset long acting insulin
1-2h
what are the insulin regimens
basal bolus or continuous pump
how does basal bolus work
3x daily short acting boluses, 1x long acting bolus
what happens first in puberty for girls
breast development- 8.5-12.5 years
when does pubic hair growth and rapid height spurt occur (female)
after breast development
when does the menarche occur
2.5 years after puberty
what happens first in puberty for males
testicular enlargement >4ml
what follows testicular enlargement
pubic haisr- 10-14 years
when does height spurt occur in males
testicular vol 12-15ml
what causes closure of the growth plates
sex hormones- females have their height spurt earlier when have menarche so stop growing after that, whereas males continue growing for a while and then have their growth spurt
what is short stature
height below 2nd centile or 0.4th (3rd)
causes of short stature
familial, IUGR, extreme prem, constitutional delay of growth and puberty, endo- hypothyroid, decr GH, decr IGF1, steroid excess, nutritional deficiency, chronic illness, psychosocial deprivation, chromosomal
GH treatment
biosynthetic GH, recombinant IGF1
investigations in short stature
X ray wrist and hand for bone age, FBC (anaemia, crohns), creat and electrolytes, ca, po, alp, TSH, karyotype, endomysial and anti TTG (coeliac), CRP and ESR, IGF1, 0900 cortisol and dexamethasone suppression test
causes of tall stature
obesity, hyperthyroid, excess sex steroids, excess adrenal androgen steroids, gigantism. marfans, klinefelter, maternal diabetes, primary hyperinsulinism, beckwith syndrome
when does the posterior fontanelle close
8 weeks
when does the anterior fontanelle close
12-18 months
what is microcephaly
head circumference
causes microcephaly
familial, autosomal recessive condition, congenital infection, after insult to the brain
what is macrocephaly
> 98th centile head circumference
causes macrocephaly
tall stature, familial, incr ICP, hydrocephalus, chronic subdural haematoma, tumour
how old are you to be delayed puberty
14 years females, 15 years male
causes of delayed puberty
constitutional delay in growth and puberty; low gonadotrophin release, high gonadotrophin release
what can cause low gonadotrophin release
systemic- CF, crohns, anorexia, excess physical activity. hypothalamic- pituitary disorders-panhypopituitarism, tumour
what can cause high gonadotrophin release
chromosomal, steroid hormone enzyme deficiencies, acquired damage- surgery, chemo,radio
what are the two mechanisms for precocious puberty
gonadotropin dependent- premature activation of the axis. gonadotropin independent- excess sex steroids
when is the growth spurt females
12 years
when is the growth spurt males
14 years
staging of breast development
BI- prepubertal; BII- breast bud; BIII- smooth contour; BIV- areola and papillae project above breast; BV- adult
staging pubic hair growth male and female
PHI- pre pubertal; PHII- sparse pigmented long straight along labia or base of penis; PHIII- dark coarser curlier; PHIV- filling out towards adult distribution; PV- adult
staging genital development male
GI- preadolescent, GII- lengthening of penis, GIII- further growth in length and circumference, GIV- glans penic, scrotal skin darkening; GV- adult genitalia
is an organic cause more likely in males or females for precocious puberty
more likely in males
causes precocious puberty females
familial, idiopathic. organic causes- dissonance, rapid onset, neuro signs eg neurofibromatosis
causes precocious puberty males
intracranial tumour, gonadotropin release, small testes- adrenal cause, unilat- gonadal tumour
age of precocious puberty in females
8
age of precocious puberty in males
9
gonadotropin dependent causes of precocious puberty
CNS abnormalities- hydrocephalus, infection, tumours; hypothyroid
gonadotropin independent causes of precocious puberty
adrenal- tumours, congenital adrenal hyperplasia; ovarian and testicular tumours; exogenous sex steroids
management precocious puberty
GnRH analogues for dependent, inhibitors of sex steroids in independent
what is the term for prem breast development
thelarche
when does thelarche take place
6m-3y. doesn’t pass stage 3. absence axillary and pubic hair growth and growth spurt. self limiting
what is premature pubarche (adrenarche)
pubic hair develops
