Endocrine Flashcards

(45 cards)

1
Q

Insulin start dose

A

0.5 units/kg

increase by 1-2 units/kg

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2
Q

DKA diagnosis

A

blood glucose >11.1
blood ketones >3
metabolic acidosis

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3
Q

DKA management

A

fluids resuscitation 10ml/kg
sthen slow rehydration over 48hrs
insulin 0.1units/kg/h
watch K+

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4
Q

Congenital hypothyroidism causes

A
maldescent of thyroid 
athyrosis 
dyshormonogenesis 
iodine deficiency 
TSH deficiency
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5
Q

Descent of thyroid gland

A

sublingual position -> larynx

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6
Q

Congenital hypothyroidism clinical features

A
faltering growth 
prolonged jaundice 
constipation 
coarse facies 
large tongue 
umbilical hernia 
delayed development 
learning difficulties
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7
Q

Congenital hypothyroidism management

A

thyroxine from neonatal period

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8
Q

PTH function

A

increased osteoblast function
if Ca low-> osteoclast activity to release ca and PO
stimulates vit D metabolism

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9
Q

Hypoparathyroidism can be congenital- what is the name of the syndrome

A
DiGeorge 
Cardiac abnormalities
Abnormal facies
Thymus hypoplasia -> cellular immune deficiency
Cleft palate
Hypoparathyroidism w/ low Ca
22 chromosome
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10
Q

Hyperparathyroidism if presents in late childhood/adulthood, can be part of what syndrome?

A

MEN 1 and 2a

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11
Q

Term babies should double and treble their weight in what period of time?

A

Double in 4.5m

Treble in 1 year

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12
Q

Puberty: development order in females

A
  1. breast development
  2. pubic hair and growth spurt
  3. menarche
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13
Q

Puberty: development order in males

A
  1. testicular enlargement over 4ml volume
  2. pubic hair
  3. rapid height growth
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14
Q

Short stature define

A

below 2nd gentile (2SDs below the mean)

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15
Q

Investigation required below which height gentile

A

0.4 th

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16
Q

Short stature causes

A

familial
constitutional delay
small for gestational age and extreme prematurity
chromosomal disorders

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17
Q

Gene involved in pathological short stature

A

Short stature homeobox (SHOX) gene

X chromosome

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18
Q

Short stature investigations

A
x ray l wrist 
FBC 
Creatine (CKD)
Calcium, phos, alk phos 
TSH 
Karyotyope 
Anti-endomysial and anti-tissue transglutaminase antibodies 
CRP 
GH provocation test 
IGF-1 levels (GH axis)
Morning cortisol and dexamethasone test 
MRI
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19
Q

Growth hormone treatment indications

A
GH deficiency 
Turner syndrome 
Prader-Willi syndrome 
CKD 
SHOX deficiency 
IUGR/small for gest. age w/o catch up by 4yrs
20
Q

Tall stature causes

A
familial/inherited 
obesity 
hyperthyroidism 
XS sex steroids
gigantism (XS GH)
Syndromes (Marfan, Homocystinuria, Kliengelter, Sotos syndrome)
21
Q

Development of undifferentiated gonad in fetes into female

A

absence of SRY gene (Y chromosome)

22
Q

Development of undifferentiated gonad in fetes into testis in male

A

SRY (sex determining region on Y chromosome)
anti-Mullerian hormone (inhibits uterus and Fallopian tube development)
testosterone drives external genitalia development and maintains internal genitalia

23
Q

XS androgens in females

A

seen in congenital adrenal hyperplasia

causes virilisation in females

24
Q

inadequate androgens in male

A
under-virilisation
caused by 
-receptor problem (androgen insensitivity)
-5alpha reductase deficiency 
-abnorm. of synthesis from cholesterol
25
Congenital adrenal hyperplasia causes...
insufficient cortisol and mineralocorticoid secretion
26
Congenital adrenal hyperplasia caused by
deficiency in 21-hydroxylase | +/- aldosterone deficiency
27
Congenital adrenal hyperplasia clinical features
virilisation in females -> clitoral hypertrophy, fusion of labia enlarged penis and pigmented scrotum in males salt-loosing adrenal crisis tall stature precocious pubarche
28
Aldosterone function
salt and water retention | via increased ENaC expression
29
Congenital adrenal hyperplasia diagnosis
increased-> 17 alpha hydroxy- progesterone
30
Congenital adrenal hyperplasia: salt loosing crisis management
IV chloride glucose hydrocortisone
31
Congenital adrenal hyperplasia: general management
glucocorticoids (hydrocortisone) -> ACTH suppression -> normal growth and maturation mineralocorticoids (fludrocortisone) monitor growth, skeletal maturity, plasma androgens and 17alpha hydroxy-progesterone and adjust dose
32
HPA axis
Hypothalamus-> CRH Ant Pit -> ACTH Adrenal cortex-> cortisol
33
Primary adrenal insufficiency (Addison's disease) diagnosis
Synthacthen test | - normal response excludes adrenal insufficiency
34
Precocious puberty types
``` gonadotrophin dependent (central, true)- premature activation of the axis -> normal sequence independent (XS sex steroids outside of pituitary, LH and FSH suppressed) -> abnormal sequence ```
35
Female precocious puberty causes
idiopathic/familial* pituitary adenoma (gonad. dep)* XS androgens from CAH, adrenal tumours (gonad. independent.)
36
Female precocious puberty Ix
USS ovaries and uterus | -> progress of puberty
37
Which type of precocious puberty is common in females and why?
Gonadotrophin dependant | Ovaries are sensitive to LH and FSH
38
Which type of precocious puberty is common in males and why?
gonadotrophin independent | testes are relatively insensitive to LH and FSH
39
Male precocious puberty causes
b/l testes enlargement -> gonad. dep cause - intracration tumour - liver ca secreting b-hCG pre-pubertal testes (gonad. independent. cause) -adrenal pathology unilateral testis enlargement - gonadal tumour
40
Precocious puberty management
gonadotrophin releasing hormone analogue -> delays onset of menage Gonadotrophin independent cause - inhibitors of androgen or oestrogen production or action -> medroxyprogesterone acetate, cyproterone acetate, testolactone, ketoconazole
41
Define precocious puberty
<8yrs females | <9yrs males
42
Define delayed puberty
>14 yrs females | >15 yrs males (more common)
43
Delayed puberty causes
``` constutianal delay low gonadotrophin -systemic disease -pituitary dysfunction -isolated gonadotrophin or GH deficiency -Kallmann syndrome (LH def) -acquired hypothyroidism ``` high gonadotrophin - klinefelter's, Turner's - gonadal damage
44
Delayed puberty management in males
not usually required oxandrolone androgenic anabolic steroids testosterone
45
Delayed puberty management in females
r/o organic cause | oestradiol