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Endocrine Flashcards

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1
Q

what is the most common presenting complaint in pediatric endocrinologist

A

growth disturbances

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2
Q

what is fetal growth dependent on?

A

maternal factors (placental sufficiency, maternal nutrition, IGF-2 and insulin)

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3
Q

what is late infancy and childhood dependont on (hormones)

A

GH/IGF-1 axis and thyroid hormone

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4
Q

what is pubertal growth dependent on?

A

sex hormones
GH/IGF-1 axis
thyroid gland

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5
Q

what can you use skeletal age for?

A

To see how much more they will be able to grow

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6
Q

with endocrine problems what is a child’s weight usually like?

A

normal or excessive weight gain

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7
Q

what are some causes of short stature that are endocrine problems?

A

GH deficiency/ resistance
Hypothyroid
DM

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8
Q

what is a condition where they were following the growth curve but then curve became flat

A

acquired hypothyroidism

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9
Q

what are three causes of growth hormone deficiency?

A

congenital (SOD)
genetic (gene for GH)
acquired (histiocytosis)

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10
Q

what is the most common form of growth hormone deficiency

A

idiopathic

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11
Q

do children with GH deficiency growth normally in the first year?

A

Yes

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12
Q

when does growth drop off established percentile in children with GH deficiency

A

2nd year

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13
Q

Workup for GH deficiency

A 
Xray (bone maturation)
CBC (anemia)
ESR (inflammatory)
urinalysis, BUN/Cr (renal function)
electrolytes, stool for fat
karyotype (trisomies)
thyroid function, IGF-1
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14
Q

Tx for GH defieincy

A

replacement of GH

correct underlying dz process

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15
Q

what is tall stature associated with?

A

pituitary adenoma

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16
Q

what is the difference between gigantism and acromegaly

A

gigantism (epiphysis open)

acromegaly (epiphysis closed)

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17
Q

what is the most common cause of hypothyroid in children?

A

Hashimotos thyroiditis

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18
Q

what labs do you order for hypothyroid?

A

TSH

free T4

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19
Q

what is the most common neonatal metabolish disorder?

A

congenital hypothyroidism

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20
Q

what is an early marker of acquired (juvenile hypothyroidism)

A

growth deceleration

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21
Q

what genetic conditions is there increased incidence of hypothyroidism

A

Trisomy 21

Turner’s

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22
Q

Tx for hypothyroidism?

A

Levothyroxine

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23
Q

what is teh msot common cause of goiter and thyroiditis in childhood?

A

hashimotos (chronic lymphocytic)

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24
Q

child presents with pale, gray, cool mottled skin. Nonpitting edema, constipation, large tongue, poor muscle tone, lordosis, bradycardia, hoarse cry or voice. Lateral thinning of eyes.

