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Flashcards in Endocrine Deck (18):
1

Hypoglycemia in neonates.
What are the parameters?

In neonates, serum level <55 mg/dL when symptomatic is abnormal

2

congenital adrenal hyperplasia def

in absence of adequate adrenal function, adrenals may be congenitally hypertrophic from excess pituitary stimulus (ACTH)

3

congenital adrenal hyperplasia may be obvious due to

ambiguous genitalia at birth
due to excess steroid precursors converted to excess androgens

4

How does salt-losing congenital adrenal hyperplasia manifest?
Tx?

manifests in infants as mineralocorticoid deficiency, usually without virilization
hyponatremia and hyperkalemia by age 5 to 7 days
most common cause is 21-hydroxylase deficiency
vomiting, dehydration and acidosis characterize presentation
often mistaken for hypertrophic pyloric stenosis
in HPS, hypochloremia and low to normal potassium is present
treated with oral glucocorticoids and mineralocorticoids

5

What is Addison disease (primary adrenal insufficiency)
Tx?

autoimmune destruction of adrenal cortex
glucocorticoid and mineralocorticoid deficiencies
hyperpigmentation, salt craving, postural hypotension, fasting hypoglycemia
episodes of shock during severe illness
treated with oral glucocorticoids and mineralocorticoids

6

Panhypopituitarism. Whats it due to and the Tx?

typically traumatic or due to shock
in children, special attention paid to growth hormone replacement
thyroxine replacement
glucocorticoid replacement
diabetes insipidus (free water loss, hypernatremia) is treated with desmopressin
attention to sex hormone replacement depending on age & gender

7

parathyroid hormone is secreted in response to

low calcium

8

PTH raises serum calcium and depresses

phosphate

9

hypoparathyroidism def
hypoparathyroidism often results from?

low PTH in the setting of low calcium and high phosphate confirms a problem with PTH production.
DiGeorge syndrome.

10

What is necessary for parathyroid hormone production

magensium is necessary for parathyroid hormone production

11

neonatal tetany may result from dietary

hyperphosphatemia in a newborn fed cow’s milk

12

rickets results from?

vitamin D deficiency, but not from hypoparathyroidism

13

Diabetes mellitus defined as

fasting blood sugar over 126 mg/dL
or
2-hour postprandial blood sugar over 200
sporadic hyperglycemia, usually during illness, is common in children
glycated hemoglobin (HgbA1C) is used as a screening test (and is used for diagnosis in adults)

insulin deficiency
autoimmune destruction of pancreatic β cells
most common endocrine problem in children
1 in 300-500 people under 18 years of age
postprandial hyperglycemia is first finding
prone to ketosis with more complete insulin deficiency
more common in caucasians

14

DM type 1 clinical pres?

clinical presentation
polyuria
may manifest as enuresis
polydipsia
polyphagia
often with paradoxical weight loss
dehydration/ketosis
abdominal pain
vomiting
worsening mental status/fatigue
breath & sweat ketosis

15

Type I diabetes labs

laboratory
glucose level
electrolytes and kidney function
urinalysis
glycosuria
ketones
low pH
lab surveys for auto-antibodies and insulin-like growth factor depend on preferences of local endocrinologists

16

diabetic ketoacidosis def and pertinent findings

inability to maintain anabolic state
increased glucose levels
renal osmotic fluid losses
loss of intravascular fluid volume
loss of total body sodium, potassium
reported sodium artefactually low with high glucose
ketosis by lipolysis
acidosis worsened by both
ketonemia
lactic acid/dehydration
defined as arterial pH < 7.25, bicarbonate <15 mEq/L, and ketonemia or ketonuria
fever is unusual and should prompt confirmation of its source

17

DKA Tx

restoration of intravascular fluids
often helps reduce acidosis and glucose levels
excessive IV fluid repletion can cause cerebral edema and be fatal
electrolyte restoration
acid shift will alter potassium levels
restoration of anabolic state
exogenous insulin restored euglycemia and halts ketone production

18

Whats the "Honeymoon" period?

“honeymoon” period often follows original diagnosis
original DKA set off by acute illness while capacity for insulin production is low but not insufficient for well periods
long term treatment goals
glucose control
insulin regimen
diet
exercise
avoid complications in chronic management
renal failure
visual impairment
cardiovascular disease
iatrogenic hypoglycemia
ketosis during dehydrating circumstances