A

Hypothyroid

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25
what will labs look like with hypothyroids
T3, T4 and FT4 decreased | TSH elevated
26
what is the most common cause of excess thyroid hormone?
Graves
27
what sex is affected more by graves dz?
girls
28
what is a physical sign of graves?
goiter
29
what causes graves dz?
Antibodies directed at TSH receptor that simulated thyroid hormone production.
30
Patient presents with nervousness, emotional lability, hyperactivity, weight loss, insomnia, personality changes, diarrhea, palpitations, heat intolerance, tremor, increased sweating.
Hyperthyroid
31
what do labs look like with hyperthyroid
TSH supressed | FT4, T3 elevated
32
Tx for hyperthyroid
``` B blocks antithyroid meds (PTU, methimazole) ```
33
is precocious puberty more common in girls or boys and what is the cause?
girls, idiopathic (activation of hypothalamus, central problem )
34
Girls younger than 8 going through pubertal changes
precocious puberty
35
what test would you get on a girl with central precocious puberty?
assses with MRI
36
what are peripheral causes of precocious puberty
ovarian cyst (estrogen) adrenal tumor CAH
37
patient will have symptoms of estrogen excess- breast development and vaginal bleeding?
ovarian cysts or tumors
38
patient wil have adrenarche – pubic hair, axillary hair, acnea, some increased body odor. what type tumor do they likely have (peripheral precocious puberty)
adrenal tumors
39
what labs to get for precocious puberty?
GnRH (FSH and LH should increase) | if low likely peripheral cause leading to increased estrogen and supression of FSH/ LH
40
what imaging do you get for peripheral precocious puberty cause?
US of ovaries and adrenal
41
Treatment for central precocious puberty
Lupriolid which will down regulate teh pituitary GnRH receptors and decrease gonadotropin secretion
42
HOw do you treat peripheral precocious puberty caused by CAH?
glucocortidcoids
43
How do you tx an ovarian cyst?
Watch and wait- regress
44
Precocious puberty in boys occurs before what age?
age 9
45
true precocious puberty is boys is usually caused by what?
CNS abnormality
46
If a boy under age 9 has large testes is the precocious puberty caused by a central or peripheral process?
central process
47
what labs do you get for precocious puberty in boys?
Lh FSH 17 OHP (for CAH)
48
what imaging do you get for a boy for precocious puberty (central)?
cranial MRI
49
delayed puberty is no signs by age ___ in boys and age ___ in girls
14 in boys, 13 in girls
50
how do you evaluate a child with delayed puberty?
wrist xray for bone maturity
51
what labs do you get for delayed puberty?
Lh, FSH (if elevated will be primary hypogonadoism)
52
what is the most common cause of delayed puberty in boys?
Kleinfelter syndrome
53
what is primary hypogonadism?
absence / malfunction/ destruction of ovarian or testicular tissue
54
If there is low LH, FSH what is the cause of delayed puberty?
central hypogonadism- other pituitary hormone deficiencies, chronic dz, CNS abnormalities
55
tx for delayed puberty
sex steroids
56
most common cause of female pseudohermaphrodite, virilized
CAH
57
abnormal develop of testes, defects of sex steroid biosynthesis (testosterone, DHT) androgen receptor defects
Male pseudohermaphrodite | undervirilized
58
what is the most frequent cause of ambiguous genitalia in the newborn?
CAH
59
what is the most common form of CAH?
Elevated 17-hydroxyprogesterone (17-OH) | due to deficiency of 21-hydroxylase
60
how do you treat CAH?
hydrocortisone | mineralocorticoid
61
CAH infants are at risk for what?
electrolyte imbalances (hypoNa, hyperK, metabolic acidosis)
62
what is the most common cause of excess adrenals in children?
exogenous steroids(for RA, lupus, etc)
63
what does a mineralcorticoid deficiency lead to?
hypoNa | HyperK
64
child preents with vomiting, dehyration, acidosis, hypotensive shocks. what type adrenal insufficiency do they have?
glucocorticoid deficiency
65
tx for adrenal insufficiency?
replace hydrocortisone | fludrocortisone
66
what is test for adrenal insufficiency?
ACTH stimulation test (cortisol and aldosterone should increase markely after adiministeration of ACTH)
67
Truncal adoposity with thin extremities, moon facies, muscle wasting, weakness, easy bruising, purplish striae HTN, osteoporosis, glycosuria, hyperglycemia
Cushing syndrome
68
what is the most common cause of elevated serum corticosteroids in children <12
prolonged exogenous administration of glucocorticoid hormone
69
what condition destroys the adrenal gland. will have a negative ACTH stimulation test (adrenal insufficiency)
Addison's
70
what is the most common cause of elevated serum corticosteroids in children <12
prolonged exogenous administration of glucocorticoid hormone
71
what supression test can you do with Cushing's syndrome?
Dexamethasone suppression test – dex suppresses adrenal function normally (cortisol should go down normally)
72
If cushing syndrome is due to a pituitary adenoma, will there be a reponse to dex?
No
73
what supression test can you do with Cushing's syndrome?
Dexamethasone suppression test – dex suppresses adrenal function normally (cortisol should go down normally)
74
when will a child show symptoms of DM type 1?
after 90% of pancreatic islets are destroyed
75
what causes diabetes type 1?
immunologic destruction of beta cells of pancreatic islets (occurs over months to years )
76
3 main symptoms of DM Type 1?
polyuria polysdipsia polyphagia
77
what is the most common endocrine/ metabolic disorder of childhood?
Diabetes mellitus type 1
78
what other metabolic disorder is a child with DM at risk for?
hypothyroid (2-5%)
79
first lab you order w/ suspicion?
fasting blood glucose
80
what other metabolic disorder is a child with DM at risk for?
hypothyroid (2-5%)
81
complication of DMT1
renal failure and loss of vision | neuropathy
82
what has been shown to reverse or delay kidney damage in people with DM?
ACEI
83
what do children die from in DKA?
cerebral edema (most likely involves osmolar shift of fluid into cells)
84
patient presents with Vomiting Kussmaul Breathing +/- acetone odor Abdominal pain Somnolence  loss of consciousnesscoma
Diabetic ketoacidosis
85
3 main signs of DKA
ketonuria - diptick/ urinalysis ketonemia - serum ketoacidosis pH <7.30
86
why a children with DM peeing and thirsty all the time?
osmotic diuresis due to all the sugar
87
Tx for hypoglycemia?
IV glucose bolus 2 ml/Kg of D10W constant infusion
88
why a children with DM peeing and thirsty all the time?
osmotic diuresis due to all the sugar
89
what type DM is Acanthosis nigricans associated with?
type 2 DM
90
what part of the adrenal gland produces aldosterone?
Zona glomerulosa
91
What part of the adrenal gland produces glucocorticoids and mineralcorticoids
Zona fasciculata
92
What part of the adrenal gland produces androgens and estrogens
zona reticularis
93
what help maintain BP by supporting vascular tone and promoting Na and H2O retention.
glucocorticoids

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